Secondary primary tumor mimicking osteoradionecrosis

ABSTRACT Nasopharyngeal carcinoma (NPC) is a malignant tumor rarely found in the head and neck, representing about 1% of all malignancies. The main treatment for NPC is radiation therapy, which is often given in combination with chemotherapy. However, such treatment may lead to long‐term complications, including second primary tumors (SPTs) and osteoradionecrosis (ORN). Both complications have similar radiological characteristics, which can lead to erroneous diagnoses. This paper describes a case of a second primary tumor in a patient after 20 years of radiotherapy in the area where a previous extraction was performed, mimicking an osteoradionecrosis process.

Primary diffuse large B-cell lymphoma of the mandible

Primary intraosseous non-Hodgkin lymphoma in the mandible is uncommon, representing about 0.6% of all extranodal lymphomas. We present the case of a 51-year-old male with a 4-month complaint of mandibular swelling and paresthesia, which had been previously submitted to an unsuccessful periodontal treatment. The intra-oral evaluation showed an extensive swelling with teeth mobility in the right mandible body. The panoramic radiography and computed tomography images showed an extensive osteolytic lesion. An incisional biopsy was performed and the histopathological and immunohistochemical analysis established the diagnosis of diffuse large B-cell lymphoma. The treatment included six cycles of chemotherapy with complete remission. The patient is under the seventh month of follow-up with no evidence of relapse. Although uncommon in the oral cavity, lymphoma should be considered in the differential diagnosis.

Oral ulcerative lesions in a post-liver-transplantation patient

Oral involvement is rarely found in histoplasmosis, except in its disseminated form, which is mostly observed in the severely immunocompromised host. Herein, we presented the case of a 36-year-old female with a previous history of liver transplant, who was hospitalized due to fever, chills, night sweats, diarrhea, and painful oral lesions over the last 3 days. The oral examination revealed the presence of painful shallow ulcers lined by a pseudomembrane in the gingiva and the soft and hard palate. The initial working diagnosis comprised cytomegalovirus reactivation or herpes simplex virus infection. The diagnostic work-up included incisional biopsies of the gingiva and the sigmoid colon. Both biopsies confirmed the diagnosis of histoplasmosis. Intravenous itraconazole was administered with significant improvement after 7 days. Although oral involvement is rare, histoplasmosis should be included in the differential diagnosis of oral lesions, particularly when the patient is immunosuppressed. This study reports a rare presentation of histoplasmosis involving the mucosa of the oral cavity and the colon.

Mandible metastasis of small cell lung cancer mimicking a residual cyst

Small cell lung carcinoma (SCLC) is an uncommon tumor characterized by an aggressive behavior with early metastasis, usually to the contralateral lung, liver, brain, and bones. There are only five cases of this particular tumor metastasizing to the oral cavity described in the English literature. We present the case of metastatic SCLC in the mandible with radiographic findings resembling a residual cyst. A 66-year-old man with previous diagnosis and treatment for a SCLC was referred to the Stomatology Department with a history of persistent pain in the mandible 1 year after the inferior right pre-molar tooth extraction. The radiographic exam showed a well-delimited radiolucent area on that extracted tooth's region resembling a residual cyst. Biopsy was performed yielding the diagnosis of metastatic SCLC. The patient was referred to the clinical oncologist for chemotherapy. Although uncommon, this tumor should be included in the differential diagnosis of jawbone lesions, particularly when the patient presents a previous diagnosis of SCLC.

Clinical features and preventive therapies of radiation-induced xerostomia in head and neck cancer patient: a literature review

Xerostomia or dry mouth is one of the most common and disturbing adverse effects following radiotherapy for head and neck cancer (HNC). This complication strongly increases the risk for dental caries, difficulties with chewing, swallowing and sleep disorders with significant impact on patients' quality of life. Current treatment approaches of xerostomia are often difficult and bring in many cases no substantial relief for the patient. This paper discusses the clinical features and current knowledge of xerostomia prevention in order to evaluate the real possibilities of reducing the incidence and severity of this complication in HNC patients. Salivary gland cytoprotectants (amifostine), muscarinic agonist stimulation (pilocarpine and bethanechol), salivary gland-sparing radiation technique (intensity-modulated radiotherapy- IMRT), surgical relocation of the submandibular gland, intraoral stent and stem cell transplantation are promising techniques that are discussed in this study (AU)

Estudo prospectivo do uso do betanecol na fisiologia de glândulas salivares em pacientes irradiados em região de cabeça e pescoço / A prospective study of bethanechol in the salivary glands physiology in patient following head and neck radiotherapy

Introdução: Xerostomia e/ou hipossalivação são complicações frequentes em pacientes submetidos à radioterapia em região de cabeça e pescoço. Estes efeitos adversos aumentam o risco de cárie dentária, dificuldades em mastigar, engolir e dormir, causando impacto significativo na qualidade de vida. Objetivos: Verificar se o uso profilático do betanecol durante a Radioterapia Conformada Tridimensional (RTC3D) ou Radioterapia com Intensidade Modulada do Feixe (IMRT) em região de cabeça e pescoço, reduz a queixa de xerostomia, mantém o fluxo salivar e a função das glândulas salivares. Além disso, comparar a qualidade de vida dos pacientes irradiados com e sem o uso da medicação. Método: Foi realizado estudo prospectivo duplo-cego, avaliando 97 pacientes randomizados e alocados nos Grupos betanecol (n=48) ou placebo (n=49). Os pacientes utilizaram 25mg de betanecol ou placebo duas vezes ao dia, iniciando no primeiro dia da radioterapia e mantendo até 1 mês após o tratamento. A intensidade da xerostomia foi avaliada semanalmente, desde o início até 3 meses após o término do tratamento. Foram realizados sialometria, cintilografia das glândulas salivares e questionário de qualidade de vida da Universidade de Washington (QQV-UW) em 3 Fases: Fase 1 (previamente a radioterapia); Fase 2 (entre 30-35 Gy); Fase 3 (após 60 dias da radioterapia). Resultados: Em relação à intensidade da xerostomia, os pacientes que fizeram uso da medicação apresentaram menores queixas de boca seca durante todo o período de avaliação (p<0,001). Analisando os exames de sialometria, foi observado que tanto na Fase 2 quanto na 3, o Grupo betanecol apresentou saliva não-estimulada e estimulada significantemente maior que o placebo (p<0,05). Em relação aos resultados da cintilografia, a porcentagem média de captação da parótida e excreção da submandibular do Grupo betanecol foi significativamente maior que do Grupo placebo (p<0,05). ...