Recurrence of premalignant oral cavity and oropharynx lesions after pulsed diode laser treatment

PurposeLeukoplakia is common with a 1 % incidence in the population and may harbor preneoplastic changes. Diode lasers provide both precision and coagulation for excision of superficial lesions in clinical and operative settings with little damage to deeper tissue. We aim to determine the rate of oral and oropharyngeal hyperkeratosis and dysplasia recurrence after treatment with diode laser.Materials and methodsPatients with oral or oropharyngeal hyperkeratotic or mild dysplastic lesions treated with pulsed diode laser between 2013 and 2020 at a tertiary academic institution were analyzed. The main outcome measure was recurrence of hyperkeratosis and dysplasia after treatment.ResultsFourteen patients received diode laser treatment for hyperkeratotic or mild dysplastic lesions of the oral cavity or oropharynx. Demographic features included 9 (64.3 %) females and mean age of 66.6 years. In these 14 patients, 18 distinct lesions were identified. Eleven (61.1 %) lesions were located on the oral tongue, 4 (22.2 %) on the buccal mucosa, 2 (11.1 %) on the hard palate, and 1 (5.6 %) on the soft palate. Average time from lesion clinical diagnosis to the first diode laser treatment was 8.3 months with an average number of 1.4 treatments per lesion. Three (16.7 %) lesions experienced recurrence after the most recent treatment. None of the lesions underwent malignant transformation. None of the patients experienced bleeding, tethering, or dysarthria after treatment. One patient developed pyogenic granuloma and reported chronic tongue pain.ConclusionsPulsed diode laser treatment of leukoplakia was well tolerated with low complication rates and reasonable control of precancerous lesions.     

Spindle cell lipoma of the mandibular mucogingiva unction： a case report of unusual oral neoplasm

Spindle cell lipoma（SCL） is a benign lipomatous neoplasm typically located in the posterior neck and back of older males. It presents as a well-circumscribed mass in the buccal mucosa, tongue, floor of the mouth or hard palate. There are only two case reports of SCL in the gingiva and alveolar ridge. Here, we report a case of SCL in the mandibular mucogingival junction of a 68-year-old male. Clinical,histopathological and immunohistochemical findings are presented. Although oral SCL is rare, it should be considered in the differential diagnosis of spindle cell neoplasms occurring in the oral cavity.     

Neurinoma of the hard palate in an 11-year-old girl. Case report]

BACKGROUND: Neurinomas or schwannomas are benign, encapsulated growing tumors of the Schwann cells of the nerve sheets; 25-45% are located in the head and neck region. They are found rarely in the oral cavity. Most of the intraoral schwannomas are located on the tongue. Other less common locations are the buccal mucosa, palate, floor of the mouth, gingiva and lips. The therapy of choice is complete surgical excision. CASE REPORT: An 11-year-old girl presented with a 3-month history of painless swelling of the hard palate. CT scan showed a right palatinal mass of 2 cm, reaching into the right maxillary sinus. After complete surgical excision the histological findings showed a neurinoma (Antoni type A). During a 2-year follow-up, there were no signs of recurrence. Because of the benign tumor type we considered the young patient to be healed.     

Pyogenic granuloma (lobular capillary hemangioma) of the tongue

A patient with a pyogenic granuloma which occurred in an unusual location and at an earlier age is presented. Pyogenic granuloma is not an uncommon entity which may occur on oral mucosa, face and fingers. The most frequent location encountered for oral cavity pyogenic granuloma is the gingiva and the tongue is a rare location for its occurrence. These lesions are usually seen between 11 and 40 years age. Surgical excision and removal of etiological factors are needed for treatment.     

Pediatric lobular capillary hemangioma of the nasal cavity

Lobular capillary hemangioma (LCH), also called pyogenic granuloma, is a benign vascular tumor that is pedunculated on the skin and the mucous membranes of the oral cavity. This disease occurs in all ages, but more often in the 3rd decade, and is seen in females more than males. LCH commonly appears in early childhood and affects males more than females in the pediatric age group. The gingiva, lips, tongue and buccal mucosa are the most common sites of mucosal LCH, but the nasal cavity is rare. Micro-trauma and hormonal factors are the most common etiologic factors. Epistaxis and nasal obstruction are the most marked symptoms. We describe the case of a 6-year-old girl with intra-nasal lobular capillary hemangioma presented with epistaxis and nasal obstruction. This should be considered in the differential diagnosis of childhood endonasal masses with bleeding. Total excision using endoscopic technique is the treatment of choice.     

Pyoderma Gangrenosum with Oral Involvement - Case Report and Review of the Literature

Pyoderma gangrenosum (PG) is a rare, noninfectious neutro-philic dermatosis. Clinically, it begins with sterile pustules that rapidly progress into painful ulcers of variable depth and size with undermined violaceous borders. The diagnosis of PG is based on the history of an underlying disease, a typical clinical presentation, histopathology, and exclusion of other diseases. The peak incidence occurs between the ages of 20 to 50 years with women being more often affected than men. There have been very few reports of pyoderma gangrenosum with oral mucosal involvement. Oral lesions in previously reported cases have included ulcers of varying sizes froma few mm to several cm and have been reported to have been found on the tongue, soft and hard palate, buccal mucosa, and gingiva. Some of these oral lesions have been associated with ulcerative colitis, inflammatory bowel disease, and polycythemia rubra vera. A few cases were reported with biopsy findings, the histological picture being nonspecific, showing ulceration, and necrosis with inflammatory cell infiltrate. A peculiar case of pyoderma gangrenosum with an oral lesion is presented here, and the differential diagnosis is discussed.     

头颈部原发性结外淋巴瘤146例临床分析

目的探讨原发于头颈部的结外型淋巴瘤的临床特点和误诊原因，为该病的诊治提供经验。方法选取2001-2011年诊治的146例原发于头颈部并经病理证实为结外型淋巴瘤患者，对其临床资料进行回顾性分析。结果146例患者根据病检结果及病情采取不同的治疗方案；其中3年生存率为55％，5年生存率为41％。不同部位及不同病理类型生存率有明显差异。结论原发于头颈部的结外型淋巴瘤可发于多个部位，部分位置隐蔽，不易发觉，临床症状无特异性，及时针刺活检和术中快速病理切片可提高诊断率和患者生存率。     

Incidence of reactive hyperplastic lesions in the oral cavity: a 10 year retrospective study in Santa Catarina,Brazil

IntroductionReactive hyperplastic lesions develop in response to a chronic injury simulating an exuberant tissue repair response. They represent some of the most common oral lesions including inflammatory fibrous hyperplasia, oral pyogenic granuloma, giant cell fibroma, peripheral ossifying fibroma, and peripheral giant cell lesions.ObjectiveThe incidence of those lesions was investigated in an oral pathology service, and the clinical characteristics, associated etiological factors, concordance between the clinical and histopathological diagnostic was determined.MethodsA total of 2400 patient records were screened from 2006 to 2016. Clinical features were recorded from biopsy reports and patients’ files.ResultsA total of 534 cases of reactive hyperplastic lesions were retrieved and retrospectively studied, representing 22.25% of all diagnoses. The most frequent lesion was inflammatory fibrous hyperplasia (72.09%), followed by oral pyogenic granuloma (11.79%), giant cell fibroma (7.30%), peripheral ossifying fibroma (5.24%), and peripheral giant cell lesions (3.55%). Females were predominantly affected (74.19%), the gingiva and alveolar ridge were the predominant anatomical site (32.89%), and chronic traumatism was presented as the main etiological factor. The age widely ranges from the 1st decade of life to the 7th. Clinically, the reactive hyperplastic lesions consisted of small lesions (0.5–2 cm) and shared a strong likeness in color to the oral mucosa. The concordance between the clinical and histopathological diagnostic was high (82.5%).ConclusionReactive hyperplastic lesions had a high incidence among oral pathologies. The understanding of their clinical features helps to achieve a clearer clinical and etiological diagnosis, and the knowledge of factors related to their development. This may contribute to adequate treatment and positive prognosis.     

Lobular capillary hemangioma on the floor of the mouth (pyogenic granuloma). Report of a case and literature review

Lobular capillary hemangioma or pyogenic granuloma is a benign lesion with a focal reactive development of fibrovascular tissue and endotelial proliferation. It can appear to any age in different locations and usually has the aspect of a pediculate mass with or without ulceration zones on the area. Its treatment is the simple surgical removal and the control of the traumatic and infectious influential factors. We report a case of pyogenic granuloma on the floor of the mouth making a literature review at respect of that common clinical entity.     

Bullous autoimmune diseases of the oral mucosa

Autoimmune bullous diseases (AIBD) are characterized by autoantibodies targeted against adhesion molecules, impairing their formation. According to localization criteria, pemphigus (intraepidermal blister and desmosomal involvement) and pemphigoid (subepidermal blister and dermoepidermal junction involvement) can be distinguished. In two-thirds of the cases, pemphigus vulgaris begins with oral lesions (mainly the buccal mucosa and palate, rarely the gingiva). Skin lesions are usual. Excepting paraneoplastic pemphigus (a recently individualized entity), oral lesions are uncommon in other types of pemphigus. Cicatricial pemphigoid mainly involves oral mucosa, frequently other mucous membranes, and rarely the skin. Gingival involvement is frequent. In case of desquamative gingivitis, the clip sign gives the diagnosis of cicatricial pemphigoid. Ocular involvement is frequent and causes blindness. Epidermolysis bullosa acquisita and IgA linear dermatosis are rare. Bullous pemphigoid and bullous lupus rarely involve the oral mucosa. Diagnosis of AIBD requires a biopsy within the mucosal membrane lesion for pathology examination and another biopsy in a lesion-free area for direct immunofluorescence detection of antibody fixation. Immunoelectron microscopy or immunoblast transfer may be needed for positive diagnosis. Corticosteroids are used to treat pemphigus and dapsone is used for cicatricial pemphigoid. Immunosuppressive therapy is rarely needed.     

Common oral manifestations of systemic disease

Oral manifestations of systemic diseases are potential indicators of an array of conditions. Truly the oral cavity is a mirror that reflects and unravels many of the human body's internal secrets. Some of these manifestations are disease specific and help raise a high degree of suspicion for the alert clinician. Because oral manifestations may accompany many systemic diseases, it is essential that these are appropriately recognized to provide correct diagnosis and referral for treatment and patient care. Multiple entities involving the various areas of the oral cavity like the soft palate, hard palate, tongue, gingiva, oral mucosa, the dentition, periodontium, and the salivary gland tissue have been enlisted. Although this article is not all-inclusive, the authors highlight lesions or conditions that are directly related to or are caused by some of the more common systemic diseases, and hope to provide ample insight for physicians, dentists, and clinicians in otolaryngologic practice.     

Primary malignant melanoma of the oral cavity

Primary mucosal melanomas of the upper aero-digestive tract are uncommon and represent only 1.7 to 3 per cent of all primary melanomas. The most frequent localizations are the nasal fossae, the paranasal sinuses and the oral cavity where melanomas most often arise from the palate and alveolar ridge, buccal mucosa, lips, tongue and floor of mouth. The authors describe a case of malignant melanoma of the uvula, review the literature and discuss the aetiology, pathology and diagnostic and therapeutic problems.     

多重癌的临床分析

目的探讨先证舌鳞状上皮癌(简称鳞癌)多重癌的临床特点和预后。方法中山大学肿瘤防治中心头颈科1992年1月～2001年12月收治580例舌鳞癌患者中,48例多重癌,其中先证舌鳞癌19例,回顾分析其临床和随访资料,探讨其临床特点和预后;Kaplan- Meier方法计算累积生存率。结果全组患者总的3年、5年生存率分别为30.3%、20.2%;第二原发癌19例包括口腔鳞癌9例(舌癌5例、软腭癌2例,口底和牙龈癌各1例)、食管鳞癌4例(其中发生在颈段1例)、肺癌3例,腮腺腺癌、喉鳞癌和乳腺腺癌各1例。两癌发生的中位时间间隔为78个月(范围:6～132个月)。结论舌鳞癌多重癌占全部舌鳞癌患者的8.1%,其中39.5%为先证舌鳞癌;第二原发癌63.1%发生在头颈部,该类患者预后较差,故加强舌鳞癌患者的随访及时发现第二原发癌甚为重要。     

Primary diffuse large B cell lymphoma of the base of tongue: A rare entity

Primary lymphomas of the oral cavity are uncommon and of the tongue even rarer. It is more common in the masticatory mucosa than the lingual and buccal mucosa. We describe a 63 year old male who presented with dysphagia & change in voice. Computed tomography revealed a 4.8 × 3.7 cm mass localized to the base of tongue. He underwent biopsy and IHC studies & was diagnosed as having diffuse large B cell lymphoma. The patient was successfully treated with wide excision of the lesion and is undergoing chemotherapy now. Although oral lymphoma of tongue is very uncommon, it should always be considered in differential diagnosis of various benign and malignant lesions in this region. A proper clinical evaluation and histopathologic as well as immunohistochemical evaluation of biopsy specimen are required to establish the diagnosis and for further management. This is one of the few cases of non-Hodgkin's lymphoma of the base of tongue being reported from India.     

Pyogenic granuloma of the epiglottis

The lobular capillary hemangioma, commonly known as pyogenic granuloma, is a common benign vascular lesion arising from both cutaneous and mucosal sites. The lesion is prevalent in the pediatric population, although airway involvement is rare. To date localization to a supraglottic subsite remains unreported in the literature. Here we describe a unique case of pyogenic granuloma arising from the epiglottis of a three year-old patient.     

Cancer of the oral cavity in Nigerian Igbos

An unselected biopsy material of 31 Nigerian Igbo patients with cancer of the oral cavity is presented. The descending order of localization was gingiva, palate, tongue and floor of mouth. Burkitt's tumour was limited to the jaw and affected older rather than younger children. There was scarcely any preponderance of squamous cell carcinoma in males. It would appear that cancer of the oral cavity is not a great problem in the Igbos and that potent carcinogens concerned with the causation are lacking in the community.     

Treatment effects in patients with squamous cell carcinoma of the oral cavity

A total of 221 patients (155 males, 66 females; stage I, n = 55: stage II, n = 58; stage III, n = 57; stage IV, n = 51) with squamous cell carcinoma of the oral cavity were studied. Tumor localization was as follows: cancer of the tongue, n = 161; cancer of the oral floor, n = 28; cancer of the hard palate, n = 12; cancer of the buccal mucosa, n = 11; and cancer of the gingiva, n = 9. In order to compare the effect of different treatments, three major treatment groups were defined, namely a surgery group, a radiotherapy group and a combination treatment group. Five-year cumulative survival rates showed significant differences between stage classifications (stage I = 91%, stage II = 73%, stage III = 63%, stage IV = 47%; p < 0.01) but not between tumor sites. The 5-year cumulative survival rate was highest for oral floor cancer (80%). In the early-cancer group, the 5-year cumulative survival rate for the surgery group (92%) was significantly higher (p < 0.05) than those for both the radiation (69%) and combination (71%) groups. In the advanced-cancer group, the 5-year cumulative survival rate for the surgery group (74%) was significantly higher (p < 0.05) than those for both the radiation (37%) and combination (51%) groups. No significant difference in regional control rates was observed between the treatment groups. Five-year regional control rates were 86% for cervical untreated patients with T1N0 tumors and 60% for cervical untreated patients with T2N0 tumors. Fourteen N0 cases were treated with neck dissection. Cervical metastasis was found pathologically in 2/14 (14%) of these cases. The 5-year survival rate for patients with cervical recurrences after primary tumor resection was 70% (n = 15). In contrast, the 5-year survival rate for patients with both primary tumor resection and neck dissection was 74% (n = 14) but no significant difference was observed between these 2 groups.     

Lobular capillary hemangioma of the neonatal larynx

OBJECTIVE: To describe a previously unreported condition of the neonatal larynx. DESIGN: Case series of 4 neonates with an uncommon laryngeal lesion. SETTING: Tertiary care children's hospital. PATIENTS: Four neonates in the first 10 days of life with stridor, hoarseness, and respiratory distress. INTERVENTION: The patients were examined using flexible fiberoptic laryngoscopy, and laryngeal lesions were identified and subsequently removed using microlaryngoscopy. Photodocumentation of the lesions was performed. Microscopic evaluation of biopsy specimens by a pathologist followed. MAIN OUTCOME MEASURES: Each patient's medical record was carefully reviewed for prenatal history, birth history, neonatal history, pathologic findings, and office follow-up. RESULTS: All 4 neonates were delivered atraumatically and developed symptoms of upper airway obstruction within the first few minutes to days of life. Each neonate was found to have an obstructive laryngeal lesion requiring surgical intervention. No child had other congenital abnormalities or a history of obvious laryngeal trauma. Pathologic review of each laryngeal specimen revealed inflammatory lesions with characteristic features of a lobular capillary hemangioma (or a pyogenic granuloma). CONCLUSIONS: The diagnosis of a lobular capillary hemangioma of the larynx should be considered in the differential diagnosis of a newborn with stridor, hoarseness, or respiratory distress. The cases seem to be of congenital origin, although acquired pathogenesis cannot be ruled out. Treatment of these lesions includes microscopic surgical excision.     

Squamous papilloma: case report and review of literature

Squamous papillomas are common lesions of the oral mueosa with a predilection for the mucosa of the hard and soft palate.As an oral lesion,it raises concern because of its clinical appearance,which may mimic exophytic carcinoma,verrucous carcinoma or condyloma acuminatum.Its pathogenesis is related to human papilloma virus but there is controversy regarding its viral origin.We present a case of squamous papilloma presenting as oral lesion along with a review of the literature.     

Oral melanoacanthoma: a case report, a review of the literature, and a new treatment option

OBJECTIVES: Oral melanoacanthoma is a rare condition that presents as a pigmented, painful lesion, most commonly on the buccal mucosa. Argon plasma coagulation is a new treatment option for benign oral lesions and is hypothesized to be efficacious for this rare mucosal disorder. METHODS: Treatment of a case and a review of the English-language literature were performed. RESULTS: One patient received a diagnosis of oral melanoacanthoma, and argon plasma coagulation treatment resulted in ablation of the lesion with excellent mucosal healing. A review of the literature demonstrated that this lesion is most commonly associated with black (90.9%), adult female (69.7%) patients and is most commonly located on the buccal mucosa (64.7%). CONCLUSIONS: Oral melanoacanthoma is a rare, benign mucosal lesion that may require surgical intervention for symptomatic relief. Argon plasma coagulation is a relatively safe and effective means of treating this lesion. Argon plasma coagulation treatment may be expanded to include other benign, superficial lesions of the oral mucosa.