Histopathological Factors in Oral Squamous Cell Carcinoma-Should a Clinician Look Beyond Clinical Staging?

Poorly Differentiated Squamous Cell Carcinoma With Jaw Bone Osteomyelitis and Skin Perforation: A Report of a Rare Clinical Case

Oral squamous cell carcinoma is a perpetual challenge for current clinicians and oral pathologists. In this case report, we present an unusual case of oral squamous cell carcinoma involving the left buccal mucosa with extensive bone exposure and skin perforation. It showed features of ulceration, necrosis, and maggot infestation. On histological examination, the malignant epithelial cells in the dense fibrous connective tissue stroma were keratinized, highly pleomorphic, had a high nucleo-cytoplasmic ratio, and were organized in sheets, cords, and nests. Decalcified tissue sections revealed the presence of necrotic bone. Immunohistochemistry indicated diffuse PanCK (cytokeratin) positivity confirming the epithelial origin of the malignant tumor cells. A final diagnosis of poorly differentiated squamous cell carcinoma (Bryne score 13/16) with chronic osteomyelitis and skin involvement was confirmed. Palliative care with supportive therapy was recommended. Hence, this case report emphasizes how critical it is to receive an early diagnosis and treatment to stop the disease progression, prevent the host's immune suppression, and improve the overall quality of life of the patient.

Margin to depth of invasion ratio as an indicator for stratifying close margins in early-stage oral squamous cell carcinoma

OBJECTIVES

In early-stage oral squamous cell carcinoma (OSCC) patients, whether the margin-to-depth-of-invasion ratio (MDR) can assist in stratifying the prognosis remains unclear.

METHODS

Patients diagnosed with early stage OSCC at National Taiwan University Hospital between January 2007 and December 2021 were reviewed. Patients with margin > 1 mm were classified into two groups: MDR < 0.5 and MDR ≥ 0.5.

RESULTS

We analyzed 911 pT1-2N0M0 OSCC patients, 723 (79.36 %) with MDR ≥ 0.5 and 188 (20.64 %) with MDR < 0.5. Patients in the MDR < 0.5 group displayed a significantly higher local recurrence rate (odds ratio 2.81, p = 0.002) compared with MDR ≥ 0.5 group. The 5-year disease-free survival were 80.8 % for clear margin, 76.3 % for close margin (MDR ≥ 0.5), and 65.2 % for close margin (MDR < 0.5). The overall survival displayed a similar pattern, with 5-year rates of 88.3 % for clear margin, 86.8 % for close margin (MDR ≥ 0.5), and 75.0 % for close margin (MDR < 0.5). There were no significant overall survival differences between the two MDR ≥ 0.5 groups, but both were significantly superior to patients with MDR < 0.5 (p = 0.001; p = 0.01). After multivariant cox analysis, MDR < 0.5 was a significant risk factor for disease-free survival (p < 0.001).

CONCLUSION

For early stage OSCC patients without positive margin (≦1mm), the survival outcome between MDR ≥ 0.5 group and MDR < 0.5 group was significantly different. The MDR < 0.5 group had significantly higher risk of local recurrence that may warrant adjuvant treatment.