Nevoid basal cell carcinoma syndrome and fetal rhabdomyoma: a case study

Fetal rhabdomyoma is not generally considered part of nevoid basal cell carcinoma syndrome. However, a review of the literature revealed five patients with this syndrome who also had fetal rhabdomyomas in various locations. We report the first patient with nevoid basal cell carcinoma syndrome and a fetal rhabdomyoma of the tongue. We recommend that embryonal rhabdomyosarcoma be ruled out to avoid overly aggressive treatment of these patients.

A patient with Rothmund–Thomson syndrome and tongue cancer — experience of radiation toxicity

We describe a male patient with Rothmund-Thomson syndrome (RTS) given postoperative radiotherapy for squamous carcinoma of the tongue. This was well tolerated. This is only the second reported case of oral cancer and radiotherapy in RTS.

Pulmonary Langerhans cell histiocytosis associated with lingual carcinoma

A 57-year-old man who was a heavy smoker was admitted to our hospital for further evaluation of abnormal shadows on a chest X-ray film. Chest radiography and a computed tomography (CT) scan revealed nodular lesions and multiple thin-walled cysts in both lungs. Histopathological examination of one of these cystic lesions showed that the predominant cellular population was Langerhans cells, with the cytoplasm testing positive for S-100 protein and the cell membrane showing a positive reaction for CD1a. The pathological diagnosis was pulmonary Langerhans cell histiocytosis (LCH). A lingual carcinoma that had been detected simultaneously was treated with neoadjuvant therapy and the patient was advised to stop smoking. However, only limited improvement was seen on follow-up chest CT. In view of this, a radical resection of the lingual carcinoma was performed. There was a subsequent dramatic improvement in the pulmonary LCH. Langerhans cells may play a role in the immune response to tumors. In this patient, we suggest the possibility that both the habitual smoking and the lingual carcinoma may have contributed to the development of pulmonary LCH.

Kaposi's sarcoma of the tongue associated with median rhomboid glossitis in a non-AIDS patient. A case report

Kaposi's sarcoma (KS) of the tongue is extremely rare in immunocompetent patients. We report a case of KS of the tongue associated with a median rhomboid glossitis. The main clinical, pathological and immunohistochemical features allowed the differential diagnosis.

Primary B-cell lymphoma of the tongue in a patient with systemic sclerosis

We report a patient with systemic sclerosis who had the unusual development of a large-cell B-cell lymphoma of the base of his tongue. Patients with systemic sclerosis display an increased incidence of malignant neoplasms, particularly, breast and lung carcinomas [Arthritis. Rheum. 36 (1993) 460; Ann. Rheum. Dis. 52 (1993) 531]. The description of this case adds further evidence to the possible interrelationship of systemic sclerosis and the development of malignant neoplasms. A careful review of the English medical literature disclosed that B-cell lymphoma of the tongue in a patient with systemic sclerosis is an association which has not been described previously.

Lingual tumors in infants: a case report and review of the literature

Tumors of the tongue and the base of mouth are seen rarely in children. The incidence of the ones that are large enough to fill the oral cavity is especially low. If not recognized and treated, tongue tumors may obstruct the upper aero-digestive tract and be fatal. A case of a huge lingual cystic tumor mimicking ranula, and obstructing the upper aero-digestive tract, which was diagnosed antenatal and treated during and after the delivery, is presented together with a review of the literature.

Six cases of children with a benign cervical tumor who required tracheostomy

Cervical tumors sometimes cause airway obstruction. We have treated six children with benign cervical tumors who required tracheostomy. Two cervical and one glossal lymphangiomata treated with local injection of OK432 after creating a tracheostomy were successfully decannulated after the treatment. One patient with a giant cervical lymphangioma needed an EXIT (ex utero intrapartum treatment) procedure. He underwent tracheostomy at 10 months of age after long-term endotracheal intubation, but he died of sepsis and hypoxic brain damage at 18 months. One patient with a subglottic hemangioma treated with steroids finally achieved closure of the tracheostomy at 2 years of age. A 7-year-old girl with a tracheal schwannoma underwent tracheostomy performed a week after admission, but she already had hypoxic brain damage resulting from problems with intubation. Most patients with a lymphangioma or hemangioma in the cervical region have required early tracheostomy before commencing treatment with OK-432 or steroids. If there is any sign of possible airway compromise, then it is vital to perform an early tracheostomy, even for benign tumors.

[Role of ligation of the external carotid artery in the treatment of malignant tumors of the tongue]

This paper presents analysis of the efficiency of ligation of the external carotid arteries in the treatment of malignant tumors of the tongue, based on the data of Department of Head and Neck Diseases of Tver Regional Clinical Oncological Center for two recent decades. A total of 87 case histories of patients in whom 26 ligations of the external carotid artery were performed, are analyzed. This operation is used if the tumor is located in the posterior third and root of the tongue and if it involves the tissues of the bottom of the oral cavity. If the tumor was located in the two anterior thirds of the tongue or a small tumor is located at the root of the tongue, this intervention was not used. It is indicated for decreasing the hemorrhage during surgery for malignant tumors of the tongue and for preventing postoperative hemorrhages, hemorrhages from degrading tumor in inoperable patients, in patients with threatened hemorrhage before radiotherapy, and during bleeding.

Fanconi's anemia and clinical radiosensitivity report on two adult patients with locally advanced solid tumors treated by radiotherapy

BACKGROUND

Patients with Fanconi's anemia (FA) may exhibit an increased clinical radiosensitivity of various degree, although detailed clinical data are scarce. We report on two cases to underline the possible challenges in the radiotherapy of FA patients.

CASE REPORT AND RESULTS

Two 24- and 32-year-old male patients with FA were treated by definitive radiotherapy for locally advanced squamous cell head and neck cancers. In the first patient, long-term tumor control could be achieved after delivery of 67 Gy with a-in part-hyperfractionated split-course treatment regimen and, concurrently, one course of carboplatin followed by salvage neck dissection. Acute toxicity was marked, but no severe treatment-related late effects occurred. 5 years later, additional radiotherapy was administered due to a second (squamous cell carcinoma of the anus) and third (squamous cell carcinoma of the head and neck) primary, which the patient succumbed to. By contrast, the second patient experienced fatal acute hematologic toxicity after delivery of only 8 Gy of hyperfractionated radiotherapy. While the diagnosis FA could be based on flow cytometric analysis of a lymphocyte culture in the second patient, the diagnosis in the first patient had to be confirmed by hypersensitivity to mitomycin of a fibroblast cell line due to complete somatic lymphohematopoietic mosaicism. In this patient, phenotype complementation and molecular genetic analysis revealed a pathogenic mutation in the FANCA gene. The first patient has not been considered to have FA until he presented with his second tumor.

CONCLUSION

FA has to be considered in patients presenting at young age with squamous cell carcinoma of the head and neck or anus. The diagnosis FA is of immediate importance for guiding the optimal choice of treatment. Radiotherapy or even radiochemotherapy seems to be feasible and effective in individual cases.

Topical ketamine in the treatment of mucositis pain

Ketamine oral rinse provided effective palliation of intractable mucositis pain in a 32-year-old woman with squamous carcinoma of the tongue undergoing radiation therapy. Pain at rest and with eating decreased with ketamine, allowing for a tapering of her opiate dose. No side effects of ketamine were reported. Treatment benefits most likely arose from the inhibition by ketamine of peripheral N-methyl D-aspartate receptors, though other mechanisms of action may have been contributory. Further evaluation of topical ketamine in the treatment of mucositis-related pain, and, potentially, other causes of inflammatory oral pain, are warranted.

Macroglossia combined with lymphangioma: a case report

A four year old white female with a clinical presentation of macroglossia is described. Speech disturbances and occasional episodes of traumatic injury to the tongue with severe bleeding brought the patient to seek dental care. Lymphangioma was diagnosed after incisional biopsy. The differential diagnosis of tongue enlargement in children is discussed including review of the literature relevant to the diagnosis and treatment of lymphangioma.

Voice quality after laser surgery or radiotherapy for T1a glottic carcinoma

OBJECTIVE

To compare the effect on phonation of radiotherapy and endoscopic laser surgery for stage T1a glottic squamous cell carcinoma.

STUDY DESIGN

Retrospective.

METHODS

Patients treated for stage T1a glottic carcinoma from August 1994 to March 2000 and who had been followed for at least 1 year were candidates. Eight patients who underwent radiotherapy and 22 who underwent laser surgery were enrolled. Indirect laryngoscopy and stroboscopic examination were performed, and voice quality was analyzed using standard parameters.

RESULTS

Maximum phonation time, average airflow rate, sound pressure level, and average fundamental frequency during unconditional phonation were similar after laser surgery and radiotherapy. However, compared with normal men who were 50 years of age or older, the average fundamental frequency was higher after laser surgery.

CONCLUSIONS

Contrary to some reports, the voice quality is minimally affected by laser surgery for T1a glottic carcinoma, and outcome is similar to radiotherapy. The average fundamental frequency is higher than normal after laser surgery, but the effect on the quality of life was trivial.

Obstructive sleep apnea in head and neck cancer patients post treatment ... something to consider?

Obstructive sleep apnea (OSA) occurs due to enlarged tissue such as tonsils, base of tongue or palate, pharyngeal space narrowing, or decreased muscle tone of the pharyngeal dilator muscles. Treatments for head and neck cancer may cause physical changes resulting in OSA. Based on recent anecdotal experience and limited research available looking at the incidence of OSA in post treatment head and neck cancer patients, assessment for signs and symptoms of OSA by otorhinolaryngology nurses seems warranted. Prompt diagnosis and treatment of OSA in the patient with head and neck cancer may significantly improve the person's health and quality of life.

Prosthetic management of a total glossectomy defect after free flap reconstruction in an edentulous patient: a clinical report

Total glossectomy with surgical reconstruction can result in a significantly altered mandibular arch anatomy. In edentulous patients, lingual vestibules along with the mandibular alveolar ridge can be obliterated. With the absence of lower anterior dentition, support of the lower lip is lost and traction from surgical closure can cause the lower lip to collapse into the oral cavity. This report describes the prosthetic treatment of an edentulous total glossectomy patient with an unconventional custom impression procedure to develop and record proper lower lip and cheek support. It also discusses some issues involved in the prosthetic management of the total glossectomy patient.

[Verrucous carcinoma of the tongue occurring on lesions of lichen planus]

BACKGROUND

Verrucous carcinoma of the oral cavity is a rare entity that was formerly controversial. Etiopathogenesis remains unclear, notably as for its possible association with lichen planus. We report a case of verrucous carcinoma occurring in lesions of lichen planus of the tongue.

CASE REPORT

A 78-year old, non smoking patient, with past history of cutaneous lichen planus presented for lesions of oral lichen planus affecting both the tongue and the palate. A treatment by topical tretinoin improved him in a spectacular way and brought about a remission which lasted 5 years. A recurrence occurred when the treatment was stopped; new whitish, warty cauliflower-like lesions appeared on the tongue. A biopsy confirmed the clinical suspicion of verrucous carcinoma. A laser resection was performed. Three months later, another recurrence was observed. A chemotherapy associating isotretinoin and methotrexate eliminated all lesions. The patient's condition is considered stable, under treatment, one year later.

DISCUSSION

Verrucous carcinoma is a rare slow-growing oral tumor that is chiefly exophytic and does not metastasize, but it can invade and destroy oral tissues. Its clinical presentation contrasts with benign histologic features: papillomatosis, acanthosis, dysplasia in variable degrees. The occurrence on lesions of lichen planus, although "classic", is very rarely found in the literature. The treatment is not well codified. An additional chemotherapy seems necessary to prevent recurrences.

A giant teratoma of the tongue

Teratoma of the tongue is an extremely rare tumour of the oral cavity, which is composed of ectoderm, mesoderm and endoderm with differentiation to identifiable tissues and organs. We described a female neonate with a giant teratoma of the tongue and an incomplete cleft palate. The tumour was attached to 1/3 right anterior of her tongue and its largest diameter was 13 cm. Histopathologically, it consisted of stratified squamous epithelium on the surface, and ciliated prismatic epithelium, cartilage and neuroglial tissue. Two years after excision there was no sign of recurrence.

Pharyngoesophageal pressure in patients with swallowing disorders

We developed and tested a pressure transducer to correctly determine swallowing pressure at different sites in the pharynx. In normal individuals three pressure peaks were obtained in the mesopharynx, hypopharynx and cervical esophagus, respectively. A patient with central dysphagia demonstrated markedly low mesopharyngeal and hypopharyngeal swallowing pressure. One tongue cancer patient who had undergone right hemiglossectomy, including partial resection of the root of the tongue and bilateral superior neck dissection, had markedly low swallowing pressure in the mesopharynx and vallecula area. Another supraglottic cancer patient treated by supraglottic horizontal partial laryngectomy showed extremely low swallowing pressure in the supraglottic area. Based on our findings, we suggest that measurements using a pressure transducer such as the one described here should be used in combination with radiographic study to diagnose swallowing anomalies correctly. Data obtained with the pressure transducer will allow the clinician to identify the site responsible for postoperative dysphagia as well as its severity, and facilitate planning of reconstructive surgery when required.

Cranial nerve XII: the hypoglossal nerve

The hypoglossal nerve, cranial nerve XII, is the motor supply of the tongue. An understanding of the intracranial and extracranial components is fundamental in the evaluation of hypoglossal pathology. The following discussion of the evaluation of the hypoglossal nerve will involve the embryology, anatomy, clinical basis, and imaging techniques with pathologic correlations.

[Arterial chemoembolization in the combined treatment of malignant tumors of the tongue and maxilla: preliminary results]

The authors made a clinical evaluation of the efficiency of regional bolus chemotherapy and embolization as a stage of combined therapy in patients with inoperable cancer of the tongue and maxilla complicated by bleeding episodes. Carotid angiography by attempting to make chemoembolization was performed in 15 patients. The procedure could not be done in full in 2 (13%) patients due to transient vascular and neurological disorders. The remaining 13 (87%) patients had successful chemoembolization of tumor-supplying arteries with 5-fluorouracil (700 mg/m2) and methotrexate (40 mg/m2) in combination with finely cut hemostatic sponge and fragments of metallic spirals (n = 12) or regional bolus injection of a cytostatic (n = 1) without arterial occlusion. After embolization, bleeding episodes ceased in all the patients. Full (n = 1) and partial (n = 6) responses to treatment or stabilization of the process (n = 5) were noted in 12 (92%) cases, progression was only in 1 (8%) case. The study suggests that chemoembolization of the branches of the external carotid artery in patients with cancer of the tongue and maxilla contributes to the arrest of chronic tumorous bleeding and to the reduction in the risk for acute A combination of systemic multidrug therapy, radiation therapy, and chemoembolization stabilizes a tumorous process in most patients.