Paulo Sergio Souza Pina

Oral mucosal melanoma is a rare and aggressive malignant neoplasm, frequently associated with delayed diagnosis and unfavorable prognosis. This study aims to report a case of oral mucosal melanoma located at a non-palatal site, presenting as an extensive pigmented lesion affecting the lower gingiva and extending to the floor of the mouth, a topography less frequently described for this neoplasm, as well as to present a narrative review of the literature. An adult patient presented with a pigmented lesion in the lower gingival region extending to the floor of the mouth. The diagnosis was established through histopathological and immunohistochemical examination, confirming oral mucosal melanoma. The literature review addressed clinical, diagnostic, and prognostic aspects of oral mucosal melanoma, highlighting the influence of anatomical location and the biological particularities of this neoplasm in comparison with cutaneous melanoma. It is concluded that the recognition of atypical melanocytic lesions in less common sites of the oral cavity is essential for early diagnosis and appropriate clinical management of oral mucosal melanoma.

Sialolithiasis is the most common cause of salivary gland obstruction, predominantly affecting the submandibular gland. Giant sialoliths are rare and may pose diagnostic challenges, particularly when symptoms are atypical. This case report describes a 40-year-old female who presented with a two-month history of a foreign body sensation in the floor of the mouth, associated with intermittent purulent discharge. Clinical examination and cone-beam computed tomography revealed a large radiopaque mass measuring 23 × 10 × 6 mm in the left submandibular gland region. The lesion was successfully managed through intraoral surgical removal, followed by uneventful healing. Histopathological examination confirmed the diagnosis of sialolithiasis, demonstrating ductal alterations and chronic inflammatory changes consistent with long-standing obstruction. Despite the relatively short duration of symptoms, the size of the calculus suggests prolonged asymptomatic growth. This report highlights the importance of recognizing atypical subjective complaints as potential indicators of salivary duct obstruction and supports conservative, gland-preserving surgical management for giant submandibular sialoliths to achieve favorable functional outcomes.

Aims: To describe a probable oral mucosal injury associated with the off‐label sublingual administration of captopril in a medically complex patient, and to illustrate the role of structured clinical reasoning in identifying route‐related adverse drug reactions, with exploratory insights into AI‐assisted reasoning. Methods and Results: A 77‐year‐old patient presented with persistent burning pain and a progressive oral mucosal lesion on the floor of the mouth. Despite appropriate management of local infectious and mechanical factors, symptoms worsened over time. A consistent temporal relationship was observed between lesion exacerbation and repeated sublingual captopril use during hypertensive episodes. Structured clinical reasoning, including iterative causal analysis, supported identification of a probable route‐related adverse drug reaction. Discontinuation of sublingual captopril, combined with topical corticosteroid therapy, resulted in complete resolution of the lesion. An exploratory interaction with a large language model was conducted to examine how structured clinical input may influence the coherence and clinical relevance of AI‐assisted reasoning. Conclusion: Sublingual administration of captopril may cause localized chemical injury to the oral mucosa, particularly in vulnerable patients with complex medical conditions. Recognition of route‐specific adverse effects is essential to avoid unnecessary interventions and improve patient outcomes. This case also illustrates that AI‐assisted reasoning is highly dependent on the structure and quality of clinical input, supporting its role as a complementary cognitive tool rather than an autonomous diagnostic system.

Oral vascular malformations (VMs) are low blood flow vascular anomalies that present therapeutic challenges, often requiring minimally invasive approaches. This study aims to evaluate, through a comprehensive literature review, the clinical effectiveness of sclerotherapy and FDIP in managing VMs in the oral cavity, particularly regarding lesion volume reduction and symptomatic relief. This narrative review examined the clinical outcomes of sclerotherapy and forced dehydration with induced photocoagulation (FDIP) in the treatment of oral VMs. A total of ten studies published between 2014 and 2024, encompassing 2,120 patients, were included. The lower lip, tongue, and buccal mucosa were the most affected sites. Monoethanolamine oleate (5%) and polidocanol, particularly in foam form, were the most effective agents, yielding high rates of lesion regression with low complication rates. Pingyangmycin/Bleomycin showed promising results, especially in combination with electrochemical therapy, while sodium tetradecyl sulfate demonstrated lower efficacy but favorable safety. FDIP emerged as an effective alternative, though its broader use is limited by cost. The findings support sclerotherapy as a first-line, safe, and effective treatment for low-flow oral vascular malformations.

Objectives To address critiques of the original study entitled “The role of exfoliative cytology in diagnosis of oral lesions,” emphasizing the method’s diagnostic value and limitations. Methods Lesions were categorized based on provisional diagnoses provided by clinicians to the Pathology Service. Table II presents the frequency of lesion categories, including fungal lesions such as prosthetic stomatitis, which is known to have a fungal etiology. Results A notable disagreement was observed between the clinicians’ provisional diagnoses and the final diagnoses obtained through exfoliative cytology. Conclusions Oral candidiasis was the most frequently identified lesion. No cytological features suggestive of squamous cell carcinoma were observed. Although exfoliative cytology can reveal morphological changes associated with malignancy risk, it should be considered a presumptive diagnostic tool, especially in at-risk patients. Clinical relevance Despite its diagnostic potential, exfoliative cytology has a limited role in the routine diagnosis of oral lesions. The findings underscore the critical importance of biopsy for definitive diagnosis and highlight the need for improved diagnostic acumen among clinicians.

Objectives The study aimed to evaluate the use of oral exfoliative cytology and highlight its limited effectiveness in diagnosing oral diseases. Materials and methods A total of 1000 consecutive cases of oral cytology were retrieved from the files of an Oral Pathology Service, comprising the period between January 2002 and December 2022. Patient data and clinical details of the lesions were collected, and all slides were reviewed. Categorical data were presented in absolute and relative frequency (%), while numerical data were expressed as the median with minimum and maximum values. The Chi-square (X²) test was employed for frequency comparisons, with a significance level of 5%. Results Men constituted 64.6% (n = 646) of the cases, with a statistically significant predominance of white individuals (69.4%; n = 694). Of the 1000 evaluated cases, 87.8% (n = 878) were graded using Papanicolaou staining. Regarding provisional diagnoses, most clinicians (79.1%) suspected fungal lesions (n = 817). Analysis of the agreement between provisional and final cytological diagnoses revealed a statistically significant disagreement. Conclusions This work reinforces the limited use of exfoliative cytology in diagnosing oral lesions. Clinical relevance Exfoliative oral cytology should be restricted to specific cases, particularly for diagnosing fungal disease, and occasionally when oral cancer is suspected, but a biopsy cannot be performed at that time.

Adenoid cystic carcinoma (ACC) is a rare neoplasm known for its indolent clinical course, risk of perineural invasion, and late onset of distant metastasis. Due to the scarcity of samples and the tumor’s rarity, progress in developing effective treatments has been historically limited. To tackle this issue, a high-throughput screening of epigenetic drugs was conducted to identify compounds capable of disrupting the invasive properties of the tumor and its cancer stem cells (CSCs). ACC cells were screened for changes in tumor viability, chromatin decondensation, Snail inhibition along tumor migration, and disruption of cancer stem cells. Seven compounds showed potential clinical interest, and further validation showed that Scriptaid emerged as a promising candidate for treating ACC invasion. Scriptaid demonstrated a favorable cellular toxicity index, effectively inhibited Snail expression, induced hyperacetylation of histone, reduced cell migration, and effectively disrupted tumorspheres. Additionally, LMK235 displayed encouraging results in four out of five validation assays, further highlighting its potential in combating tumor invasion in ACC. By targeting the invasive properties of the tumor and CSCs, Scriptaid and LMK235 hold promise as potential treatments for ACC, with the potential to improve patient outcomes and pave the way for further research in this critical area.

A hamartoma is a benign proliferation of typical mature cells specific to a particular anatomical site. In the oral cavity, they may occur as isolated cases or be associated with genetic syndromes. Oral‐facial‐digital syndrome type VI is a rare genetic disorder with an estimated incidence of one in 50,000–250,000 newborns. Here, we report a case of a 2‐year‐old boy diagnosed with oral‐facial‐digital syndrome type VI who was referred for evaluation of a bilateral and normochromic to slightly pinkish nodule on the lateral surface of the tongue. Clinically, the child presented hypotonia, low visual acuity, absence of oculocephalic reflex, delay in neuropsychomotor development, and polydactyly in the feet. Excisional biopsies of both sides of the tongue were performed using a 1.5 W high‐power diode laser (wavelength of 980 nm), and histopathological analysis revealed abundant mature adipocytes predominantly arranged in lobules that mainly surrounded the minor salivary gland parenchyma. The surgical sites healed with no complications and the patient remains under follow‐up for 10 months. Due to the limited literature on this syndrome and the frequent presence of tongue hamartomas in children, dentists need to be familiar with them.