Oral carcinoma development after 23 years of renal transplantation

Renal transplant patients are treated with immunosuppressive drugs that decrease the effectiveness of the immune system, making them more prone to developing cancer. Skin and lip carcinomas are common malignancies encountered after transplantation, whereas oral carcinomas are rare. We report the case of a 51-year-old female Caucasian patient, with no history of smoking, who presented white lesions on the tongue and an ulcerated lesion on the lower lip beginning 4 months prior. Diagnosis of squamous cell carcinoma for both lesions was made following incisional biopsies. Interestingly, the patient reported a renal transplantation 23 years prior, and was maintained on a combination of cyclosporine, mycophenolate sodium and prednisone. The patient also presented a history of several basal and squamous cell carcinomas on sun-exposed areas of the skin. Both lesions were surgically excised. No sign of recurrence or new lesions in the oral cavity have been observed; however, new skin lesions are frequently diagnosed. This case report highlights that oral cancers may occur in transplant patients in the absence of classical risk factors. Thus, clinicians must be aware of the importance of thorough oral examination in transplant patients in routine follow-up.

Clinical Features and Treatment of Fibrous Histiocytomas of the Tongue: A Systematic Review

Abstract Introduction Benign fibrous histiocytomas are common lesions of the skin that rarely affect the tongue. Such cases are available in the literature exclusively as case reports. Similarly, malignant fibrous histiocytoma, now classified as undifferentiated pleomorphic sarcoma, is exceedingly rare in the tongue and not fully understood. Objectives This study systematically reviews the available literature discussing the clinical and pathological features of malignant and benign fibrous histiocytomas. Data Synthesis A total of 20 cases were included in this review. Patient-level data were extracted from cases to include clinical presentation, workup, treatment, and outcome. Conclusion Benign fibrous histiocytomas are consistent in clinical and histopathologic presentation. Surgical treatment provides excellent outcome, with no recurrence in all excised cases. Malignant tumors have a more aggressive clinical and pathological presentation. Surgical treatment with possible adjuvant radiotherapy resulted in recurrence in 40% of cases (follow-up of 24 months), and death due to disease in 47% of patients (follow-up of 19 months).

Schwanoma lingual: presentación de un caso / Lingual schwannoma: case presentation

Introducción:el Schwanoma forma parte de los tumores que derivan de la vaina nerviosa, de crecimiento lento, asintomático en una parte de los casos, raro en la cavidad bucal y de etiología desconocida, con lo que su diagnóstico definitivo es anatomopatológico. No encontramos ningún reporte en las revistas electrónicas cubanas ni yemenitas sobre esta afección, lo cual sumado a su comportamiento no patognomónico y su rareza, nos motivó a reportar el caso. Objetivo: presentar un caso de un tumor bucal raro, con localización lingual poco frecuente. Presentación del caso: paciente masculino de 26 años de edad, procedente de Yemen, quien acude al Servicio de Cirugía Maxilofacial de la Universidad de Adén, por presentar aumento de volumen en la lengua de un año de evolución, asintomático hasta 10 días antes que se lo traumatizó y comenzó con molestias; se interpretó inicialmente como un granuloma piógeno; se decidió su escisión y biopsia para el diagnóstico definitivo, la cual se realizó bajo anestesia local sin complicaciones, con una evolución postoperatoria favorable. El resultado del examen histopatológico fue Schwanoma lingual. Discusión: se analizan los diferentes tumores benignos y malignos que en la lengua pueden confundir el diagnóstico, se valora el comportamiento no patognomónico de la entidad y a diferencia de la localización posterior reportada por muchos autores, la punta lingual fue la afectada en nuestro caso. Conclusiones: el Schwanoma es una rara afección de la cavidad bucal, que requiere el análisis histopatológico para su diagnóstico definitivo y con un buen pronóstico postquirúrgico.

Introduction: schwannoma is one of the tumors derivates from neural sheet, characterized by a slow growing, symptomless in some cases, rare in the oral cavity, unknown etiology which definitive diagnosis should be made by the anatomopathologic analysis. Not any reports at the Cubans or Yemenis electronic journals were founded. This observation in conjunction with the not patognomonic way of presentation and rareness of the lingual Schwannoma, motivated us to report this case. Objective: to present a case of rare oral tumor, with uncommon tongue location. Case presentation: a 26 years old male patient, from Yemen was attended at the Maxillofacial Service of Aden University, complaining about a mass on the tongue since one year ago which was asymptomatic, but about ten days ago the patient suffered from a masticatory trauma that produced some discomfort. Initial diagnosis was as pyogenic granuloma; excision and biopsy were made under local anesthesia to achieve the final diagnosis. Not any complications and a favorable postsurgical evolution were observed. The conclusion of the histopathological study was lingual Schwannoma. Discussion: different benign and malignant tumors of the tongue that make confusion in the diagnosis of this disease were analyzed and the not patognomonic behavior of this affection was taking into account. Many authors report about the posterior localization of this tumor, but in our case was localized at the tip of the tongue. Conclusions: Schwannoma is a rare disease of the oral cavity that requires histopathological analysis for the final diagnosis and has a good postsurgical prognosis.

Neurilemoma: relato de caso clínico / Neurilemmoma: a case report

O Neurilemoma (schawannoma) é um tumor benigno que sedesenvolve a partir de uma proliferação desordenada das célulasde Schwann. É uma lesão nodular, assintomática, localizadapreferencialmente na língua e semelhante a lesões proliferativasnão neoplásicas. Microscopicamente exibe padrões histológicoscaracterísticos denominados Antoni A e Antoni B. O objetivodeste trabalho e fazer uma breve revisão da literatura e relatarum caso clínico

Neurilemmoma (Schwannoma) is a benign tumor of nervesheath origin. It occurs in the head and neck regions and a fewcases are reported intraorally. Neurilemoma of the tongue presentsas a painless mass, in the third decade of life and displayno gender predilection. It is generally round or oval shaped, solitary,soft, smooth, sharply circumscribed, slow growing, andwell encapsulated, and usually ranges in size from 0.25 to 3.00cm. Surgical enucleation is easy to perform and recurrence israre. Histopathologic examination shows an encapsulated spindlecell tumor, of which two types of the tissue are Antoni A andB. The authors report a case of neurilemmoma of the tongue anda brief review of the literature of this unusual clinical entity.

Occult Lymph Node Metastasis in Early Oral Tongue Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The most significant prognosticator of survival for patients with squamous cell carcinoma of the oral tongue has been the association of neck nodal metastasis. However, no consensus exists as to whether an elective neck dissection should be performed in patients with early oral tongue squmous cell carcinoma with a clinically negative neck. SUBJECTS AND METHOD: A retrospective analysis was performed on 54 early oral tongue squamous cell carcinoma patients (T1=26 and T2=28) with clinically negative necks who were treated between 1992 to 2003. All patients had an ipsilateral neck dissection and 29 patients had a contralateral neck dissection. Surgical treatment was followed by postoperative radiotherapy in 20 patients. The follow-up period ranged from 3 to 110 months (mean, 56 months). Data were analyzed using the Kaplan-Meier method, log-rank test, and the chi-square test. RESULTS: Clinically occult, but pathologically positive ipsilateral lymph nodes were found in 26% (14/54) and contralateral lymph nodes in 3% (1/29). Based on the clinical staging of the tumor, 19% (5 of 26) of the cases showed lymph node metastases in T1 tumors, and 36% (10 of 28) in T2. All regional recurrences developed in the ipsilateral necks, there was no cases of contralateral neck recurrence. Patients with no evidence of occult nodal cancer have significantly improved disease-specific free survival rates over patients with any pathologically positive nodes (5 year disease specific survival rate, 90% vs 38%, p< or = 0.05). CONCLUSION: This study showed that ipsilateral elective neck dissection should be performed for early oral tongue cancers. On the other hand, our series suggests that it may not be harmful to observe the contralateral N0 neck in the treatment of early oral tongue cancer.

Two Cases of Double Free Flap Reconstruction for Oromandibular Defect / 대한이비인후과학회지

En bloc defects, which can also be defined as extensive composite defects, present as one of the most complex reconstructive challenges in the head and neck area. Although most head and neck defects can be reconstructed using a single free tissue transfer, the use of two free flap is indicated for massive tissue defects or for composite tissue requirement that cannot be met with a single free flap. In this paper, we report two patients with composite defects. They underwent single-stage, double free flap reconstruction utilizing a fibular osteoseptocutaneous flap to reconstruct the mandible and floor of the mouth, as well as an innervated radial forearm fasciocutaneous composite flap with the palmaris longus tendon and the latissimus dorsi free flap for the total tongue reconstruction. Both patients had acceptable functional and aesthetic outcomes.