In June 1999 she attended the Hospital de Clínicas de Porto Alegre (HCPA), a 13-year-old female CMT patient, Caucasian, born and residing in the city of Erechim, RS.
The patient complained of abdominal pain, headache, dizziness and mild agitation.
They evaluated it, but did not obtain a definitive diagnosis.
In June 2000, the patient returned to the hospital with an increase in jaundice and worsening of abdominal pain. A new definitive diagnosis was not obtained.
At the same time, the patient reported the appearance of a lower lip lesion similar to that of a face that had been removed by the city physician, but without histopathological examination.
At the end of the same year the patient was admitted to the Pediatric LU of HCPA due to autoimmune hepatitis A associated with leptospirosis.
After one month of hospitalization (11/2000), approximately 4 months after the removal of the lesion in the lip reappeared presenting occasional pain and frequent bleeding.
The lesion was clinically diagnosed as herpes simplex and treated with topical and systemic antiviral therapy.
In October 2001, she attended the HCPA again for consultation at the Ambulatory of Symptoms.
The patient continued with topical medication and the lip lesion was ulcerated, with crusted surface, mild symptoms, measuring 1.5 x 1.5 cm in diameter, located in the lower lip in the midline region.
He also had leukoplakia in the lower lip around the lesion and in the buccal mucosa of the right side, as well as right anterior cervical adenomegaly.
Topical medication was suspended and an incisional biopsy of the lip lesion was indicated.
The first anatomopathological examination was not conductive, because it covered only the area of necrosis, so the procedure was repeated whose result was suggestive of verrucous carcinoma.
To confirm the diagnosis another biopsy was performed, whose result of the histopathological examination was verrucous carcinoma.
The patient had no metastases, only inflammatory nodules in the carotid and submandibular chains.
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Treatment was initiated in January 2002 when the lesion already compromised the entire vermellion and part of the lower lip mucosa, measuring 4.0 x 2.0cn.
The established protocol for the case was Radiotherapy associated with Chemotherapy.
Radiotherapy was divided into 35 sessions, with a dose of 2 Gy in each cycle and a total dose of 70Gy (Fixe AL e-8 Mev.), directly and only affecting the tumor.
It began on January 21, 2002 and ended on April 17, 2002.
The patient developed severe mucositis in the lower lip due to radiotherapy, leading to discontinuation of treatment twice.
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Cisplatin (8 cycles) chemotherapy had the function of only potentiating the effects of radiotherapy.
During and after the treatment, the patient was instructed with oral hygiene, topical use of 1% sodium fluoride and regular visits to the Stomatology Outpatient Clinic of HCPA to control caries and oral lesions.
After treatment, there was total tumor remission, and the patient was being followed up with the Pediatric Onset of HCPA.
