Primary oral leiomyosarcoma: A systematic review and update

The aim of this systematic review was to address the clinicopathologic inconsistencies noted with primary oral leiomyosarcoma in the literature by amassing the available data published into a comprehensive analysis. Eligibility criteria included publications of cases with dedicated immunohistochemical work‐up along with radiographs to evaluate location. Based on these criteria, the systematic review compiled 29 cases. Four primary location sites were identified in the reported cases: soft tissue presentation only, soft tissue with bony involvement, bony involvement only, and bony involvement with a soft tissue component. The majority of primary oral leiomyosarcoma cases reviewed showed a soft tissue predilection, which is in contrast to prior reports of jawbones being the most common site. In addition, there was an improved 5‐year survival rate for primary oral leiomyosarcoma limited to the oral cavity and gnathic bones without extension into paranasal sinuses.     

口腔颌面部平滑肉瘤临床和治疗（附10例报道）

平滑肌肉瘤发生于口腔颌面部极为罕见。颌骨是常见发病部位，常见年龄３０－４０岁，无明显性别差异，临床上多表现为境界清楚固定的无痛性肿块，病程可长可短，常易误诊为良性肿瘤或牙周疾患；确诊依靠病理检查和免疫组化检查。治疗首选局部扩大切除，放、化疗不敏感；仅行剜除易局部复发及远处转移。3年、5年生存率尚不清楚。     

Marginal and segmental mandibulectomy in patients with oral cancer: a statistical analysis of 106 cases.

PURPOSE: The treatment of oral squamous cell carcinoma may require mandibular resection to secure adequate margin. This bone resection often is segmental or marginal mandibulectomy. The purpose of this work was to evaluate the local control and survival after surgical treatment of oral cancer, according to these 2 different mandibular resection procedures. PATIENTS AND METHODS: We conducted a retrospective study of a 20-year cohort of 106 patients who underwent marginal or segmental mandibulectomy for oral cancer. All patients had a biopsy-confirmed diagnosis of squamous cell carcinoma involving either the floor of the mouth, mandibular gingiva, retromolar trigone, tongue, buccal mucosa, or oropharynx. The type of mandibular resection and treatment outcome were compared, using an univariate analysis by the Pearson chi(2) test, logistic regression model for multivariate analysis, and Kaplan-Meier method to determine survival. RESULTS: The 5-year observed survival rate was 60.35%. The presence of histologic mandibular invasion increased the local recurrence rate. Early tumor stages (P =.02) were found to be associated with decreased local recurrence rates. Our findings indicate that tumor stage and size of mandibulectomy are more important than the type of mandibulectomy in predicting histologic bone involvement. The cases treated with a greater than 4 cm bone resection showed a lower survival rate than those treated with less than 4 cm mandibulectomy (P =.01). Patients in advanced stages (P =.006) and those with surgical margin (P =.0001) or the bone (P =.003) affected by the tumor showed a statistically significant lower survival rate. However, no statistically significant differences were found between patients treated by marginal or segmental mandibulectomy. CONCLUSIONS: Among the prognostic factors studied, the status of the surgical resection margin, the bony involvement and the size of mandibulectomy affected the prognosis for oral carcinoma. Mandibular conservation surgery is oncologically safe for patients with squamous carcinoma in early stages. The marginal technique was not associated with worse prognosis.     

Outcome of local failures after oral cancer – recurrence vs. second primary

J Oral Pathol Med (2010) 39 : 657–661 Background/objective: A high risk of new mucosal malignancies of the upper aerodigestive tract (UADT) is seen in patients successfully treated for oral cancer. The prognosis is unclear for these patients. A typical failure may be located at the site of the first tumor i.e. a local recurrence; or separately as a second primary tumor (SPT). It is unknown whether these two types of local failures have different prognosis. Study design: Longitudinal observational cohort study employing prospectively collected data over 25 years. Methods: The rate of local recurrences and UADT SPTs was analyzed in 151 patients previously treated for T1N0M0 oral squamous cell carcinoma. Survival after failure was compared between patients with local recurrence and local SPT. Results: All patients had a 5‐year cancer specific survival of 86.3%. Of the 151 patients, 20 had a local recurrence, and 16 had an UADT SPT. After a local failure, survival was median 17.2 months for local recurrence and 18.9 for UADT SPT (cancer specific). Time from primary tumor treatment to local recurrence was median 42 and months vs. 125 months for UADT SPTs. A similar linear pattern of presentation over time was seen for both tumor types. Conclusion: Outcome was poor after the date of the local failure. No difference in survival was seen whether the failure was a local recurrence or a second primary tumor. The similarity in survival and pattern of presentation suggests that these two entities may be biologically analogous.     

Odontogenic tumors: analysis of 289 Nigerian cases

Two hundred and eighty-nine cases of odontogenic tumors that accumulated in the files of the biopsy service of the Lagos University Teaching Hospital during a period of 21 years were analysed and categorised according to the most recent WHO classification of odontogenic tumors. Odontogenic tumors constituted 19% of all oral/jaw tumors and tumor-like lesions. Ameloblastoma, which accounted for 58.5% of odontogenic tumors in the series, was the most common, and showed a predilection for males and the posterior mandible. 94.8% of odontogenic tumors were benign, while malignant odontogenic tumors accounted for 5.2%. Odontogenic carcinoma was the most prevalent malignant odontogenic tumor; it showed a predilection for the mandible and occurred at a mean age of 37 years.     

Metastatic tumours to the oral region. An overview

Metastatic tumours to the oral region are uncommon. There are more published cases of jawbone métastases than in oral soft tissues. The most common primary sources of metastatic tumours to the oral region are the breast, lung, kidney, bone and colon. The breast is the most common primary site for tumours metastasising to the jawbones, whereas the lung is the most common source for métastases to the oral soft tissues. In the jawbones, the common location of the metastatic lesions is the mandible, with the molar area being the most frequent involved site. In the oral soft tissues, the attached gingiva is the most common affected site followed by the tongue. In nearly 30% of cases, the metastatic lesion in the oral region is the first indication of an undiscovered malignancy at a distant site. The biological basis of the metastatic process is discussed.     

涎腺腺样囊性癌预后因素的探讨

目的 探讨影响涎腺腺样囊性癌（ａｄｅｎｏｉｄ ｃｙｓｔｉｃ ｃａｒｃｉｎｏｍａ,ＡＣＣ）预后的各因素。方法 对１９６０～１９８５年间收治并随诊１０年以上的ＡＣＣ１２例进行临床病理分析,对各项指标采用乘限法（ｐｒｏｄｕｃｔ ｌｉｍｉｔ）,估计各时点的生存率,并绘制Ｋａｐｌａｎ－Ｍｅｉｅｒ生存曲线,同时序检验（ｌｏｇ ｒａｎｋ ｔｅｓｔ）各组间差异。全部资料用生存分析软件完成。结果 １０年随诊临床与病     

Gingival involvement in oral paracoccidioidomycosis

BACKGROUND: Paracoccidioidomycosis, a deep mycosis endemic in parts of Latin America, often presents with oral lesions involving the gingiva. Nevertheless, the periodontal literature is devoid of references to oral paracoccidioidomycosis. The purpose of this study was to characterize the gingival involvement in oral paracoccidioidomycosis and to contrast clinical and histopathologic diagnosis of the disease. Differential diagnosis and management of oral paracoccidioidomycosis were reviewed. METHODS: From January 1995 to October 2006, the files of the Oral Pathology Laboratory, School of Dentistry, Alfenas Federal University, were reviewed to identify cases referred because of a clinical diagnosis of oral paracoccidioidomycosis. Data collected included patient demographics (age, gender, race, and occupation), clinical information (oral lesion location), and histopathologic diagnosis. RESULTS: Forty-six cases were identified, and 34 were histopathologically confirmed as paracoccidioidomycosis. Of the remaining 12 cases, one-half were diagnosed as either carcinoma or dysplastic leukoplakia. Of the 34 confirmed paracoccidioidomycosis cases, 45% presented with multiple site involvement, whereas the gingiva/alveolar process was the most prevalent site overall (52%). The gingiva/alveolar process was the most prevalent site in both multiple and single site cases. The majority of patients were men (88%), white (75%), and in their fourth decade of life (47%). Statistical analysis revealed that patients with gingival/alveolar process involvement were demographically indistinguishable from those without. CONCLUSIONS: Oral paracoccidioidomycosis has a strong predilection for the gingiva, whereas patients with gingival lesions do not differ from patients lacking such involvement. Early diagnosis of gingival/oral lesions may prevent life-threatening complications of this mycosis.     

舌鳞状细胞癌预后因素的探讨

目的：探讨影响舌鳞癌预后的有效因素,方法：对121例舌鳞癌患者进行回顾研究,应用Cox比例风险模型对13个与舌鳞癌术后生存率有关的指标进行回归分析。结果：只有原发灶的切缘状态和颈淋巴结转移情况才是影响舌鳞癌术后生存率的独立指标（P＜0．05）,结论：对原发灶和颈转移淋巴组织的彻底手术切除是提高舌鳞癌患者生存率的关键。     

Factors influencing prognosis of tongue cancer: a retrospective study of 260 cases

This paper is a retrospective study of prognostic factors involved the tongue cancers. The 3 and 5 year survival rates of the tongue cancer were 63.77% 61.2%, respectively. I. The prognosis in females was poorer than that of males II. The prognosis of oral tongue cancer was better than oropharyngeal tongue cancer. III. The larger the cancer, the poorer the prognosis. IV. Node involvement was an important factor influencing survival rate. V. Immediate repair of defect did not influence survival rate. VI. The main cause of death was recurrence of the primary site, which generally occurred within 3 years postoperatively. The authors suggest that I. The depth of the tumours infiltration should be an index for the evaluation of prognosis. II. The neck dissection, either functional or radical, should be carried out as a routine. III. The management of mandible will be determined according to the tumor infiltration. IV. immediate reconstruction is recommended.     

Leiomyosarcomas of the oral tissues: clinicopathologic analysis of 50 cases.

PURPOSE: Primary oral leiomyosarcomas are rare tumors. Information regarding the biological behavior, prognosis, and appropriate management of this neoplasm is lacking in the literature. The purpose of this report was to summarize the data of isolated case reports of primary oral leiomyosarcoma that have been published in the English literature during the past 25 years. The cases of 4 additional new patients who have been treated in our department during the past 10 years are also presented. PATIENTS AND METHODS: The data for 46 patients obtained from 32 individual articles retrieved from the English literature were added to our 4 cases and produced a total number of 50 cases of primary leiomyosarcomas of the oral tissues. Patients were analyzed according to demographic data, anatomic location, type of treatment, and survival. RESULTS: Primary oral leiomyosarcoma may affect any age with peaks of occurrence in the third, sixth, and seventh decades of life. There is no gender predilection. Female patients presented the higher incidence in the third decade, whereas males had an even age distribution. The tumor arises in approximately 70% of the cases in the maxillary and mandibular bones. Radical surgery was the treatment of choice. Radiotherapy and chemotherapy when applied in recurrent tumors had little effect. The most adverse prognostic factor was the positive surgical margins. The 5-year survival was 62% (62.9% for females and 52.6% for males, P > .1968). CONCLUSIONS: Cases of oral leiomyosarcoma appear to be associated with major neurovascular structures of the facial skeleton, as evidenced from the imaging studies of our 4 patients. Primary oral leiomyosarcoma is a rare tumor that should be managed with aggressive surgical resection in order to safeguard curability. Histopathologic diagnosis is greatly facilitated with positive immunohistochemical staining for smooth muscle antigenic markers.     

Maspin expression in oral squamous cell carcinoma

Maspin (mammary serine protease inhibitor) is a member of the serpin superfamily of protease inhibitors and it has a role as a tumor suppressor. Maspin has been reported to be important in processes relevant to tumor growth and metastasis such as cell invasion, angiogenesis, and apoptosis. A high expression of maspin was correlated with better rates of survival and absence of nodal metastases in head and neck squamous cell carcinoma. In contrast, some studies have shown that maspin overexpression is correlated with a poor prognosis in pancreatic and ovarian cancers and in lung adenocarcinoma. The aim of this study was an immunohistochemical evaluation of the maspin expression in oral squamous cell carcinoma and thus 89 patients were evaluated. Maspin expression in oral squamous cell carcinoma was significantly associated with the tumor differentiation grade (chi test: P = 0.0318) and the lymph node status (chi test: P < 0.005), but not with the tumor stage (chi test: P = 0.666). Metastatic involvement of lymph nodes was observed more frequently in maspin-negative cases than in tumors with more than 5% of positive cells (P = 0.0024). The present results confirm that maspin expression predicts a better prognosis in oral squamous cell carcinoma and that maspin probably plays a role in tumor progression.     

Metastatic tumor of the jaw--diagnosis and management

Metastatic tumors to the oral region are not common. The most common primary sources of metastatic tumors to the oral region are the breast, lung and kidney. The breast is the most common primary site for metastatic tumors to the jawbone, whereas the lung is the most common source for metastases to the oral soft tissues. In the jawbones, the most common location is the mandible, with the molar area being the most frequent involved site. In nearly 30% of the cases, the metastatic lesion in the oral region is the first indication of an unknown malignancy at a distant primary site. The diagnosis and management of a case with metastatic tumor to the mandible is described.     

Neuroendocrine cells and associated malignancies of the oral mucosa: a review

J Oral Pathol Med (2010) 39 121–127 Neuroendocrine cells of the oral mucosa constitute an under‐recognized component of the diffuse neuroendocrine system with diverse subpopulations and elusive biologic roles in the oral cavity. Primary malignant oral tumors that show a neuroendocrine phenotype display histomorphologic heterogeneity thereby giving rise to a spectrum of lesions in this rare category of oral malignancy. These lesions can be divided into neuroendocrine carcinomas (NECs) of small cell or non‐small cell type. The former is further subdivided into the Merkel cell type or the pulmonary type while the latter includes atypical carcinoid tumor and large cell NEC. All histologic subtypes of oral NEC appear to have a strong predilection for men in their fifth or sixth decade and arise predominantly in the non‐keratinized oral mucosa. The biologic behavior of oral Merkel cell carcinomas appears to be more aggressive than those of skin. It remains to be determined whether histologic categorization of the remaining tumor subtypes is predictive of patient survival in oral neuroendocrine tumors.     

Leiomyosarcomas of the oral cavity. Report of four cases and review of the literature

Leiomyosarcomas (LMS) make up 7% of all soft tissue sarcomas. In the oral cavity, the LMS is rare due to the paucity of smooth muscle in that region. Four cases of intraoral LMS are reported, plus 34 cases found in the literature reviewed. There were 24 males and 14 females. The age range at presentation was 10 months to 88 years with no predilection for any particular age group. The commonest presenting symptom was a mass. The intraoral LMS occurred most commonly in the jaws (59% of cases). The mass was painful in 61% of cases. Follow-up of the case reports was assessed. Recurrence occurred in 36% of cases. Distant metastases occurred in 39% of cases, most commonly to the lungs. Cervical nodal metastasis was reported in 15% of cases. The 5-year survival rate determined on cases with adequate follow-up (n = 13) was 23% free of disease, 8% alive with disease and 69% who died of disease. In comparison with stage I and stage II tongue squamous cell carcinomas, the intraoral LMS is very aggressive. It is best treated surgically, early and aggressively.     

A retrospective study of oral and maxillofacial injuries in Seremban Hospital,Malaysia

Abstract – Introduction: Aetiology of oral and maxillofacial injuries in this country includes motorvehicle accident (MVA), fall, industrial accidents and others. Among these causes, MVA accident is the predominant cause of injury in Malaysia. Materials and methods: A retrospective record review was carried out using hospital records of all patients who sustained oral and maxillofacial injury at the Department of Oral Surgery, Seremban Hospital, Negeri Sembilan, Malaysia between 1998 and 2002. Information related to demographics, aetiology of trauma, vehicles involved in collision, location of injuries and treatment modalities were reviewed. Results: Two thousand nine hundred and eighty‐six patients sustained oral and maxillofacial injuries. Of these patients, 79.2% were men and the remaining were women. Among all the races, Malays had the highest involvement (50.6%) followed by Indians (24.5%), Chinese (19.6%) and others (5.3%). There were statistically significant results on the association of aetiology and the ethnic groups, in the age group of 30 years or less and male gender (P < 0.001). The most common injury was the soft‐tissue injury followed by dental and dentoalveolar injuries and bony fracture. Among all facial fractures, 66.3% were managed conservatively, 13% were treated surgically and 19.7% did not have any intervention. In relation to dental and dentoalveolar injuries, 64.8% had treatment in the form of splinting, restorations or dental extraction. The rest of the patients (35.2%) were referred to their dentists or did not have any active treatment at Seremban Hospital. Conclusion: Most of the dental and facial injuries in Seremban Hospital were caused by MVA and were predominantly managed using conservative methods.     

口腔粘膜原发恶性黑色素瘤的临床病理学研究

目的　研究口腔粘膜原发恶性黑色素瘤的临床病理特点及其与预后的关系。方法　采用回顾性分析的方法对73例口腔粘膜原发恶性黑色素瘤进行了临床病理学研究并对有随访资料的患者进行Kaplan-meier生存曲线及Log rank检验的统计学分析。结果　口腔粘膜原发恶性黑色素瘤多发于40~60岁的男性,腭部和牙龈多见。临床分期以I期最多;病理分型中结节型多见,其次是雀斑样型和表浅扩散型;按细胞形态分型以混合细胞型最为多见,其次是上皮样细胞型和梭形细胞型。有随访资料的43例患者3年生存率为19·86%,5年生存率为11·91%;淋巴结转移、浸润深度、临床分期、病理分型和治疗方法与预后有关(P<0·05)。黑斑与病理分型有关(P<0·05),黑斑多见于雀斑样型口腔粘膜原发恶性黑色素瘤,且预后较好。结论　口腔粘膜恶性黑色素瘤是一种预后差的恶性肿瘤;有无黑斑和淋巴结转移、浸润深度、临床分期、病理分型、治疗方法等与预后有关。     

Oral synovial sarcoma: a report of 2 cases and a review of the literature

The head and neck region constitutes the second most common site of involvement for synovial sarcoma, accounting for up to 10% of all cases. Intraoral synovial sarcoma is rare; in fact, only 29 cases have been reported. We describe 2 additional cases occurring in the floor of the mouth and the retromolar area. In addition, we have reviewed the clinicopathologic features of the previously reported cases. Our findings indicate that intraoral lesions differ from lesions occurring in other sites only in that intraoral cases show a greater male predilection and a generally painless initial presentation. In the oral cavity, the possible earlier detection, easy accessibility, and small size render these tumors more likely to be amenable to surgical excision, but their biologic behavior remains aggressive, with a poor long-term prognosis. Awareness of the potential for the occurrence of this neoplasm in the oral cavity is important for effective histopathologic diagnosis of intraoral spindle cell malignancies.     

The prognostic significance of histological features in oral squamous cell carcinoma

Background:  Different factors predict nodal metastasis, recurrence and survival in oral cancer. The aim was to assess the prognostic value of histological features related to the primary tumour.
Methods:  A total of 144 patients surgically treated at Odense University Hospital for oral cancer between 1999 and 2004 were included in the study. Postoperative radiation therapy was given in case of close and involved margins or high TNM stages (UICC 1997). Median follow-up time was 38 months. All surgical resections were reviewed and 22 histological characteristics were assessed.
Results:  The predominant sites were floor of mouth (FOM, 39%) and lateral tongue (35%). Fifty-nine per cent had UICC97 stage I–II disease. Five-year cause-specific survival was observed in 65%. Nodal involvement at diagnosis was observed in 36% which was significantly related to grade, neural and vascular invasion; surgical margins and increasing tumour depth. A cut-off value of 2 mm (4 mm for FOM) separated patients without and with nodal metastasis at the time of diagnosis. However, on multivariate analysis, neck disease was only associated with tumour depth and grade. Cox analysis of local recurrence in the oral cavity over time showed that tumour diameter and surgical margins were significant predictors while cause-specific survival was related to diameter, depth of invasion, surgical margins and extracapsular spread (ECS).
Conclusions:  Tumour depth and grade were strong prognostic factors for nodal metastasis, independently of other histological features. Tumour diameter and margins independently predict local recurrences in the oral cavity as well as cause-specific survival. Nodal involvement and ECS were associated with adverse prognosis.