S100 negative granular cell tumor of the oral cavity: dermoscopy and surgical approach

Abstract: We report the case of a 47-year-old male patient with S100 negative granular cell tumor of the oral cavity, focusing on dermoscopic features as well as surgical approach, not previously reported in the literature. The study contributes to the literature on dermoscopy and surgical treatment for this tumor and provides a practical approach to differentiating non-neural granular cell tumors and granular cell tumors.

Diagnostic test for detection of cervical lymph node metastasis from oral squamous cell carcinoma via infrared thermal imaging / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the diagnostic performance of a non-invasive, non-radiating, economical and convenient infrared thermal imaging in the detection of oral squamous cell carcinoma (OSCC) cervical lymph node metastasis, and evaluate its applicability via parallel test and series test.@*METHODS@#This study was a prospective clinical study which passed the ethical review by the Biomedical Ethics Committee, Hospital of Stomatology, Peking University, and had been submitted for clinical trial registration. Totally 74 OSCC patients who were to undergo a neck dissection were included in this study. The inclusion criteria were patients who: (1) were pathologically diagnosed as malignant tumors and planned to undergo surgical treatment including neck dissection; (2) agreed to participate in this study. The exclusion criteria were those who: (1) had undergone surgeries at head and neck previously; (2) with a history of systemic tumor adjuvant therapies such as radiotherapy or chemotherapy etc; (3) were unwilling or unable to cooperate. Basal information as well as clinical examination results were collected, such as physical examination and contradictive enhanced CT. Besides, infrared thermal imaging was done ahead of surgery. Analysis of the diagnostic power of infrared thermal imaging followed the principles of diagnostic test. The positive signs of infrared thermal imaging were: (1) asymmetric thermographic pattern including vascular pattern in ROI; (2) thickening image of unilateral facial artery/vein, submental artery/vein or external carotid artery; (3) surface temperature of ROI raised over 1 °C compared with the opposite side; (4) changes of neck profile with abnormal temperature pattern. The gold standard of this diagnostic test was pathology diagnosis of cervical lymph nodes.@*RESULTS@#The sensitivity of infrared thermal imaging was 75.0%, while the specificity was 69.0%, accuracy was 71.6%, positive predictive value was 64.9% and negative predictive value was 78.4%. The sensitivity of parallel test which stood for the combination of infrared thermal imaging and conventional clinical examinations was 87.9% while the specificity of series test was 97.6%.@*CONCLUSION@#Infrared thermal imaging is a promising non-invasive, non-radiating and economical tool in the detection of cervical lymph node metastasis from OSCC when combined with conventional pre-operative examination.

Economic Burden of Selected Diagnostic Imaging Methods in Oral Cancer

Objective: To analyse of proportion and economic burden of selected diagnostic imaging methods of oral cancer according to quarters and average percentage differences in the Slovak population in the period 2016-2017. Material and Methods: In this descriptive study, the data were retrieved from the information system of the largest public health insurance company on our request, which archives the cost and proportion of diagnostic imaging methods of oral cancer in Slovak population. It was evaluated 48,995 of selected diagnostic imaging methods (Computed Tomography [CT], Magnetic Resonance Imaging [MRI] and X-Ray) in the period 2016-2017. Results: The most frequently used diagnostic imaging method of oral cancer was magnetic resonance imaging method every quarters in 2016 and 2017 (53.7-54.7%) with slightly increasing trend in period 2016-2017. Mean economic burden of selected diagnostic imaging methods of oral cancer were 1,974,900€ for MRI method, 598,187€ for CT method and 5,394€ for RTG method in 2017. Decreasing trend of economic burden of diagnostic imaging method was found in MRI method and CT method in period 2016-2017. Conclusion: Our economic burden study provides a useful source for public health professional and clinicians in better understanding the economic burden of diagnostic methods in oral cancer.

Carcinoma escamoso de cavidad oral en paciente menor de edad / Oral squamous cell carcinoma in an underage patient

El objetivo de este caso es profundizar en el conocimiento del cáncer de lengua en pacientes jóvenes. Se trata de un caso clínico: Mujer de 17 años sin antecedentes ni hábitos tóxicos, que acude por presentar tumoración en hemilengua izquierda con biopsia de carcinoma escamoso. En TAC: Lesión en hemilengua izquierda que afecta al suelo de la boca. Adenopatías bilaterales. Estadío IVA. Se decide quimioterapia de inducción seguido de quimioradioterapia. Presentó recidiva tras 5 meses de seguimiento, y se realizó glosectomía parcial. Tras 12 meses libre de enfermedad presentó nueva recidiva local que se intervino quirúrgicamente. Actualmente en seguimiento y sin signos de enfermedad. Existen estudios que indican que la prevalencia del cáncer de cabeza y cuello está aumentando en pacientes jóvenes; comportándose de forma diferente entre unos grupos de edad y otros. Concluimos que los factores epidemiológicos, genéticos, etiológicos y clinicopatológicos de los pacientes jóvenes con cáncer de cabeza y cuello sugieren una divergencia biológica frente a lo que ocurre con dichos cánceres en pacientes añosos. La mejora del conocimiento de la biología molecular es necesaria para establecer el éxito en la prevención y el tratamiento de dichos pacientes.

To delve into the knowledge of tongue cancer in young patients. Case We presented a 17 years-old female, without tobacco and alcohol exposure, referred to Oral and Maxillofacial department with a squamous cell carcinoma in the tongue with bilateral cervical metastasis. We decided, in a multidisciplinary team, to treat her with chemotherapy followed by chemoradiotherapy. She had two local recurrences 5 and 12 months after the treatment which we treated with surgery both. Afher that, we follow her every month and she is without recurrences. Several reports suggest increasing incidence trends of head and neck cancer in young patients, disproportional to the patients above 45 years old. Moreover, the majority of young non-smoking non-drinking head and neck cancer patients is female. This disparity suggests that the pathogenesis of head and neck cancer in young patients differs from head and neck cancer development in old patients. Conclusion: The unique epidemiologic, genetic, etiologic, and clinicopatho- logic characteristics of young-onset HNSCC suggests a divergent biology from HNSCC occurring in older patients. Improved definition of this biology is needed to establish successful preventive and treatment de intensification efforts.

Tratamento cirúrgico de cementoblastoma assintomático em elemento hígido / Surgical treatment of asymptomatic cementoblastoma in higid element

O cementoblastoma benigno é uma lesão patológica rara, de origem odontogênica, caracterizada pela proliferação anormal de cementoblastos, o que forma, consequentemente, uma massa de tecido semelhante a cemento. Na maioria dos casos, é encontrado em associação com primeiros molares inferiores. Ocorre mais frequentemente em caucasianos, entre as 2ª e 3ª décadas de vida, afetando, assim, raramente dentes decíduos. Geralmente, apresenta sintomatologia dolorosa e expansão de corticais ósseas. Seu tratamento vai desde a remoção completa da lesão com extração do dente envolvido até o tratamento endodôntico com preservação do elemento dentário. No presente artigo, relata-se um caso de cementoblastoma benigno em uma paciente de 23 anos sem sintomatologia dolorosa e ao exame clínico nada de anormal foi observado, sendo tratada através da remoção da lesão e extração do dente... (AU)

The benign cementoblastoma is a rare pathologic wound, of odontogenic origin feature of the abnormal cementoblast proliferation, resulting hence a coat mass like to cement. Usually is found in association with the first bottom molars. This happen more frequently on Caucasian, between the 2ª and 3ª decade of life, affecting rarely the primary dentition . Generally show a painful symptomatic and expansion of the cortical bone. The treatment starts with the removal wound full of with the tooth extraction involved in the endodontico treatment , with preservations of the dental element. This article descrambles a cementobastoma benign case in a patient with 23 years old, asymptomatic and the clinic exam nothing abnormal was found. Was treated through the wound removal and the tooth extraction... (AU)

Occurrence of dermoid cyst in the floor of the mouth: the importance of differential diagnosis in pediatric patients

Abstract Lesions in the floor of the mouth can be a challenging diagnosis due to the variety of pathological conditions that might be found in this area. Within a broad range of lesions, attention has to be addressed to those that require specific management, such as a dermoid cyst (DC) and a ranula. Especially in pediatric patients, in whom the failure of diagnosis can postpone the correct treatment and cause sequelae later in life. DC, a developmental anomaly, is managed primarily by surgical resection. On the other hand, ranula is a pseudocyst that may be treated by marsupialization. This article reports a large and painful lesion in the floor of the mouth in a pediatric patient. With a diagnostic hypothesis of ranula, two surgical interventions were performed, but there were recurrences of the lesion. Subsequently, the patient was referred to the Oral and Maxillofacial Surgery Unit for re-evaluation. Computed tomography showed a semi-transparent image suggesting a cystic formation. Another surgical procedure was performed where the lesion was completely removed. Anatomopathological analysis confirmed the diagnosis of DC. The five-year follow-up showed no signs of recurrence. This article indicates that although DC in the floor of the mouth is rare, it should be considered in the differential diagnosis of other diseases in this area. This precaution may be particularly important in the following circumstances: 1) Similar lesions that have different therapeutic approaches and, 2) To prevent future sequelae in pediatric patients.

Giant Epignathus Teratoma Discovered at Birth: A Case Report and 7-Year Follow-Up

Abstract Teratomas are tumors composed by tissues derived from the three germ cell layers, and they are relatively uncommon in head and neck. The term epignathus has been applied to teratomas from the oropharynx. This paper reports the case of a giant epignathus teratoma discovered at birth, which was successfully managed and followed up for 7 years. A newborn boy presented a polypoid tumor mass exteriorizing through the mouth over a length of 9 cm, with some surface areas resembling skin and others exhibiting hair. Computed tomography showed that the mass arose deep from the left hemiface. Alpha-fetoprotein (AFP) levels were high (316,000 ng/mL). Surgery was performed and microscopic analysis confirmed the diagnosis of mature teratoma. Because of residual tumor and high AFP levels, the patient was submitted to chemotherapy, resulting in complete regression of the lesion and normalization of AFP levels. Surgical repair of a cleft palate was performed at 5 years of age. At 7 years of age, the patient was in good general health and showed no clinical signs of recurrence. Although epignathus is a rare condition, it should be diagnosed in the fetus as early as possible. Prenatal care provides unquestionable benefits, providing the early diagnosis of anomalies that can jeopardize the life of the fetus and contributing to the indication of cases that require treatment before birth.

Resumo Teratomas são tumores constituídos por tecidos derivados das três camadas de células germinativas e são relativamente incomuns em cabeça e pescoço. O termo epignathus tem sido utilizado para designar teratomas que se originam na orofaringe. Este artigo relata o caso de um teratoma epignathus gigante descoberto ao nascimento, o qual foi tratado com sucesso e proservado por 7 anos. Um menino recém-nascido apresentou uma massa tumoral polipoide que se exteriorizava através da boca por uma extensão de 9 cm, com regiões da superfície semelhantes à pele e outras exibindo pelos. Exame de tomografia computadorizada revelou que a massa se originava profundamente na hemiface esquerda. Os níveis de alfa-fetoproteína (AFP) se apresentavam elevados (316.000 ng/mL). Foi realizada cirurgia e a análise microscópica confirmou o diagnóstico de teratoma maduro. Por apresentar lesão residual e altos níveis de AFP, o paciente foi submetido à quimioterapia, resultando em regressão completa da lesão e normalização dos níveis de AFP. Correção cirúrgica de uma fenda palatina foi realizada aos 5 anos de idade. Aos 7 anos de idade, o paciente apresentava um bom estado de saúde geral, sem sinais clínicos de recorrência da lesão. Embora o epignathus seja uma condição rara, seu diagnóstico no feto deve ser realizado o mais precocemente possível. O cuidado pré-natal proporciona benefícios inquestionáveis, permitindo o diagnóstico precoce de anomalias que podem comprometer a vida do feto e contribuindo para a indicação de casos que requerem tratamento antes do nascimento.

Optical Coherence Tomography; A Modern Technique to Detect Oral Mucosal Lesion: A Review.

Early detection and management of potentially malignant oral lesions can significantly reduce progression of these lesions into invasive cancer, and would thus reduce morbidity and fatality rate. Cancerous and potentially malignant lesions show dysplastic feature which is mostly detected by biopsy. However, biopsy has a certain constraints like (i) biopsy can cause delay in the result, (ii) experienced pathologist must expound the biopsy sample (iii) sometimes can cause spread of cancer cells, (iv) cannot be done repeatedly. Therefore, in potentially malignant lesions and cancer optical coherence tomography (OCT) is utilized to detect early dysplastic changes. Therefore, we are presenting a review on the applications of OCT in oral mucosal lesions.

Sarcoma Pleomórfico Indiferenciado de Maxilar de Alto Grado: Diagnóstico, Tratamiento y Pronóstico / Undifferentiated Pleomorphic Sarcoma of the Maxillary: Diagnosis, Treatment and Prognosis

Los sarcomas son neoplasias poco vistas en el territorio maxilofacial, donde la baja frecuencia de casos y los cambios de nomenclatura, han dificultado su estudio. Una de las variables de este tipo de lesiones corresponde a un tumor conocido como sarcoma pleomórfico indiferenciado, del cual se sabe muy poco pues se describe una incidencia de 1:1.000.000. Corresponde a un tumor maligno con características clínicas e imagenológicas de crecimiento invasivo y destructivo; la confirmación diagnóstica se realiza por medio de una biopsia en base al estudio histológico e inmunohistoquímico. Aparece principalmente en el tracto nasosinusal y su manejo terapéutico se basa en la cirugía con amplios márgenes de seguridad y radioterapia o quimioterapia según corresponda. No presenta metástasis locales pero si a distancia con gran afinidad por el pulmón. Se reporta un caso de sarcoma pleomórfico indiferenciado de alto grado de maxilar diagnosticado en la Unidad de Patología Oral y Maxilofacial del Hospital las Higueras de Talcahuano durante el año 2014, que a diferencia de la mayoría de los casos reportados, producto de su extensión, fue tratado con radioterapia paliativa. Además, se realizó una revisión de la literatura disponible en diversas bases de datos con lo cual se obtuvo información de casos ya reportados. Actualmente resulta difícil producto de la baja cantidad de casos descritos poder hacer proyecciones en cuanto a su pronóstico o evolución, sin embargo hay consenso de que el manejo interdisciplinario, diagnóstico precoz y la confirmación de este por medio de exámenes complementarios son fundamentales para su adecuado tratamiento.

Sarcomas are neoplastic lesions rarely observed in the maxillofacial region. Due to the few cases reported and to changes in nomenclature of these tumors their study has been difficult. One of the variants of this kind of lesion corresponds to a tumor currently known as undifferentiated pleomorphic sarcoma, which there is scarce knowledge of. In fact the incidence described is about 1:1.000.000. This one corresponds to a malignant tumor with image and clinical features as invasive and destructive growth, the confirmation of diagnosis is carried out by performing biopsy based on histologic and immunohistochemical studies. They appear mostly in the nose and sinusal tract. Its therapeutic management is based on surgery with wide security margins and radio or chemotherapy when warranted. No local metastases but distant ones are found and highly affined with lungs. We report a case of an advanced undifferentiated pleomorphic sarcoma diagnosed at the Oral and maxillofacial pathology unit of Hospital Las Higueras in Talcahuano at 2014, which in spite of most of the reported cases in literature; because of the extent it was treated with palliative radiotherapy. Also has been made review of the available literature in different databases with which information of the reported cases was obtained. Nowadays, due to the low number of cases described it is difficult to establish projections in terms of prognosis or evolution. However, there is consensus that interdisciplinary management, early diagnosis and confirmation with complementary exams are essential for an appropriate treatment.

Síndrome de Gardner / Gardner´s syndrome

El síndrome de Gardner, una variante de la poliposis adenomatosa familiar, es una enfermedad hereditaria autosómica dominante caracterizada por la presencia combinada de múltiples pólipos intestinales y manifestaciones extraintestinales que incluyen osteomas múltiples, tumores del tejido conectivo carcinoma de tiroides hipertrofia del epitelio pigmentado de la retina, también son frecuentes la presencia de dientes supernumerarios retenidos y odontomas. Se presenta un caso clínico de un paciente masculino, de 20 años de edad que acude a consulta por presentar aumento de volumen en tres localizaciones de la región facial. Radiográficamente se constataron las imágenes radiopacas características del osteoma y con la rectosigmoidescopia la presencia de pólipos intestinales. La intervención quirúrgica de los osteomas se realizó bajo anestesia general que incluyó condilectomía del lado izquierdo. El diagnóstico histopatológico fue de osteoma ebúrneo. Un año después del procedimiento se observó clínicamente recuperación estética y funcional y radiográficamente buena regeneración ósea en al ángulo mandibular donde se encontraba el osteoma de mayor diámetro. El paciente ha tenido hasta la actualidad una evolución muy satisfactoria, con excelente apertura bucal. El objetivo es describir el manejo que se tuvo con un paciente con síndrome de Gardner en el Servicio de Cirugía Maxilofacial de Artemisa(AU)

Gardner's syndrome, a variant of familial adenomatous polyposis, is a dominant autosomal inherited disease characterized by multiple intestinal polyps together with extra-intestinal manifestations including multiple osteomas, connective tissue tumors, thyroid carcinomas, hypertrophied pigmented epithelium of the retina, and also frequent retained supernumerary teeth and odontomas. The objective of this paper was to describe the management of a patient with Gardner's syndrome at the maxillofacial surgery service in the province of Artemisa. The clinical case of a male patient aged 20 years, who went to the maxillofacial service on account of increased volume of the facial area in three sites. The X-rays showed radiopaque images characteristic of osteomas whereas rectosigmoidoscopy revealed intestinal polyps. The osteomas were surgically removed under general anesthesia including condylectomy on the left side. The histological-pathological diagnosis was osteoid osteoma. One year after the surgical procedure, the clinical exam showed esthetic and functional recovery and the radiographies disclosed good bone regeneration in the mandibular angle where the biggest osteoma was found. The patient has recovered very satisfactorily, with excellent oral opening(AU)

Diagnostic accuracy of color doppler ultrasonography in evaluation of cervical lymph nodes in oral cancer patients.

Aims: To assess the diagnostic accuracy of color doppler ultrasonography (CDUS) in differentiating metastatic from reactive lymph nodes in oral cancer patients. Material And Methods: Study comprised 80 adult subjects with oral cancer, divided in two groups based on clinical criteria. Group I included 40 patients with clinically suspected metastatic cervical lymph nodes, Group II included 40 patients with clinically suspected reactive cervical lymph nodes. Study population was evaluated with CDUS for color flow signals and intranodal vascular resistance (Pulsatility Index and Resistivity Index), followed by Fine Needle Aspiration Cytology, used as a standard, to confirm the etiology of the lymph node enlargement. Statistical Analysis Used: Chi-Square Test (SPSS 15.0 version) was used to evaluate the significance of the parameters used between the two study groups. Results: Sensitivity of CDUS by vascular flow pattern was 94.1%, specificity of 100%, with accuracy of 95.4% and by vascular indices the sensitivity was 81.4%, specificity of 100%, and accuracy of 85.5%, with statistically significant correlation.(P < 0.05) Conclusion: CDUS plays a definitive role as an adjunct to clinical evaluation of differentiating metastatic from reactive cervical lymph involvement in patients with oral cancer as it aid in grading and staging of oral cancer and can determine the treatment plan prognosis and morbidity by diminishing the possibility nodal dissection.