Comparative analysis of three histologic grading methods for squamous cell carcinoma of the lip.

OBJECTIVES: The aim of this study was to evaluate three histologic grading methods for squamous cell carcinoma (SCC) of the lip, the conventional three-grade model proposed by the World Health Organization, tumor budding and depth of invasion (BD) model, and histologic risk assessment (HRA) model, and to correlate them with prognosis. MATERIALS AND METHODS: Fifty-three patients with lip SCC were evaluated. RESULTS: The mean age was 65 years, 69.8% of the participants were men, and 66.0% of the patients had early-stage tumors. Using the BD and conventional three-grade methods, 52.8% and 64.2% of the cases were graded as low risk, respectively. The HRA model graded 54.7% of the cases as medium risk. In the BD model, the higher histologic grade was associated with worse prognosis (P = 0.045). Overall survival at 5 years was 87.8%. Tumor size (T3 + T4) and lymph node involvement (N+) were associated with reduced overall survival and recurrence-free survival (RFS) (P = 0.002 and 0.005; 0.007 and 0.01, respectively). Surgical treatment combined with radiotherapy was associated with lower RFS (P = 0.03). CONCLUSIONS: High-grade lip SCC in advanced stages is associated with a poor prognosis. The BD model is a simple and effective tool for the prognostic evaluation of lip SCC.

Siringoma condroide en el labio superior: reporte de un caso / Chondroid syringoma of the upper lip: report of a case

Paciente masculino de 81 años de edad que acudió a consulta con un cirujano dentista por presentar una lesión nodular, asintomática, firme y móvil en el labio superior del lado derecho. El sujeto refi rió tener la lesión desde la infancia, pero notó crecimiento lento en el último año. El diagnóstico clínico indicaba un adenoma pleomorfo, por lo que el individuo se sometió a biopsia escisional bajo anestesia local. El espécimen se envió a estudio histopatológico. La evolución del paciente fue satisfactoria, sin reincidencia de la lesión. El examen microscópico reveló la presencia de una neoplasia bien delimitada constituida pormúltiples estructuras ductales pequeñas en la dermis. Estos ductos se encontraban revestidos por dos hileras de células epiteliales planas y contenían cantidades variables de material amorfo en la luz. El estroma presentaba diferenciación condroide.

An 81-year-old male patient consulted a dental surgeon due to his presenting a fi rm, mobile, asymptomatic nodular lesion on the upper lip. The patient stated that he had had the mass since childhood but that it had grown slowly over the course of the previous year. The clinical diagnosis was pleomorphic adenoma, for which reason the patient underwent an excisional biopsy under local anesthesia. The specimen was sent for histopathological examination. The patient’s progress was satisfactory and there was no recurrence of the lesion. Micro-scopic examination revealed the presence of a well-defi ned neoplasm consisting of multiple small ductal structures located in the dermis. These ducts were lined with two rows of fl attened epithelial cells and contained varying amounts of amorphous material in the lumen. The stroma exhibited chondroid differentiation.

Surgical attitude in premalignant lesions and malignant tumors of the lower lip.

INTRODUCTION: Malignant tumors of the lower lip may have a variety of histopathology forms. The diagnosis and treatment of premalignant lesions are extremely important to avoid their malignant evolution. The lower lip tumor diagnosis is based on a series of correlations: anamnestic, clinical, laboratory and histopathological (the latter giving the certain diagnose). MATERIAL AND METHODS: This study was carried out by selecting the cases with lower lip tumors operated between January 2012 and July 2014, in the Plastic Surgery and Reconstructive Microsurgery Clinic of Bucharest Clinical Emergency Hospital. The variables considered in the study were the following: age, gender, exposure to risk factors, diagnosis, and histopathology. RESULTS: The histopathological examination revealed 63% squamous cell carcinoma, 30% basal cell carcinomas, 5% keratoacanthoma and 2% actinic keratosis. Men were the predominantly affected genre, with a percentage of 70%. In the group of patients studied, 66% were smokers. DISCUSSIONS: The rate of the malignant transformation of premalignant lesion was 32.6% for keratoacanthoma, 16.9% for actinic cheilitis, 10% for actinic keratoses. CONCLUSIONS: There were no clinical or laboratory features to plead for the pre-malignant or malignant character of the of a lower lip tumor, consequently histopathological examination was used for the diagnosis of the lesion. Due to the high percentage of malignant transformation of precancerous lesions, particularly in the form of squamous cell carcinoma, the surgical attitude intending to eradicate a lower lip tumor from an oncological point of view was the excision with oncologic safety margins followed by a lip reconstruction.

Advanced lip reconstruction: functional and aesthetic considerations.

The lips have both aesthetic and functional features that serve to provide recognizable individualized beauty, emotional cues, sensual interactions, speech abilities, and oral continence for nutrition. Lip distortion or loss occurring from trauma or neoplasms can have devastating cosmetic and form deficits with resultant psychological, physical, and nutritional detriments. Appropriate reconstruction of the lips requires a balance between form, function, and aesthetics. Conservation of tissue when feasible should be the overall goal followed by exhausting and maximizing on all adjacent local tissue advancements, rotations, and transposition options. Tissue preservation as the first line of lip reconstruction will achieve the highest success in maintaining sphincteric function along with balancing appearance. This goal should be maintained when dealing with simple lacerations with minimal tissue loss to extensive near or total lip defects. We hope to provide an algorithm and review of aesthetic considerations in lip reconstructive techniques for a wide range of lip defects. An anatomic review and historical background followed by aesthetic issues and pearls related to defect size-dependent lip reconstruction techniques will be presented. The emphasis will be on cosmetic issues that arise with lip reconstruction and how to incorporate a detailed preoperative assessment; minimize donor site morbidity; match tissue size, texture, and color; and maintain stomal competence to balance form, function, and beauty.

Clinical parameters in T1N0M0 lower lip squamous cell carcinoma.

This retrospective study was carried out to asses the clinical outcome of T1 (i.e., tumor 2 cm or less at greatest dimension) squamous cell carcinoma of the lower lip (SCCLL) and verify the impact of some clinical parameters on prognosis. Fifty-seven patients with histologically proven T1 SCCLL were analyzed. Fifty-two patients were never treated before admission, whereas five (8.8%) had a second radical resection of the primary tumor location; none had neck nodes (i.e., N0) or distant metastasis (i.e., M0). The global disease-specific survival rate at 32 months was 100%, irrespective of grading and type of surgery, and thus no differences were statistically detected. Therefore, we concluded that radical tumor resection is a viable procedure for T1 SCCLL, irrespectively of grading. In addition, a second surgery on the primary tumor location is possible and has effectiveness on survival. Finally, neck dissection is not necessary in cases of T1 SCCLL.

Adenoma pleomórfico en labio superior: relato de un caso / Pleomorphic adenoma of the upper lip: report of a case

El adenoma pleomórfico, también conocido como tumor mixto benigno, es la neoplasia mas común tanto en glándulas salivales mayores como en menores. Suele presentarse como una lesión firme de crecimiento lento y asintomático. En glándulas salivales menores, el sitio preferencial está en el paladar, seguido del labio superior y mucosa yugal. Su diagnostico esta basado en el aspecto histopatológico en que puede ser bastante diversificado. El tratamiento del adenoma consiste en la remoción quirúrgica. El objetivo de este trabajo fue describir un caso de adenoma pleomórfico de aproximadamente cuatro centímetros localizado en el labio superior de una paciente del sexo femenino, 68 años, que ha sido tratada por escisión quirúrgica.

Pleomorphic adenoma is the most common salivary gland neoplasm in both the major and minor salivary glands. It presents like a solid tumor of slow growth and asymptomatic. On minor salivary glands, the site more often affected is the hard palate, followed by the upper lip and buccal mucosa. The diagnosis is base on the histopathology features that can be very diversificated. Pleomorphic adenoma's treatment consists at surgical excision The aim of this study was to report a case of pleomorphic adenoma, of 4cm in dimension in upper lip of a female patient, 68 years old that was treated by surgical treatment.

Adenoma Pleomórfico é o tumor de glândula salivar mais comum tanto em glândulas maiores como nas menores, apresentando crescimento lento e assintomático. O local preferencial de acometimento, em glândulas salivares menores, é palato duro, seguido pelo lábio superior e mucosa jugal. Seu diagnóstico é baseado nos aspectos histopatológicos que podem se apresentar de forma bastante diversificada. Seu tratamento consiste em excisão cirúrgica. O objetivo deste trabalho foi relatar um caso de adenoma pleomórfico de 4 cm localizado em lábio superior de uma paciente do sexo feminino, 68 anos de idade, que foi tratado cirurgicamente.

High (nuclear) grade adnexal carcinoma with microcystic adnexal carcinoma-like structural features.

Microcystic adnexal carcinoma (MAC) is a slow growing, locally aggressive sweat gland tumor. It predominantly affects the face and tends to recur despite local excision. Microscopically, MAC is characterized by a stratified proliferation of microcysts, cords, and ducts of cells that show squamous or adnexal differentiation. Atypia and mitoses are almost completely absent and metastatic deposits are rare and mostly limited to the regional lymph nodes; rather than real metastases, they might be the result of local extension of the tumor through perineurial spaces. We report a case of adnexal carcinoma with architectural features of MAC that displayed also marked nuclear pleomorphism and hyperchromasia with squamous pearl formation and a widespread strong p53 immunoreaction. The lesion behaved as a high-grade neoplasm with rapid growth, carcinosarcomatous metaplastic transformation in a relapse, and what were clinically suspected to be metastases. The literature contains several other examples reported as metastatic high-grade MAC, one of them with widespread distant metastases. We therefore want to sound an alert about the possible existence of tumors displaying microscopic findings characteristic of the aggressive forms of sweat gland carcinoma (nuclear pleomorphism and hyperchromasia, vascular invasion, and necrosis) in addition to architectural features of MAC. Whether these tumors should be called high-grade MACs or belong to a separate category remains an open issue until more cases are reported and bridge cases are eventually documented.

[Remarks concerning up to date TNM staging of cancer localized in lip and oral cavity, pharynx, nasal cavity and paranasal sinuses, and major salivary glands]. / Uwagi dotyczace aktualnej klasyfikacji TNM dla raka wargi i jamy ustnej, gardla, krtani, jamy nosa i zatok przynosowych oraz duzych gruczolów slinowych.

The general principles and historical background of TNM classification was briefly discussed, with advantages as well as weakness and limitations of the system. The current TNM staging of lip and oral cavity, pharynx. The currant TNM staging of carcinoma in lip and oral cavity, pharynx, larynx, nasal cavity and paranasal sinuses and major salivary glands was presented, pointing out the last changes in the classification.

A study of small superficial capillary hemangiomas on the lips in children.

PURPOSE: This study describes 77 small vascular lesions on the lips of 74 children and adolescents. RESULTS: Of the 77 lesions, 70% were on the lower lip and 30% on the upper. The diameter range was 0.5-5.0 mm (mean 1.4 mm). On both lips the lesions were in the vermilion zone, close to the border with the skin. The surface of the lesions was smooth and slightly raised, and varied in color from red (49%) through bluish red (45%) to purple (6%). The borders were well defined in most cases. The histology of the lesions was consistent with capillary hemangioma. Small superficial capillary hemangiomas (SSCH) in this study behaved differently from most hemangiomas and vascular malformations in that they did not increase in size, and were persistent in the age group in which most hemangiomas are reported to involute or disappear. The gender distribution of SSCH also differed from the female predominance in hemangioma. SSCH is a solitary benign lesion on the lips of children and adolescents, which has not been separately classified before. CONCLUSIONS: Based on the differences from hemangioma in gender distribution, size, border definition, and growth characteristics, it is suggested that SSCH be classified as a variant or a subgroup of hemangioma.

Desmoplastic squamous cell carcinoma of skin and vermilion surface: a highly malignant subtype of skin cancer.

BACKGROUND: The prognosis of squamous cell carcinoma (SCC) of the skin is directly related to the development of metastases or local recurrence. This is affected by numerous factors, most of which are independent: clinical tumor size, histopathologic tumor thickness, depth of penetration, degree of cell differentiation, degree of keratinization, location, and immunosuppression. The determination of whether desmoplasia, previously described in only one case of SCC, constitutes an additional prognostic factor was the objective of this study. METHODS: The study was performed prospectively on 594 SCCs from 509 patients. All of the factors mentioned earlier were present. Forty-four SCCs were identified by light microscopy as desmoplastic due to their prominent trabecular growth patterns, narrow columns of atypical epithelial cells, and marked desmoplastic stromal reaction, in some cases with perineural and perivascular invasion. Follow-up ranged from 4 to 10 years (median, 5.3 years). RESULTS: All tumors in the study patient population were treated using the paraffin section method of micrographic surgery. The 44 desmoplastic SCCs were found to metastasize 6 times more often than the remaining 550 tumors (22.7% vs. 3.8%), with 10 times as many local recurrences (27.3% vs. 2.6%). CONCLUSIONS: Desmoplasia is a highly significant (P < 0.001) prognostic factor for SCCs and is associated with the development of metastases or recurrence.

Microstaging of squamous cell carcinomas.

The clinical classification of squamous cell carcinoma, which was established primarily by the International Union Against Cancer (UICC), does not permit optimal estimation of expected metastasis. The authors' results indicate that metastasis can be more accurately estimated on the basis of invasion depth, histopathologic grading, and especially tumor thickness. One essential advantage of these criteria is that they can be established by a histopathologist. It is interesting to note that in the authors' collective no carcinoma less than 2 mm thick metastasized, that is, a relatively high percentage of carcinomas (48%) can be graded as no-risk carcinomas. The risk of metastasis for undifferentiated carcinomas greater than 6 mm thick that have infiltrated the musculature, the perichondrium, or the periosteum, however, is quite high. Tumors between 2 and 6 mm thick with moderate differentiation and a depth of invasion that does not extend beyond the subcutis can be classified as low-risk carcinomas.

[Studies on the quality of leukoplakias of the oral mucosa and lips]. / Studien zur Dignität der Leukoplakien von Mundschleimhaut und Lippen.

Clinical and histological studies of 671 leukoplakias and 591 carcinomas of the oral mucosa and lips confirm that only inhomogenous leukoplakias may be qualified as precancerous lesions. Compulsory registration of inhomogenous leukoplakias as preneoplastic conditions is recommended.

[The diagnosis of precancerous diseases and cancer of the lip and oral mucosa by using contact fluorescence biomicroscopy]. / Diagnostika predopukholevykh zabolevanii i raka guby i slizistoi oboochki polosti rta s primeneniem kontaktnoi fliuorestsentnoi biomikroskopii.

In order to improve the results of clinical diagnostic in labial and oral precancers and cancers the contact fluorescent microscopy was performed in addition to cheiloscopy and stomatoscopy in 82 patients. Fluorescent images of precancers and cancers were described and classified. In 94.0 +/- 2.6% of the cases the diagnose was correct.