Chronic nonspecific cheilitis associated with tislelizumab treatment in a patient with a history of tongue squamous cell carcinoma: a case report

BACKGROUND

Chronic nonspecific cheilitis is a complex condition characterized by persistent lip peeling and discomfort. This case report explores the clinical progression of a patient with history of tongue squamous cell carcinoma and subsequent Tislelizumab treatment, presenting with persistent lip peeling.

CASE PRESENTATION

A patient with a history of tongue squamous cell carcinoma (T2N0M0), treated with chemotherapy, surgery, and Tislelizumab, presented with six months of persistent lip peeling. Clinical examination revealed distinct features of chronic nonspecific cheilitis with infectious angular cheilitis (Oral Candidiasis). A tailored treatment plan, emphasizing oral hygiene practices and local treatments with Sodium Bicarbonate, Tacrolimus ointment, and Chlortetracycline ointment. Follow-up visits demonstrated sustained improvement, highlighting the significance of individualized approaches.

CONCLUSIONS

This case underscores the importance of recognizing and managing oral manifestations in patients with a history of cancer and immunotherapy. The patient's response to treatment suggests that a multifaceted approach, combining local therapy with lifestyle modifications, can be effective in managing chronic nonspecific cheilitis associated with immunotherapy. Routine follow-up appointments, guided by personalized medicine principles, contribute to sustained patient well-being.

A Novel Risk Model for Predicting Dysphagia after Tongue Reconstruction: A Retrospective Multicenter Study in Japan

BACKGROUND

There is no consensus on the postoperative outcomes of tongue reconstruction. Therefore, the authors developed a novel risk model for predicting dysphagia after tongue reconstruction.

METHODS

This retrospective study was conducted by the Oral Pharyngeal Esophageal Operation and Reconstruction Analytical, or OPERA, group across 31 cancer centers and university hospitals in Japan. A total of 532 patients [390 (73.3%) men and 142 (26.7%) women; median age at surgery, 60 years (range, 15 to 88 years)] who were diagnosed with oral tongue squamous cell carcinoma and underwent tongue reconstruction following glossectomy between 2009 and 2013 were included. Independent risk factors were identified using univariate regression analysis and converted to a binary format for multivariate analysis. An integer value was assigned to each risk factor to calculate a total score capable of quantifying the risk of feeding tube dependence.

RESULTS

Overall, 54 patients (10.2%) required a feeding tube at the time of evaluation. Predictive factors for feeding tube dependence were advanced age, lower American Society of Anesthesiologists physical status, low body mass index, lower serum albumin, comorbid hypertension and diabetes, extended tongue defect, resection beyond the tongue, laryngeal suspension, postoperative radiation therapy, and no functional teeth. In multivariate logistic regression analysis, age greater than or equal to 58.5 years, postoperative radiation therapy, wider tongue defect, and body mass index less than 21.27 kg/m 2 earned 6, 4, 3, and 2 points, respectively, for a maximum total score of 15.

CONCLUSION

The authors' risk model provides a mathematical tool for estimating the individual risk of postoperative feeding tube dependence before tongue reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Risk, III.

Quality of life in tongue cancer treated patients before and after speech therapy: a randomized clinical trial

Introduction

Tongue cancer is one of the most common subtypes of head and neck cancer. The aggressive effects of treatment cause aesthetic, psychosocial and functional deficits, especially dysphagia, which affects patient quality of life. Rehabilitation, which is essential for functional maximum recovery, helps patients deal with new and altered structures and has a positive impact on quality of life.

Objective

To verify the impact of speech therapy on swallowing quality of life in tongue cancer patients after treatment.

Methods

This parallel randomized clinical trial was conducted at a public hospital in Porto Alegre, RS, Brazil. Before and after the intervention, a quality of life questionnaire (the Deglutition Handicap Index) was employed, dysphagia severity was assessed with fiberoptic endoscopic evaluation of swallowing, and the Functional Oral Intake Scale carried out. The experimental group underwent four-week sessions of speech therapy over one month, while the control group received the institution’s usual follow-up.

Results

Thirty individuals treated for tongue cancer were divided into a study and a control group. Deglutition Handicap Index scores decreased significantly (approximately 40 points) (p < 0.001) after the intervention in the study group. There was a significant correlation between improved quality of life, reduced dysphagia severity and increased in Functional Oral Intake Scale scores (p < 0.001).

Conclusion

After speech therapy, quality of life scores related to deglutition and dysphagia severity improved in patients treated for tongue cancer.

SARS-CoV-2 detection in formalin-fixed paraffin-embedded tissue specimens from surgical resection of tongue squamous cell carcinoma

In the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, pathologists can be exposed to infection handling surgical specimens. Guidelines related to safety procedures in the laboratory have been released. However, there is a lack of studies performed on biopsy and surgical resection specimens. Here we report the detection of SARS-CoV-2 in formalin-fixed paraffin-embedded samples from surgical resection of tongue squamous cell carcinoma of a patient who developed COVID-19 postsurgery. RNA of SARS-CoV-2 strain was detected in the tumour and the normal submandibular gland samples using real-time PCR-based assay. No viral RNA was found in metastatic and reactive lymph nodes. We demonstrated that SARS-CoV-2 RNA can be detected in routine histopathological samples even before COVID-19 disease development. These findings may give important information on the possible sites of infection or virus reservoir, and highlight the necessity of proper handling and fixation before sample processing.

Fu's subcutaneous needling for subcutaneous adhesions and scar hyperplasia in the neck region: A case report

RATIONALE

Lymphadenectomy for tongue cancer in the neck region is often accompanied by local impaired mobility, gland damage, difficult in swallowing, and postoperative complication and seriously affects patients life quality. We reported a case of subcutaneous adhesions and scar hyperplasia in the neck region after lymphadenectomy for tongue lesions accompanied by impaired neck mobility and difficult in swallowing was treated using Fu's subcutaneous needling (FSN) treatment.

PATIENT CONCERNS

A 55-year-old male with tongue cancer received surgical intervention with lymphadenectomy 8 years ago was revealed a 15 cm-long curved surgical incision in the neck region and surrounded by numerous scar tissues.

DIAGNOSIS

Post-operation subcutaneous adhesions and scar hyperplasia in the neck region after lymphadenectomy was diagnosed.

INTERVENTIONS

FSN treatment was performed 2 to 3 times per week for 1 month to sway the affected tightened muscle and dissociate the superficial fascia beneath the scar resulted in a considerable improvement in neck movement.

OUTCOMES

The Vancouver Scar Scale (VSS) was as follows: color (M) - 1; vascular distribution (V) - 0, thickness (H) - 2, and flexibility (P) - 4, with a total of 7 points before FSN treatment. The VSS after 1 month of FSN treatment was as follows: M1, V0, H2, and P2, with a total of 5 points. Neck mobility in different directions, i.e., stretching to the back of the neck and laterally bending the neck to the left and/or right side, was improved (P < .05).

LESSONS

At present, treatment of chronic scar hyperplasia has certain side effects and limitations. FSN is safe and convenient, with minimal destruction of the superficial fascia, having evident effects of dissociating tissue adhesion under scars and compensating for deficiencies in scar hyperplasia treatment. It can provide new ideas for future treatments.

Treatment of syncope in tongue cancer with palliative chemotherapy in the intensive care unit: A case report

RATIONALE

Syncope caused by head and neck cancer (HNC) is rare. However, syncope caused by tongue cancer (TC) is even rarer. In TC, syncope is caused by tumor-mediated compression of the carotid sinus and stimulation of the glossopharyngeal nerve.

PATIENT CONCERNS

In this study, we report the case of a 48-year-old male patient who was diagnosed with advanced TC and bilateral cervical lymph node metastasis. On the third day of admission, the patient experienced recurrent syncope with hypotension and bradycardia.

DIAGNOSES

The patient was diagnosed with a well-differentiated squamous cell carcinoma of the tongue along with massive cervical lymph node metastasis and carotid sinus syndrome.

INTERVENTIONS

Initially, symptomatic treatment of syncope boosted the blood pressure and increased the heart rate. Thereafter, a temporary pacemaker was implanted. Finally, chemotherapy was used to control the tumor and relieve syncope.

OUTCOMES

After chemotherapy, the tongue ulcers and cervical lymph node reduced in size; syncope did not recur.

LESSONS

This case shows that chemotherapy may be a valid treatment option in patients with cancer-related syncope; however, the choice of chemotherapeutic drugs is critical. Intensive care provides life support to patients and creates opportunities for further treatment.

Ulcerated bleeding palisaded encapsulated neuroma of the tongue

INTRODUCTION

Palisaded encapsulated neuroma (PEN) is a benign lesion of Schwann cells and its occurrence in the oral mucosa especially the tongue is very rare.

CASE REPORT

This article describes a case of a 41-year-old male, a chronic smoker with an actively bleeding, ulcerated, solitary, firm lesion on the lateral border of the tongue which had bled thrice before. A differential diagnosis of pyogenic granuloma, haemangioma, fibroma, nerve sheath tumour, salivary gland tumour and malignancy was made and surgically excised. Histopathology of the excised specimen revealed a well-circumscribed lesion with spindle-shaped cells arranged in interlacing fascicles and with the help of immunohistochemical markers confirmed it to be a PEN.

DISCUSSION

To our knowledge, this is the first description of an ulcerated PEN presented with an active bleed.

Coexisting Congenital Subglosso-palatal Membrane and Tongue Dermoid in a Neonate

BACKGROUND

Neonatal respiratory distress due to coexisting subglosso-palatal membrane and tongue dermoid has not been reported yet.

CASE CHARACTERISTICS

A newborn with respiratory distress having a membrane in the oral cavity. Excision of membrane revealed a tongue mass with cleft palate, obstructing the nasopharynx completely. Elective ventilation was followed by excision of mass.

OUTCOME

The child was cured with uneventful course at follow-up of six months.

MESSAGE

Co-existing congenital anomalies causing airway obstruction may be missed in presence of subglosso-palatal membrane.

Cardiac metastasis of tongue squamous cell carcinoma complicated by pulmonary embolism: A case report

RATIONALE

Cardiac metastasis is known as a rare complication of head and neck malignancy.

PATIENT CONCERNS

We present a 58-year-old woman patient with a history of tongue carcinoma who was admitted in emergency department for sudden chest pain. Imaging work-up by computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) diagnosed a cardiac metastasis complicated by intraventricular thrombus and pulmonary embolism.

DIAGNOSIS

Cardiac metastasis from tongue carcinoma complicated by pulmonary embolism.

INTERVENTIONS

After undergoing 2 cycles of palliative chemotherapy, the patient declined any further treatment.

OUTCOMES

Patient died 3 months after the diagnosis of cardiac metastasis.

LESSONS

Cardiac metastasis should be considered as a differential diagnosis in patients with a history of head and neck malignancy who present non-specific cardiac symptoms.

Holt-Oram syndrome: Anesthetic challenges and safe outcome

Holt-Oram syndrome (HOS) is an autosomal dominant disease with skeletal and cardiac manifestations. We here are presenting a 31-year-old man and a diagnosed case of HOS, with an ulceroproliferative lesion on lateral border of the tongue, was posted for wide excision of lesion with primary closure and left side radical neck dissection.

[Anesthetic Management of Cesarean Section in a Pregnant Woman with Advanced Tongue Cancer]

It is very difficult to decide the best time to deliver the baby for a pregnant woman with advanced cancer. We experienced the perioperative and perinatal management of a 39-year-old pregnant woman with advanced tongue cancer. The cancer had already metastasized to the lung and lymph nodes. Furthermore a recurrent thumb-sized tumor was found in her mouth. She had firmly desired to discontinue all anticancer treatment for protecting the fetus. On the other hand, her family could not accept her determination yet. Therefore the medical team was organized with doctors and co-medicals from multiple departments such as gynecology, pediatrics, radiology, oncology, midwife, psychotherapy and anesthesiology. After several conferences including herself and family, finally cesarean section was scheduled for the 30th gestational week. Prepared for unexpected emergency delivery, airway stenosis was ruled out by fiberoptic laryngoscopy and the consent for emergency tracheostomy was obtained. The operation was performed successfully under spinal anesthesia without any severe troubles. Medical care as a team from early phase enabled elaborate observation and preparation through the perioperative and perinatal period. Furthermore, it was efficient to provide satisfaction to the patient and her family as well.

Granular cell (Abrikossoff) tumor in the head and neck: A series of 5 cases

We evaluated a series of 5 patients-3 men and 2 women, aged 39 to 70 years (mean: 54.4)-with a granular cell tumor (GCT) of the head and neck in an effort to better define the clinical presentation, imaging characteristics, and surgical management of this type of tumor. In all cases, the diagnosis was established by pathologic analysis. There were 2 cases of laryngeal GCT and 1 case each of GCT arising in the nostril, hypopharynx, and the tongue base. The clinical findings were variable, depending on the location and extent of each lesion. Four of these patients underwent endoscopic examination, and in 2 cases computed tomography was performed. Treatment included wide surgical excision of the lesion in all cases. Otolaryngologists should be familiar with this unusual tumor. Although an accurate preoperative diagnosis is extremely difficult to make, appropriate therapeutic intervention is associated with a cure rate that is quite high.

Gulossectomy and Skeletal Anchorage as Aajuncts to Orthodontic Correction of a Severe Open Bite Case

Etiology of open bite malocclusion is multifactorial; therefore, elimination of the main etiologic factor is the key for successful treatment. Tongue size and posture can cause open bite; thus, glossectomy is one of the treatment choices in severe cases. A 19 year old girl with a chief complaint of extra-large tongue and anterior open bite due to hemangioma was referred to us. Hemangioma removal and partial glossectomy were performed. With no other intervention, the anterior open bite decreased 10 millimeters within 3 years. Since the patient refused orthognathic surgery, the remaining malocclusion was resolved by orthodontic treatment using skeletal anchorage.

[Dynamics of morbidity of patients with malignant tumors of the tongue with regard to the stage of disease and histological structure of tumors (population-based study)]

INTRODUCTION

Malignant tumors of the tongue (C-01. 02) are relatively rare visual tumor sites. Incidence rate in men is usually 4-5 times higher than in women. To estimate a complex of analytical rates with respect to malignant tumors of the tongue (morphological level of verification, the distribution of patients by the stage of disease, to evaluate one-year and relative survival, etc. ) in accordance with the state report (F. №35) is impossible since malignant tumors of the tongue are not considered separately. Such research can be performed only on the basis of data of the population-based cancer registry.

PURPOSE OF THE STUDY

To study the prevalence, the detailed structure of morbidity, to estimate a number of analytical rates characterizing malignant tumors of the tongue.

MATERIALS AND METHODS

On the basis of materials of the International Agency for Research on Cancer (IARC), Statistical Handbooks of the P. A. Herzen Moscow Research Oncological Institute and database of the Population-based Cancer Registry of St. Petersburg there were studied all the aspects put in the purpose of the study, using a range of instructional techniques recommended by the International Association of Cancer Registries, which member we are at number 221.

RESULTS

This study showed that from 1970 to 2005 in various countries of the world the incidence rate (standardized rate the world standard) of malignant tumors of the tongue increased a little or maintained its level. In Russia it is possible to carry out such assessment only from 1989 to 2013. During this period the incidence rate of malignant tumors of the tongue has increased from 2,20/0000 till 2,30/0000 in men, and from 0,40/0000 and 0 ,50/0000 in women. In St. Petersburg-Leningrad since 1980 standardized rate of malignant tumors of the tongue has increased from 2,1 till 3,5 0/0000 in men or by 66. 6% and from 0,5 till 1,50/0000 in women three times more. Positive dynamics of survival rates of patients with malignant tumors of the tongue but a significant backlog from the European average retains.

An unusual presentation of a lingual dermoid cyst

Dermoid cysts are rare lesions of the head and neck that usually present in children as an asymptomatic, slowly growing mass. We report a case that demonstrates that dermoid cysts can present later in life as a recurrent acute infection. Our patient was a 48-year-old man with a 22-year history of recurrent abscesses of the tongue and floor of the mouth that had required a tracheotomy and multiple hospitalizations. Magnetic resonance imaging performed between acute episodes revealed the presence of a 1.8-cm lesion within the tongue musculature. The patient underwent resection, and pathology was consistent with a lingual dermoid cyst. At 2 years of follow-up, he experienced no recurrence of symptoms.

Co-existence of Carcinoma Tongue with Pulmonary Tuberculosis

We present the case of a 45-year-old male diagnosed to have carcinoma base of tongue, whose chest radiograph showed bilateral lung infiltrates and was referred for evaluation of suspected pulmonary metastases. Diagnostic evaluation confirmed the diagnosis of smear-positive pulmonary tuberculosis.

Lymphangiomatous macroglossia associated with extensive cervicomediastinal cystic hygromas

Children with lymphangiomatous macroglossia often have difficulty eating and talking, and their airways may be compromised because of bleeding and infection, especially when extensive cervicomediastinal cystic hygromas are present. We report a case of lymphangiomatous macroglossia associated with extensive cystic hygromas in the cervicomediastinal region. The 3-year-old girl was treated with anterior wedge reduction of the tongue, needle aspiration of the cervicomediastinal cystic hygromas, and systemic steroids and antibiotics. The extensive cystic cervicomediastinal hygromas spontaneously regressed, and further surgery was not needed until 4 years later. Surprisingly, subtotal or partial lymphatic malformation removal improved the complicated lymphatic malformation.