Clinical analysis of second primary gingival squamous cell carcinoma after radiotherapy

INTRODUCTION

Clinically, we have observed that some oral cancer patients have a history of radiotherapy for head and neck cancer; we have named this condition radiotherapy-associated cancer (RAC). Gingival cancer, which is usually juxtaposed with other oral cancer subtypes, is seldom reported individually, and there are few reports on the association between the incidence of oral cancer and history of radiation therapy. Therefore, this study aimed to elucidate the clinicopathological features and prognosis of second primary gingival squamous cell carcinoma after head and neck radiotherapy.

MATERIALS AND METHODS

The data collected included 450 patients diagnosed with gingival squamous cell carcinoma from 1964 to 2012 at Sun Yat-sen University Cancer, among whom 52 patients had a history of radiotherapy for head and neck cancer. We retrospectively analysed the differences in the clinicopathological characteristics and prognosis between sporadic gingival squamous cell carcinoma and radiation-associated gingival carcinoma, with an emphasis on gingival carcinoma.

RESULTS

Sporadic gingival squamous cell carcinoma is less likely to have more advanced T stage, and the second primary tumour is more likely to be located in the molar area of the maxillary gingiva than in the mandibular gingiva (75.6% vs 24.4%, P < 0.05). The 5-year overall survival of patients with second primary gingival carcinoma was influenced by age distribution, T classification, N classification, clinical TNM stage, histological grade and radiation history in head and neck. Mandibular gingival carcinoma was more likely to have an increased neck lymph node metastasis than maxillary gingival carcinoma (P = 0.001), but there was no significant difference in 5-year overall survival between these two groups (P = 0.828). The main therapy for gingiva carcinoma is surgery or comprehensive treatment based on surgery.

CONCLUSIONS

Second primary gingival squamous cell carcinoma after radiotherapy demonstrated particular clinicopathologic features, such as prominent sites and TNM stage; and there was statistically significant difference in 5-year overall survival and prognosis between second primary gingival carcinoma after radiotherapy and sporadic gingival carcinoma.

[Change in the incidence of diabetes mellitus in oral cancer patients based on a long-term comparative study]

Our research is focused on the incidence of diabetes mellitus and glucose metabolic disorders among oral cancer patients and the frequency of different oral localizations of cancer. Diabetes mellitus affects 7% of the Hungarian population. This study uses data spanning 14 years, with 2 datasets of 1998-1999 and 2012-2013, collected first hand by the authors. These datasets have led us to examine the blood glucose level in 267 patients with histologically confirmed malignant tumours in the oral cavity. Diabetes mellitus was found in 59 of them (22.1%), The blood glucose was elevated in 32 cases (12%). The most frequent tumor locations among the diabetic patients: labial, lingual and gingival tumors gingivae. Comparative epidemiological study demonstrates that in 2012-2013 dataset there was an increased observed percentage of people with diabetes mellitus [17.6% to 22.1%]. The percentage of patients with IFG (impaired fasting glucose) also increased from 9.8% to 12%. Overall the number of patients with glucose metabolic disorders climbed from 27.4% to 34.1%, (p > 0.05). Our intention of this introductory analysis is to emphasize the close connection of these two very important disease groups, and the wider spread of diabetes mellitus.

A retrospective histopathological review of oral squamous cell carcinoma in a Nigerian teaching hospital

This study was undertaken to describe the demographic pattern of oral squamous cell carcinoma (OSCC) in Ibadan, Nigeria and compare our findings with that of other countries. It involved a retrospective review of OSCC diagnosed at the University College Hospital Ibadan, Nigeria between 1990 and 2008. A review of studies from other countries was done with respect to the three most frequently affected sites by OSCC, as well as mean ages and gender ratios. OSCC comprised 181 (43.7%) of the 414 malignant neoplasms diagnosed in the oral cavity within the study period. The most frequently affected sites were the maxillary gingiva (24.9%) and mandibular gingiva (21.5%). There was a slight male preponderance; with a male to female ratio of 1.2:1. The peak age was in the eighth decade of life. About 17.7% of cases were diagnosed in patients below the age of 40 years and 1.1% of cases occurred in children. Worldwide, the tongue is the most frequently affected site by squamous cell carcinoma followed by the floor of the mouth. Males are also more frequently affected. In conclusion, OSCC remains an important cause of morbidity and mortality among middle aged individuals in our environment and worldwide, but sometimes affecting younger individuals.

Pediatric localized reactive gingival lesions: a retrospective study from Israel

PURPOSE

Chronic irritation of the gingiva causes localized reactive hyperplastic lesions (LRHLs), which are classified into: peripheral ossifying fibroma (POF); peripheral giant cell granuloma (PGCG); pyogenic granuloma (PG); and focal fibrous hyperplasia (FFH). The purpose of this study was to determine the frequency of localized reactive hyperplastic lesions in Israeli children and adolescents.

METHODS

All consecutive archival LRHL biopsies of the gingiva between 1989 and 2008 were included. Lesions were analyzed according to location and patients' age and gender. Our findings were compared to pediatric and all-age data in publications from other countries.

RESULTS

Of 233 gingival LRHL specimens, POFs were most common (33%), followed by PGs (25%), FFHs (23%) and PGCGs (20%). PGs and FFHs were more common in females, and PGCG were more common in males. POFs showed no gender predilection. PGCGs and FFHs were distributed almost equally between the maxilla and mandible, while POFs and PGs were more common in the maxilla. Comparing data to other countries was problematic because there were so few dedicated to the pediatric population and because of inconsistencies in data presentation.

CONCLUSIONS

Pediatric dentists should be aware of gingival LRHLs, because they are not uncommon among children.

Oral squamous cell carcinoma: a clinicopathological study of 342 Thai cases

AIM

To conduct a clinicopathological review of oral squamous cell carcinoma (SCC) and to analyze it with respect to gender, age at diagnosis, clinical presentation, lesion location, and histological grading.

METHODS AND MATERIALS

Information on the clinicopathological characteristics of SCC was obtained from pathology reports of 342 cases.

RESULTS

The male to female ratio was 1:1 and the incidence increased with age. Among the patients 4.7% were younger than 40 years and males were predominant in this subgroup. The alveolar ridge and gingiva were the most commonly affected sites (50%). The majority of the SCC cases presented as ulcers or masses. Swelling and/or pain were the first signs and/or symptoms in most patients (52.6%). The age at diagnosis in relation to the site of occurrence varied. Conventional SCC was the most common subtype (88%). Well-differentiated SCC was the most common histological grading (78.6%).

CONCLUSION

In the present study, the incidence of SCC was age-related and showed equal gender distribution.

CLINICAL SIGNIFICANCE

Routine examination of the oral cavity by dental practitioners and other health care providers aids in the early detection of premalignant and malignant oral disease. Dentists can play a significant role in disseminating information regarding oral cancer.

[Oral cancer: morbus Hungaricus in the 21st century]

Hungary is the leader both in oral cancer morbidity and mortality among the European countries. Oral cancer mortality had increased dramatically in Hungary to near fourfold between 1975 and 2002 both among the male and female populations. The increased oral cancer morbidity among the non-smoker, non-drinker elderly women and young adults, suggest that factors other than tobacco and alcohol consumption may also have important role in the pathogenesis of oral cancer. To reveal the epidemiological changes oral cancer cases and tumor-free controls were studied in the Department of Oral and Maxillofacial Surgery of the Semmelweis University in two phases between 1985-1986 and 2004-2005. In the 1st phase of the study, 460 cases with histologically confirmed oral squamous cell cancer and 350 tumor-free control cases were included. In the 2nd phase data of 550 oral cancer cases and 450 tumor-free controls were examined. Location of the tumors, alcohol consumption, and smoking habits of the male and female patients were separately evaluated. Among the oral cancer cases and their controls the ratio of smokers showed a significantly decreasing tendency in the examined period. Both the male oral cancer patients and their controls showed a significant decrease in the ratio of regular drinkers, whereas among the female tumor cases and controls the ratio of alcohol consumers were similarly low in both phases. The high male to female ratio of oral cancer cases significantly decreased over the examined period. Among elderly women (>60 yrs) oral cancer morbidity conspicuously increased. Among male cases the primacy of lower lip cancer had been taken over by sublingual cancer during the examined period. Among female patients, gingival tumor location was the most frequent in both phases. Our data suggest that the extraordinarily rapid increase in oral cancer morbidity and mortality in Hungary is not reasonable simply on the basis of excessive tobacco and alcohol consumption habits. Changes in the male to female ratio of oral cancer after 20 years, the older age of female patients as compared with males and the gender related difference of the prevalent tumor sites suggest some role of gender specific, systemic risk factors for oral cancer.

Pyogenic granuloma, peripheral giant cell granuloma and peripheral ossifying fibroma: retrospective analysis of 138 cases

AIM

The present study examined retrospectively the clinical and radiographic characteristics of pyogenic granuloma (PG), peripheral giant cell granuloma (PGCG) and peripheral ossifying fibroma (POF), located in the gingiva and alveolar ridge.

METHODS

Biopsy records of the Stomatology Service of São Lucas Hospital-PUCRS were reviewed between 1980 and 2006. The medical charts of patients with histopathologic diagnosis of PG, PGCG and POF were selected. The data obtained were evaluated by means of descriptive statistics, analysis of variance (ANOVA), and the chi-squared test (chi-squared), considering the 5% level of significance.

RESULTS

Of the 138 cases analyzed, 57.2% corresponded to PG, 22.5% to PGCG and 20.3% to POF. PG and POF exhibited a predilection for females and PGCG for males. PG occurred in younger individuals and showed a greater tendency for bleeding (P=0.018). PG showed a greater frequency of reddish color (P<0.001), PGCG purplish (P<0.001) and POF pinkish (P<0.001). In the radiographic examination, the presence of radiopaque foci was greater in POF (P<0.001), and resorption of the subjacent alveolar bone was found more often in PGCG (P<0.001). POF exhibited a longer evolution. There was no difference in lesions with respect to local irritating factors, ulceration, size, site and recurrence. Pregnancy was a factor linked to PG.

CONCLUSION

Despite the lesions investigated exhibit similar clinical characteristics, the present study demonstrated that aspects such as age of the patient and evolution, color, bleeding and radiographic characteristics can help in the differential diagnosis of these lesions.

Oral squamous cell carcinoma incidence by subsite among diverse racial and ethnic populations in California

OBJECTIVE

The aim of this report was to examine the oral cancer incidence by sex, race/ethnicity, and anatomical subsite.

STUDY DESIGN

Data from the California Cancer Registry (CCR) were used to calculate the age-adjusted incidence rates of invasive oral squamous cell carcinoma (OSCC) by sex, race/ethnicity, and anatomical subsite among residents in California during 1988 to 2001.

RESULTS

Although non-Hispanic (NH) black men have the highest overall incidence rate for OSCC, NH whites and NH blacks have similar incidence patterns by subsite, but the male-to-female (M:F) rate ratio is higher among NH blacks. The OSCC incidence rates for Hispanics are much lower than those for NH whites and NH blacks and similar to those of Asians. The Asian ethnic groups display dramatic variations in terms of the subsite-specific incidence rates and M:F rate ratios.

CONCLUSION

The findings illustrate the heterogeneity and complexity of oral cancer by anatomical location and the importance of cultural habits and behavioral factors in the development of oral cancer.

Oral and oropharyngeal cancer in a Venezuelan population

The aim of this work was to analyze diagnosed cases of Oral Cancer (OC) and Oropharyngeal Cancer (OPC) in a Venezuelan population. We clinically evaluated 130 patients with OC and OPC and a histopathologic diagnosis of squamous cell carcinoma. The patients were analyzed according to gender age, and use of alcohol and tobacco and the tumors were classIfied based on anatomic location, staging parameters, and degree of difFerentiation. Ninety one patients (70%) were male and 39 (30%) were female. Patients' age ranged from 26 to 86 years old. Use of smoking tobacco, alcohol or both was reported by 84.3%, 49.1% and 45.4% of patients, respectively, and was more frequent in males. The most common oropharyngeal anatomic location was the base of the tongue (22.3%), followed by the tonsils (13.9%), while the most frequently affected oral location was the oral tongue (19.2%) followed by the gingiva and alveolar mucosa (10.8%), and the floor of mouth (7.7%). The majority of tumors (77.7%) were diagnosed at an advanced stage (Stage III or IV); metastasis to the regional lymph nodes occurred in 53.1% of cases. According to degree of diferentiation, well, moderately and poorly difFerentiated tumors accounted for 45.4%, 46.1% and 8.5% of cases, respectively. Well differentiated tumors accounted for 56.7% of OC cases, while the majority of OPC cases were classified as moderately or poorly differentiated (72.3%) (p < or = 0.002). Also, non-metastatic cases (NO) showed a predominance of well-diferentiated tumors (61.2%), while metastatic tumors (N+) were classified as moderately or poorly differentiated in 89.8% of cases (p < or = 0.0001). Our study population was characterized by a predominance of smokers and/or drinkers and a predilection for male patients. Most tumors were diagnosed at an advanced stage with a high incidence of metastatic spread to the regional lymph nodes, indicating possible delays in diagnosis. Less differentiated tumors were more frequently encountered among OPC cases and accounted for the vast majority of metastatic cases, supporting the prognostic value of assessing the degree of difFerentiation.

Squamous cell carcinoma of the oral cavity: a case series analysis of clinical presentation and histological grading of 1,425 cases from Iraq

Peoples in Iraq face a mixture of health hazards associated with poverty. Oral cancer is a major public health issue worldwide; it remains a highly lethal and disfiguring disease. It is primarily a disease of epithelial origin. A total of 1,425 cases of histologically diagnosed squamous cell carcinoma collected from the main centers of pathology in Iraq were analyzed according to age, sex, site, patient complaints at the time of presentation, and histological grading. Patients at their fifth decade of life were the most commonly affected with a male-to-female ratio of 2:1. The lower lip was the most commonly affected site followed by the tongue. The most common clinical complain was ulceration and swelling. More than 70% of the cases were well-differentiated squamous cell carcinoma. Oral cancer is increasingly seen as a major health problem-In line with general trend in the region, the need for interprofessional health care delivery approaches for reducing oral cancer mortality and improving patient's quality of life.

Reactive hyperplasia of the oral cavity in Kerman province, Iran: A review of 172 cases

The purpose of this study was to present the clinical features of reactive hyperplasia among Iranian people. A series of 172 consecutive confirmed cases were studied using the database available at the Department of Oral Medicine, Kerman School of Dentistry. Reactive hyperplasia was classified into five groups: traumatic fibroma, peripheral fibroma with calcification, pyogenic granuloma, peripheral giant cell granuloma, and hyperplasia caused by dentures. Age, sex, site, clinical and radiographic findings, and outcome of treatment were recorded. Ages ranged from 5 to 79 years (mean 36). More women were affected than men (M/F 1:1.5). Pyogenic granuloma (M/F 1:2.2, chi(2)=6.4, p=0.011) and hyperplasia caused by dentures (M/F 1:3.7, chi(2)=10.9, p=0.001) were significantly more common among women. Peripheral giant cell granuloma was more common among men (M/F 1.4:1). Of the 172 cases, 111 (64%) involved the gingiva. Pyogenic granuloma more often affected the maxillary gingiva, while traumatic fibroma, peripheral fibroma with calcification, and peripheral giant cell granuloma, were more common in the mandibular gingiva. Twenty peripheral giant cell granulomas and 23 pyogenic granulomas had ulcers on the surface. A tendency to bleed was common among patients with pyogenic granuloma (n=31) and peripheral fibroma with calcification (n=12). We have confirmed that the clinical features of reactive hyperplasia among Iranians are, for the most part, similar to those reported by other investigators.

Relative frequency of peripheral odontogenic tumors: a study of 45 new cases and comparison with studies from the literature

BACKGROUND

Peripheral (extraosseous) odontogenic tumors are rare, and reports in the literature have mainly been single case reports or a small series of cases. The aim of this study was to determine the relative frequency of peripheral (extraosseous) odontogenic tumors relative to one another and relative to their central (intraosseous) counterparts in an oral pathology biopsy service and to compare these data with information available in the literature.

METHODS

The files of the Pacific Oral and Maxillofacial Pathology Laboratory of the University of the Pacific, San Francisco, CA, USA, served as the source of material for this study. Files were systematically searched for all cases of peripheral odontogenic tumors (POTs) during a 20-year-period.

RESULTS

There were 91,178 cases accessed in which central and POTs were identified in 1,133 (1.24%), central tumors in 1,088 (1.2%), and peripheral tumors in 45 (0.05%). Peripheral tumors accounted for 4% of all 1133 central and POTs. Peripheral odontogenic fibroma (PODF) was the most common of the 45 POTs accounting for 51.1% (23 cases) followed by peripheral ameloblastoma (PA) 28.9% (13 cases) and peripheral calcifying cystic odontogenic tumor (PCCOT) 13.3% (six cases). Peripheral calcifying epithelial odontogenic tumor, peripheral ameloblastic fibroma, and peripheral ameloblastic carcinoma were also identified--each comprised 2.2% (one case each). PODF was more common than its central counterpart by a 1.4:1 ratio. This was the only peripheral tumor that was more common than its central counterpart. PA accounted for 9.3% of all ameloblastomas and PCCOT for 26% of all calcifying cystic odontogenic tumors.

CONCLUSION

There is only scarce information in the literature on the relative frequency of POTs. Additional studies should be conducted to determine the true relative frequency. To ensure accuracy, pathologists with experience in the field of odontogenic tumors should conduct these studies. Intraosseous tumors that perforate through the bone to the gingival tissue, clinically presenting as 'peripheral tumors' should be excluded.

Biopsied gingival lesions in northern Jordanians: A retrospective analysis over 10 years

The frequency and distribution of 183 consecutive cases of biopsied gingival lesions from northern Jordanians are presented here. Lesions were analyzed for age and sex of subject and location and type of lesion. Neoplasms accounted for 9% of biopsies (7% benign, 3% malignant). The most frequent neoplasm was peripheral ossifying fibroma. The maximum number of benign neoplasms occurred in patients aged 20 to 39 years, and malignant neoplasms did not occur in patients younger than 30 years. Nonneoplastic lesions accounted for 91% of cases; they comprised nine types, with pyogenic granuloma being the most frequent. The frequency and distribution of gingival lesions in north Jordan are similar to those found in other countries. Additional nationwide multicenter studies are needed to describe all aspects of epidemiology of gingival lesions in Jordan.

Gingival Involvement in a Case Series of Patients With Acquired Immunodeficiency Syndrome-Related Kaposi Sarcoma

BACKGROUND

This case series presents the polymorphic clinical characteristics of gingival acquired immunodeficieny syndrome (AIDS)-related Kaposi sarcoma (KS), a malignancy that is gradually becoming uncommon in developed nations. An up-to-date overview of the related epidemiology, etiopathogenesis, histopathology, and treatment is provided, along with a pictorial guide to ease clinical diagnosis.

METHODS

The oral/maxillofacial pathology records at Aristotle University and the University of Geneva were retrospectively reviewed. Thirty-two cases diagnosed with oral AIDS-related KS were retrieved between 1991 and 2004. KS diagnosis was established histologically by incisional biopsies from intraoral lesions. All charts contained clinical oral examination data, radiological images, and detailed photographic records.

RESULTS

Thirteen patients (12 males and one female) presented with KS gingival involvement (40.6%). Eleven of the male patients were homosexual/bisexual men. The mean age of the patients at the time of intraoral KS diagnosis was 42.1 years, and the mean CD4 cell count was 103 (0 to 481). Gingival epidemic KS presented with various degrees of pigmentation and a wide range of clinical patterns, from relatively flat macules (early stage) to tumors with variable nodular morphology (advanced disease). Solitary or multiple gingival involvement may appear concomitantly with palatal and/or cutaneous lesions.

CONCLUSIONS

Even though the incidence of intraoral KS had fallen precipitously in developed countries after the mid-1990s, gingival KS should be considered in the differential diagnosis of every pigmented gingival lesion. Periodontists are in a unique position to identify gingival involvement of intraoral KS and facilitate early diagnosis.

Epidemiology of oral cavity cancer in taiwan with emphasis on the role of betel nut chewing

This article reports the epidemiological characteristics and the possible contributing etiology of oral cavity cancer in Taiwan. Data on oral cavity cancer from the period between 1986 and 1997 were compiled from the Taiwan Cancer Registry Annual Report. The amount of average annual consumption per person of cigarettes, alcohol and betel nut were extracted from the Annual Report of Taiwan Tobacco and Wine Monopoly Bureau and the Agriculture Counsel of Taiwan. The incidence of oral cavity cancer increased annually. Both the total and male incidence have increased substantially since 1993. Regarding the peak incidence, most cases were seen in the sixth to eighth decades of life. Multiple regression models indicated that 86.2% variation in the incidence of oral cavity cancer was explained by the annual average betel nut consumption per person. These results imply that those who chew betel nut belong to a high-risk group and require special consideration and attention regarding health education and health promotion.

A survey of localized lesions of oral tissues: a clinicopathological study

OBJECTIVE

The purpose of this study was to establish the relative prevalence of the different histopathological aspects of biopsied localized soft tissue oral lesions in a university-based dental school biopsy service.

STUDY DESIGN

A retrospective analysis of patients' records with localized lesions treated in the Department of Oral Medicine and Oral Surgery between 2001 and 2004 was conducted. The lesions were classified into either fibrous lesions or soft hemorrhagic lesions. Clinical data regarding age, gender, location, and treatment of the lesions were obtained for each case.

RESULTS

The majority of the lesions were located in the gingiva. There were a total of 294 cases of which 182 (61.9%) were fibrous lesions and 112 (38.1%) were soft hemorrhagic lesions. All cases were treated by excisional biopsy and elimination of the chronic irritant.

CONCLUSION

Although this data might be used as a guide for forming clinical impressions about oral lesions, the clinician must always be aware of the possible occurrence of more rare lesions. This study indicates there are some differences in age and gender distribution as well as in location between the different lesions.

[Oral cancer. Retrospective analysis of 118 cases]

AIM

Oral carcinoma is a form of neoplasia with well-known clinical and morphologic features. This study presents the difference of incidence and behaviour in relation to the time of onset of oral carcinoma, and describes the experience made at the Department of Oral and Maxillofacial Surgery of the Second University of Naples.

METHODS

In this study 118 patients are analysed. They are divided into 3 groups according to age: group A up to 40 years; group B, from 41 to 75 years; group C from 75 years onwards.

RESULTS

No patient of group A showed a carcinoma of verrucous type. This histologic type was found in group B, (14 patients: 14,1%) and in group C (6 patients: 46,1%).

CONCLUSIONS

The results of this study underline the importance of the time of onset in the behaviour of oral carcinoma and the age of patients.

Oral Kaposi's sarcoma: a clinicopathologic study from South Africa

OBJECTIVES

In this retrospective study, we defined the clinicopathologic characteristics of oral Kaposi's sarcoma (KS) and determined the presence of human herpesvirus 8 in the oral lesions in a group of South African patients. These results were compared with similar data from patients in developed countries.

STUDY DESIGN

Eighty-one cases of oral KS were retrieved from the departmental archives. Fourteen patients with oral pyogenic granuloma served as control subjects. DNA was extracted by using a modified phenol chloroform extraction method and amplified by using polymerase chain reaction. If beta-globin DNA sequences could not be demonstrated, the patient was excluded from the study.

RESULTS

Of the 81 patients included in the study, 68 (84%) had been diagnosed since 1997. Oral KS was often the first presenting sign of human immunodeficiency virus infection. Some of the lesions exceeded 4 cm in diameter. The most commonly affected site was the palate (37 patients), followed by the tongue and gingiva. Multiple oral sites were frequently involved. The mean age of the patients was 34.7 years (range, 2-58 years). The male-to-female ratio was 1.31 to 1. Most of the patients (94%) were black. Human herpesvirus 8 DNA sequences were detected in 44 of the 45 cases of oral KS in which the DNA was analyzed, and in 1 case of pyogenic granuloma.

CONCLUSIONS

The only significant clinicopathologic differences in findings between our study and previous studies in developed countries were (1) the male-to-female ratio, (2) the preponderance of black patients, and (3) the more frequent involvement of the tongue. There are no studies reporting the clinicopathologic characteristics of oral KS in populations of developing countries.

Squamous cell carcinoma of gingiva and edentulous alveolar ridge: a clinicopathologic study

All oral squamous cell carcinomas were retrieved from the files of Temple University's Oral Pathology Laboratory from 1967 through 1994 for a clinicopathologic study of those occurring on the gingiva. A total of 1,193 cases had sufficient data for tabulation and statistical analysis, of which 300 (25%) arose on the gingiva or alveolar ridge. The largest number of these cases (211/300) occurred on the mandibular gingiva or alveolar ridge. The mean age of the patients was 66.66 years, with males accounting for 57% of cases. Many case comparison analyses of oral squamous cell carcinomas do not separate oral subsites or specifically address carcinoma of the gingiva. The results were compared with other published series and suggest that further studies are needed because of the wide range of reported figures on the incidence of gingival squamous cell carcinomas.

Are cancers of the salivary gland increasing? Experience from Connecticut, USA

BACKGROUND

Recent studies indicate that cancers of the salivary gland are increasing, and the factors responsible for the increase are unknown. Artefactual changes, such as shift in classifying cancers of the floor of the mouth to cancers of the salivary gland, could affect the time trend for salivary gland cancer.

METHODS

The current study examined the time trends for cancers of the salivary gland and for cancers of the floor of the mouth and lower gum by using Connecticut Tumor Registry data for the time period 1935-1992. A regression model was used to identify the components of birth cohort, period and age as determinants of the observed time trend.

RESULTS

Cancers of the salivary gland have recently increased in Connecticut, with a relative risk of 1.48 (95% CI: 1.06-2.08) for females in 1990-1992 compared to 1980-1984, and a comparable relative risk of 1.60 (95% CI: 1.16-2.22) for males. The increase was found in all age groups 40 and over, particularly among those aged 70 and over. The results from age-period-cohort modelling show a recent upturn in the trend for period slopes, with no clear increase from recent birth cohorts, which is consistent with the results from univariate analyses suggesting no clear increase among those under 40 years of age.

CONCLUSION

Our results suggest that artifactual changes, such as a shift in designation of cancer sites, increasing use of the needle aspirate biopsies, and greater access to medical care for the elderly, may have largely contributed to the rising trend. The known risk factors, radiation exposure and a history of a prior cancer, can hardly explain the observed increase. The Epstein-Barr virus infection has only been associated with certain types of rare squamous cell carcinomas of the salivary gland in the Eskimo population. The AIDS epidemic also cannot explain why older age groups have accounted for most of the increase in incidence of the disease. An examination of the incidence rates for cancers of the salivary gland from other populations may help to clarify the issue.

Squamous cell carcinoma of the gingiva. A case series analysis

Recent studies suggest that patients with carcinoma of the gingiva exhibit demographic features that differ from those of persons with squamous carcinoma at other intraoral sites. In this study, we sought to explore this hypothesis in greater detail. Records from the University of Connecticut Oral Biopsy Service from 1975 through 1992 inclusive were surveyed for cases of oral carcinoma. A total of 577 cases were retrieved and analyzed with respect to prevalence, gender distribution, and age at diagnosis. We found that the gingiva (alveolar ridge included) was the third most common site for oral squamous carcinoma after carcinoma of the floor of the mouth and tongue. Further, the relative proportion of gingival cancer versus carcinoma at other intraoral subsites remained essentially constant throughout the study period. Male-to-female ratios were significantly greater for cancer of the floor of the mouth as compared with both cancer of the tongue and cancer of the gingiva (ridge included). Age was not a significant predictor of oral cancer subsite, and there were no apparent differences between carcinoma of the dentate gingiva and that of the edentulous ridge. Results of this study indicate that gender-specific predilections exist for squamous cell carcinoma at different intraoral subsites. These differences suggest the possibility of different etiologic factors and pathogenetic mechanisms involved in carcinoma of the gingiva compared with surface carcinoma at other intraoral sites.

A diagnostic survey of biopsied gingival lesions

PURPOSE

The primary objective of this study was to determine the most commonly biopsied gingival lesions in a university-based school of dentistry biopsy service.

METHODS

The biopsy service at the Louisiana State University Medical Center School of Dentistry accumulated 30,056 cases during a 24-year period (1969 to 1992). Microcomputer technology was used to sort these cases to study the gingival lesions including the incidence of neoplasm and epidemiologic factors of age, gender, and race.

RESULTS

Of the 30,056 biopsies submitted for diagnosis, 3,859 (12.8%) were taken from the gingiva. The most common diagnoses for gingival lesions were periodontal disease, fibrous hyperplasia, pyogenic granuloma, peripheral ossifying fibroma, and epithelial hyperplasias/hyperkeratoses. Benign and malignant neoplasms made up 15.5% of the cases. The largest number of cases was from individuals between the ages of 30 and 39 (18.2%). Of the biopsies submitted, 63.3% were from female patients, and 85.8% of the cases were from Caucasian patients.

CONCLUSION

Gingival lesions often are detected by dental hygiene and dental professionals. Knowledge of the frequency and presentation of the most common gingival lesions is beneficial in developing a clinical impression of such lesions encountered in practice.

[Benign maxillary tumors. Epulis in Senegal]

The epulis is a hyperplasic tumour restricted to the gum. It is the most widely spread tumour among the benin gum tumours. It has various etiologies. The authors emphasize the epidemiological and clinical aspects of 96 cases. Four types of epulis are observed, the most common type being the acquired epulis. On an etiological level, the factor related to oral hygiene is the most criticized. Their frequency in the oral pathology should lead the dental surgeon to master his treatment.

Chromium-induced carcinoma in the nasal region. A report of four cases

The carcinogenicity of chromium is well established in chromium-induced lung cancer. As of yet, however, there have been only few reports of head-and-neck cancer induced by chromium. We report four cases of carcinoma in the nasal region which seemed to be induced by chromium. All patients have worked at the same chromate factory for 19 to 32 years. The first patient has suffered from squamous cell carcinoma of the left nasal cavity, starting 11 years after his retirement. He received radiotherapy followed by surgery. A malignant fibrous histiocytoma occurred in his left upper gingiva in a previously irradiated region, 7 years after the previous treatment. Surgery and chemotherapy for palliation failed to control the tumour, and he eventually expired. The other three patients underwent lobectomy for lung cancer. In cases 2 and 3, the tumour occurred in the left nasal cavity six and ten years, respectively, each after the lobectomy. In case 4, the tumour arose from the nasopharynx 15 years after the lobectomy. These patients are alive and well without any sign of tumour. The presented cases seem to be induced by long-term exposure to chromium. We conclude that regular physical examination of chromate workers is mandatory for the early detection not only of lung cancer but also of head-and-neck cancer.

Tobacco and alcohol related to the anatomical site of oral squamous cell carcinoma

The aim of the present study was to evaluate the possible relationship between tobacco smoking and alcohol drinking and the anatomical sites of squamous cell carcinoma (SCC) of the lip and oral cavity. For this purpose, a case-case study has been performed in 690 patients. The study was focused on the relative risk (RR) or developing SCC at various (sub)sites, for smokers and drinkers of alcohol (divided into moderate and heavy users) relative to non-smokers and non-drinkers. Estimates of ratios of these relative risks were obtained. The relative risk associated with tobacco smoking, adjusted for the use of alcohol, appeared to be highest for SCC in the retromolar area, followed by the floor of mouth, whereas the lowest RR was found in the cheek mucosa. For alcohol drinking, adjusted for tobacco smoking, RR of SCC of the floor of mouth was significantly higher than for the tongue, whereas the RR of SCC of the cheek appeared to be lowest. Furthermore, this study suggests that the contrasts between relative risks, observed by anatomical site of oral SCC, are more pronounced for tobacco smoking than for the use of alcohol. The possible local and systemic factors responsible for these variations of susceptibility for tobacco and alcohol within the oral cavity are discussed.

The efficacy of radiation therapy for a malignant melanoma in the mucosa of the upper jaw: an analytic study

An analysis has been made of the effect of radiation therapy in 28 patients with a malignant melanoma (Stage I: 18 cases; Stage II: 10 cases) in the mucosa of the upper jaw. Treatment had been provided by one of the following methods: intraoral mold (10 cases), interstitial brachytherapy (two cases), intraoral electron therapy (nine cases), or external irradiation (seven cases). The results have shown that the survival rate for all 28 patients was 25%, and that the survival rate for stage I patients treated by intraoral electron or brachytherapy was 47%. The primary tumor control rate in percentages was 79% (22/28) in all 28 radiotherapy patients; 92% (11/12) for tumors treated by a mold or an interstitial implant; 67% (6/9) for tumors treated by an intraoral cone; and 71% (5/7) for tumors treated by external irradiation with or without surgery. A neck metastasis that was found in 19 patients was treated by surgery, radiotherapy, and/or immunochemotherapy, and the result was successful in nine patients. The major factor in the failure of treatment was a distant, metastatic dissemination. This analysis revealed that radiotherapy has achieved similar or better results than surgery and may be advocated for the management of a localized malignant melanoma in the mucosa of the upper jaw.

Comparison of oral carcinomas in smokeless tobacco users and nonusers

Biopsy reports of squamous cell carcinoma (SCC) and verrucous carcinoma (VC) were retrospectively evaluated to determine the prevalence of smokeless tobacco (ST) use and to ascertain if any clinical or histologic differences existed when comparing ST users with nonusers. Of the 874 SCC cases, 12 patients (1.4%) were ST users as compared with 7.7% (10 of 129) of the VC patients. The carcinomas in ST users, either SCC or VC, were diagnosed at a later age and were more likely to occur in the buccal mucosa/vestibule area. The SCCs in ST users were more often histologically well differentiated. Because of the anatomic site predilection, it appears probable that ST use is a causative factor in the development of some cases of oral carcinoma.

Pregnancy tumor: an analysis

There is some disagreement about the validity of the clinical term "pregnancy tumor." On the basis of its clinical presentation and histologic appearance, some authors believe that it simply represents a pyogenic granuloma (PG), whereas others believe that the lesion is unique because of the apparent influence of female sex hormones. In an attempt to resolve this problem, a study was undertaken to determine whether a significant correlation exists between PG and pregnancy, and whether the clinical term applies to the other epulides. The study involved 42 epulides diagnosed clinically as pregnancy tumors. A chi-square analysis comparing 32 of these lesions with 757 epulides occurring in women revealed a significant disproportion in the number of PGs, whereas the number of peripheral ossifying fibromas and peripheral giant cell granulomas were within the expected range. Very few focal fibrous hyperplasias (fibromas) were diagnosed as pregnancy tumors. Clinical and behavioral features of pregnancy tumors diagnosed microscopically as PGs were also analyzed. The results indicated that the diagnosis of pregnancy tumor is valid clinically in describing a PG occurring in pregnancy, because it describes a distinct lesion not on the basis of histologic features but on etiology, biologic behavior, and treatment protocol.

Statistical and pathological analysis of oral tumors in the Hong Kong Chinese

A total of 805 intra-oral neoplasms was diagnosed in Chinese subjects from 1964-1982 in the University Department of Pathology, Hong Kong. Squamous cell carcinoma (SCC) totalled 502 and constituted 86% of 582 malignant tumors. Although the majority (82%) of SCC were of the well-differentiated type, the relatively poor differentiation exhibited by palatal SCC in the females, was noteworthy. There was a marked male predominance in all SCC subgrouped by anatomic site, but the sex difference declined after the 6th decade and disappeared by the 9th decade. A significant rise in the incidence rate was observed in the decade after 1973 compared to that for 1964-72 in both male (p less than 0.0001) and female (p less than 0.001). It is speculated that, in the absence of improved oral hygiene and dental care, changes in the smoking and drinking habits in the local Chinese are of causal importance.

Sources of error in the registration of oral cancer

The names of 102 patients with histologically confirmed squamous cell carcinoma of the oral cavity were checked against Cancer Registry data for the Trent Region. The study was carried out to determine the accuracy of site recording and the failure rate of registration. Although 94 of the patients were registered, 38 per cent of these were incorrectly coded with respect to site. The way in which such errors may occur is discussed and the procedure for registration of oral cancer is explained.

Major histologic types of cancers of the gum and mouth, esophagus, larynx, and lung by sex and by income level

Incidence rates by income level were computed for squamous cell carcinomas of the gum and mouth, larynx, and esophagus and for squamous cell carcinoma, small cell carcinoma, and adenocarcinoma of the lung in white males and females aged 35--64 years, with the use of data for the nine geographic areas of the Third National Cancer Survey and the 1970 U.S. census. Within sex, age, and geographic area groups, patterns of cancer incidence by income level were analyzed by use of a nonparametric statistical method. Higher rates for males than for females were found for every histologic type studied, and the ratio of male-to-female rates increased with age (especially for squamous cell carcinomas of the larynx and lung). A strong inverse relation to income level was found for all of the histologic types studied in males and for squamous cell carcinomas of the gum and mouth and esophagus and small cell carcinoma of the lung in females. These findings are discussed with reference to patterns of smoking and alcohol use by sex and social class.

Snuff dipping and oral cancer among women in the southern United States

A case-control study in North Carolina involving 255 women with oral and pharyngeal cancer and 502 controls revealed that the exceptionally high mortality from this cancer among white women in the South is primarily related to chronic use of snuff. The relative risk associated with snuff dipping among white nonsmokers was 4.2 (95 per cent confidence limits, 2.6 to 6.7), and among chronic users the risk approached 50-fold for cancers of the gum and buccal mucosa--tissues that come in direct contact with the tobacco powder. In the absence of snuff dipping, oral and pharyngeal cancer resulted mainly from the combined effects of cigarette smoking and alcohol consumption. The carcinogenic hazard of oral snuff is of special concern in view of the recent upswing in consumption of smokeless tobacco in the United States.

Reactive lesions of the gingiva. A clinicopathological study of 741 cases

A series of 741 consecutive cases of localized hyperplastic lesions of the gingiva were studied. The lesions were reclassified into four groups: pyogenic granuloma, peripheral giant cell granuloma, fibrous hyperplasia and peripheral fibroma with calcification. This study indicates that there are some differences between these groups in age and sex distribution as well as in location and size of the lesion. Fibrous hyperplasia was the most common type, followed in descending order by pyogenic granuloma, peripheral fibroma with calcification and peripheral giant cell granuloma. The peripheral giant cell granuloma showed no sex predilection while fibrous hyperplasia, pyogenic granuloma and peripheral fibroma with calcification were more common in females. Pyogenic granuloma and peripheral fibroma with calcification occur in younger patients more often than fibrous hyperplasia, and thus may represent a stage in the development of fibrous hyperplasia.

Cancer of the oral cavity in Nigerian Igbos

An unselected biopsy material of 31 Nigerian Igbo patients with cancer of the oral cavity is presented. The descending order of localization was gingiva, palate, tongue and floor of mouth. Burkitt's tumour was limited to the jaw and affected older rather than younger children. There was scarcely any preponderance of squamous cell carcinoma in males. It would appear that cancer of the oral cavity is not a great problem in the Igbos and that potent carcinogens concerned with the causation are lacking in the community.

Oral cancer in Puerto Rico

All cancer cases diagnosed in Puerto Rico are analyzed and registered in the Central Cancer Registry. The incidence of oral cancer in Puerto Rico is fourth-highest in the world. (In 1972 oral cancer accounted 72% of all cancers in males in Puerto Rico.) A review of the data revealed important contrasts with reported statistics from the continental United States (e.g., 75.6% of the cases in Puerto Rico were initially treated by radiation, compared with 15.3% of the cases in Western New York States.