Oral presentation of paraneoplastic pemphigus as the first sign of tonsillar HPV associated squamous cell carcinoma. A case report.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub
; 166(4): 447-450, 2022 Dec.
Article
en En
| MEDLINE
| ID: mdl-34188253
ABSTRACT
BACKGROUND:
Paraneoplastic pemphigus (PNP) in the oral cavity is a rare variant of blistering pemphigus disease closely associated with mostly malignant tumors. The diagnosis may even precede an underlying malignancy enabling early detection. Here, we describe a previously unreported case of PNP associated with HPV-related tonsillar squamous cell carcinoma. METHODS ANDRESULTS:
A 50-year-old woman was referred to a dentist because of painful oral lesions resembling aphthae major and minor. Later, blisters appeared and an incisional biopsy was performed. Histological examination revealed an unusual coexistence of subepithelial and intraepithelial blisters raising suspicion of paraneoplastic pemphigus. The patient underwent 18F-FDG PET/MRI, showing a metabolically active process in the left palatal tonsil. Diagnostic biopsy revealed HPV type 16 associated tonsillar squamous cell carcinoma. A left tonsillectomy with elective left-sided neck dissection was performed. The postoperative period was complicated by bilateral fluidothorax. Two weeks after radical tumor removal, the mucosal and skin lesions of PNP disappeared. The patient currently shows no evidence of recurrence either of malignancy or PNP eight months after the surgery.CONCLUSION:
PNP is a rare autoimmune blistering disease characterized by polymorphous cutaneous and mucosal lesions associated with internal neoplasms including HPV associated squamous cell carcinoma of a tonsil. In order to identify an occult malignancy, a whole-body PET/CT or PET/MRI scan is recommended. Rarely, accurate patient management may depend on the dentist being familiar with this entity and on interdisciplinary cooperation involving dermatologist, radiologist, pathologist, and pneumologist. A strict patient follow-up is indicated.Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Síndromes Paraneoplásicos
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Enfermedades Autoinmunes
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Carcinoma de Células Escamosas
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Pénfigo
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Infecciones por Papillomavirus
Tipo de estudio:
Risk_factors_studies
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Screening_studies
Límite:
Female
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Humans
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Middle aged
Idioma:
En
Revista:
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub
Asunto de la revista:
MEDICINA
Año:
2022
Tipo del documento:
Article
País de afiliación:
República Checa