Prognostic Factors of Primary Intraosseous Squamous Cell Carcinoma (PIOSCC): A Retrospective Review

Squamous Cell Carcinoma Arising From Odontogenic Cyst Epithelium or Oral Mucosa Epithelium After Marsupialization of Odontogenic Radicular Cyst in Posterior Mandible?

Squamous cell carcinomas (SCCs) are common malignant tumors in the oral and maxillofacial region. However, SCCs secondary to marsupialization of odontogenic radicular cysts are extremely rare. The authors report an unusual case of a 43-year-old male presented with dull pain in the right molar region of the mandible without numbness of lower lips, who had a long history of smoking, alcohol consumption, and betel nut chewing. Computerized tomography revealed a round well-defined unilocular radiolucent at the apex of lower right premolars, 2 nonvital teeth. The clinical diagnosis was the radicular cyst of the right mandible. The patient was initially treated with root canal therapy of the teeth followed by marsupialization with a mandibular vestibular groove incision. While the patient did not follow the instruction of irrigation of the cyst and had no regular follow-up. The reexamination of computerized tomography indicated a round well-defined unilocular radiolucent at the apex of lower right premolars and filled with a soft tissue without clear boundary with buccal muscles at 31 months follow-up. There were no masses or ulcer around the mandibular vestibular groove incision and the patient had no sign of numbness of lower lips. The clinical diagnosis was the radicular cyst of right mandible with infection. A curettage was performed. However, the pathologic diagnosis was well-differentiated SCC. An extended radical surgical resection including segmental resection of the right mandible was performed. The histopathology was well-differentiated SCC without the cyst epithelium and invasion of bone, which can be distinguished from primary intraosseous SCC. The case indicates that marsupialization performed in patients with a history of smoking, alcohol consumption, and betel nut chewing, has a risk of suffering from oral SCC.

Outcome of primary intraosseous carcinoma: cases review of a single institution

OBJECTIVE

The purpose of this study was to investigate the prognostic factors and treatment of primary intraosseous carcinoma.

METHODS

Patients diagnosed with primary intraosseous carcinoma and received treatment in Sichuan cancer hospital from 2000 to 2019 were followed up and retrospectively reviewed.

RESULTS

A total of 28 patients were included in the study, with a mean age of 60 years (60±10.11). The 2-year and 5-year overall survival were 60.7% and 38.5% respectively. In the univariate analysis, surgery combined with adjuvant therapy improved the overall survival compared with surgery or radiotherapy alone (P=0.035), and patients received postoperative adjuvant radiotherapy had a higher overall survival than those who received radical radiotherapy (P = 0.01). In addition, patients with well differentiated tumors have increased progression free survival (P=0.01). Multivariate analyses showed that radiotherapy was an independent indicator for overall survival (P = 0.007).

CONCLUSIONS

surgery combined with adjuvant therapy is the superior treatment strategy for primary intraosseous carcinoma at present. This study is the first to confirm the positive role of radiotherapy in treating primary intraosseous carcinoma with data to back it up.

Primary intraosseous carcinoma in the pediatric and adolescent mandible

BACKGROUND

Primary intraosseous carcinoma (PIOC) is a rare malignant odontogenic tumor that predominantly occurs in males older than 50 years. PIOC can be misdiagnosed as odontogenic cyst because it occasionally shows a well-defined border on radiography. In this study, related literatures of pediatric and adolescent PIOC cases were analyzed under strict PRISMA guidelines along with an adolescent case who was provisionally misdiagnosed as an odontogenic cyst.

METHODS

All case reports for PIOC published in English from 1966 to 2021 were collected. Cases under the age of 20 were classified as pediatric and adolescent populations in this study. A total of 12 pediatric and adolescent cases including 11 PIOCs from the literature and one new case of a 14-year-old female were analyzed. Clinical and radiographic features, diagnosis and treatment approaches, and prognosis were investigated.

RESULTS

Ages ranged from 4 to 18 years. The female to male ratio was 1.4:1. Seven cases occurred in the mandible. Swelling was observed in 11 patients. The radiologic borders were well-defined in six cases and corticated in four cases. Tooth displacement and root resorption were observed in four and six cases, respectively. The provisional diagnosis for seven patients was odontogenic cyst and enucleation was performed in six cases including the new case. During the follow-up period, local recurrence occurred in three patients. The pediatric and adolescent PIOC cases with local recurrence showed poor prognosis. The locally recurred lesion in the new case did not decrease in size despite concurrent chemo-radiation therapy.

CONCLUSIONS

Three-dimensional imaging modalities and incisional biopsy with multiple specimens are necessary to rule out PIOC in the lesions with atypical radiographic findings. PIOC should be diagnosed differentially from odontogenic cyst even in pediatric and adolescent populations to properly manage the disease with poor prognosis.

Fluorodeoxyglucose positron emission tomography/CT for primary malignant intraosseous neoplasms of the mandible

Primary intraosseous malignant neoplasm of the mandible is a very rare entity. There are few publications regarding fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT for primary intraosseous neoplasms of the mandible. FDG PET/CT scans from 10 patients with primary malignant neoplasm of the mandible were retrieved from the Picture Archiving and Communication System database, and image findings were analyzed with correlation to contrast-enhanced diagnostic CT and surgical pathology. Accuracy of the FDG PET/CT findings was evaluated with respect to uptake intensity, lesion extension to adjacent soft tissue, lymph node and distant metastasis. All untreated primary mandible neoplasms demonstrated high FDG avidity on PET imaging. Most mandible lesions extended beyond the bones and involved perimandibular soft tissue. FDG PET/CT imaging showed improved sensitivity and specificity compared with that for CT for lymph node staging in 3 cases, with discordant findings between diagnostic CT and PET/CT. FDG PET/CT identified 4 distant metastases, which were not documented prior to PET/CT. The results suggested that FDG PET/CT was a valuable image modality to demonstrate all primary and metastatic lesions of primary malignant neoplasm of the mandible, to define perimandibular soft tissue involvement, and more accurately stage/restage the disease than diagnostic CT.

Sequential treatment from mandibulectomy to reconstruction on mandibular oral cancer - Case review I: mandibular ramus and angle lesion of primary intraosseous squamous cell carcinoma

Primary intraosseous squamous cell carcinoma (PIOSCC) is very rare type of squamous cell carcinoma (SCC) that occurs within the jaw and arises from remnants of odontogenic epithelium with no connection to the oral mucosa. This study reports two cases of PIOSCC of the mandible. Reported in this article are two cases of PIOSCC of the mandible that were treated with resection and reconstruction using a fibular free flap. The first case was a 36-year-old male patient who complained of right mandibular pain. Computed tomography (CT) and panoramic radiograph revealed a large radiolucency in the mandibular ramus area. At first, an odontogenic keratocyst was tentatively diagnosed, and an excision procedure was carried out at another clinic. A final biopsy after cyst enucleation revealed well-differentiated SCC, so we proceeded with segmental mandibulectomy and reconstruction using a fibular free flap. The second case was a 48-year-old male patient with left mandibular pain. CT and panoramic radiograph revealed irregular radiolucency in the mandibular angle area near tooth #38. At first, osteomyelitis was tentatively diagnosed, and a curettage was carried out. A later biopsy revealed well-differentiated SCC, so segmental mandibulectomy and reconstruction with a fibular free flap were secondarily performed. Our two cases have had no recurrence. The facial appearance of both patients is satisfactory, and the neo-mandibular body created using a fibular bone transfer displays adequate bony volume.

Primary intraosseous squamous cell carcinoma arising from an odontogenic keratocyst: case series and literature review

Background

The aim of this study was to investigate the clinicopathologic features of primary intraosseous squamous cell carcinoma arising from an odontogenic keratocyst (PIOSCC ex OKC) and comprehensively improve the understanding of this disease.

Material and Methods

We retrospectively investigated five cases of PIOSCC ex OKC at Peking University School and Hospital of Stomatology. We also conducted a systematic review of studies on PIOSCC ex OKC by using online databases from their inception until February 2020.

Results

In our series of five cases, all lesions were located in the mandible. Three cases (60%) showed recurrent OKCs and two cases (40%) showed primary OKCs. During the follow-up period, one patient died of local relapse. No patients developed metastasis. On the basis of our literature survey, we selected 22 articles reporting 29 patients with PIOSCC ex OKC. Seven of these patients (24.1%) showed local recurrence, three patients (10.3%) developed cervical metastasis, three patients (10.3%) developed distant metastasis (in the pleura in one case and in the lung in two cases), and seven patients died from the disease during the follow-up period. The disease-specific 5-year survival rate in the study group was 53.2%. Through univariate and multivariate analysis, local recurrence was identified as the only significant independent prognostic factor for survival (P < 0.05).

Conclusions

The results suggest that PIOSCC ex OKC is a rare intermediate-grade malignancy. Although elective neck dissection is typically unnecessary, adequate therapy should be applied to achieve the lowest local recurrence rate possible to ensure a favorable survival rate.

Key words:Primary intraosseous squamous cell carcinoma, odontogenic keratocyst, prognosis.

Carcinomatous Transformation of Odontogenic Keratocyst and Primary Intraosseous Carcinoma: A Systematic Review and Report of a Case

PURPOSE

To assess the prognostic findings of the carcinomatous transformation of odontogenic keratocyst (OKC).

METHODS

A systematic review of all cases of carcinomatous transformation of OKC was completed, and a case report was included.

RESULTS

A total of 679 publications were screened, and 37 cases met inclusion criteria. The mean age for patients with malignant transformation of OKC was 45.1 years. Pain (67.5%) and swelling (78.3%) were the most common symptoms. The malignant transformation occurred with increased frequency in the posterior mandible and larger lesions that span greater than 2 subunits of the involved jaw. Resection was the definitive treatment in all cases and 14 cases (46%) utilized adjuvant treatment.

CONCLUSIONS

Patient outcomes and follow-up was variable in our study such that overall survival was difficult to determine. However, overall survival in malignant transformation of odontogenic cysts of all kinds ranges from 62 to 85% and 30 to 8% for 2 and 5 years, respectively.

Residual cyst of the jaws: A clinico-pathologic study of this seemingly inconspicuous lesion

OBJECTIVES

Residual cysts are relatively rare inflammatory cysts of the jaws. They are essentially radicular cysts without the presence of the offending dentition. These lesions have the ability to destroy bone within the jaws without any symptoms. Moreover, they can mimic more aggressive cysts and tumours on radiographs. The aim of this study was to describe the clinico-pathological features of residual cysts in order to discern them from other cystic lesions as well as analyse their management and recurrence patterns.

MATERIALS AND METHODS

Sixty-four histopathologically confirmed residual cysts were analysed based on their clinical, radiological and histopathological features. Their management and follow-up were also noted.

RESULTS

The majority of lesions presented in elderly (46.8%), edentulous patients (60.9%) and were most commonly found in the posterior regions of the mandible (51.6%). Clinico-pathological features that aided in their diagnosis included long-standing history with slow growing swelling and presence of well-defined, unilocular cystic lesion associated with previously extracted dentition. Enucleation was a successful method in the management of residual cysts with very low recurrence rate (1.6%). Two patients (3.1%) developed squamous cell carcinoma from the cyst lining.

CONCLUSION

Residual cysts should be high on the list of differential diagnosis when elderly, edentulous patients present with cystic lesions in the jaws compared to dentate patients (P<0.01). All lesions should by biopsied and sent for histopathological examination along with radiological correlation as they have the potential to transform into primary intra-osseous squamous cell carcinoma with devastating consequences to the patient.

Primary Intraosseous Squamous Cell Carcinoma Involving the Jaw Bones: A Systematic Review and Update

Primary intraosseous oral squamous cell carcinoma (PIOSCC) is a rare malignant neoplasm that affects the jaws. Despite its aggressive biological behavior, there are no studies that evaluated the clinicopathological features of this tumor and parameters associated with its prognosis. The objective of the present study was to conduct a systematic review of the available data on oral and maxillofacial PIOSCC in order to determine its clinicopathological characteristics and biological behavior. We conducted a systematic review in May 2020 in multiple databases using a specific search strategy. Cases diagnosed as PIOSCC in the oral cavity and maxillofacial complex that had sufficient histopathological data, absence of ulceration in the oral mucosa, a negative result for a distant primary tumor, and radiographic evidence of an osteolytic lesion that was entirely or mostly surrounded by the jaw bones were included. A total of 109 published articles were included in our systematic review, corresponding to 257 cases. PIOSCC showed a male predilection (69.3%) and a preference for the mandible (7:1), with the posterior region being the most commonly affected site. The mean age at diagnosis was 57.3 years. Cortical expansion, pain, and lip/facial paresthesia were the most common clinical features. Regarding histopathological features, most PIOSCC were well-differentiated and the solid subtype was the most common. Statistical analysis showed that PIOSCC located in the mandible (p = 0.03) and recurrence (p < 0.01) were significantly associated with a higher mortality rate. PIOSCC has a poor prognosis, with high rates of mortality.

Diagnosis and Treatment of an Odontogenic Epithelial Tumor in a Dog With Features of Squamous Odontogenic Tumor

A 9-year-old standard poodle presented for a comprehensive oral health assessment and treatment, at which time a left rostral mandibular swelling was recognized. The mass was biopsied and eventually excised by a left rostral mandibulectomy en bloc resection. Histopathology supported the diagnosis of a benign, intraosseous, epithelial tumor that was otherwise unclassified. The clinical, radiological, and histological features of this case are similar to those reported for squamous odontogenic tumor (SOT) in humans. This case study relays the diagnosis, treatment, and follow-up of the first SOT-like tumor in a dog.

Evaluation of metastasis and 5-year survival in oral squamous cell carcinoma patients in Isfahan (2001-2015)

BACKGROUND

Frequency analysis of metastasis in patients with oral squamous cell carcinoma (OSCC) helps to partly anticipate the upcoming chance of metastasis in the patients following primary diagnosis. This study was conducted to determine the evaluation of metastasis and 5-year survival in OSCC.

MATERIALS AND METHODS

This was a retrospective, descriptive study. A total of 96 OSCC patients were studied. Demographic data and clinical view of lesion as well as histopathological grade of patients were recorded in previously prepared forms of pathology centers. These findings were then evaluated in relation to the 5-year survival. The obtained data were fed into SPSS and analyzed by Chi-square test, t-test, one-way ANOVA, and Scheffé test. A significant level of α = 0.05 was used.

RESULTS

The 5-year survival of patients was 41.7%. From among the patients, 44% were found to have local recurrence and 36% were reported to have distant metastasis. There was no significant association between the 5-year survival rate and primary grade (P = 0.105). However, it revealed a significant relationship between the 5-year survival rate and distant metastasis (P = 0. 001).

CONCLUSION

This study showed that the 5-year survival is dependent on the primary site of involvement, local recurrence, regional and distant metastasis, and mean age. However, gender (P = 0.89), grade (P = 0.105), and stage (P = 0.242) have no effect on the 5-year survival of patients.

Remarkable Short-Term Regression of a Posterior Mediastinum Metastasis From Primary Intraosseous Carcinoma Treated With Nivolumab: A Case Report

Primary intraosseous carcinoma (PIOC; not otherwise specified) is a rare odontogenic malignancy that is believed to arise from the odontogenic epithelium. In addition, some cases arise in odontogenic cysts or other benign precursors. There are no established treatment protocols for PIOC because of its rarity. In particular, no standard therapy has been established for patients with recurrent or metastatic PIOC. This report describes a case in which the use of nivolumab showed a marked treatment response in metastatic PIOC. The patient was a 71-year-old man with PIOC. The patient underwent segmental mandibulectomy with modified radical neck dissection after neoadjuvant chemotherapy, including 2 cycles of paclitaxel, cetuximab, and carboplatin and 1 cycle of docetaxel, cisplatin, and 5-fluorouracil. The lesion rapidly enlarged during neoadjuvant chemotherapy, and surgical specimens showed no histologic therapeutic effects of chemotherapy. Three months after the surgery, contrast-enhanced computed tomograms showed posterior mediastinal lymph node metastasis. Treatment with nivolumab was initiated, and notable clinical improvement was noted after 2 cycles. Although it was a short-term treatment, remarkable effects were observed and no adverse events were noted during and after nivolumab treatment. Nivolumab could be an attractive treatment option for metastatic PIOC that is resistant to traditional chemotherapy and target therapy, including cetuximab. Further investigation of this treatment is warranted.

Solid type primary intraosseous squamous cell carcinoma in a cat

Background

Squamous cell carcinoma (SCC) is the most common nonodontogenic oral tumor in cats. In the jaw, it usually presents as an ulceroproliferative lesion associated with enlargement of the affected bone.

Case presentation

This report describes the case of a cat in which clinical and radiographic findings of a mandibular swelling were suggestive of an aggressive process, but the oral mucosa was unaffected. The results of histopathological and immunohistochemical examination of the samples obtained from the intraosseous lesion were consistent with SCC. The animal was euthanized 5 months after initial presentation as a result of the severe progression of the disease, and no other primary tumors were identified at necropsy.

Conclusions

Based on the clinicopathological, microscopic, and immunohistochemical staining features, as well as the absence of a primary tumor at a distant site, we propose that the term, solid type primary intraosseous SCC (PIOSCC), be used to describe this neoplasia, as it shares similar features with human PIOSCC.

Primary intraosseous squamous cell carcinoma of the mandible: locoregional control and survival is significantly reduced if the tumour is more than 4cm in size

To establish the prognostic factors for primary intraosseous squamous cell carcinoma we designed a retrospective study of patients treated in the head and neck department of a tertiary referral centre in China from 2010-2015. We collected clinical, radiological, and histopathological data from 36 patients treated during the given time period, among which 34 were followed up. There were 22 male and 12 female patients, 13 of whom gave a history of smoking tobacco and four who drank alcohol. All 34 patients were treated by segmental mandibulectomy and neck dissection. Nine had cervical lymph node metastases on histopathological examination, and none had invaded surgical margins. Twenty-eight were treated with radiotherapy postoperatively. During follow up nine died of locoregional recurrence or metastases. Specific factors such as cervical lymph node metastases were related to a greater likelihood of locoregional recurrence. Patients who drank alcohol were also more likely to develop metastases postoperatively. Tumours more than 4cm in size were significantly associated with reductions in locoregional control and survival.

Metformin sensitizes the response of oral squamous cell carcinoma to cisplatin treatment through inhibition of NF-κB/HIF-1α signal axis

Resistance towards chemotherapy is a common complication in treatment of oral cancers, which leads to treatment failure and poor outcome. In recent years, a growing body of evidence has shown that tumour hypoxia significantly contributes to chemoresistance. Metformin, a widely used oral hypoglycaemic drug, can reportedly potentiate the efficacy of chemotherapeutic drugs in various cancers; however, the underlying mechanisms are intricate and have not been fully understood. In this study, we explored the role of metformin in chemosensitivity of oral squamous cell carcinoma cells (OSCC) to cisplatin both in vitro and in vivo, and attempted to elucidate its possible underlying mechanisms. Encouragingly, we found that metformin synergistically enhanced cisplatin cytotoxicity and reversed the chemoresistance to certain extent. This mechanism could likely be related with inhibition of the NF-κB/HIF-1α signal axis and lead to the downregulation of hypoxia-regulated genes products. Therefore, metformin could serve as a chemosensitiser for cisplatin-based regimens for OSCC, thereby providing a theoretical basis for future use in the treatment of oral cancers.