RESUMEN
INTRODUCTION: Neuroendocrine tumours comprise 0.5-2% of all malignancies in adulthood, and very rarely metastasize to the oral cavity. When they do metastasize to the oral cavity, the mandible is the most common site. This can lead to symptoms such as a numb chin and lip, which in the absence of any odontogenic cause may be an important sign indicating malignant disease. We present a rare case of metastatic neuroendocrine carcinoma to the mandible, resulting in the so-called "numb chin syndrome". PRESENTATION OF CASE: An elderly lady presented with numbness to the right chin and lip, as well as hypoglossal nerve palsy. She had significant back pain and gave a history of repeat chest infections. Intra-oral clinical examination was normal, but upon further special investigations, the right mental region was suspicious of multiple lytic lesion. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) demonstrated marrow changes in the mandible suspicious of malignant disease. Further findings included multiple pathological fractures of the spine and a mass in the left lung base. A trephine biopsy gave a diagnosis of metastatic neuroendocrine carcinoma, with the left lung mass considered to be the primary site. DISCUSSION: We discuss the rarity of metastatic disease to the oral cavity, and the importance of "numb chin syndrome" in indicating malignancy. CONCLUSIONS: This case promotes the importance of considering sinister pathology when presented with sudden, altered sensation to the chin and lips. The "numb chin syndrome" should always raise the suspicion of primary or metastatic disease to the mandible.
RESUMEN
The incidence of tongue carcinoma in Trinidad and Tobago and the greater West Indies is unknown; therefore, the present study examines the frequency of tongue carcinoma cases, drawing comparisons to worldwide and regional data. A retrospective analysis of all confirmed cases of tongue carcinoma was conducted using eight years of data from the pathology records at the Port of Spain General Hospital (Port of Spain, Trinidad and Tobago). A total of 26 cases were confirmed, of which 21 were male (81%) and five were female (19%). The age range was 29-86 years, with a mean age of 57 years, and the most common group affected was the 61-70 years age group. In addition, the number of newly diagnosed cases per year ranged between one and seven, with an average of 3.25 new cases per year and a peak incidence of seven new cases in the year of 2009. In the 19 cases where the degree of differentiation was recorded, histological analysis revealed the extent of differentiation as follows: Five cases (26%) were poorly-differentiated squamous cell carcinoma (SCC); eight cases (42%) were moderately-differentiated SCC; and six cases (32%) were well-differentiated SCC. In addition, one case of chronic inflammatory process and one case of mucoepidermoid adenocarcinoma of the tongue in a 57-year-old female were identified. Overall, the incidence of tongue carcinoma in Trinidad and Tobago appears to be low, estimated at 0.46/100,000 individuals/year. The male:female ratio is 4:1 and SCC is the dominant cancer type (96% of cases). The peak age of occurrence is at 61-70 years. These findings are in agreement with previously determined global data, however, additional research of the risk factors and outcomes of surgery as a treatment strategy for tongue carcinoma is required.
RESUMEN
The epidemiology of parotid gland tumours in Trinidad and Tobago and the wider Caribbean is currently unknown. Therefore, an analysis of the pathological records was conducted to determine the pattern of this disease in Trinidad and Tobago. A retrospective analysis was conducted on all parotid gland tumours and the demographic and histological data were analysed. Data from 60 cases were collected over a period of 8 years (October, 2003 to February, 2012), including 56 primary and 4 secondary tumours (1 basal cell carcinoma and 3 metastatic tumours). The patients included 31 men and 29 women, with a mean age of 48.7 years and an age range of 21-73 years (peak age, 51-60 years). The surgical interventions included 53 superficial parotidectomies, 6 radical parotidectomies and 1 biopsy. Of the 56 primary tumours, 41 were benign [34 pleomorphic adenomas and 7 Warthin's tumours (adenolymphomas)], accounting for 73.2% of the cases. The malignant lesions included 6 squamous cell carcinomas, 3 mucoepidermoid carcinomas, 2 acinic cell carcinomas, 2 adenoid cystic carcinomas, 1 anaplastic carcinoma and 1 papillary carcinoma, accounting for 26.8% of the total cases, without any age predominance. The pattern of disease distribution was similar to that indicated by worldwide data, with benign primary lesions accounting for ~80% of the cases (pleomorphic adenomas, 80% and Warthin's tumours, 20%). The most common carcinomas were mucoepidermoid and adenoid cystic types, as indicated by worldwide data; however, in our series, squamous cell carcinoma was the most common type, followed by mucoepidermoid, acinic cell and adenoid cystic carcinomas. The present study will hopefully provide useful information on parotid pathology in Trinidad and Tobago and encourage further research in this field.
