Carcinoma escamoso variedad sarcomatoide de lengua. Reporte de caso / Sarcomatoid variant squamous cell carcinoma of the tongue. Case report

Introducción. El carcinoma de células escamosas es una patología relativamente frecuente en Paraguay, que debe ser diagnosticada y tratada a tiempo. La variedad sarcomatoide es un subtipo poco frecuente, pero mucho más agresivo que la presentación convencional, con altas tasas de recurrencia y metástasis linfática. La exposición previa a radiación es uno de los principales factores desencadenantes. Caso clínico. Paciente de 83 años con antecedente de radioterapia por carcinoma escamocelular del paladar blando, quien consultó por una masa en el borde lateral de la lengua que correspondió a un carcinoma escamocelular del subtipo sarcomatoide. Resultados. El paciente fue sometido a cirugía y quimioterapia, pero presentó recaída tumoral a los cuatro meses, sin aceptar una cirugía de rescate, optando por el tratamiento paliativo y falleciendo a los pocos meses. Conclusión. El examen exhaustivo de la cavidad oral en una primera consulta permite identificar lesiones en estadios tempranos y el tratamiento multidisciplinario temprano puede mejorar la supervivencia global. El pronóstico de estos pacientes en estadios avanzados es desalentador. Actualmente la cirugía microvascular es la mejor opción terapéutica, pero la hemiglosectomía sin reconstrucción sigue siendo una opción aceptable en nuestro medio, conociendo los altos costos de la primera y el requerimiento de un grupo mayor de especialistas, largos tiempos quirúrgicos y estancias hospitalarias.

Introduction. Squamous cell carcinoma is a relatively common pathology in Paraguay, which must be diagnosed and treated on time. The sarcomatoid variety is a rare subtype, but much more aggressive than the conventional presentation, with high rates of recurrence and lymphatic metastasis. Previous exposure to radiation is one of the main triggering factors. Clinical case. An 83-year-old patient with a history of radiotherapy for squamous cell carcinoma of the soft palate, who consulted for a mass on the lateral edge of the tongue that corresponded to a squamous cell carcinoma of the sarcomatoid subtype. Results. The patient underwent surgery and chemotherapy, but had tumor relapse after four months, without accepting salvage surgery, opting for palliative treatment and dying a few months later. Conclusion. Exhaustive examination of the oral cavity in a first consultation allows lesions to be identified in early stages and early multidisciplinary treatment can improve overall survival. The prognosis of these patients in advanced stages is discouraging. Currently, microvascular surgery is the best therapeutic option, but hemiglossectomy without reconstruction continues to be an acceptable option in our environment, knowing the high costs of the former and the requirement for a larger group of specialists, long surgical times and hospital stays.

Quality of life in tongue cancer treated patients before and after speech therapy: a randomized clinical trial / Qualidade de vida em pacientes tratados por câncer de língua pré e pós fonoterapia: ensaio clínico randomizado

Abstract Introduction: Tongue cancer is one of the most common subtypes of head and neck cancer. The aggressive effects of treatment cause aesthetic, psychosocial and functional deficits, especially dysphagia, which affects patient quality of life. Rehabilitation, which is essential for functional maximum recovery, helps patients deal with new and altered structures and has a positive impact on quality of life. Objective: To verify the impact of speech therapy on swallowing quality of life in tongue cancer patients after treatment. Methods: This parallel randomized clinical trial was conducted at a public hospital in Porto Alegre, RS, Brazil. Before and after the intervention, a quality of life questionnaire (the Deglutition Handicap Index) was employed, dysphagia severity was assessed with fiberoptic endoscopic evaluation of swallowing, and the Functional Oral Intake Scale carried out. The experimental group underwent four-week sessions of speech therapy over one month, while the control group received the institution's usual follow-up. Results: Thirty individuals treated for tongue cancer were divided into a study and a control group. Deglutition Handicap Index scores decreased significantly (approximately 40 points) (p < 0.001) after the intervention in the study group. There was a significant correlation between improved quality of life, reduced dysphagia severity and increased in Functional Oral Intake Scale scores (p <0.001). Conclusion: After speech therapy, quality of life scores related to deglutition and dysphagia severity improved in patients treated for tongue cancer.

Resumo Introdução: O câncer de língua é um dos subtipos mais comuns do câncer de cabeça e pescoço. Os efeitos agressivos do tratamento causam impactos estéticos, psicossociais e funcionais, principalmente a disfagia, os quais afetam a qualidade devida do paciente. A reabilitação, essencial para a máxima recuperação funcional, auxilia o paciente a lidar com as novas estruturas e tem impacto positivo na qualidade de vida. Objetivo: Verificar o impacto da fonoterapia na Qualidade de Vida relacionada à deglutição de pacientes tratados por câncer de língua. Método: Ensaio clínico randomizado paralelo, realizado em um hospital público de Porto Alegre, RS, Brasil. Antes e após a intervenção, os participantes foram avaliados por meio de um questionário de Qualidade de Vida (o Índice de Desvantagem da Deglutição), classificados quanto a gravidade da disfagia (por meio do exame de Videoendoscopia da Deglutição) e quanto ao nível da escala funcional de ingestão por via oral. O grupo experimental foi submetido a quatro sessões semanais de fonoterapia no período de um mês, enquanto o grupo controle recebeu o acompanhamento habitual da instituição. Resultados: Trinta indivíduos tratados para câncer de língua foram divididos em um grupo estudo e um grupo controle. Houve uma diminuição significativa, de aproximadamente 40 pontos (p <0,001), nos escores de Qualidade de Vida após a intervenção no grupo experimental. Verificou-se correlação significativa entre a melhora da Qualidade de Vida, a redução da gravidade da disfagia e o aumento dos níveis da escala funcional de ingestão por via oral (p <0,001). Conclusão: Após a fonoterapia, pacientes tratados por câncer de língua apresentaram melhora nos escores de Qualidade de Vida relacionada à deglutição e na gravidade da disfagia.

Assessment of depth of invasion in early tongue squamous cell carcinoma based on dynamic contrast-enhanced MRI / 中华放射学杂志

Objective:To investigate the feasibility of dynamic contrast-enhanced (DCE)-MRI in assessing the depth of invasion (DOI) of early tongue squamous cell carcinoma.Methods:From January 2016 to December 2020, a total of 100 patients with early tongue squamous cell carcinoma confirmed by postoperative pathology were retrospectively analyzed in the Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine. The study included 48 cases of T1 stage and 52 cases of T2 stage. All patients underwent routine MRI, DCE-MRI and contrast-enhanced T 1WI (CE-T 1WI) before surgery. The DOI was measured on images at different phases of axial DCE-MRI (30, 60 and 120 s after contrast injection) and CE-T 1WI (MRI-DOI) by 2 doctors independently. The intraclass correlation coefficient (ICC) was applied to evaluate the consistency of the measurements. MRI-DOI measured on DCE-MRI 30, 60, 120 s, CE-T 1WI and pathological DOI measured on biopsies were statistically analyzed with analysis of variance for repeated measurement and least significant difference t test. Pearson correlation coefficient was used to compare the correlation between MRI-DOI and pathological DOI. Receiver operation characteristic (ROC) curve analysis was used to explore the performance of MRI-DOI for clinical T1 and T2 staging. Results:There was a good consistency in MRI-DOI measured on DCE-MRI 30, 60, 120 s, and CE-T 1WI images with ICC of 0.752, 0.875, 0.883, and 0.841, respectively. The values of MRI-DOI were (8.35±3.52), (6.88±2.41), (7.52±2.65) and (8.60±3.39) mm, respectively, and pathological DOI was (5.75±2.01) mm. There was statistically significant difference in the overall comparison among different phases of MRI-DOI and pathological DOI ( F=69.25, P<0.001). MRI-DOI were significantly higher than pathological DOI ( P<0.05). All MRI-DOI measured on DCE-MRI 30, 60, 120 s and CE-T 1WI correlated positively with pathological DOI ( r=0.574, 0.851, 0.731, 0.663, all P<0.001). MRI-DOI derived from DCE-MRI 60 s showed the highest diagnostic efficiency for T1 and T2 staging (area under the ROC curve was 0.931, 95%CI 0.881-0.982). When the optimal cutoff value was 6.0 mm, the accuracy, sensitivity and specificity were 88.0%, 96.2% and 79.2%, respectively. Conclusions:DCE-MRI can be applied to assess DOI in early tongue squamous cell carcinoma. MRI-DOI based on DCE-MRI 60 s has the best correlation with pathological DOI and has a potential to predict clinical T staging in early tongue squamous cell carcinoma.

Value of MRI radiomics for predicting occult cervical lymph nodes metastases in early-stage oral tongue squamous cell carcinoma / 中华放射学杂志

Objective:To explore the value of conventional MRI radiomics for predicting occult cervical lymph nodes (LNs) metastases in early-stage oral tongue squamous cell carcinoma (OTSCC).Methods:The preoperative MRI data of 77 cases of early-stage OTSCCs (cT1-2N0M0) in Shanghai Ninth People′s Hospital from January 2015 to December 2019 were retrospectively analyzed. All patients underwent primary lesion resection with selective neck dissection and the pathologic reports of LNs couldal be obtained. In total, 168 LNs (51 positive and 117 negative metastases) were enrolled and allocated into training set ( n=112) and validation set ( n=56) with a ratio of 2∶1 using random number table. The volumes of interest of LNs on T 2WI and contrast enhanced T 1WI (ceT 1WI) were delineated by two doctors using ITK-SNAP software. The 1 046 radiomics features of each sequence were extracted using 3D Slicer software. Data dimension reduction was done by inter-observer agreement analysis and univariate analysis. The least absolute shrinkage and selection operator regression analysis were used for selecting optimal feature subsets and constructing radiomics signature for each sequence. Mann-Whitney U test was used to compare the differences of node size and radiomics scores between the LNs with positive and negative metastases. The receiver operating characteristic (ROC) curve was used to explore the performance of LNs size, T 2WI radiomics signature and ceT 1WI radiomics signature in predicting occult LNs metastases. Stepwise logistic regression was used to determine the independent predictors. Results:Fifteen and 10 optimal features were selected to construct radiomics signature for T 2WI and ceT 1WI respectively. The short diameter, T 2WI radiomics signature and ceT 1WI radiomics signature showed significant differences between LNs with positive and negative metastases in the both training and validation sets (all P<0.05), with the areas under the ROC curve of 0.67, 0.83 and 0.82 in the training set, and 0.69, 0.78 and 0.70 in the validation set, respectively. In the stepwise logistic regression analysis, T 2WI radiomics signature was identified as the independent predictor in the both sets (training set: OR=5.92, P<0.001; validation set: OR=2.53, P=0.012). Conclusion:Conventional MRI radiomics can provide a good potential to predict occult LNs metastases in early-stage OTSCC.

Tumor de células granulares: a propósito de un caso / Granulle cell tumor: a case report

RESUMEN Fundamento: el mioblastoma de células granulares también conocido como tumor de Abrikossoff es una neoplasia benigna de rara frecuencia formada por células de aspecto granular. Objetivo: exponer aspectos clínicos del mioblastoma de células granulares. Presentación del caso: se reportó el caso de un paciente masculino de raza negra, 50 años de edad, que fue remitido de la Atención Primaria con impresión clínica de fibroma lingual, al examen bucal se observó lesión ovoide de 3 cm de diámetro en el dorso de la lengua, asintomática, firme, hipocoloreada, consistencia dura y bordes precisos. Se realizó exéresis mediante biopsia escisional. El diagnóstico histopatológico determinó mioblastoma de células granulares. Conclusiones: tanto las características clínicas como histológicas del tumor de células granulares son muy semejantes a otras neoplasias malignas que se asientan en la lengua como el carcinoma epidermoide por tanto su diagnóstico constituye un reto para el estomatólogo.

ABSTRACT Background: granular cell tumor known as Abrikossoff´s tumor is a benign neoplasm of rare incidence formed by cell of granular aspects. Objective: to expose clinical aspects of granular cell tumor. Case report: a clinical case is reported of a 50 years-old black male patient. He was remitted of Primary Health Service with diagnostic impression of tongue's fibroma, in the oral exam was detected an oval lesion of 3cm of diameter on dorsum of the tongue, asymptomatic, firm consistency, and well defined. The lesion was removed by excision biopsy. The histological-pathological study determined a granular cell tumor. Conclusions: both the clinical and histological characteristics of the granular cell tumor are very similar to other malignant neoplasm that settle on the tongue such as epidermoid cell carcinoma therefore its diagnosis constitutes a challenge for the dentistry.

Effect of micro RNA-296-3p regulated cell on proliferation, migration and invasion of tongue squamous cell carcinoma by targeting nucleoprotein 1 / 中国医师进修杂志

Objective:To investigate the effects of micro RNA(miR)-296-3p on cell proliferation, migration and invasion of tongue squamous cell carcinoma and its underlying mechanism.Methods:Normal oral epithelial mucosal keratinocytes HOK was used as the control. Real-time quantitative polymerase chain reaction (PCR) was used to detect the expression of miR-296-3p and nucleoprotein 1(NUPR1) mRNA in tongue squamous cell carcinoma cell lines CAL27, SCC15 and SCC9, and Western blot was used to detect the expression of NUPR1 protein. CAL27 cells were divided into NC group, miR-con group, miR-296-3p group, si-con group, si-NUPR1 group, miR-296-3p+pcDNA group and miR-296-3p+pcDNA-NUPR1 group, then CCK8 method was used to detect the cell activity. Transwell was used to detect the cell migration and invasion. Western blot was used to detect the protein expression levels of proliferating cell nuclear antigen (PCNA), matrixmetallo proteinase-2(MMP-2) and matrixmetallo proteinase-9(MMP-9). Dual-luciferase reporter assay system was implemented to verify the relationship between miR-296-3pand NUPR1.Results:Compared with the HOK cells, the content of miR-296-3p in the tongue squamous cell line CAL27, SCC15 and SCC9 groups was significantly reduced (0.54 ± 0.08, 0.38 ± 0.05, 0.59 ± 0.07 vs. 1.04 ± 0.12, t = 10.401, 15.231 , 9.718, P<0.05), while the expression levels of NUPR1mRNA (5.94 ± 0.40, 4.48 ± 0.45, 5.19 ± 0.48 vs.0.94 ± 0.12, t = 35.918, 22.803, 25.769) and protein (0.79 ± 0.09, 0.54 ± 0.05, 0.62 ± 0.08 vs. 0.28 ± 0.04, t = 15.535, 12.182, 11.404) were significantly increased (all P<0.05). Compared with those in the NC group or miR-con group, CAL27 cell activity, migration number, invasion number and the protein expression of PCNA, MMP-2 and MMP-9 in the miR-296-3p group were decreased (all P<0.05). Compared with those of the NC group or the si-con group, the CAL27 cell activity, migration number, number of invasions and the protein expression of PCNA, MMP-2 and MMP-9 in the si-NUPR1 group were decreased (all P<0.05). miR-296-3p negatively regulatedthe expression of NUPR1 in CAL27 cells. Compared with the miR-296-3p+pcDNA group, CAL27 cell viability (138.34 ± 5.73 vs. 98.54 ± 5.89, t = 14.530), migration number (95.28 ± 7.56 vs. 67.92 ± 5.23, t = 8.929), invasion number (184.53 ± 17.57 to 101.26 ± 10.64, t = 12.162) and the protein expression of PCNA (0.68 ± 0.07 to 0.35 ± 0.06, t = 10.738), MMP-2 (0.43 ± 0.05 to 0.29 ± 0.04, t = 6.559) and MMP-9 (0.58 ± 0.06 vs. 0.33 ± 0.08, t = 7.500) in the miR-296-3p+pcDNA-NUPR1 group were increased (all P<0.05). Conclusions:miR-296-3p may inhibitthe proliferation, migration and invasion of tongue squamous cell carcinoma cells by negatively regulating NUPR1.

Accuracy analysis of MRI in the depth of invasion assessment of tongue squamous cell carcinoma / 口腔疾病防治

Objective @#To analyze the accuracy of the infiltrating depth of tongue squamous cell carcinoma measured by magnetic resonance imaging (MRI) using pathological sections under a light microscope to provide a clinical reference.@*Methods @#Seventy-three patients with tongue squamous cell carcinoma who visited the Department of Stomatology of the First Hospital of Shanxi Medical University and Xiangya Stomatological Hospital from January 2018 to September 2020 were selected. Preoperative MRI was performed to evaluate the infiltration depth of tongue squamous cell carcinoma, and intraoperative frozen pathological sections were used to confirm the infiltration depth of tongue squamous cell carcinoma measurement. @*Results @#The infiltration depth of tongue squamous cell carcinoma measured by T1-weighted imaging was 1.11 mm (95% CI=0.51-1.70; t=3.72; P < 0.001), and the correlation coefficient r was 0.95. The T2-weighted average overestimation was 2.17 mm (95% CI=1.32-3.02; t=5.10; P < 0.001), and the correlation coefficient was 0.92. The Bland-Altman plot showed good consistency between T1- and T2-weighted images and pathologic measurements.@*Conclusion @#The infiltration depth of tongue squamous cell carcinoma measured by MRI is more accurate, with an average overestimation of 1-2 mm compared with pathological measurements, and T1-weighted images are better than T2-weighted images.

Expression of Bex1 and NF-kBp65 in tongue squamous cell carcinoma and its significance / 口腔疾病防治

Objective @#To investigate the expression of brain expressed X-linked gene 1(Bex1) and nuclear factor-kBp65 (NF-kBp65) in tongue squamous cell carcinoma, and its significance.@*Methods@# Immunohistochemistry was used to detect the expression of Bex1 and NF-kBp65 in 60 tongue squamous cell carcinoma (TSCC) tissues and adjacent normal tissues, and the relationships between Bex1, NF-kBp65 and the clinicopathological features and prognosis of patients were analyzed.@*Results @#The positive expression rate of Bex1 in TSCC was 48.3% (29/60), which was significantly lower than that in adjacent normal tissues 88.3% (53/60) (x2=22.18, P < 0.01). The positive rate of Bex1 was negatively correlated with TNM stage, and the difference was statistically significant (P < 0.05). The positive rate of 63.3% (38/60) in TSCC was significantly higher than 20% (12/60) in adjacent normal tissues (x2=23.18, P < 0.01), the positive rate of NF-kBp65 was positively correlated with TNM stage, and the difference was statistically significant (P < 0.05). According to the Pearson correlation analysis results, the expression of Bex1 and NF-kBp65 in TSCC tissues was negatively correlated (r=-0.302, P=0.019). Kaplan-Meier survival curves showed that the survival rate of Bex1 positive patients was significantly higher than that of Bex1 negative patients.@*Conclusion @#In TSCC tissues, the low positive expression rate of Bex1 and the high positive expression rate of NF-kBp65 may promote tumor invasion and metastasis, and the negative expression of Bex1 may be related to the poor prognosis of patients.

The clinical effect of free anterior lateral thigh flap with cutaneous nerve on repair and reconstruction after radical operation of tongue cancer / 中国医师杂志

Objective:To evaluate the clinical effect of free anterior lateral thigh flap (ALTF) with cutaneous nerve on repair and reconstruction after radical operation of tongue cancer.Methods:79 patients with tongue cancer who underwent radical resection in the stomatology department of Hunan Provincial People′s Hospital from October 2015 to October 2020 were selected and divided into observation group (38 cases) and control group (41 cases) according to the treatment method. The observation group was reconstructed with free ALTF with cutaneous nerve, and the control group was reconstructed with free ALTF without cutaneous nerve. The survival of the flap was observed and the function and morphology of the reconstructed tongue were evaluated.Results:All flaps survived and had good blood supply; the blood supply was good, the wounds healed in the first stage, and there were no cases of infection and arterial crisis. The appearance of the reconstructed tongue was plump and showed mild atrophy. The observation group was significantly better than the control group in terms of language clarity, masticatory efficiency, sensory excellence rate and University of Washington Quality of Life questionnaire (UW-QOL) score ( P<0.05). Conclusions:The ALTF with cutaneous nerve for repair and reconstruction after radical operation of tongue cancer, can significantly improve the reconstruction of tongue sensory function and the quality of life of patients.

Oral squamous cell carcinoma of the tongue in a young Lao patient: a rare case report and literature review / Lao Medical Journal

@#Oral cancer has been regarded as disturbingly high and diagnosed mostly among males, with median age at the diagnosis of tongue cancer was 61 years, with only approximately 2% of patients under 35 years old. Oral squamous cell carcinoma is rare in young age groups, and may misdiagnosed resulting for late treatment leading to poor survival rate. We report the case of a 27year-old Lao woman with tongue cancer in the lateral posterior border area.

Association of Socio-Demographic and Clinicopathological Risk Factors with Oral Cancers: A 19-Year Retrospective Study

ABSTRACT Objective: To determine the association of socio-demographic and clinic-pathological risk factors with oral cancer in Kelantan, Malaysia. Material and Methods: A 19-year cross-sectional survey was performed in Hospital Universiti Sains Malaysia (HUSM), Malaysia. Medical record of 301 oral cancer patients was retrieved from the Medical Records office. Results: The majority of the oral cancer cases were male (62.8%), non-smokers (57.5%), non-alcohol consumers (83.4%), non-betel quid chewers (96.7%), and belonged to Malay ethnicity (68.8%). At the time of diagnosis, most of the patients were at stage II (38.9%). Approximately one-third (30.6%) of the total OC patients experienced loco-regional/distant metastasis, whereas no metastasis was detected in around two-thirds of cases (69.4%). A combination of surgery and radiotherapy was the most commonly employed treatment modality (27.2%). At the time of this study, the survival status of most of the patients was alive (69.1%). The most frequently encountered oral cancer in the Kelantanese population was oral squamous cell carcinoma (70.1%), with the tongue being the most frequently involved oral cavity site (35.5%). Conclusion: More than three-fourths of the cases were alive at follow-up, which included the cases that did not undergo any form of treatment.

The influence of tobacco and alcohol in oral cancer: literature review / A influência da associação de tabaco e álcool no câncer bucal: revisão de literatura

ABSTRACT In Brazil, smoking and drinking are more common in male patients, less frequently affecting female patients. The most diagnosed type of lesion is squamous cell carcinoma. This article aims to understand the literary references associated with the influence of tobacco and alcohol on the development of oral cavity cancer. In order to elaborate an analytical and thematic literature review, using the Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), Scientific Electronic Library Online (Scielo), US National Library of Medicine National Institutes of Health (PubMed) and Medline databases, articles from the English and Portuguese literatures published between 2007 and 2019 were searched with the help of the terms: prognostic factors and indicators, tobacco, alcohol and oral carcinoma. Proper knowledge of the disease and its etiological and prognostic factors should make professionals able to prevent, identify and control oral cancer.

RESUMEN En Brasil, el humo y la ingestión de bebidas alcohólicas son más comunes en hombres. El tipo de lesión más frecuente es el carcinoma. Tuvimos como objetivo hacer un inventario de referencias literarias publicadas acerca de la influencia del tabaco y del alcohol en el desarrollo del cáncer en la cavidad oral. Para la revisión de literatura, de tipo analítica y temática, la búsqueda de artículos en las lenguas inglesa y portuguesa publicados entre 2007 y 2019 se realizó en las bases de datos Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), Scientific Electronic Library Online (Scielo), US National Library of Medicine National Institutes of Health (PubMed) y Medline, con los siguientes términos: factores e indicadores pronósticos, tabaco, alcohol, y carcinoma oral. El conocimiento adecuado de la enfermedad y de sus factores etiológicos y pronósticos debe capacitar a los profesionales de salud para prevenir, identificar y controlar el cáncer oral.

RESUMO No Brasil, o fumo e a ingestão de bebidas alcoólicas são mais comuns em homens. O tipo de lesão mais diagnosticada é o carcinoma epidermoide. Este artigo tem como objetivo realizar um levantamento das referências literárias já publicadas associadas à influência do tabaco e do álcool no desenvolvimento do câncer na cavidade bucal. Para elaborar uma revisão de literatura, do tipo analítica e temática, utilizamos a Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), o Scientific Electronic Library Online (Scielo), o US National Library of Medicine National Institutes of Health (PubMed) e o Medline. Nessas bases de dados, foram pesquisados artigos das literaturas inglesa e portuguesa publicados entre 2007 e 2019, com auxílio dos seguintes termos: fatores e indicadores prognósticos, tabaco, álcool e carcinoma bucal. O conhecimento adequado da doença e dos seus fatores etiológicos e prognósticos devem capacitar os profissionais para prevenir, identificar e controlar o câncer de boca.

Chimeric perforator flap based on the descending branch of lateral circumflex femoral artery for tongue reconstruction after advanced tongue cancer resection / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the advantages and clinical efficacy of free chimeric perforator flap based on the descending branch of circumflex femoral artery applied to tongue reconstruction after advanced tongue cancer resection.@*Methods@#From October 2013 to December 2018, 57 cases received tongue and oral base reconstruction surgeries using the descending branch of circumflex femoral artery chimeric perforator flap, including 39 males and 18 females, ranged from 20 to 76 years old. And all cases were with stage T3 and T4 tongue cancers, including 35 cases of squamous cell carcinoma, 7 cases of low differentiation cancer, 5 cases of oncosarcoma, and 10 cases of adenoid cystic carcinoma. The tongue was reconstructed by using perforator flap and muscle flap to fill the dead space at the oral floor. The artery anastomoses with the superior thyroid artery or facial artery in the receiving area, and the vein anastomoses with the internal jugular vein in the receiving area. The shape, function and local complications of the reconstructed tongue were observed after operation.@*Results@#Of 57 cases, only one case had partial necrosis of flap, while other 56 cases with chimeric perforator flap survived. Postoperative gastric tube and tracheal cannula were removed in all patients, no cases with oral fistula. All donor sites were sutured in one stage. Postoperative radiotherapy was performed in 41 of the patients. All patients were followed up for 3 to 60 months (average of 20.7 months), with satisfactory esthetic and functional results in reconstructed tongues. Only linear scars were left in the donor areas of the legs, and no lower limb dysfunction was observed.@*Conclusions@#The descending branch of circumflex femoral artery chimeric perforator flap can used for repairing simultaneously the defects of both tongue and oral base. It is helpful to avoid the occurrence of oral fistula and to provide the reconstructed tongue with a good function. It is a good choice to use the descending branch of circumflex femoral artery chimeric perforator flap for tongue reconstruction after resection of advanced tongue cancer resection.

Dysphagia in Patients with Tongue Cancer Treated with Surgery / 대한연하장애학회지

OBJECTIVE: To evaluate the swallowing problems after a primary resection in patients with tongue cancer. METHODS: Thirty-eight patients with primary tongue cancer, who underwent a glossectomy and had undergone a Video Fluoroscopic Swallowing Study (VFSS) prior to surgery in a university hospital between January 2010 and May 2015, were included retrospectively. The clinical and swallowing features, including the VFSS parameters before and after surgery, were analyzed. RESULTS: Among the 38 patients, 33 patients were T1 and T2 stage. Thirty-one, six and one patient underwent a partial glossectomy, hemiglossectomy, and total glossectomy, respectively. More than ninety percent of the patients had a selective neck dissection. All the patients were on a regular diet before surgery and showed no penetration or aspiration on the VFSS. Immediately after surgery, 33 patients (87%) had to change to non-oral feeding. At discharge, 8 patients (21%) maintained non-oral feeding, and 30 patients ate a limited diet. In a telephone survey (mean 19 months after surgery), among the 25 survey participants, 24 patients (96%) reported no problems with their regular diet. CONCLUSION: In tongue cancer patients with low Tumor-Node-Metastasis (TNM), American Joint Committee on Cancer (AJCC) stages, a primary resection of tongue cancer did not cause statistically significant dysphagia after surgery. Although many patients had to change their diet to limited or non-oral feeding immediately after surgery, almost all patients improved and could eat a regular diet after the long term follow up.

Research progress in the methods for evaluating depth of invasion of tongue squamous cell carcinoma / 中华口腔医学杂志

Depth of invasion is a newly added index for TNM staging of oral cancer in the eighth edition. Preoperative evaluation of depth of invasion not only provides a reference for surgical margin, but also serves as an independent prognostic factor for predicting lymph node metastases. At present, the main methods for assessing the depth of invasion of tongue squamous cell carcinoma include ultrasound examination, MRI, CT, positron emission tomography (PET) and histopathological examination. This paper summarizes the evaluation method and clinical effect of depth of invasion of tongue cancer, and analyzes its advantages and boundedness. In addition, this study is expected to provide a reference for the surgical treatment of tongue squamous cell carcinoma.

Clinicopathological and immunohistochemical analysis of spindle cell squamous cell carcinoma of the tongue: a rare case / Análise clinicopatológica e imuno-histoquímica do carcinoma de células escamosas de células fusiformes da língua: um caso raro

ABSTRACT Spindle cell squamous cell carcinoma of the tongue is a rare variant of squamous cell carcinoma. This paper reports the case of a spindle cell squamous cell carcinoma of the tongue, in a 64-year-old male patient, and presents a review of the etiopathogenesis, clinicopathological and immunohistochemical features and treatment of the malignancy. The patient presented for evaluation of a painful swelling on his tongue. Extraoral examination revealed palpable submandibular and superior cervical lymph nodes. Based on the presumptive diagnoses of squamous cell carcinoma or malignant salivary gland neoplasm, an incisional biopsy was performed. Histopathological analysis showed a proliferation of atypical spindle cells, exhibiting extensive pleomorphism. Tumor cells were positive for vimentin, P53 and alpha-smooth muscle actin, focally positive for epithelial membrane antigen and P63, and negative for pan-cytokeratin (AE1/AE3), CK7, CD138, CD34, CD56, and S-100. The positivity index for Ki-67 was approximately 40%. The diagnosis of spindle cell squamous cell carcinoma was established and the patient was referred to a head and neck surgery service. In the oral cavity, spindle cell squamous cell carcinoma of the tongue is an aggressive variant of squamous cell carcinoma, which usually presents as an exophytic mass located on the tongue of elderly males. Due to its distinct histopathological characteristics, immunohistochemistry is a valuable and helpful tool to establish the diagnosis of spindle cell squamous cell carcinoma of the tongue.

RESUMO O carcinoma de células escamosas de células fusiformes da língua, é uma variante rara do carcinoma de células escamosas. Este trabalho relata o caso de um paciente do sexo masculino de 64 anos de idade com carcinoma de células escamosas de células fusiformes da língua. Foi feita uma revisão dos aspectos relacionados a etiopatogenia, características clinicopatológicas e imuno-histoquímicas, além do tratamento dessa neoplasia. O paciente procurou atendimento para avaliação de tumefação dolorosa na língua. O exame extraoral revelou linfonodos cervicais submandibulares e cervicais superiores palpáveis. Foi realizada biópsia incisional com base nas hipóteses diagnósticas de carcinoma de células escamosas ou neoplasia maligna de glândula salivar. A análise histopatológica demonstrou proliferação de células fusiformes atípicas, exibindo extenso pleomorfismo. As células tumorais foram positivas para vimentina, p53 e alfa-actina de músculo liso, focalmente positivas para antígeno de membrana epitelial e P63, e negativas para pancitoqueratina (AE1/AE3), CK7, CD138, CD34, CD56 e S-100. O índice de positividade para o Ki-67 foi de aproximadamente 40%. Foi feito o diagnóstico de carcinoma de células escamosas, de células fusiformes, e o paciente foi encaminhado para um serviço de cirurgia de cabeça e pescoço. Na cavidade oral, o carcinoma de células escamosas de células fusiformes da língua, é uma variante agressiva do carcinoma de células escamosas, que geralmente se apresenta como massa exofítica localizada na língua de homens idosos. Devido às suas distintas características histopatológicas, a imuno-histoquímica é uma ferramenta valiosa e útil para estabelecer o diagnóstico de carcinoma de células escamosas de células fusiformes da língua.

Frequency of Cervical Nodal Metastasis in Early- Stage Squamous Cell Carcinoma of the Tongue

Abstract Introduction Oral cavity carcinoma is an aggressive tumor, with the tongue being one of the most common subsites of involvement. Surgery is a gold standardmethod of dealing with advanced-stage tumors. However, for early-stage carcinomas of the tongue, the management remains controversial. Several studies have indicated that early-stage cancers have a high chance of occult cervical node metastasis, which, if left untreated, can greatly affect the prognosis. Certain parameters can help identify patients with occult cervical node metastases, and can avoid unnecessary neck dissection in node negative patients. Tumor thickness is one such objective parameter. Objective To estimate the frequency of cervical lymph node metastasis in patients with early-stage, node-negative (N0) squamous cell carcinoma of the tongue. Methods In-patient hospital data was reviewed from January 2013 until March 2014, and 78 patients who underwent primary resection of the tumor and neck dissection for biopsy-proven, early stage squamous cell carcinoma of the tongue were included. Data such as tumor thickness, tumor differentiation and presence of occult nodal metastasis in the surgical specimen were gathered from the histopathology reports. The frequency of subclinical cervical lymph node metastasis in patients with early-stage squamous cell carcinoma of the tongue was estimated. Results A total of 69% of the patients with tumor thicknesses > 5 mm had tumor metastases in the neck nodes, while 100% of the patients with tumor thicknesses < 5 mm had no neck nodal metastasis. Conclusion A tumor thickness > 5 mm is significantly associated with subclinical metastasis, and prophylactic neck dissection is warranted in such cases.

Preoperative MRI staging in diagnosis of tongue squamous cell carcinomas / 中国医学影像技术

Objective To observe the value of MRI in preoperative staging of tongue squamous cell carcinomas (TSCC).Methods Totally 154 patients with TSCC underwent MR scanning.MR manifestations of TSCC were analyzed,and the preoperative staging of Tumor (T),Node (N) and American Joint Committee on Cancer (AJCC) were performed.Then the consistency between preoperative MRI staging and postoperative pathology staging was evaluated.Results Preoperative MRI T staging were T1 in 37 patients,T2 in 54,T3 in 7 and T4 in 56 patients,respectively,while N staging were N0 in 104 patients,N1 in 31 and N2 in 19 patients,respectively.For AJCC staging,there were 34 patients in Ⅰ stage,37 in Ⅱ stage,21 in Ⅲ stage and 62 in Ⅳ stage,respectively.Between preoperative MRI and postoperative pathology staging,the Kappa of T,N and AJCC staging was 0.814,0.786 and 0.790,respectively (all P＜0.01).The accuracy rate of preoperative MRI T,N and AJCC staging of TSCC was 87.01％ (134/154),88.96％ (137/154) and 85.06％ (131/154),respectively.Conclusion The consistency was good between preoperative MRI T,N and AJCC staging and postoperative pathology staging of TSCC.

The value of MRI texture analysis based on gray level co-occurrence matrix to predict cervical lymph node metastasis in tongue carcinoma patients / 中华放射学杂志

Objective To evaluate the value of MRI texture analysis based on gray level co-occurrence matrix to predict cervical lymph node metastasis in patients with tongue carcinoma. Methods A total of 70 patients with tongue carcinoma confirmed by pathology were analyzed retrospectively. The patients were divided into cervical lymph node (LN) metastasis group (unilateral LN+, n=18;bilateral LN+,n=22) and no cervical lymph node metastasis(LN-,n=30). T1W, T2W and contrast-enhanced T1W images of the largest section of tumor were selected. ROI of the lesion was manually drew and GLCM texture parameters (energy, contrast, correlation, inverse difference and entropy) were extracted. The tumor length, thickness and para-lingual distance between tumor and tongue midline were also measured.Differences of all parameters were compared between LN+ group and LN- group, unilateral and bilateral cervical lymph node metastasis group, the parameters with statistically significant difference in predicting the efficiency of cervical lymph node metastasis were analyzed. The diagnostic efficiency of lymph node metastasis was calculated. Results The correlation, inverse difference and entropy based on T2WI showed significant difference (Zcor elation=2.97, tinverse dif erence=5.14, tentropy=2.41; P<0.05), entropy showed the best diagnostic efficiency, the area under the ROC curve (AUC) was 0.90, the cut off value was 7.19, the sensitivity was 80.0％, specificity was 86.7％. Only entropy showed significant difference between unilateral LN+group and bilateral LN+group (P<0.05), the AUC was 0.82, the cut off value was 7.47, the sensitivity was 90.9％, specificity was 78.8％. The index of tumor length, thickness and para-lingual distance between tumor and tongue midline all showed significant difference between LN+group and LN-group (P<0.05), the thickness showed the best diagnostic efficiency, the AUC value was 0.81, the cut off value was 11.19, the sensitivity was 78.0％, specificity was 81.7％. The index of tumor length, thickness and para-lingual distance between tumor and tongue midline showed no significant difference between unilateral LN+ group and bilateral LN+ group (P>0.05). The diagnostic sensitivity of radiologists was 65.0％ (26/40), the specificity was 80.0％ (24/32) on cervical lymph node metastasis. Conclusion Texture analysis based on T2WI can predict cervical lymph node metastasis in patients with tongue carcinoma. Entropy has certain value in predicting bilateral cervical lymph node metastasis.

Expression level and clinical significance of serum syndecan-1 in oral tongue squamous cell carcinoma patients / 国际肿瘤学杂志

Objective To detect the level of serum syndecan-1 in patients with oral tongue squamous cell carcinoma (OTSCC),and to investigate the effect of serum syndecan-1 in OTSCC diagnosis and disease progression assessment.Methods The serums of a total of 65 OTSCC patients (OTSCC group) and 74 healthy subjects (control group) were collected from March 2015 to June 2017 in the Fourth Hospital of Xi'an.Enzyme linked immunosorbent assay was used to detect the level of serum syndecan-1.Receiver operating characteristic (ROC) curve was conducted to evaluate the diagnostic value of serum syndecan-1 in OTSCC and its disease progression.Results The level of serum syndecan-1 in OTSCC group was significantly lower than that in the control group [(91.87 ± 33.18) ng/ml vs.(162.32 ± 51.16) ng/ml,t =1.977,P =0.002].The serum syndecan-1 levels of different TNM stage (F =3.536,P =0.025),tumor invasive depth (F =1.254,P =0.039) and lymph node metastasis (t =2.420,P =0.018) in OTSCC group had statistically significances.ROC curve analysis showed that 95.54 ng/ml serum syndecan-1 [area under the curve (AUC) =0.944,P ＜ 0.001,95％ CI:0.915-0.974] was the cut-off value of OTSCC diagnosis,and 74.54 ng/ml of lymph node metastasis in OTSCC diagnosis (AUC =0.783,P ＜ 0.001,95％ CI:0.697-0.867).Conclusion Serum syndecan-1 level is markedly decreased in patients with OTSCC,and is valuable to diagnose OTSCC or its lymph node metastasis,which is worthy of clinical application.