Functional and survival outcomes in elderly patients undergoing transoral robotic surgery.

OBJECTIVES: To determine if elderly patients (≥70 years) have differences in functional and survival outcomes compared to non-elderly patients (<70 years) following transoral robotic surgery. MATERIALS AND METHODS: A retrospective cohort study was conducted on patients undergoing robotic surgery for head and neck cancer at a tertiary institution from 2011 to 2016. Functional status was evaluated with diet, enteric feeding status, Functional Oral Intake Scale (FOIS), tracheostomy tube placement, and unplanned readmission. Kaplan Meier method and Cox proportional hazard model were used to assess overall survival (OS) and disease-free survival (DFS) between elderly and non-elderly patients. RESULTS: Two hundred and forty-six patients met inclusion criteria. The mean age of the cohort was 63.5 ± 9.74 years. There were 64 patients (26.0%) that were ≥70 years. Elderly patients were more likely to be discharged with enteric access (p < 0.002). As early as 3 months, there was no significant difference in need for enteric feeds, diet, or FOIS score. There was no difference in tracheostomy tube rates and unplanned readmission between both cohorts. There was no significant difference in OS and DFS between age groups when stratified by p16 status. CONCLUSIONS: Elderly patients are more likely to require perioperative enteric feeding, but 3-month, 1-year, and 2-year functional outcomes are comparable to younger patients. Survival outcomes are similar in both populations.

Recurrent oral squamous papilloma in a pediatric patient: Case report and review of the literature.

Squamous papillomas are common lesions of the oral mucosa. They are benign proliferating lesions often painless, slow growing and with a cauliflower appearance. However, its clinical appearance which sometimes mimics exophytic carcinoma, verrucous carcinoma or condyloma acuminatum raises concern when it occurs in the oral cavity. Squamous papilloma occurs predominantly in 30- to 50-year old's. However, they may be seen in children <10 years and accounted for 8% of all oral tumors in children. There is no sex predilection. It has a predilection for the tongue and soft palate, but may occur on any other surface of the oral cavity. Oral squamous papillomas have been associated with infection by the human papilloma virus (HPV). The present report is a case of a recurrent squamous papilloma of the hard palate in a 5-year-old patient with a review of the literature.

Oral squamous papilloma occurring on the palate with review of literature.

Squamous papillomas are common lesions occurring on skin, oral and nasal mucosa and male and female genital organs. Oral squamous cell papilloma (OSP) is a benign proliferation of the stratified squamous epithelium and is generally believed to be caused by Human Papilloma Viruses (HPV). It constitutes around 2.5% of all oral verruco-papillary lesions. We here, report a case of palatal OSP occurring in a 55-year-old male. The aetiological, clinical, diagnostic and treatment aspects of OSP are discussed here.

Clinical, histopathological and immunohistochemical study of oral squamous papillomas.

OBJECTIVE: The aim of this study was to analyze the clinicopathological and immunohistochemical features of oral papillomas. MATERIALS AND METHODS: Biopsies of oral papillomas analyzed in the laboratory between 1996-2012 were extracted from the database and used to conduct this retrospective review. The following clinical data were extracted: sex, age, location, clinical appearance, time of evolution, recurrence and first clinical diagnosis. Immunohistochemical analysis for Human Papillomavirus (HPV)and histological evaluation of the lesions were performed. RESULTS: A total of 205 papillomas were identified in 197 patients (♂=110, ♀ = 87; mean age = 48.4 ± 17.9 years).The majority of the lesions (n = 47) occurred on the soft palate (23%). The border of the tongue was the second most common site (n = 20, 9.8%). Lesions were more common in males than in females (ratio = 1.26:1). Statistical analysis did not show any correlation between the assessed variables. Clinically, papillomas were predominantly described by the practitioners as small nodules, with a papillary surface (98.1%) and pedunculated attachment(83.1%). Data supported a low recurrence (2.0%) and multiplicity (2.0%). Evolution time varied from a few weeks to several years. Most frequent misdiagnosis was condyloma. Immunohistochemistry rarely showed HPV presence (9.3%). Microscopically, lesions were very often keratinized (93.2%) and showed chronic inflammatory cells (68.8%). CONCLUSIONS: In this series papillomas showed a slight male predilection and occurred mostly in the sixth decade of life. Histologically, they were usually keratotic and exhibited variable inflammation. HPV virus was rarely detected by immunohistochemistry. No statistical correlation could be established between clinicopathological features.

Association between human papilloma virus/Epstein-Barr virus coinfection and oral carcinogenesis.

BACKGROUND: The recent epidemic of head and neck squamous cell carcinomas associated with human papilloma virus (HPV) has not addressed its association with lymphoid tissue in the oropharynx or the potential role of Epstein-Barr virus (EBV)/HPV coinfection. METHODS: The prevalence of HPV and EBV infection/coinfection and CD21 mRNA expression were determined in normal and cancerous tissues from the oropharynx using in situ hybridization (ISH), p16, and quantitative reverse transcriptase PCR (qRT-PCR). The effects of coinfection on tumorigenicity were evaluated using proliferation and invasion assays. RESULTS: Normal oropharynx, tonsil, non-cancer base of tongue (BOT), and BOT from sleep apnea patients demonstrated EBV positivity ranging from 7% to 36% depending on the site and methods of detection used (qRT-PCR or ISH). Among non-malignant BOT samples, HPV positivity was noted only in 20%. The percent of tonsil and BOT cancers positive for HPV (up to 63% and 80%, respectively) or coinfected with HPV/EBV (up to 25% and 70%, respectively) were both significantly associated with cancer status. Notably, HPV/EBV coinfection was observed only in malignant tissue originating in lymphoid-rich oropharynx sites (tonsil, BOT). CD21 mRNA (the major EBV attachment receptor) was detected in tonsil and BOT epithelium, but not in soft-palate epithelium. Coinfected cell lines showed a significant increase in invasiveness (P < 0.01). CONCLUSIONS: There is a high prevalence of HPV/EBV infection and coinfection in BOT and tonsil cancers, possibly reflecting their origins in lymphoid-rich tissue. In vitro, cells modeling coinfection have an increased invasive potential.

Comparison between p16 INK4A immunohistochemistry and human papillomavirus polymerase chain reaction assay in oral papillary squamous cell carcinoma.

PURPOSE: Oral papillary squamous cell carcinoma (OPSCC) is a histologic variant of SCC with a growth pattern suggesting human papillomavirus (HPV) infection. The aim of this study was to investigate the presence of HPV genotypes in OPSCC. MATERIALS AND METHODS: All cases with a histologic diagnosis of OPSCC from 1993 through 2008 were retrieved and confirmed. Immunohistochemical evaluation for the surrogate marker p16(INK4A) and HPV polymerase chain reaction were performed in tissue and DNA derived from formalin-fixed paraffin-embedded tissue. RESULTS: Forty-four patients with confirmed OPSCC (mean age, 71.96 yr; female-to-male ratio, 1.75:1) comprised the study population. The most common site of involvement was the gingiva followed by the palate and buccal mucosa. Forty cases exhibited an invasive component, 1 was noninvasive, and in 3 cases invasion could not be confirmed owing to suboptimal thickness of the biopsy. Paraffin tissue blocks were available in 41 cases. Twenty-three cases (56.1%) exhibited positive p16(INK4A) staining, which was primarily weak to moderate with a generally focal pattern. Polymerase chain reaction assays were negative for HPV DNA in all cases. CONCLUSIONS: In this study, there was a clinical predilection of OPSCC in older women, with most cases occurring in the masticatory mucosa. Weak to moderate and focal p16(INK4A) staining was appreciated in contrast to reported staining properties in genital and oropharyngeal PSCC. Failure of the polymerase chain reaction assay to exhibit transcriptionally active HPV genotypes suggests that HPV is not associated with OPSCC tumorigenesis.

Disseminated Kaposi's sarcoma and HCV infection: only a casual relationship? A case report.

The authors present a case of disseminated Kaposi's sarcoma in a male patient, HIV negative and Hepatitis C virus (HCV) positive. Although it is well-known that in HCV positive patients the onset of cutaneous diseases such as porphyria cutanea tarda, mixed essential cryoglobulinemia, lichen planus, polyarteritis nodosa, itch/prurigo, is possible, papers on its association with disseminated Kaposi's sarcoma in HIV negative patients are rare in the literature. Such an association is probably not a matter of chance: in fact, the changes to the immune system induced by the HCV virus, in synergy with those induced by the Human Herpetic virus-8, could likewise play a role in the development of Kaposi's sarcoma as happens in patients with immunodeficiency .

Necrotizing sialometaplasia of the palate associated with angiocentric T-cell lymphoma.

In this article we present 2 cases of necrotizing sialometaplasia (NS) associated with angiocentric lymphoma of the midline. Immunohistochemical analysis confirmed a T-cell origin, and in situ hybridization in one case revealed its relationship to Epstein-Barr virus. These findings suggest that vascular occlusion by the neoplastic cells produces ischemia, which leads to local infarction contributing to the salivary gland lesion. To our knowledge, the association between angiocentric lymphoma and NS has been previously reported in only one instance, and we suggest that this particular type of lymphoma should be added to the list of related conditions for NS.

Oral Hodgkin lymphoma: a wolf in wolf's clothing.

Hodgkin lymphoma typically presents as a nodal lesion and infrequently involves extranodal sites. The English language literature contains only 7 reports of primary Hodgkin lymphoma arising in the oral mucosa in the absence of nodal disease. We report a case of primary, extranodal Hodgkin lymphoma in the palatal mucosa of a 79-year-old white female. An incisional biopsy revealed a diffuse, mixed cellular infiltrate, consisting of benign lymphocytes, plasma cells, histiocytes, and foci rich in eosinophils. Within this background was a scattering of large, atypical cells, including Reed-Sternberg forms that exhibited immunoreactivity for CD30 and CD20 and nonreactivity for CD15 and CD45RO, supporting a diagnosis of classical Hodgkin lymphoma. Positron emission tomography exhibited a single focal area of abnormal hypermetabolic activity involving the left palate area, without involvement of any other site. The clinical stage was Ann Arbor I-A. The primary tumor and submandibular and upper neck lymph nodes were treated with a 6-MV photon beam to a total dose of 4000 cGy. There was no evidence of disease at 15-month follow-up.

Extensive papillomatosis of the palate exhibiting epithelial dysplasia and HPV 16 gene expression in a renal transplant recipient.

We report a unique case of extensive papillomatosis of the palate in a renal transplant recipient. The condition resembled inflammatory papillary hyperplasia; it exhibited severe epithelial dysplasia and concurred with generalized gingival hyperplasia. We document and discuss the probable multifactorial etiology of the lesions, including evidence for human papillomavirus (HPV) type 16 expression, as detected by in situ reverse transcription polymerase chain reaction. This report illustrates the need for careful clinical investigation and follow-up of immunosuppressed individuals presenting with apparently benign, common oral lesions.

Gingival involvement in a case series of patients with acquired immunodeficiency syndrome-related Kaposi sarcoma.

BACKGROUND: This case series presents the polymorphic clinical characteristics of gingival acquired immunodeficieny syndrome (AIDS)-related Kaposi sarcoma (KS), a malignancy that is gradually becoming uncommon in developed nations. An up-to-date overview of the related epidemiology, etiopathogenesis, histopathology, and treatment is provided, along with a pictorial guide to ease clinical diagnosis. METHODS: The oral/maxillofacial pathology records at Aristotle University and the University of Geneva were retrospectively reviewed. Thirty-two cases diagnosed with oral AIDS-related KS were retrieved between 1991 and 2004. KS diagnosis was established histologically by incisional biopsies from intraoral lesions. All charts contained clinical oral examination data, radiological images, and detailed photographic records. RESULTS: Thirteen patients (12 males and one female) presented with KS gingival involvement (40.6%). Eleven of the male patients were homosexual/bisexual men. The mean age of the patients at the time of intraoral KS diagnosis was 42.1 years, and the mean CD4 cell count was 103 (0 to 481). Gingival epidemic KS presented with various degrees of pigmentation and a wide range of clinical patterns, from relatively flat macules (early stage) to tumors with variable nodular morphology (advanced disease). Solitary or multiple gingival involvement may appear concomitantly with palatal and/or cutaneous lesions. CONCLUSIONS: Even though the incidence of intraoral KS had fallen precipitously in developed countries after the mid-1990s, gingival KS should be considered in the differential diagnosis of every pigmented gingival lesion. Periodontists are in a unique position to identify gingival involvement of intraoral KS and facilitate early diagnosis.

Investigation of a broad-spectrum PCR assay for human papillomaviruses in screening benign lesions of the upper aerodigestive tract.

BACKGROUND: A variety of different human papillomavirus (HPV) types can be found in benign and malignant lesions of the upper aerodigestive tract. Therefore a broad-spectrum assay is needed for screening reasons. METHODS: A PCR system with degenerate consensus primers originating from a very conserved region (e.g. L1) of the HPV genome was applied. The sensitivity level was improved by combining PCR and nested PCR. RESULTS: A total of 27 biopsies from laryngeal papillomas (9), exophytic (3) and inverted (6) papillomas of the nasal cavity or paranasal sinuses, papillomas of the uvula or soft palate (5), leukoplakias of the larynx (2), seborrheic keratosis (1) and granulation tumor of the tongue (1) were analyzed by the broad-spectrum PCR system. Sixteen cases showed a positive result in either PCR or nested PCR or both. CONCLUSIONS: It was shown that the applied broad-spectrum PCR system is a reliable tool in the detection of HPV DNA in benign lesions of the upper aerodigestive tract.

Human papillomavirus, type 40-associated papilloma, and concurrent Kaposi's sarcoma involving the anterior hard palate of an HIV-positive man.

A number of oral lesions have been reported in association with HIV, including lesions caused by other viruses such as the epitheliotropic human papillomavirus (HPV). More than 90 types of HPV have been identified, with the less commonly encountered strains of HPV tending to show association with immunodeficiency states. In addition, HIV-infected patients may have Kaposi's sarcoma develop, a malignancy thought to be caused by human herpes virus, type 8. Recent evidence suggests a sexual mode of transmission for this virus. We report an HIV-positive man with a large, HPV type 40-associated papilloma of the anterior palate and a previously undiagnosed focus of Kaposi's sarcoma.

Viral infections in the mouth.

Oral hairy leukoplakia (OHL) and Kaposi's sarcoma (KS) are commonly encountered in the HIV-infected patient. A unique feature of OHL is non-cytolytic high level of replication of Epstein-Barr virus (EBV) in the glossal epithelium. The expression of viral-encoded anti-apoptotic proteins concomitant to replicative proteins probably underlies this phenomenon. The question of whether OHL arises from activation of EBV latent in the tongue, or from superinfection by endogenous EBV shed via nonglossal sites or by exogenous EBV remains unresolved. Human herpesvirus 8 (HHV8) is now seen as necessary but not sufficient cause of KS. Expression of HHV8-encoded oncogenic proteins in endothelial cells probably explains the aberrant proliferation of these cells in KS lesions. Studies into why KS is so commonly observed at the palate in HIV-infected patients may provide important clues to its pathogenesis.

Lymphoepithelioma-like carcinoma of oral cavity: report of three cases and literature review.

Lymphoepithelioma-like carcinoma is a rare tumour in the oral cavity and is characterized histologically by non-keratinizing, undifferentiated squamous cell carcinoma with lymphocytic infiltration. Three consecutive cases of intraoral lymphoepithelioma-like carcinoma are reported. A review of the literature reveals a similar biological behaviour to that of nasopharyngeal lymphoepithelioma: a high incidence of cervical nodal spread and remarkable radiosensitivity. Chemotherapy should be considered when nodal or distant metastases are present. The association of the Epstein-Barr virus with this tumour remains unclear but our experience suggests a positive correlation in Chinese individuals.

Prevalence of Epstein-Barr virus in oral squamous cell carcinoma.

Forty-six samples of oral squamous cell carcinoma (OSCC) were evaluated for the prevalence of Epstein-Barr virus (EBV) infection by the polymerase chain reaction (PCR), Southern blot hybridization, and in situ hybridization (ISH). EBV DNA was detected in 7 (15.2 per cent) out of 46 samples by a combination of PCR and Southern blot hybridization methods. All seven positive samples showed well-differentiated carcinoma, thus suggesting a possible relationship between EBV infection and the degree of differentiation of carcinoma tissue. Latent infection membrane protein 1 (LMP1) was detected immunohistochemically in six of the EBV-positive OSCCs. However, no signal of the EBV-encoded small RNA (EBER)-1 was demonstrated by the ISH method. No significant relationship was observed between EBV infection and lymph node metastasis. A follow-up study (range from 4.4 to 79 months; mean 34.9 months) showed no recurrence or death to occur in the EBV-positive patients, which thus suggested a good prognosis for EBV-positive OSCC patients.

Sialadenoma papilliferum of the palate: case report and literature review.

Sialadenoma papilliferum (SP) is a rare tumor of salivary gland ducts which bears a strong histologic resemblance to the more common syringocystadenoma papilliferum (SCAP). We report a case occurring on the palate of a 50-year-old man, and review the clinical and histologic features of this tumor. Because of the histologic similarities between these two tumors and squamous papillomas, polymerase chain reaction (PCR) for human papilloma virus (HPV) DNA was performed on this tumor and on two cases of SCAP, with negative results. To our knowledge, this is the first case report of SP in the dermatopathology literature.