Avaliação de neoplasias malignas que mimetizam periapicopatias crônicas: uma série de casos multi-institucional

Abstract

Cysts and periapical granulomas represent the histopathological diagnoses most frequently obtained from radiolucent/hypodense lesions located jaw bones. It is estimated that approximately 4% of the lesions with a clinical-imaginological diagnosis of chronic periapical disease have a histopathological diagnosis not arising from a pulp pathology. Of these, about 0.39 to 3.7% are malignant neoplasms at histopathological examination, including metastatic lesions, malignant salivary gland neoplasms and carcinomas. Misdiagnosis of malignat non-endodontic lesiosn (MNEL) leads to a delay in antineoplastic treatment, which interferes with the survival of these individuals. The objective of the present study was to analyze a series of MNEL cases, obtained in a consortium of three Brazilian centers of Oral and Maxillofacial Pathology. The study was approved by the Ethics Committee of the Federal University of Pelotas (nº 2.887,524). For each case, the following variables were collected: sex, age, time of evolution, symptomatology, anatomical location, radiographic characteristics, histopathological diagnosis, follow-up and patient status. Data were evaluated using descriptive statistics. Twelve cases of MNEL were obtained. Seven cases (58.33%) occurred in women and five (41.67%) in men. The mean age at diagnosis was 48.5±19.17 years (range: 16 to 75 years). Regarding the anatomical location, six cases (50%) affected the posterior maxilla, three (25%) the posterior mandible, two (16.67%) the anterior mandible and one (8.33%) the anterior maxilla. Seven different histopathological diagnoses were identified: Mucoepidermoid carcinoma (n=1/16.68%), Acinar cell carcinoma (n=1/8.33%), Adenoid cystic carcinoma (n=1/8.33%), Squamous cell carcinoma (n=3/25%), renal metastasis (n=3/25%), Ewing's sarcoma (n=1/8.33%) and Langerhans cell histiocytosis (n=1/8.33%). The present study added twelve new cases of MNEL. Although rare, general practitioners and endodontists should consider MNEL in their diagnostic hypotheses in clinical situations suggestive of cysts and periapical granulomas.