Cases reported "Mouth Neoplasms"

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21/96. Indications for vascularized free rectus abdominis musculocutaneous flap in oromandibular region in terms of efficiency of anterior rectus sheath.

    The anterior rectus sheath, efficacious in reconstructive surgery, is used in oromandibular reconstruction with the free rectus abdominis musculocutaneous flap. This study describes reconstruction with this sheath in 20 patients: to preserve only the swallowing function in 10 patients (formation of the bulge of the reconstructed oral floor and prevention of its sinking); to preserve both swallowing and articulation in 5 patients (formation of the bulge of the reconstructed tongue and prevention of its sinking, concurrent with a money-pouch-like reconstruction of the tongue, laryngeal suspension, and neuroanastomosis); and to prevent exposure of the reconstruction plate, replacing the resected mandibular continuity in 5 patients. The purpose of reconstruction was achieved in all patients. The vascularized free rectus abdominis musculocutaneous flap with a firm anterior rectus sheath may be the first choice for these types of reconstruction.
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22/96. Upregulation of cystatin m during the progression of oropharyngeal squamous cell carcinoma from primary tumor to metastasis.

    To identify metastasis-associated molecules in oropharyngeal squamous cell carcinomas (OSCC), we recently compared mRNA expression profiles of cell lines derived from primary and metastatic lesions of OSCC using microarray technology. cystatin m, an endogenous cathepsin b inhibitor, was expressed 40-fold higher in the metastatic versus the primary tumor cell line. To show that different cystatin expression levels affect the cell lines' sensitivities to TNF-induced apoptosis by differentially regulating cathepsin b activity. The 686Tu and 686Ln cell lines were established from a 49-year-old male patient with an OSCC involving the posterior tongue and oro-pharynx (tumor stage T(3)N(3B)). RT-PCR, Western blots, immunohistochemistry, and in situ hybridization all confirmed increased cystatin m expression in 686Ln compared to 686Tu cells, and in the parent archival tumors. TNF-alpha induced apoptosis was easily detected in 686Tu, but only marginally in 686Ln cells. Thus, we propose that elevated cystatin m expression aids metastasis by blocking intrinsic cathepsin b activity and rescuing tumor cells from TNF-induced apoptosis.
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23/96. A novel mutation in the keratin 4 gene causing white sponge naevus.

    BACKGROUND: White sponge naevus (WSN) is a rare, autosomal dominant disorder that predominantly affects noncornified stratified squamous epithelia, most commonly the buccal mucosa. Clinically, WSN manifests as thickened spongy mucosa with a white opalescent tint in the mouth and may be confused with other disorders that cause white lesions on oral mucosa. Recent studies have identified pathogenic mutations in KRT4 and KRT13, the genes encoding mucosa-specific keratins, in WSN. OBJECTIVES: To search for possible mutations in KRT4 and KRT13. methods: We report a case of WSN in a young man who presented with diffuse irregular whitish plaques involving the buccal and gingival mucosae and the tongue. Results Pathologically, the affected mucosa showed epithelial thickening, parakeratosis and extensive vacuolization of the suprabasal keratinocytes. mutation analysis revealed a heterozygous missense mutation 1345G-->A in KRT4, predicting an amino acid change, E449K, in the 2B domain of the K4 polypeptide. CONCLUSIONS: We report the first mutation analysis of a Taiwanese patient with WSN. Potentially this novel mutation could disrupt the stability of keratin filaments and result in WSN.
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24/96. Basaloid squamous carcinoma of the buccal cavity.

    Basaloid-squamous carcinoma was first recognized as a separate pathologic entity in 1986. It has been described in the hypopharynx, larynx, base of tongue, and nasal cavity. We report the first case of this rare tumor occurring in the buccal cavity and review the atypical squamous cell carcinomas that occurred in these sites.
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25/96. Application of a mandibular nerve block using an indwelling catheter for intractable cancer pain.

    We report a case in which a mandibular nerve block using an indwelling catheter was employed for pain management in a terminal case of orofacial cancer. The patient was a 74-year-old female weighing 27 kg. She had a 27-month history of mouth floor and tongue cancer. The cancer recurred and spread to bilateral face and neck. The severest pain mainly originated from the right mandibular region. Two steps of pain relief were performed for the patient. First, pain control using 1% lidocaine or 0.25% bupivacaine administered intermittently or continuously through an indwelling catheter in the mandibular nerve was performed for 1 week to estimate the amount of pain relief thereby obtained. Second, a neurolytic block was applied to the mandibular nerve through the catheter. After the neurolytic block, the total dosage of morphine and diclofenac remained unchanged for 2 months. We conclude from the present case that this technique is an excellent means of obtaining long-term pain control in patients with intractable orofacial cancer pain.
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26/96. Transformation of proliferative verrucous leukoplakia to oral carcinoma: a ten years follow-up.

    The authors present a case of proliferative verrucous leukoplakia (PVL) in a 78-year-old man. It was initially presented as leukoplakia on the tongue but a microscopic investigation in 1991 revealed it to be a mild epithelial dysplasia. After 5 years of follow-up, the lesion presented changes in size and location, and a recidivant behavior. In 1996, a red granular and indurated area that appeared on the tongue was found to be a microinvasive squamous cell carcinoma when microscopically investigated. After a review of the clinicopathologic behavior of this entity, the authors concluded that it was a typical PVL, whose diagnosis is difficult and retrospective, as indicated by others. The authors emphasize the importance of periodic detailed clinical and histological examination of this type of lesions in order to detect early signs of malignancy.
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27/96. Oral solid form of primary effusion lymphoma mimicking plasmablastic lymphoma.

    Primary effusion lymphoma (PEL) is a rare large cell lymphoma subtype that usually is associated with human immunodeficiency virus infection. Features facilitating PEL identification are its clinical presentation, cytologic findings, immunophenotypic profile, and particularly, relation to human herpesvirus 8 (HHV8) infection. Uncommonly, PEL may present as a solid form that predominantly involves the distal digestive tract and poses major diagnostic problems, especially when unassociated with body cavity effusions. We herein report the case of an hiv-positive 42-year-old male with synchronous presentation of a pleural cavity PEL and a tongue-based lesion, both displaying plasmablastic features. Demonstration of HHV8 presence in the lingual lesion excluded a plasmablastic lymphoma and established the diagnosis of an oral solid form of PEL. This case illustrates the need for investigating HHV8 in any plasmablastic-looking lymphoma, especially in hiv-infected patients.
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28/96. Malignant fibrous histiocytoma of the head and neck after radiation for squamous cell carcinoma.

    A 60-year-old man presented with malignant fibrous histiocytoma of the oropharynx. The mass extended into the nasopharynx and larynx and caused severe upper airway obstruction that required emergency tracheotomy. Ten years earlier, he had undergone a right partial glossectomy and segmental mandibulectomy for squamous cell carcinoma of the right tongue base,followed by 50 Gy of radiation delivered over 33 sessions. The tumor was so aggressive that changes in its volume were visually distinguishable during physical examination over a 2-week hospital stay. Histologic evaluation revealed 7 mitotic figures per high-power field. Although radiation-induced malignant fibrous histiocytoma is rare in the head and neck, the recent medical literature indicates that its incidence is rising. This rise has been attributed to the increased effectiveness of head and neck cancer therapy, which results in prolonging patients' survival and, hence, their risk of subsequent disease. Because malignant fibrous histiocytoma is a late complication of radiation therapy, appearing on average 10 years following treatment, it is important that physicians who treat head and neck cancer monitor these patients over the long term and remain alert for its appearance, even despite the apparent "cure" of their original neoplasm.
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29/96. Oral mucosal melanoma: a series of case reports.

    INTRODUCTION: Due to the rarity of oral malignant melanomas case reports are a necessary source of information. Ten new cases are reported with a minimum follow-up of 3 years. patients AND methods: patients were treated during a period of 10 years. Clinical, demographic and pathologic findings were examined. RESULTS: In 6 males (60%) and 4 females with a mean age of 64.3 years the tumour locations were: hard palate-maxillary gingiva (3 cases), maxillary gingiva (2), lower gingiva (2), tongue (2), hard/soft palate-buccal mucosa (1). Pre-existing melanotic pigmentation had been present in 4 patients. Four patients were in stage I, 5 in stage II, and 1 in stage III. Surgical excision was the primary treatment in 9 cases. Five patients underwent simultaneous neck dissections. All patients received radiation and multimode adjuvant therapies. After a 3-year follow-up 3 patients are still alive (50% (2/4) of those presenting in stage I and 20% (1/5) in stage II). CONCLUSIONS: Due to the rarity of oral melanoma, individual experience is limited. The poor prognosis and the different treatments reflect this situation.
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30/96. Primary malignant melanoma of oral cavity.

    Primary oral malignant melanomas (POMM) are very rare. Definitive identification is usually possible only after they develop metastases. So every new case is instructive. P.P., a 76-year-old woman presented with a painless exophytic mass (measuring 3 x 3.5 cm) on a pedicle in the right alveolar crest of the upper jaw (teeth 6, 7 and 8) and the palate. The mass was dark red with lobate and ulcerated surface and dense and elastic consistency. Electroresection was performed until healthy tissue was reached. One year later there were enlarged lymph nodes submandibularly on the right: a metastasis arising from an achromatic melanoma of the upper jaw. Fontana-Masson staining, expression of S-100 protein in the melanocytes. The patient was in good condition two years after the administered telegamma and immunotherapy. POMM affects mainly men at advanced age. It is four times as frequent in the upper jaw and palate as it is on the surfaces. The tongue is not affected by POMM but is targeted by the melanoma metastases. Only one third of all cases of POMM are pigmented. They arise on the basis of premelanotic changes. Every equivocal pigmented lesion in the oral cavity should be obligatorily subjected to biopsy. Primary lymph dissection is not used routinely. The therapy of choice is a radical resection combined with chemical, radio and immunotherapy. prognosis remains grave in spite of treatment.
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