Angioleiomioma oral: relato de um caso e revisão dos achados atuais

Abstract

Angioleiomyoma is a benign neoplasm that was considered a tumor of smooth-muscle origin until the most recent (2013) WHO classification of soft tissue tumors, in which it was reclassified as a tumor of perivascular origin. Angioleiomyomas rarely occur in the oral cavity. These lesions are treated surgically with good prognosis. This article presents a review of reports of oral angioleiomyoma in the literature from the last 5 years and describes the case of a 44-year-old man who presented with an asymptomatic nodule in the upper lip that had developed over a 6-month period. Diagnostic hypotheses of pleomorphic adenoma or canalicular adenoma were raised. Biopsy of the lesion, histopathological and immunohistochemical analysis (S100, CD34, H-caldesmon, and desmin) confirmed a diagnosis of angioleiomyoma. It is noteworthy that immunohistochemistry is an important auxiliary method for differential diagnosis of angioleiomyoma from other tumors, particularly myopericytoma.Keywords: angioleiomyoma; diagnoses; immunohistochemistry. ResumoO angioleiomioma é uma neoplasia benigna que, a partir da nova classificação da OMS (2013) para os tumores de tecidos moles, deixou de ser considerado um tumor de origem muscular lisa, passando a ser considerado um tumor de origem perivascular. Raramente os angioleiomiomas ocorrem na cavidade oral. A lesão é tratada cirurgicamente, com prognóstico considerado favorável. Este trabalho revisa os casos de angioleiomioma oral relatados na literatura nos últimos 5 anos e descreve esse tumor em um homem de 44 anos que apresentou um nódulo assintomático localizado em lábio superior, com evolução de 6 meses. As hipóteses diagnósticas foram de adenoma pleomórfico e adenoma canalicular. A lesão foi submetida a biópsia e análise histopatológica e imuno-histoquímica (S100, CD34, α-SMA, H-caldesmon e desmina) confirmaram o diagnóstico de angioleiomioma. Destacamos a imuno-histoquímica como um importante método auxiliar no diagnóstico diferencial do angioleiomioma com outras lesões e, principalmente, com o miopericitoma.Palavras-chave: angioleiomioma; diagnóstico; imuno-histoquímica.

Vascular leiomyoma in the oral cavity – Report of two cases

“…Of 14,056 cases diagnosed in our Oral Pathology service, within a 57-year interval, only 5 cases (0.036%) of VL were found ( Table 1), of which two have already been published (6). The mean age of our patients was 52.6 ± 12.52 years, slightly older than other series (4,5), with a predominance of males (3:2), in agreement with the data in the literature (4,5). Also, in the study by Brooks et al (4), 76,412 biopsies of the oral pathology service were analyzed and only 12 cases were identified as VL (approximately 0.016%).…”

“…The most involved oral sites are lips, followed by palate, buccal mucosa and tongue. Silva et al (5) reviewed the oral VL cases published between 2011 and 2016 and found 17 cases, with gingiva as the most common involved anatomical site. Of 14,056 cases diagnosed in our Oral Pathology service, within a 57-year interval, only 5 cases (0.036%) of VL were found ( Table 1), of which two have already been published (6).…”

Angioleiomioma en cavidad oral ''una neoplasia rara en un sitio poco común''. Reporte de un caso y revisión de la literatura.

“…4,5 La etiología es desconocida, pero se han descrito posibles factores etiológicos como el trauma menor, desbalance hormonal, estasis venosa, disminución de la irrigación venosa y alteraciones genéticas. 4,[6][7][8] El AL representa 5% de las neoplasias de tejidos blandos y puede llegar a representar hasta 50% de todos los leiomiomas superficiales; sin embargo, en cavidad oral la incidencia es de 0.06 a 0.065% y esto se relaciona con la escasa presencia de músculo liso en esta área. 4,9 Los sitios de predilección son labios, paladar duro, carrillos, mucosa yugal, encía y lengua.…”

“…10,11 Contrario a lo observado en el leiomioma convencional, donde la prevalencia es mayor en mujeres y en sitios como extremidades inferiores y tronco, el AL es más común en hombres entre la cuarta y sexta década de la vida, específicamente en las áreas de cabeza y cuello. [4][5][6]10,12 Clínicamente se ha descrito como una masa asintomática, sésil, solitaria, móvil, esférica y bien circunscrita. Su coloración es muy similar a la de la mucosa adyacente, aunque en ocasiones se observa con parches rojos.…”

“…Su tamaño promedio varía desde 1 hasta 3 cm de diámetro. 5,6,[13][14][15][16] Respecto a la imagenología, la resonancia magnética nuclear (RMN) y la tomografía computarizada (TC) con medio de contraste son los estudios con mayor utilidad para la ubicación de la lesión y planificación de la cirugía. 6,12 Microscópicamente se caracteriza por la proliferación de fascículos de músculo liso maduro alrededor de la luz de los vasos sanguíneos, encapsulada por una capa de tejido conectivo colagenizado.…”