Differences among oral carcinomas arising de novo from those associated with oral potentially malignant disorders: a systematic review and meta-analysis.

OBJECTIVE: To analyze the frequency of sequential oral squamous cell carcinomas (s-OSCC), preceded by oral potentially malignant disorders, and OSCC de novo (OSCC-dn) and explore differences in their clinicopathologic presentations. STUDY DESIGN: A structured electronic search strategy identified studies that analyzed frequency, clinical, biological, demographic, biomarkers, and prognostic features of s-OSCC and OSCC-dn according to PRISMA guidelines in PubMed, Scopus, Cochrane Library, and Google Scholar, up to January 31, 2023. Inclusion criteria were original English, Spanish, Portuguese, French, Italian, and German cross-sectional, cohort, and case-control studies. The quality of studies was assessed using the Agency for Research and Health Quality tool and the Newcastle-Ottawa Scale tool. RESULTS: The final selection included 40 studies. OSCC-dn and s-OSCC represent, respectively, 71% and 29% of cases of OSCC (P = .00), showing a higher percentage of T1 or of T1+T2 in s-OSCC (P < .0001). The association meta-analysis showed OSCC-dn with a significant association. The meta-analysis showed that s-OSCC was significantly associated with smaller tumor size, absence of distant metastases, relapses, male sex, and tumor sites different from tongue; and OSCC-dn was associated with more advanced tumor size, more regional and distant metastases, more advanced stages, and worse survival. CONCLUSIONS: S-OSCC was less frequent than expected. OSCC-dn seems to have specific clinical, biological, and prognostic features. Future perspectives on oral cancer prevention should address novel approaches and alternatives to screening, such as urgent referral of OSCC-dn.

Chronic mechanical irritation enhances the effect of tobacco and alcohol on the risk of oral squamous cell carcinoma: a case-control study in Argentina.

OBJECTIVES: Oral squamous cell carcinoma (OSCC) is a multifactorial disease. The individual effect of each risk factor for OSCC may be conditioned by the frequency of other factors. The objective of this study was to identify the association between chronic mechanical irritation (CMI) and OSCC and to analyse the influence of CMI on other important risk factors for OSCC. MATERIALS AND METHODS: A prospective and age/sex-matched case-control study was performed in two institutions from Argentina between 2009 and 2019, with consecutive and newly diagnosed OSCC. The frequencies of tobacco, alcohol, and CMI were analysed using conditional logistic regression. Cumulative tobacco consumption and the presence of CMI were analysed using the Mann-Whitney test. RESULTS: CMI and OSCC were associated with an OR of 7.02 (95% CI 3.57-13.78, p < 0.001). The combination of CMI and alcohol demonstrated the highest risk of OSCC (OR 53.83, CI 95% 8.04-360, p < 0.0001), followed by the combination of CMI, tobacco, and alcohol (OR 48.06, CI 95% 8.47-272, p < 0.0001). The combination of CMI and tobacco was also significant (OR 5.61, CI 95% 1.07-29.54, p = 0.042). Patients with CMI developed OSCC with less cumulative tobacco use compared with those without CMI. CONCLUSION: CMI is an independent risk factor for OSCC, and it could act as a risk modifier among tobacco and alcohol users having an enhancing effect. CLINICAL RELEVANCE: Elimination of CMI could decrease the risk of OSCC.

Oral Squamous Cell Carcinoma Associated with Arsenic Exposure: A Case Series from Argentina / Carcinoma Oral de Células Escamosas Asociado con la Exposición al Arsénico: Una Serie de Casos de Argentina

ABSTRACT: Many areas of South America are directly affected by Arsenic (As) contaminated groundwater. A high percentage of the water samples taken in multiple areas of Argentina had As concentrations above the WHO level recommended guidelines. This condition was previously associated with an increased risk of chronic diseases, including different cancers. Long-term As exposure was proposed as a risk factor for Oral Squamous Cell Carcinoma (OSCC). The aim of this study is to present a series cases of Argentine patients diagnosed with OSCC who have consumed water contaminated with As for more than 10 years. Clinical data were obtained from the archive of Clinical Records Histories of the Oral Medicine Department of the Dentistry School, Universidad Nacional de Córdoba and Universidad Católica de Córdoba, Argentina. 15 cases of OSCC were included. The male: female sex ratio was 2:1. The average age was 66 years (31-89 years). Regarding location, the gum or edentulous alveolar ridge was the most prevalent site (6/15; 40 %), followed by the tongue margin. The average years of exposure to arsenical waters were 24 years (13 - 40 years of exposure). The majority of the presented cases were non drinkers non smokers. 60 % of the tumors were diagnosed at advanced stages. the epidemiological studies carried out in As-contaminated areas that address oral cancer should always incorporate the record of variables related to As exposure. Patients who live or lived at As-contaminated areas must be regularly followed up for early diagnosis of potentially malignant or malignant lesions. The high frequency of gum cancer among these cases, should raise awareness of periodontic specialists to perform a careful and thorough periodontal examination.

RESUMEN: Muchas regiones de América del Sur están directamente afectadas por aguas subterráneas contaminadas con arsénico (As). Un alto porcentaje de las muestras de agua tomadas en múltiples áreas de Argentina tenían concentraciones de As superiores al nivel aprobado por la OMS. Esta condición se asociaba previamente con un mayor riesgo de enfermedades crónicas, incluidos diferentes tipos de cáncer. La exposición a largo plazo se propuso como un factor de riesgo para el carcinoma oral de células escamosas (OSCC). El objetivo de este estudio es presentar una serie de casos de pacientes diagnosticados con OSCC que han consumido agua contaminada con As durante más de 10 años. Se obtuvieron datos clínicos del archivo de Historias de registros clínicos del Departamento de Medicina Oral de la Facultad de Odontología, Universidad Nacional de Córdoba y Universidad Católica de Córdoba, Argentina. Se incluyeron 15 casos de OSCC. La relación de género masculino: femenino fue de 2: 1. La edad promedio fue de 66 años (31-89 años). En cuanto a la ubicación, la encía o la cresta alveolar edéntula fue el sitio más frecuente (6/15; 40 %), seguido del borde de la lengua. El promedio de años de exposición a las aguas arsenicales fue de 24 años (13 - 40 años de exposición). La mayoría de los casos presentados fueron de pacientes no bebedores y no fumadores. El 60 % de los tumores fueron diagnosticados en etapas avanzadas. Los estudios epidemiológicos realizados en áreas contaminadas con As que abordan el cáncer oral siempre deben incorporar el registro de variables relacionadas con la exposición a As. Se debe hacer un seguimiento continuo de los pacientes que viven o que vivieron en áreas contaminadas con As para el diagnóstico temprano de lesiones potencialmente malignas. La alta frecuencia de cáncer de encías en estos casos, debe concienciar a los especialistas en periodoncia para que realicen un examen periodontal cuidadoso y completo.

Clinical and Immunohistochemical epithelial profile of non-healing chronic traumatic ulcers

BACKGROUND: Chronic wounds were previously related to cancer. Chronic Traumatic Ulcers (CTU) are lesions caused by chronic mechanical irritation (CMI) frequently diagnosed in Oral Medicine. Although these conditions may reflect a benign nature, some authors have proposed its relationship with malignant transformation. Currently, there are scarce investigations that evaluate biomarkers within CTU. The aim of this study was to evaluate cell differentiation and proliferation biomarkers patterns of CTU and OSCC through recognized markers such as cytokeratin 19 and Ki67 and correlate it with clinical features of both groups of patients. MATERIAL AND METHODS: A Cross-sectional study of adult patients (n = 79), both sexes, attended at Oral Medicine Department, Facultad de Odontología, Universidad Nacional de Córdoba. The patients were classified into two groups: CTU (n = 41), and OSCC (n = 38). A subset of specimens were immunolabeled with Ki67 and Ck19. RESULTS: The population consisted of 51.9% male and 48.1% female, with an average of 57.0 ± 13.9. years (OSCC group) and 60.9 ± 14.9 years (CTU group). OSCC group presented higher scores for both biomarkers (Ki67 and Ck19), but only there were differences statistically significant for Ki67 (p = 0.032). 25% of non-healing CTU were positive with medium scores of Ck19 and showed an immunohistochemical profile similar to OSCC. The lateral tongue was the most frequent site in both groups. CONCLUSION: The altered immunohistochemical pattern found in many specimens of CTU was also observed in OSCC. The tongue border presents physiological conditions that could offer a suitable environment for the development of neoplastic events associated with CMI. Further studies are needed to understand the underlying mechanisms that could link oral non-healing ulcers with early malignant changes

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Liquen plano oral. Reporte de un caso y revisión de la literatura / Oral lichen planus. Case report and literature review

El liquen plano oral (LPO) es una enfermedad mucocutánea crónica, de carácter inflamatorio, etiología desconocida y naturaleza autoinmune, en la que se produce una agresión por parte de los linfocitos T dirigida frente a las células basales del epitelio de la mucosa oral. El diagnóstico del LPO debe basarse en la observación clínica y confirmarse con la descripción de las características histopatológicas. Se presenta caso clínico de paciente femenina de 39 años de edad que acudió a consulta odontológica al Servicio de Estomatología de la Escuela de Odontología, de la Facultad de Ciencias de la Salud, Universidad Católica de Córdoba, por presentar múltiples lesiones blancas en la cavidad bucal de 1 año de evolución. La paciente manifiesta episodios de stress. Se realizó biopsia de tipo incisional y se envió a anatomía patológica donde se confirmó el diagnóstico de Liquen Plano Oral. (AU)

Oral lichen planus (LPO) is a chronic mucocutaneous disease, of an inflammatory nature, unknown etiology and autoimmune nature, in which aggression by T lymphocytes directed against the basal cells of the oral mucosa epithelium occurs. The diagnosis of LPO should be based on clinical observation and confirmed with the description of histopathological characteristics. There is a clinical case of a 39-year-old female patient who attended a dental office at the Stomatology Service of the School of Dentistry, Faculty of Health Sciences, Catholic University of Córdoba for presenting multiple white lesions in the oral cavity of 1 year of evolution. The patient manifests episodes of stress. An incisional type biopsy was performed and sent to a pathological anatomy where the diagnosis of Oral Lichen Planus was confirmed. (AU)

Errores cognitivos de diagnóstico en medicina bucal / Cognitive errors of diagnosis in oral medicine

La Medicina Bucal, como toda actividad humana, puede ser abordada desde dos sistemas de razonamiento, conocidos como Sistemas Cognitivos. El Sistema 1 es intuitivo, económico y rápido, mientras que el Sistema 2 es analítico, lento, costoso en esfuerzo, pero más confiable. Ambos sistemas interactúan entre sí, de manera que nuestra actividad de diagnóstico emplea a uno y otro. Los errores de diagnóstico en Medicina Bucal pueden basarse en falta de aplicación de reglas sistemáticas del sistema 2, o en errores cognitivos al utilizar exclusivamente el sistema 1. Estos errores derivan generalmente en considerar falso un diagnóstico verdadero, o en considerar verdadero un diagnóstico falso. Existen estrategias para reducir estos errores cognitivos, pero el paso fundamental es conocer cómo pensamos y cuáles son los errores que podemos cometer. El análisis reflexivo de los errores cognitivos de diagnóstico (metacognición) permitiría transformarlos en oportunidades de crecimiento profesional y en una mejor atención para nuestros pacientes. (AU)

Oral Medicine, like all human activity, can be approached from two systems of reasoning, known as Cognitive Systems. System 1 is intuitive, economical and fast, while System 2 is analytical, slow, costly in effort, but more reliable. Both systems interact with each other, so that in our diagnostic activity we use both. Diagnosis errors in Oral Medicine can be based on the lack of application of systematic rules of the system 2, or on cognitive errors when the system 1 is used exclusively. These errors derive generally in false considering a true diagnosis, or in considering true a diagnosis false. There are strategies to reduce these cognitive errors, but the fundamental step is to know how we think and what are the mistakes we can make. The reflexive analysis of cognitive errors of diagnosis (metacognition) would allow transforming them into opportunities for professional growth and better care for our patients. (AU)

Osteosarcoma mandibular osteogénico / Mandibular osteogenic sarcoma

El osteosarcoma es una neoplasia maligna, poco frecuente, que se presenta de forma agresiva y sepuede originar en el hueso de la cavidad oral. Se caracteriza por la producción de osteoide tumoral(trabéculas óseas inmaduras) por parte de las células neoplásicas. Estos tumores suelen formarse en la región metafisiaria de los huesos largos de los miembros, en especial en el fémur y en la tibia. Se presenta el caso clínico de un paciente que concurre al servicio de Estomatología de la Escuela deOdontología, de la facultad de Ciencias de la Salud, Universidad Católica de Córdoba; masculino de 26 años de edad de nacionalidad peruana con diagnóstico clínico de osteosarcoma mandibular, el cual fue tratado con hemisección, quimioterapia y radioterapia en la zona mandibular sector posterior de lado izquierdo con colocación de una placa de titanio en la región.

Osteosarcoma is a malignant, rare and aggressive neoplasm that originates in the bone of the oralcavity. It is characterized by the production of tumor osteoid (immature bone trabeculae) by neoplasticcells. These tumors usually originate in metaphyseal region of long limb bones, especially in femurand tibia.Case report: 26-year-old peruvian male patient attending the Stomatology service at the School ofDentistry, Faculty of Health Sciences, Catholic University of Cordoba. The patient was clinically diagnosedwith mandibular osteosarcoma, treated with hemisection, chemotherapy, radiotherapy onmandibular zone posterior sector of left side and fixation of a titanium bone plate.