Cementoblastoma

TCFC mostrando uma lesão hiperdensa bem delimitada arredondada, associada ao ápice de um dente supranumerário na mandíbula (seta), com uma borda hipodensa circundando.
TCFC mostrando uma lesão hiperdensa bem delimitada arredondada, associada ao ápice de um dente supranumerário na mandíbula (seta), com uma borda hipodensa circundando.[1]

O cementoblastoma ou cementoma verdadeiro é um tumor odontogênico benigno incomum, formado a partir de cementoblastos.[2][3]

Sinais e sintomas

O cementoblastoma normalmente é assintomático e descoberto acidentalmente em exames radiográficos.[3] Entretanto, alguns podem exibir um comportamento localmente agressivo, causando dor, edema, expansão óssea, reabsorção dentária, deslocamento dos dentes adjacentes e assimetria facial.[3] Nos tumores recorrentes, expansão e perfuração da cortical óssea podem ocorrer. Geralmente o dente associado ao tumor é vital, a menos que tenha sido envolvido acidentalmente.[3]

Aspectos radiográficos e histológicos

Radiograficamente, o tumor possui um formato arredondado radiopaco, circundado por uma fina linha radiolúcida, fundido às raízes de um dente vital.[3] Perifericamente, as trabéculas de cemento são perpendiculares à cápsula.[4]

Histologicamente, pode-se perceber que o tumor se funde à dentina radicular em uma massa sólida e calcificada, composta por trabéculas de cemento.[3]

Causas

O cementoblastoma possui, desde a nova classificação de lesões odontogênicas de 2022 da OMS, marcadores genéticos específicos que o relacionam com o osteoblastoma: a superexpressão de c-FOS e o rearranjo de FOS.[5] Por isso, teoriza-se que o cementoblastoma pode não ser um tumor odontogênico individual, e sim uma neoplasia óssea que existe no espectro do osteoblastoma e osteoma osteoide.[5]

Epidemiologia

Corresponde a 0,69 - 8% de todos os tumores odontogênicos.[3] Não possui predileção por gênero, ocorrendo mais na segunda e terceira décadas de vida, e afetando predominantemente a mandíbula posterior.[5] Cerca de 50% dos casos envolvem o primeiro molar inferior.[3]

Diagnóstico

O diagnóstico é radiológico, mas o exame anatomopatológico pode ser utilizado para confirmar e diferenciá-lo de outras patologias como o osteoblastoma.[3][5]

Prognóstico e tratamento

O tratamento consiste na remoção completa do tumor e do dente associado.[2] Em alguns casos, apicectomia seguida de tratamento endodôntico possibilita a preservação do dente.[2][3] A recidiva do tumor é possível, e pode atingir taxas de até 37,1% se houver excisão incompleta, por isso a enucleação total é recomendada.[3]

Referências

  1. ↑ Silva, Brunno Santos Freitas; Bueno, Mike Reis; Yamamoto-Silva, Fernanda P.; Gomez, Ricardo Santiago; Peters, Ove Andreas; Estrela, Carlos (3 de julho de 2017). «Differential diagnosis and clinical management of periapical radiopaque/hyperdense jaw lesions». Brazilian Oral Research (em inglês): e52. ISSN 1806-8324. doi:10.1590/1807-3107BOR-2017.vol31.0052. Consultado em 24 de setembro de 2024 
  2. ↑ a b c de Souza, Vasconcelos, Neto, da Silva, Rebeca Cecília Vieira, Belmiro Cavalcanti do Egito, Fernando Ferreira dos Santos, Igor Chaves Gama (21 de março de 2016). «Tratamento cirúrgico de cementoblastoma assintomático em elemento hígido» (PDF). Revista Cirúrgica BMF. Consultado em 8 de abril de 2023  line feed character character in |titulo= at position 54 (ajuda)
  3. ↑ a b c d e f g h i j k Sankari, Leena S; Ramakrishnan, K (2011). «Benign cementoblastoma». Journal of Oral and Maxillofacial Pathology : JOMFP (3): 358–360. ISSN 0973-029X. PMC 3227271Acessível livremente. PMID 22144847. doi:10.4103/0973-029X.86725. Consultado em 24 de setembro de 2024 
  4. ↑ Soluk-tekkesin, Merva; Wright, John M. (2013). «The world health organization classification of odontogenic lesions: a summary of the changes of the 2017 (4th) edition». Turkish Journal of Pathology. ISSN 1018-5615. doi:10.5146/tjpath.2017.01410. Consultado em 24 de setembro de 2024 
  5. ↑ a b c d Soluk-Tekkesin, Merva; Wright, John M. «The World Health Organization Classification of Odontogenic Lesions: A Summary of the Changes of the 2022 (5th) Edition». Turkish Journal of Pathology (2): 168–184. ISSN 1018-5615. PMC 9999699Acessível livremente. PMID 35578902. doi:10.5146/tjpath.2022.01573. Consultado em 24 de setembro de 2024 

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