1
|
Watanabe M, Arakawa M, Ishikawa S, Yusa K, Hemmi T, Okuyama N, Kasuya S, Sasahara N, Suzuki N, Sekiguchi M, Maehara K, Iino M. Factors influencing delayed referral of oral cancer patients from family dentists to the core hospital. J Dent Sci 2024; 19:118-123. [PMID: 38303788 PMCID: PMC10829543 DOI: 10.1016/j.jds.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/16/2023] [Indexed: 02/03/2024] Open
Abstract
Background/purpose Most oral cancer (OC) cases are identified by family dentists in Japan. However, a significant number of patients with OC in Japan are referred to core hospitals at advanced stages. Therefore, identifying the factors that contribute to delayed referrals from family dentists to core hospitals is crucial for detecting OC in its earlier stages. The aim of this retrospective study was to identify the risk factors for referral delays from family dentists to core hospitals. Materials and methods The study included 63 patients with OC who were referred by family dentists to the Yamagata University Hospital between 2010 and 2022. The clinical parameters related to referral delays were retrospectively investigated using letters of reference provided by the family dentists and patient charts. Backward multiple regression analysis was performed to identify the relationships between the length of referral delay and potential risk factors. Additionally, backward multivariate logistic regression analysis was performed to examine the independent association between referral delays of >4 weeks and several clinical parameters. Results Multiple regression analysis revealed that misdiagnosis of malignant lesions by family dentists (P = 0.047) was significantly associated with longer referral delays. Additionally, misdiagnosis of malignant lesions by family dentists was also an independent risk factor for referral delays of >4 weeks (odds ratio, 10.387; P = 0.006). Conclusion Misdiagnosis of malignant lesions by family dentists was a significant risk factor for referral delays from family dentists to core hospitals. Our results will motivate family dentists to improve their ability to diagnose OC.
Collapse
Affiliation(s)
| | - Mariko Arakawa
- Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Shigeo Ishikawa
- Department of Dentistry, Oral and Maxillofacial Plastic and Reconstructive Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Kazuyuki Yusa
- Department of Dentistry, Oral and Maxillofacial Plastic and Reconstructive Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Tomoharu Hemmi
- Department of Dentistry, Oral and Maxillofacial Plastic and Reconstructive Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Naoki Okuyama
- Department of Dentistry, Oral and Maxillofacial Plastic and Reconstructive Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Satoshi Kasuya
- Department of Dentistry, Oral and Maxillofacial Plastic and Reconstructive Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Nobuyuki Sasahara
- Department of Dentistry, Oral and Maxillofacial Plastic and Reconstructive Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Nagiko Suzuki
- Department of Dentistry, Oral and Maxillofacial Plastic and Reconstructive Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Manato Sekiguchi
- Department of Dentistry, Oral and Maxillofacial Plastic and Reconstructive Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Kaori Maehara
- Department of Dentistry, Oral and Maxillofacial Plastic and Reconstructive Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Mitsuyoshi Iino
- Department of Dentistry, Oral and Maxillofacial Plastic and Reconstructive Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| |
Collapse
|
2
|
Arzoun H, Srinivasan M, Thangaraj SR, Thomas SS, Mohammed L. The Progression of Chronic Myeloid Leukemia to Myeloid Sarcoma: A Systematic Review. Cureus 2022; 14:e21077. [PMID: 35036234 PMCID: PMC8752390 DOI: 10.7759/cureus.21077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/08/2022] [Indexed: 11/28/2022] Open
Abstract
Chronic myeloid leukemia (CML) is a slow-growing type of cancer that originates in the blood-forming cells of the bone marrow and is caused by a chromosomal mutation that is thought to occur spontaneously. CML could potentially lead to the development of myeloid sarcoma (MS), which is a rare neoplasm composed of immature myeloid cells that could evolve into a tumor mass at any anatomical site other than the bone marrow. MS can develop spontaneously or as a result of another form of myeloid neoplasm. Most instances of CML precede blast phase (BP) within two to three years after the first diagnosis of CML chronic phase (CP) at the age of pre-tyrosine kinase inhibitor (TKI) treatment. MS developing in CML patients during the era of TKI treatment is infrequently mentioned in the literature, primarily in single-case studies. As a result, the prognostic influence of MS in CML patients has not been well investigated. In the age of TKI treatment, it is uncertain whether MS and medullary BP have comparable clinical and prognostic relevance. The precise diagnosis of MS is critical for effective treatment, which is frequently delayed due to a high risk of misdiagnosis. This review focuses on the relationship between the development of MS from CML, and it culminates with recommendations for future hematology practice. A literature search was conducted in multiple databases, and the studies were appraised based on the inclusion and exclusion criteria. Finally, studies to date have shown that the existence of CML and its possible progression to MS in individuals map out the numerous implications this disease has in hematology practice. Though occurrences are uncommon in general, the prognosis for patients is bleak, necessitating the exploration and implementation of diagnostic and therapy advancements. Because there is limited evidence in the literature on its existence in the medullary chronic phase and outcomes in the era of TKI, it must be carefully investigated because it might be the first symptom of progressive illness prior to hematological progression.
Collapse
Affiliation(s)
- Hadia Arzoun
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mirra Srinivasan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Santhosh Raja Thangaraj
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Siji S Thomas
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Lubna Mohammed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| |
Collapse
|
3
|
Wang D, He K, Sroussi H, Treister N, Luskin M, Villa A, Woo SB, Shazib MA. Oral myeloid sarcoma as an uncommon manifestation of acute myeloid leukemia: A case series and review of the literature. J Am Dent Assoc 2021; 152:393-400.e8. [PMID: 33926625 DOI: 10.1016/j.adaj.2021.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/13/2020] [Accepted: 01/31/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OVERVIEW Oral myeloid sarcoma (MS) is an extramedullary tumor that can occur in the setting of acute myeloid leukemia, either as the first sign of an underlying disease or later in the course of disease. The authors' aim was to present the clinical features of oral MS and review the literature. CASE DESCRIPTION Case 1 was an 82-year-old woman with an asymptomatic erythematous swelling on the maxillary gingiva and no history of hematologic malignancy. Case 2, a 65-year-old man, and case 3, a 58-year-old woman, each had a history of acute myeloid leukemia and a painful ulcer on the palatal mucosa and an asymptomatic ulcer on the lower lip mucosa, respectively. Case 1 was treated with focal radiation then chemotherapy and achieved complete remission initially, but died of relapse 2 years after diagnosis. Case 2 received radiotherapy and immunotherapy and had a complete response. Case 3 received chemotherapy and achieved remission initially, but relapsed and is undergoing investigational targeted therapies. CONCLUSIONS AND PRACTICAL IMPLICATIONS Oral MS can manifest as gingival or mucosal swelling or ulceration and can indicate onset or relapse of associated hematologic malignancies, which often have a poor prognosis. Because patients with oral findings are likely to seek treatment from their dentists first, oral clinicians should maintain a broad differential diagnosis list when evaluating oral lesions, especially if treatment prescribed for a more common diagnosis fails to resolve the lesion.
Collapse
|
4
|
Cammarata-Scalisi F, Girardi K, Strocchio L, Merli P, Bernardin AG, Galeotti A, Magliarditi F, Inserra A, Callea M. Oral Manifestations and Complications in Childhood Acute Myeloid Leukemia. Cancers (Basel) 2020; 12:cancers12061634. [PMID: 32575613 PMCID: PMC7352340 DOI: 10.3390/cancers12061634] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 12/18/2022] Open
Abstract
Acute myeloid leukemia (AML) is a heterogeneous group of diseases, whose classification is based on lineage-commitment and genetics. Although rare in childhood, it is the most common type of acute leukemia in adults, accounting for 80% of all cases in this age group. The prognosis of this disease remains poor (especially in childhood, as compared to acute lymphoblastic leukemia); however, overall survival has significantly improved over the past 30 years. The health of the oral cavity is a remarkable reflection of the systemic status of an individual. Identification of the signs and symptoms of oral lesions can act as a warning sign of hidden and serious systemic involvement. Moreover, they may be the presenting feature of acute leukemia and provide important diagnostic indicators. Primary oral alterations are identified in up to 90% of cases of acute myeloid leukemia and consist of petechiae, spontaneous bleeding, mucosal ulceration, gingival enlargement with or without necrosis, infections, hemorrhagic bullae on the tongue, and cracked lips. Poor oral hygiene is a well-known risk factor for local and systemic infectious complications. Oro-dental complications due to AML treatment can affect the teeth, oral mucosa, soft and bone tissue, and contribute to opportunistic infections, dental decay, and enamel discoloration. The treatment of acute myeloid leukemia is still associated with high mortality and morbidity. The management is multimodal, involving aggressive multidrug chemotherapy and, in most cases, allogenic bone marrow transplantation. Periodontal and dental treatment for patients with leukemia should always be planned and concerted with hematologists.
Collapse
Affiliation(s)
- Francisco Cammarata-Scalisi
- Pediatrics Service, Regional Hospital of Antofagasta, Antofagasta 12440, Chile
- Correspondence: (F.C.-S.); (M.C.)
| | - Katia Girardi
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (K.G.); (L.S.); (P.M.)
| | - Luisa Strocchio
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (K.G.); (L.S.); (P.M.)
| | - Pietro Merli
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (K.G.); (L.S.); (P.M.)
| | | | - Angela Galeotti
- Unit of Dentistry, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (A.G.B.); (A.G.); (F.M.)
| | - Fabio Magliarditi
- Unit of Dentistry, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (A.G.B.); (A.G.); (F.M.)
| | | | - Michele Callea
- Unit of Dentistry, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (A.G.B.); (A.G.); (F.M.)
- Correspondence: (F.C.-S.); (M.C.)
| |
Collapse
|
5
|
Slusarenko da Silva Y, Naclério-Homem MDG. Myeloid sarcoma on the temporal region before the onset of the acute myeloid leukemia: an extremely rare case report. Oral Maxillofac Surg 2020; 24:251-254. [PMID: 31970569 DOI: 10.1007/s10006-020-00833-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/10/2020] [Indexed: 06/10/2023]
Abstract
PURPOSE Myeloid sarcoma (MS) is a rare malignant tumor that arises outside the bone marrow and usually occurs concomitantly or after the acute myeloid leukemia (AML). The aim of the present study is to report an extremely rare case of a patient with an MS arising in the maxillofacial region before the onset of AML to serve as a guide on how to conduct the initial assessment and diagnosis of similar cases. MATERIALS AND METHODS A 29-year-old healthy man complained of a "swelling on the head," which was rapidly increasing. He was asymptomatic and never had a previous AML. RESULTS The patient presented a large mass on the left temporal region. The computed tomography showed a well-delimited lesion extending from the lateral pterygoid muscle and involving the zygomatic arch and lateral orbital rim. The mass was diagnosed as an MS arising before the onset of the AML. CONCLUSION Masses of a rapid increase in the maxillofacial region should always raise suspicion of being an MS even in asymptomatic patients. Following a protocol of initial assessment and diagnosis will decrease the period between the initial appearance of the MS and effective treatment aimed to prevent or delay the manifestation of leukemia, improving the prognosis and survival of these patients.
Collapse
Affiliation(s)
- Yuri Slusarenko da Silva
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis, Faculty of Dentistry, University of São Paulo, Av Prof. Lineu Prestes 2227 Butantã, São Paulo, State of São Paulo, 05508-000, Brazil.
| | - Maria da Graça Naclério-Homem
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis, Faculty of Dentistry, University of São Paulo, Av Prof. Lineu Prestes 2227 Butantã, São Paulo, State of São Paulo, 05508-000, Brazil
| |
Collapse
|
6
|
Slusarenko da Silva Y, Naclério-Homem MDG. Reply to Letter to the Editor commenting on the article "Myeloid sarcoma on the temporal region before the onset of the acute myeloid leukemia: an extremely rare case report". Oral Maxillofac Surg 2020; 24:381-382. [PMID: 32382855 DOI: 10.1007/s10006-020-00848-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Yuri Slusarenko da Silva
- School of Dentistry - UniFG University Center (Faculty of Guanambi), Avenida Pedro Felipe Duarte 4911 São Sebastião, Guanambi, Bahia, 46430-000, Brazil.
| | - Maria da Graça Naclério-Homem
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, São Paulo, Brazil
| |
Collapse
|