Carcinoma odontogênico de células claras em parassínfise mandibular: relato de caso

Abstract

Clear cell odont ogenic carcinoma (COCC) is a rare, aggressive, malignant odontogenic tumor. It most frequently affects women in the sixth decade of life and its preferential anatomical location is the anterior region of the mandible. You may have nonspecific signs and sym ptoms. Its radiographic characteristics are confused with those of other malignant odontogenic tumors. The histological appearance of COCC commonly shows a biphasic tumor pattern. The treatment consists of surgical resection with a large margin of safety, and may be associated with cervical emptying, radius and / or chemotherapy. The present study aims to report a clinical case of COCC from diagnosis, treatment and follow up. This is a 26 year old female patient with a major complaint of facial asymmetry in the chin region. At the intraoral physical exam, mandibular swelling was observed in the region of lower right premolars. Computed tomography revealed the presence of a hypodense area with an irregular outline, well delimited, with hyperdense areas with t he appearance of "falling snowflakes", associated with the tooth 44 even. The patient presented panoramic radiography performed previously that already showed a pre existing lesion, suggesting an evolution of at least two years and four months. An incision al biopsy was performed, and the histopathological examination showed odontogenic neoplasia characterized by multiple islands and cords of epithelial cells showing periphery columnar and cubic cells, organized in palisade, with inverted polarity and cytopl asm now vacuolized, sometimes eosinophilic, sometimes clear, in addition to center composed of polygonal and basaloid cells with eosinophilic cytoplasm, sometimes clear. Subsequently the patient underwent hemimandibulectomy and ipsilateral cervical emptyin g. The histopathological examination of the surgical specimens confirmed the diagnosis of COCC, without evidence of metastatic dissemination. At the moment the patient is in postoperative follow up of one year without signs of relapse. Therefore, the denta l surgeon is an important professional for the diagnosis of these lesions and, for this, he needs to be aware of the clinical and radiographic signs, using a constant update of the available literature.