舌平滑肌瘤1例报告

平滑肌瘤是一种良性肿瘤,最常见于子宫肌层、胃肠道和皮肤。口腔缺乏平滑肌组织,所以发生于口腔的平滑肌瘤比较罕见。口腔平滑肌瘤可以发生于任何年龄,常表现为一缓慢生长的实性黏膜下结节。尽管有时会伴有疼痛,但大多数患者无任何症状,最常见的部位是唇、腭和舌。口腔平滑肌瘤的诊断主要依靠组织病理学检查,本文报道1例发生于舌的平滑肌瘤。     

累及相邻器官的晚期舌癌的手术治疗:附1例报告

报告1例晚期舌癌患者实施多器官联合切除同期双游离瓣修复术,术中切除全舌、双侧口底、右下颌骨及左下颌骨颏部、部分右上颌骨、右软腭、右扁桃体、会厌、舌骨及全喉,制备右腓骨肌瓣、左腹直肌肌皮瓣移植修复软硬组织复合缺损,临床疗效满意。推荐对晚期口腔癌患者施行救治性外科及重建。     

Health-related quality of life of patients treated with primary chemoradiotherapy for oral cavity squamous cell carcinoma: a comparison with surgery

Our aim was to document the health-related quality of life (QoL) of patients with squamous cell carcinoma (SCC) of the oral cavity who were treated with chemoradiotherapy, and to compare it with that of patients treated with conventional surgery with or without adjuvant treatment. All patients who presented with SCC of the oral cavity treated with chemoradiotherapy alone at the Royal Brisbane & Women's Hospital between 2000 and 2011 and who were alive without disease were included. Health-related QoL was assessed by the University of Washington QoL questionnaire version 4, and the European Organisation for the Research and Treatment of Cancer (EORTC) QoL questionnaires C30 and HN35. The questionnaires were sent to all survivors. Those who responded to chemoradiotherapy were matched with patients who were treated by conventional surgery with or without adjuvant treatment by age, sex, subsite of tumour, and TNM stage. Sixteen patients completed the questionnaires (8 in each group). There was no significant difference between the 2 groups in any of the domains of any of the questionnaires. The overall outcome scores for both treatments in all 3 groups were reasonably high, which suggests that both treatments provided acceptable health-related QoL. The surgical group recorded higher scores than the chemoradiotherapy alone group in all domains of the UW-QoL except shoulder and anxiety. They recorded lower scores in all scales and items of EORTC HN35. There was no significant difference in health-related QoL between the 2 groups. Conventional surgery with or without adjuvant treatment recorded higher scores in most QoL domains including chewing, swallowing, saliva, and speech, issues most important to patients with SCC of the oral cavity.     

Impact of muscle volume loss on acute oral mucositis in patients undergoing concurrent chemoradiotherapy after oral cancer resection

This study evaluated the association between skeletal muscle mass depletion and severe oral mucositis in patients undergoing concurrent chemoradiotherapy after oral cancer resection. Skeletal muscle mass was evaluated in 60 patients using the skeletal muscle index, which was based on skeletal muscle cross-sectional area (on computed tomography) at the level of the third lumbar vertebra. In accordance with the grading criteria of the Radiation Therapy Oncology Group, patients with a grade ≥3 were defined as having severe oral mucositis. Multivariate logistic regression analysis was used to evaluate independent risk factors for severe oral mucositis. Eleven patients (18.3%) were diagnosed with low skeletal muscle mass. Severe oral mucositis occurred in 17 (28.3%) patients, and the mean skeletal muscle index was 42.8 cm²/m². A low skeletal muscle mass (hazard ratio 18.1; P = 0.001) and a chemotherapy regimen consisting of 5-fluorouracil and cisplatin (versus cisplatin only) (hazard ratio 5.5; P = 0.015) were independent risk factors for severe oral mucositis. Future prospective studies are warranted to identify effective pre- and perioperative exercises and nutrition programmes to increase low skeletal muscle mass and reduce the incidence of severe oral mucositis in patients undergoing concurrent chemoradiotherapy after oral cancer resection.     

A case of papilloma associated with topical tacrolimus ointment for tongue ulcers

We report a case of tongue papilloma that developed after the topical administration of tacrolimus. A 68-year-old man was admitted to our hospital with pain in his mouth. The diagnosis was ulcerative stomatitis. Although corticosteroids were ineffective, marked improvements were noted with the use of tacrolimus ointment. During follow-up observations, papillomas were observed on the tongue at the site of ointment application. The recurrence of papillary lesions was noted, but the lesions disappeared following the oral administration of a 5-fluorouracil formulation after pancreatic cancer surgery. In this case, tacrolimus ointment may have been associated with the formation of papilloma on the tongue.     

Correlation between dermoscopic and histopathological findings of leucoplakia of the tongue: a case report

A 75-year-old Japanese man presented at our outpatient clinic with pain on the right side of his tongue. Comparison of histological and dermoscopic images showed that areas with hyperkeratosis were opaque white, areas above the papillary dermis were reddish, and that the lesion looked whiter on dermoscopy the longer the epithelial rete ridges were. A dermatocope shows structural information from the epidermis as well as the upper dermis, and could improve early diagnosis of oral mucosal squamous carcinoma in situ.     

Dental considerations for head and neck cancer: A clinical review

IntroductionRadiotherapy is one of the treatment modalities for the treatment of head and neck cancer (HNC). However, it leads to the development of chronic and acute side effects. These side effects impact negatively on the patient’s quality of life and oral functioning. This clinical review aims to provide basic information about HNC, understand the impact of radiotherapy on oral health, and explain the role of dental care providers for HNC patients during the pre-and post-radiotherapy time.Materials and MethodsElectronic databases (i.e., PubMed, Scopus, and Google Scholar) were searched using defined keywords. The main inclusion criteria were any studies describing “dental management of patients with head and neck cancer” and “dental management of patients treated with radiotherapy.”ResultsThematic analysis was used to summaries the findings of the included studies (n = 102) into main headings and subheadings. All studies were published between 1970 and 2023.ConclusionThe number of HNC patients is increasing. This necessitates the need for raising the awareness of dental care providers to the side-effects of HNC therapy which includes treatment with radiotherapy, chemotherapy, and/or surgery. Dental care providers should understand the common side-effects and their treatments besides their role in the pre- (i.e., dental extraction of teeth with poor prognosis and maintaining good oral hygiene) and post- (i.e., oral rehabilitation and post-HNC dental care) radiotherapy dental care.     

Clinical evaluation of Lugol's iodine staining in the treatment of stage I-II squamous cell carcinoma of the tongue

Oral squamous cell carcinoma (OSCC) is often surrounded by epithelial dysplasia; leaving it unresected can result in local recurrence. Staining with Lugol's iodine solution detects epithelial dysplasia in oral mucosa, but whether it decreases local recurrence after OSCC surgery is unknown. This study investigated local recurrence rates in patients with early tongue cancer who underwent surgery using Lugol's staining. 93 patients with T1-2N0 tongue SCC underwent partial glossectomy using Lugol's staining during surgery. Resection was performed at least 5 mm from the margin of the unstained area. Patients were investigated retrospectively for local recurrence status. Postoperative histology revealed negative surgical margins for SCC or epithelial dysplasia in 81 patients, close margins for SCC in 5, positive margins for mild epithelial dysplasia in 6, and a positive margin for SCC in one. Those with a positive or a close margin for SCC underwent additional resection 2-4 weeks after surgery; one was proved histologically to have residual SCC. No patients developed local recurrence, but 2 died of neck metastasis and 2 of distant metastasis. The 5-year disease specific survival rate was 93.8%. Lugol's staining during surgery can reduce local recurrence and improve survival in patients with early tongue SCC.     

Planned neck dissection after chemoradiotherapy in advanced oropharyngeal squamous cell cancer: The role of US,MRI and FDG-PET/TC scans to assess residual neck disease

ObjectiveTo investigate the ability of neck ultrasounds (US), magnetic resonance imaging (MRI) and positron emission tomography (FDG-PET/TC) in detecting residual nodal disease after chemoradiotherapy in patients with advanced oropharyngeal squamous cell carcinoma (OPSCC).MethodsFrom 2006 to 2009, 36 consecutive patients affected by OPSCC with bulky nodal disease (>3 cm), treated with primary concurrent chemoradiotherapy, were enrolled prospectively. Nodal response to treatment was assessed by using US, MRI and FDG-PET/CT. Planned neck dissection (ND) was performed in all the patients, and the histopathological node status was compared to the imaging findings in order to establish sensitivity, specificity, accuracy and predictive values of each technique.ResultsMetastatic disease was assessed in 18/37 (48.6%) hemi-necks, always localized in levels II–IV. US showed greater sensitivity (77.8%) and, combined with FDG-PET/TC, produced the highest negative predictive value (93.3%). US, MRI and FDG-PET/TC scans showed the highest specificity (100%), accuracy (93.8%) and positive predictive values (100%).ConclusionsIn the presence of advanced OPSCC with bulky nodal disease, US combined with FDG-PET/TC could be a reliable and cost-effective strategy to identify patients with complete nodal response to chemoradiotherapy that might not require post-treatment ND but only observation. When residual disease in the neck was detected, selective ND was recommended.     

Ectomesenchymal chondromyxoid tumor of the anterior tongue. Report of a case

The ectomesenchymal chondromyxoid tumor of the anterior tongue (ECT) is a recently described entity of the anterior dorsum of the tongue. The lesion is histologically characterized by a lobular proliferation of ovoid and fusiform cells, which often have multilobulated nuclei and occasional foci of atypia in a chondromyxoid background. We report a case of ECT with a discussion on the differential diagnosis and pathogenesis.     

Oral cancer adjacent to dental implants mimicking benign lesions: a case series study

Despite the long‐term survival rates of osseointegrated dental implants, several biological complications are known to affect the peri‐implant tissues, such as peri‐implant mucositis and peri‐implantitis. Occasionally, the clinical features of these more common benign lesions, or others nonrelated to implants, might be similar to oral malignancies, leading to misdiagnosis. The objective of this study was to present a case series of oral cancer located adjacent to dental implants, aimed to identify the reasons for initial misinterpretation of diagnosis. Thirteen patients, 10 females and 3 males, aged 59 to 90, were assessed. Among the differential diagnoses established, a malignant or premalignant lesion was not considered in 10 out of the 13 patients. Peri‐implantitis was the most common preliminary diagnosis, followed by fungal infection, viral infections, and traumatic ulcers. The meantime for the diagnosis of oral cancer was 21.5 months. The clinical presentation of peri‐implant malignancy, such as ulceration, white and red plaques, and exophytic lesions, might mimic benign diseases that are more common in the oral cavity. Suspicious lesions with treatment failure that persist for more than 2 weeks require biopsy and histopathological analysis to establish an early definitive diagnosis to improve the prognosis and quality of life of the patients.     

Identification and characterization of a highly metastatic epithelial cancer cell line from rat tongue cancer

ObjectivesTongue squamous cell carcinoma (TSCC) is a clinically devastating disease. However, most established TSCC cell lines currently show undesirable malignant behaviours. The purpose of this study is to establish a highly metastatic TSCC cell line to serve as a useful tool for basic research.Materials and methodsTSCCs were induced by 4-nitroquinoline-1-oxide (4NQO) in Sprague-Dawley rats. Tumor cells were obtained from the cancer tissues by primary culture and were then purified by an in vitro invasion assay and a limiting dilution assay. The growth rate, cell cycle distribution, apoptotic rate, tumorigenicity and distant metastatic phenotypes of the rat tongue cancer cells were fully investigated and characterized.ResultsTo date, the rat tongue cancer cell line, named Rca-T, has been continuously cultured in vitro for over 210 passages and exhibit a long spindle-shaped morphology, adherent growth, and a stable epithelial phenotype. The population doubling time of Rca-T cells is 23.35 h. Approximately 39.8% of these cells are in S phase, and the apoptosis rate of Rca-T cells is 7.46%. Furthermore, in immunodeficient nude mice, both the xenograft rate and the incidence of experimental lung metastasis are 100%. The in vitro assays further reveal the highly malignant and epithelial-mesenchymal transition-like properties of Rca-T cells.ConclusionIn this study, the tumorigenic and highly distant metastatic TSCC cell line Rca-T was established. The malignant features of this cell line, especially its metastatic potential, will enable a wealth of functional studies on the molecular mechanisms of TSCC metastasis in the future.     

Gardner's Syndrome revisited: a clinical case and overview of the literature

Gardner's syndrome (GS), a variant of familial adenomatous polyposis (FAP), remains a life-threatening condition of significant dental relevance. Clinicians can play an important role in the identification of this condition as the dental manifestations often precede the development of intestinal polyposis. This article describes a clinical case in which identification of the dental features of GS during routine orthodontic assessment resulted in the early diagnosis of this condition, which was previously unrecognised in a young female patient.     

Homogenous amniotic membrane as a biological dressing for oral mucositis in rats: histomorphometric analysis

Objective

Oral mucositis is a frequent and significant side effect of chemotherapy and/or radiation therapy. The purpose of this study was to evaluate the effects of the homogenous amniotic membrane (HAM) as a biological dressing for oral mucositis induced by 5-fluorouracil (5-FU) in the labial fornix region of inferior incisors in rats.

Methods

Sixty rats were divided into three groups: control (50% acetic acid), 5-FU (50% acetic acid and 5-fluorouracil-induced oral mucositis) and 5-FU + HAM (50% acetic acid and 5-fluorouracil-induced oral mucositis, and treated with HAM). Histological analyses were done 3, 7, 14 and 21 days after applying the acetic acid.

Results

HAM showed not only no signs of rejection as well as an excellent tissue adherence to the ulcerated surface. Histomorphometric analysis indicated a lower quantity of inflammatory cells in the 5-FU + HAM group in all periods when compared to the other groups and there was a statistically significant difference in the 3- and 7-day periods (P < 0.001).

Conclusions

The results of this study suggest that HAM was biocompatible with great adhesive power to the ulcerated surface, accelerated the healing process and exhibited anti-inflammatory activity. Further studies should be done to investigate the potential benefits of this material in clinical trials. HAM could lead to improved results as a biological dressing in treatment and management of oral mucositis in patients submitted to chemotherapy and/or radiation therapy.     

胸大肌皮瓣修复舌、口底癌后种植覆盖义齿1例报告

口腔癌患者手术扩大切除肿瘤组织后,口腔形态遭到严重破坏,虽经皮瓣修整缺损区,但仍不能完全恢复正常的口腔结构和功能。在这样的口腔环境下修复缺失牙,恢复患者的咀嚼功能,是修复领域的一大难点。本文描述1例舌、口底癌患者口内转移胸大肌皮瓣后,植入种植体,应用杆卡式覆盖义齿进行义齿修复的全过程,修复后患者口腔结构和功能改善,生存质量提高。     

Squamous cell carcinoma of the tongue in a patient with dyskeratosis congenita: a rare entity

Dyskeratosis congenita is a rare genetic disorder that results from progressive failure of the bone marrow. It presents with a classic triad of reticular pigmentations of the skin, dystrophic nails, and oral leukoplakia; patients rarely develop cancers. We report a patient with dyskeratosis congenita who presented with squamous cell carcinoma of the oral tongue.