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Abstract
A wide spectrum of drugs can sometimes give rise to numerous adverse orofacial manifestations, particularly dry mouth, taste disturbances, oral mucosal ulceration, and/or gingival swelling. There are few relevant randomized double-blind controlled studies in this field, and therefore this paper reviews the data from case reports, small series, and non-peer-reviewed reports of adverse drug reactions affecting the orofacial region (available from a MEDLINE search to April, 2003). The more common and significant adverse orofacial consequences of drug therapy are discussed.
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Affiliation(s)
- C Scully
- Eastman Dental Institute for Oral Health Care Sciences, University College, University of London, 256 Gray's Inn Road, London WC1X 8LD, UK.
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2
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Giagkou E, Christodoulou DK, Katsanos KH. Mouth cancer in inflammatory bowel diseases. Oral Dis 2016; 22:260-4. [DOI: 10.1111/odi.12420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/06/2015] [Accepted: 12/07/2015] [Indexed: 12/26/2022]
Affiliation(s)
- E Giagkou
- Division of Gastroenterology; School of Health Sciences; University of Ioannina; Ioannina Greece
| | - DK Christodoulou
- Division of Gastroenterology; School of Health Sciences; University of Ioannina; Ioannina Greece
| | - KH Katsanos
- Division of Gastroenterology; School of Health Sciences; University of Ioannina; Ioannina Greece
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3
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Akbas A, Tiede C, Lemound J, Maecker-Kolhoff B, Kreipe H, Hussein K. Post-transplant lymphoproliferative disorders with naso- and oropharyngeal manifestation. Transpl Int 2015; 28:1299-307. [DOI: 10.1111/tri.12632] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/07/2015] [Accepted: 06/22/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Ayla Akbas
- Institute of Pathology; Hannover Medical School; Hannover Germany
| | - Christina Tiede
- Clinic for Dental Prosthetics; Hannover Medical School; Hannover Germany
| | - Juliana Lemound
- Department of Craniomaxillofacial Surgery; Hannover Medical School; Hannover Germany
| | - Britta Maecker-Kolhoff
- Department of Paediatric Haematology and Oncology; Hannover Medical School; Hannover Germany
| | - Hans Kreipe
- Institute of Pathology; Hannover Medical School; Hannover Germany
| | - Kais Hussein
- Institute of Pathology; Hannover Medical School; Hannover Germany
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4
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Amorim Pellicioli AC, Luciano AA, Rangel ALCA, de Oliveira GR, Santos Silva AR, de Almeida OP, Vargas PA. Epstein-Barr virus (EBV)--associated posttransplant lymphoproliferative disorder appearing as mandibular gingival ulcers. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 121:e80-6. [PMID: 26321430 DOI: 10.1016/j.oooo.2015.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/15/2015] [Accepted: 07/20/2015] [Indexed: 12/13/2022]
Abstract
Posttransplant lymphoproliferative disorders (PTLDs) comprise a spectrum of complications that affect immunocompromised patients following hematopoietic stem cell transplantation or solid organ transplantation. Its incidence varies depending on the transplanted organ, occurring in approximately 2.3% of kidney transplantations. A 31-year-old woman was referred to the Dental Clinic of the State University of Western Paraná for evaluation of an oral lesion. Her medical history revealed a previous diagnosis of hypertension, Epstein-Barr virus (EBV) seropositivity, and kidney transplantation 12 years prior. She was under standard immunosuppressive therapy. Intraoral examination identified a gingival necrotic lesion with extension to the posterior right lower alveolar bone. An incisional biopsy was performed. Histologic examination showed lymphocytic proliferation of cells with small and hyperchromatic nuclei, atypical mitosis, and cells with large and pale nuclei showing prominent nucleoli permeating connective tissue, muscle fibers, and adipocytes. Correlation of clinical, histologic, and immunohistochemical findings led to a diagnosis of polymorphic EBV-associated PTLD rich in B and T cells.
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5
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Cole-Hawkins H, Fyfe E, Price C, Pring M. Posttransplant lymphoproliferative disorder presenting as a nonhealing extraction socket: a case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:e12-8. [PMID: 22668635 DOI: 10.1016/j.oooo.2011.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 10/24/2011] [Accepted: 10/30/2011] [Indexed: 01/12/2023]
Abstract
Posttransplant lymphoproliferative disorder (PTLD) is a well-recognized complication of long-term immunosuppression following hematopoietic or solid organ transplantation and is associated with significant morbidity and mortality. We present a unique case of PTLD that manifested with a nonhealing dental extraction socket 17 years after renal transplantation. We summarize the existing literature and present a review of an additional 25 cases. These highlight the variable clinical presentations of PTLD within the oral cavity and clear potential for delayed presentation at this anatomical subsite.
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León JE, Takahama Júnior A, Vassallo J, Soares FA, de Almeida OP, Lopes MA. EBV-associated polymorphic posttransplant lymphoproliferative disorder presenting as gingival ulcers. Int J Surg Pathol 2009; 19:241-6. [PMID: 20034982 DOI: 10.1177/1066896909353599] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Posttransplant lymphoproliferative disorders (PTLDs) present a wide clinicopathological spectrum, varying from the usual Epstein-Barr virus (EBV)-driven infectious mononucleosis-type polyclonal proliferations to EBV-positive or EBV-negative proliferations indistinguishable from overt lymphomas that occur in immunocompetent individuals. PTLDs characteristically have a predilection for extranodal sites and association with EBV.These disorders are usually B-cell type, although T-cell and rare cases involving both T- and B-cell types have also been described. The initial treatment consists in decreasing the immnosupressive therapy, usually with favorable results. The authors report on a rare case of a 19-year-old girl, with post-renal transplantation EBV-associated polymorphic lymphoproliferative gingival ulcerated lesions. To the best of their knowledge, this is the first case described in the English-language literature of polymorphic PTLD involving both B-cell and T-cell lineages, with an unusual immunoprofile affecting the mouth. The authors warn that this condition could be easily misdiagnosed as malignant lymphoma if not properly recognized.
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Affiliation(s)
- Jorge Esquiche León
- Departmento de Diagnóstico Oral, Faculdade de Odontologia, Piracicaba Dental School, University of Campinas-UNICAMP, Piracicaba-SP, Brazil.
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Daly RM, Healy CM, Toner ME, Flint SR. Spontaneous regression of non-Hodgkin's lymphoma in the oral cavity after incisional biopsy. Br J Oral Maxillofac Surg 2007; 46:223-225. [PMID: 17478018 DOI: 10.1016/j.bjoms.2007.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2007] [Indexed: 10/23/2022]
Abstract
We report a case of gingival T cell non-Hodgkin's lymphoma that responded initially to chemotherapy, recurred at another site a year later, but regressed spontaneously after incisional biopsy. We are not aware of any other reports about spontaneous regression of T cell lymphomas in the oral cavity.
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Affiliation(s)
- R-M Daly
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Oral Pathology, Dublin Dental School and Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - C M Healy
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Oral Pathology, Dublin Dental School and Hospital, Trinity College Dublin, Dublin 2, Ireland.
| | - M E Toner
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Oral Pathology, Dublin Dental School and Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - S R Flint
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Oral Pathology, Dublin Dental School and Hospital, Trinity College Dublin, Dublin 2, Ireland
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8
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Abstract
Mounting effective anti-tumor immune responses against tumors by both the innate and adaptive immune effectors is important for the clearance of tumors. However, accumulated evidence indicates that immune responses that should otherwise suppress or eliminate transformed cells are themselves suppressed by the function of tumor cells in a variety of cancer patients, including those with oral cancers. Signaling abnormalities, spontaneous apoptosis, and reduced proliferation and function of circulating natural killer cells (NK), T-cells, dendritic cells (DC), and tumor-infiltrating lymphocytes (TILs) have been documented previously in oral cancer patients. Several mechanisms have been proposed for the functional deficiencies of tumor-associated immune cells in oral cancer patients. Both soluble factors and contact-mediated immunosuppression by the tumor cells have been implicated in the inhibition of immune cell function and the progression of tumors. More recently, elevated levels and function of key transcription factors in tumor cells, particularly NFkappaB and STAT3, have been shown to mediate immune suppression in the tumor microenvironment. This review will focus on these emerging mechanisms of immunosuppression in oral cancers.
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Affiliation(s)
- A Jewett
- The Jane and Jerry Weintraub Center for Reconstructive Biotechnology, Jonsson Comprehensive Cancer Center (JCCC), Department of Head and Neck Surgery, UCLA School of Dentistry and Medicine 90095-1688, USA.
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9
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Rhinow K, Schirmer I, Loddenkemper C, Anagnostopoulos I, Stein H, Reichart PA. Orale Epstein-Barr-Virus-assoziierte diffuse großzellige B-Zell-Lymphome bei HIV-negativen immunsupprimierten Patienten. ACTA ACUST UNITED AC 2006; 10:155-61. [PMID: 16685566 DOI: 10.1007/s10006-006-0689-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Diffuse large B-cell lymphomas (DLBCL) are non-Hodgkin's lymphomas (NHL) and with a prevalence of 30-40% they comprise the most frequent NHL in adults. Although their etiology is still unknown, a virus induction, especially by the Epstein-Barr-virus (EBV), is the subject of discussion. Patients with congenital or acquired immunodeficiency are primarily afflicted. PATIENT 1: A 39-year-old female patient developed an EBV-associated DLBCL of the plasmablastic subtype in the maxillary alveolar ridge in the region of teeth 11 and 21 after 24 years of immunosuppressive therapy with azathioprine due to myasthenia gravis. Clinically the lesion presented as a localized acute necrotizing periodontitis that was resistant to symptomatic therapy. After polychemotherapy the disease is in complete remission until today. PATIENT 2: A 56-year-old male patient developed an EBV-associated DLBCL of immunoblastic variant of the right maxillary edentulous alveolar ridge in the posterior region 7 weeks after heart transplantation and immunosuppressive therapy with azathioprine and cyclosporine A. Clinically, a soft, nonpainful, swelling measuring 1.5x0.5x0.5 cm with a central ulceration was evident. The tumor was excised followed by local radiation therapy. No recurrence was noted during a 15-year-follow-up. DISCUSSION The presented clinical cases demonstrate the increased risk of occurrence of oral malignant B-cell lymphomas as adverse effects of immunosuppressive therapy. The demonstration of EBV in the tumor cells in both cases underlines the involvement of this virus in the pathogenesis of oral DLBCL arising in the setting of an immunodeficiency as has been shown previously in patients with HIV. CONCLUSIONS Due to the varying and often nonspecific clinical appearance of oral DLBCL, an early biopsy and work-up by an institute specialized in hematopathology is essential for diagnosis, because these tumors may disseminate in early stages.
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Affiliation(s)
- K Rhinow
- Abteilung für Oralchirurgie und zahnärztliche Röntgenologie, Zentrum für Zahnmedizin, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin,
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Brouns R, De Deyn PP. Neurological complications in renal failure: a review. Clin Neurol Neurosurg 2005; 107:1-16. [PMID: 15567546 DOI: 10.1016/j.clineuro.2004.07.012] [Citation(s) in RCA: 237] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2004] [Revised: 07/27/2004] [Accepted: 07/27/2004] [Indexed: 02/08/2023]
Abstract
Neurological complications whether due to the uremic state or its treatment, contribute largely to the morbidity and mortality in patients with renal failure. Despite continuous therapeutic advances, many neurological complications of uremia, like uremic encephalopathy, atherosclerosis, neuropathy and myopathy fail to fully respond to dialysis. Moreover, dialytic therapy or kidney transplantation may even induce neurological complications. Dialysis can directly or indirectly be associated with dialysis dementia, dysequilibrium syndrome, aggravation of atherosclerosis, cerebrovascular accidents due to ultrafiltration-related arterial hypotension, hypertensive encephalopathy, Wernicke's encephalopathy, hemorrhagic stroke, subdural hematoma, osmotic myelinolysis, opportunistic infections, intracranial hypertension and mononeuropathy. Renal transplantation itself can give rise to acute femoral neuropathy, rejection encephalopathy and neuropathy in graft versus host disease. The use of immunosuppressive drugs after renal transplantation can cause encephalopathy, movement disorders, opportunistic infections, neoplasms, myopathy and progression of atherosclerosis. We address the clinical, pathophysiological and therapeutical aspects of both central and peripheral nervous system complications in uremia.
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Affiliation(s)
- R Brouns
- Department of Neurology and Memory Clinic, Middelheim General Hospital, Antwerp, Belgium
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Kumar R, Bhargava P, Zhuang H, Yu JQ, Schuster SJ, Alavi A. Spontaneous Regression of Follicular, Mantle Cell, and Diffuse Large B-Cell Non-Hodgkinʼs Lymphomas Detected by FDG–PET Imaging. Clin Nucl Med 2004; 29:685-8. [PMID: 15483478 DOI: 10.1097/00003072-200411000-00002] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Spontaneous regression of non-Hodgkin lymphoma (NHL) has been reported in low-grade tumors but is an extremely rare event in intermediate- and high-grade disease. Documentation of spontaneous regression by serial fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging has not been reported in the literature. We present 3 cases of spontaneous regression, 1 each of follicular lymphoma (FL), mantle cell lymphoma (MCL), and diffuse large B-cell lymphoma (DLBCL), which showed spontaneous regression on serial FDG-PET imaging. All patients underwent serial whole-body FDG-PET scans 60 minutes after intravenous injection of 9-11 mCi of this radiotracer. None of them had any chemotherapy, radiotherapy, or surgery after the baseline PET scan. Spontaneous regression of disease in all 3 cases was correlated with conventional imaging and clinical course. All 3 patients had positive FDG-PET results on their baseline scan. There was complete disappearance of FDG uptake on a follow-up PET scan for the patient with follicular lymphoma. These results suggest complete regression. The patients with MCL and DLBCL both showed a significant reduction in FDG uptake on serial whole-body PET scans, suggesting partial regression in both cases. Although spontaneous regression of lymphoma is uncommon, this phenomenon can be successfully demonstrated by FDG-PET imaging. Therefore, serial PET imaging may play an important role in detecting this unusual event and may further enhance our understanding of the biologic behavior of this malignancy.
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Affiliation(s)
- Rakesh Kumar
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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Dolci M, Favia G, Scully C, Di Alberti L. Keratosis follicularis of the oral mucosa with oral squamous cell carcinoma. Oral Oncol 2004; 40:856-8. [PMID: 15288843 DOI: 10.1016/j.oraloncology.2004.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2004] [Accepted: 01/12/2004] [Indexed: 10/26/2022]
Abstract
Darier's disease or keratosis follicularis is a genodermatosis which may involve the oral mucosa. Malignant degeneration is rare. We report the first case of the combined manifestation of oral keratosis follicularis and oral squamous cell carcinoma and discuss the possible involvement of ATP2A2 (located in 12q23-24.1) which encodes the sarco/endoplasmic reticulum Ca(2+)-ATP isoform 2 (SERCA2), in the pathogenesis.
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Affiliation(s)
- Marco Dolci
- Maxillofacial Surgery Section, University of Chieti, Italy
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