Gingival metastasis from primary hepatocellular carcinoma: a case report and literature review of 30 cases

BACKGROUND

Gingival metastasis from primary hepatocellular cancer (HCC) is rare, highly malignant, and generally has no distinct symptoms. Not performing a biopsy can lead to misdiagnosis. This article reports an 87-year-old male with gingival metastasis from HCC. To gain a better insight into this disease, we also conducted a literature review of 30 cases and discussed the clinical and pathological characteristics, diagnosis, treatment and prognosis of this unusual form of liver cancer.

CASE PRESENTATION

An 87-year-old man was hospitalized with a chief complaint of chronic constipation and diffuse lower extremity edema. His past medical history included a three-year hepatitis B infection and a cerebral infarction 17 years prior. Imaging examination detected a massive hepatocellular carcinoma in the right liver lobe and multiple metastases in the lungs. Oral examinations revealed a reddish, cherry-sized exophytic mass on the right upper gum. The mass was tentatively diagnosed as a primary gingival tumor and was ultimately confirmed by biopsy as a metastatic carcinoma originating in the liver. The patient decided, with his guardians, to receive palliative care and not to remove the mass. Unfortunately, the patient accidentally bit the mass open; profuse bleeding ensued and local pressure exerted a poor hemostatic effect. The patient's condition worsened, and he eventually died of multiple organ failure. We also performed a literature review and discussed 30 cases of gingival metastases from HCC. The findings indicated that these lesions affected males more than females, with a ratio of 6:1, and infiltrated the upper gingivae (63.1%) more than the lower gingivae (36.7%). Survival analysis indicated that the overall survival for patients with upper gingival metastasis was worse than for those with lower gingival metastasis, and patients receiving treatments for primary liver cancer or metastatic gingival tumors had better overall or truncated survival times.

CONCLUSION

Gingival metastasis from primary hepatocellular carcinoma is rare, and its diagnosis has presented challenges to clinicians. To avoid a potential misdiagnosis, a biopsy is mandatory regardless of whether a primary cancer is located. Early diagnosis and treatment for primary liver cancer or metastatic gingival lesions may improve survival expectations.

Gingival metastasis of a mediastinal pulmonary sarcomatoid carcinoma: a case report

BACKGROUND

Pulmonary sarcomatoid carcinoma (PSC) is a rare malignancy with both epithelial and sarcoma components, and high tumor metastasis potential.

CASE PRESENTATION

A 63-year-old male patient had a tumor in the right posterior mediastinum, and was eventually diagnosed with PSC and gingival metastasis. The patient underwent thoracoscopic right upper pneumonectomy with lymph node dissections, and the subsequent gingival biopsy revealed a metastatic PSC. The immunohistochemistry revealed that both PSC site tissues were positive for vimentin, CKAE1/AE3 and Ki-67. The patient received radiotherapy and chemotherapy after surgery, and deceased two months later due to systemic tumor metastases.

CONCLUSION

PSC metastasis is variable, and leads to diagnostic dilemma or erroneous diagnosis. A differential diagnosis can help to distinguish it from gingival cancer.

Simultaneous gingival squamous cell carcinoma in an oral lichen planus patient

OBJECTIVE

To describe a case of bilateral simultaneous squamous cell carcinoma of the gingiva affecting the mandible in a lichen planus patient and discuss the pertinent literature.

METHOD AND MATERIALS

We present a case of a 50-year-old woman with a history of oral lichen planus who was diagnosed with a primary and a second primary squamous cell carcinoma originating from the mandibular gingiva. A literature review did not disclose cases of gingival carcinoma arising simultaneously and bilaterally in the mandible.

RESULTS

Presentation of two simultaneous clinically distinct squamous cell carcinoma of gingiva, invading underlying mandible, is rare. Second primary tumor refers to a concomitant malignancy that is independent from the primary tumor. Second primary tumor is an independent prognostic factor since the surgical procedure is highly influenced by the extent of bony invasion.

CONCLUSION

The general practitioner should be aware of the possibility of multiple independent lesions at different sites of the oral cavity. A thorough oral examination of sites remote from the obvious main lesion should be performed. The presence of simultaneous primary oral cancerous lesions may indicate a greater morbidity and a grave outcome for the patient.

[A case of appearance of a prominent rash in response to alternate-day S-1 administration as adjuvant chemotherapy for lower gingival cancer]

We report the development of a prominent rash in response to alternate-day S-1 administration in a patient with oral cancer. The patient was a 75-year-old woman with left-side lower gingival cancer(T4N1M0). After chemoradiotherapy, the patient underwent radical surgery. She was treated with oral S-1, administered on alternate days at a dosage of 80mg/day (orally, twice per day), as postoperative adjuvant chemotherapy. Edematous erythema, accompanied by strong itching and paraesthesia, appeared focally on the face and the limbs 1 month after beginning S-1 treatment. Since the rash was determined to be drug-induced, S-1 administration was stopped, and steroid, antihistamine, and topical steroid treatment was initiated. The symptoms gradually improved, and the rash disappeared without recurrence approximately 1 month later. Although alternate-day administration is considered to be a safe and effective method to administer S-1 oral therapy, it should be noted that cutaneous symptoms might appear after a fixed dosage is exceeded.

Primary extranodal non-Hodgkin's lymphoma presenting as painful gingival swelling

Primary extra-nodal non-Hodgkin's lymphomas (NHL) constitute 25-40% of NHL but less than 1% arises in oral cavity. Here in 53-year-old man with stage IE gingival diffuse large B cell lymphoma who was treated successfully with chemotherapy and radiotherapy was presented.

[Congenital epulis: refrain from surgery. A case report of spontaneous regression]

INTRODUCTION

Congenital epulis is a rare benign tumor that originates from the mucosa of the dental alveolar ridge. Management of congenital epulis is unclear; most authors recommend surgical excision during infancy.

CASE REPORT

We report a case of congenital epulis arising from the anterior mandibular region that was managed conservatively. This epulis did not interfere with breast-feeding or respiration. Subsequently, there was spontaneous involution of the lesion during the 1st year of life.

CONCLUSION

Small and medium congenital epulis (<20mm) exceptionally compromises feeding and might regress spontaneously. Subsequently, conservative treatment should be adopted. Surgical treatment should be indicated only when major feeding or respiratory problems are present or when the clinical diagnosis is uncertain.

Prognosis of gingival squamous cell carcinoma diagnosed after invasive procedures

Gingival squamous cell carcinoma (SCC) has a relatively poor prognosis, because differential diagnoses of periodontitis and osteomyelitis are difficult to exclude. As such, gingival SCC is usually diagnosed late, following invasive procedures such as extraction or curettage. The purpose of this study was to classify gingival SCC patients into two groups according to the location of their primary lesion: dentate and edentulous, and to determine the appropriate treatment strategy by comparing clinical and histological features as well as treatment results. The medical records of 76 patients diagnosed with gingival SCC and treated at one institute from 1 January 1993 to 31 December 2007 were reviewed. The overall 5-year survival rate was 60.7%, and the mean survival was 98 months. Factors affecting survival included bone invasion of the primary lesion (p = 0.035), neck node metastasis (p = 0.001), and local recurrence (p = 0.000). The results suggest that more aggressive treatment, such as setting a broad surgical field and enforcing preventive neck dissection, can improve outcome, although they are associated with increased rate of cancer bone invasion and neck metastasis in patients diagnosed with cancer after receiving invasive procedures.

Gingival hemangioma with port wine nevi of the face. A case report

Hemangioma is a proliferating mass of blood vessels. Its occurrence in gingiva is rare. The diagnosis and treatment of hemangioma is complex, and any attempt to carry out biopsy/surgical excision may lead to fatal consequences due to severe hemorrhage. A rare case of gingival hemangioma with port wine nevi of face is reported. The case is of periodontal interest because the lesion occurred on the gingiva, a reliable diagnostic approach (Ultrasound Spectra Doppler Flow) was used and a conservative treatment using a sclerosing agent was employed.

[Treatment and prognosis of gingival carcinoma: a report of 116 cases]

BACKGROUND & OBJECTIVE

The treatment and prognosis of gingival carcinoma, a common oral carcinoma, have seldom been reported. This study was to explore appropriate therapies and analyze prognostic factors of gingival carcinoma.

METHODS

Clinical data of 116 gingival carcinoma patients, treated at Cancer Center of Sun Yat-sen University from 1992 to 2003, were analyzed. Survival analyses were performed for patients who received surgery, radiotherapy, or surgery combined with chemotherapy or/and radiotherapy. The patients had been followed up for more than 3 years.

RESULTS

One hundred patients received radical therapy. The overall 3-and 5-year survival rates were 52.7% and 41.8%. The 5-year survival rates were 50.3% in surgery alone group and 49.0% in combined treatment group, without significant difference. The 5-year survival rate of radiotherapy alone group was only 20.0%. For advanced gingival carcinoma, the recurrence rate was much lower in combined treatment group than in surgery alone group. Clinical stage and surgical margin status were predictors of survival.

CONCLUSIONS

Surgery alone is appropriate for gingival carcinoma patients at an early stage; surgery combined with chemotherapy or/and radiotherapy is an adequate treatment for patients at advanced stages. Clinical stage and surgical margin status are important prognostic factors.

[Epuli--the inflammatory or neoplastic tumor]

Epuli (granulomas) are the most frequently observed gingival tumours. The etiopathogenesis of the hyperplasia is not yet clear, and classification inconsistent. Literature on the subject presents considerable discrepancies regarding the tumours origin. The factors determining their development, growth rate, and tendency to recur are still unknown although several options have been considered, i.e., type of injury or inflammatory process, hygiene, nutrition, alcohol, nicotine, pharmacotherapy, hormonal status, and immune efficiency. The opinions of authors of the literature on etiopathogenetic, the classification, the clinical images and the treatment of epulides are represented.

Squamous cell carcinoma of the superior gingival–buccal complex

Squamous cell carcinoma of the superior gingival-buccal complex are rare and few English-language data have been published on their biological behaviour. Reported in this paper are the clinical behaviour and treatment outcomes of squamous cell carcinoma of the upper gingival-buccal complex. We reviewed the charts of 110 patients with squamous cell carcinoma restricted to the upper gingiva, superior gingival-buccal sulcus and adjoining buccal mucosa, seen between 1997 and 2001. Separate outcome analyses were carried out among 86 patients who had undergone surgery, and 24 patients treated by radiotherapy or chemo-radiation. Disease-free survival at 2 and 5 years was 48.9% and 36%, respectively, and was independent of epicentre of disease. Five-year, disease-free survival was 48.8% and 0% for surgical treatment and non-surgical treatment groups. T stage (p=0.024) and extra-capsular spread of disease (p=0.036) were independent predictors of disease-free survival on multivariate analysis. Adequate surgical resection and adjuvant treatment, in the first instance, offers the best chance of disease control.

Spontaneous regression of non-Hodgkin's lymphoma in the oral cavity after incisional biopsy

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.

A preliminary comparative study of the prognostic implications of type 2 diabetes mellitus for patients with primary gingival carcinoma treated with surgery and radiation therapy

PURPOSE

Type 2 diabetes mellitus (DM2) may be a risk factor in determining cancer progression. The aim of this study was to compare the progression of primary gingival cancer in patients with DM2 and nondiabetic patients.

PATIENTS AND METHODS

Prospective follow-up studies involved patients with gingival squamous cell carcinoma in stage T2-3N0M0. Treatment comprised surgical tumor extirpation, block resection of the mandible, functional cervical dissection, and 60 Gy of adjuvant irradiation. The patients were divided into a group of patients with DM2 (DM group) and a nondiabetic, control group. Progression data was recorded after a 2-year period of clinical follow-up. Surgical samples were assessed histopathologically from the aspect of tumor spread.

RESULTS

At the end of a 2-year follow-up period, the DM group demonstrated significantly worse clinical results in terms of cervical lymph node metastases (P<.05) and mortality rate (P<.001). Histologically, the degree of tumor invasion was significantly different in the DM group and controls (P<.01).

CONCLUSION

DM2 can be considered a possible prognostic factor in cases of gingival carcinoma, forecasting an unfavorable course.

[Case report of prosthetic treatment for defected jaw with enucleation of the right maxillary sinus tumor]

PATIENT

The patient is a 71-year-old woman who had undergone a gingivectomy due to a gingival carcinoma of right maxillary sinus and a denture was made for the defected jaw.

DISCUSSION

During three years and six months, |3 serves as the guidance tooth had suffered from various symptoms, from the detachment of the neighboring tooth to the use of an OP anchor followed by a partial fracture of the cuspid root. However, |3 has not been removed in accordance to the patient's request. In addition, a relining provided indirectly to the denture, it is still maintained and used for mastication, pronunciation and swallowing functions without difficulty.

CONCLUSION

This is a case that a denture was made for the defected jaw. However, it is important ot take measures in the future, as the remaining tooth is not expected to be preserved for long.

Local delivery system of cytotoxic agents to tumors by focused sonoporation

Recently, ultrasound-targeting microbubble destruction has been employed in molecular gene therapy, and a new potent nonviral gene transfer method known as 'sonoporation' has been developed. We investigated the efficiency of sonoporation toward growth inhibition of human gingival squamous carcinoma cell line, Ca9-22, in vitro and in vivo. The cytotoxicity of bleomycin (BLM) was investigated using flow-cytometric analysis and Hoechst's staining in vitro assay systems. We found that the delivery of BLM by sonoporation induced cytotoxic effect toward Ca9-22 cells in vitro. Our in vivo results showed that tumors nearly disappeared in Ca9-22 cell-implanted nude KSN/slc mice treated with a low dose of BLM followed by sonoporation during the 4-week experimental period. Histological analysis revealed that the cytotoxic effect was mainly apoptosis. We previously reported that the cytolethal distending toxin B (cdtB) from Actinobacillus actinomycetemcomitans, a periodontopathic bacterium, is responsible for cell cycle arrest and apoptosis in vitro. Thus, we used sonoporation to transfect a cdtB-expressing plasmid into Ca9-22 cells and examined cell viability in vitro and in vivo. We found that an administration of cdtB-expressing plasmid followed by sonoporation-induced marked growth inhibition of Ca9-22 cells and apoptotic cells were also observed in vitro and in vivo. These findings suggest that local administration of cytotoxic agents with sonoporation is a useful method for molecular cancer therapy.

Aids-related plasmablastic lymphoma of the oral cavity associated with an IgH/MYC translocation treatment with autologous stem-cell transplantation in a patient with severe haemophilia-A

Plasmablastic lymphoma is an AIDS related lymphoma that continues to have a poor prognosis despite significant advances in the management of HIV and lymphoproliferative diseases. In part this has been due to limited insights into the biology of this disease and the molecular mechanisms of oncogenesis. To date molecular abnormalities have not been described in plasmablastic lymphoma, and its aggressive clinical behaviour has been difficult to understand. We describe the first reported cytogenetic abnormality in plasmablastic lymphoma, an IgH/MYC translocation. It is also the first description of autologous stem cell transplantation in a patient with severe haemophilia A.

Prenatal Diagnosis of Congenital Epulis

Congenital granular epulis is a rare benign tumour situated on the alveolar ridge, which usually presents as a single tumour of variable size. Prenatal diagnosis of epulis has rarely been reported in medical literature. A possible complication is airway obstruction, which is essentially determined by the size of the tumour. Because of the potential risk of neonatal respiratory distress, prenatal diagnosis is valuable in the organization of a safe delivery. The case presented here is the prenatal diagnosis of a congenital epulis discovered in the 32nd week of pregnancy.

Myeloid sarcoma occurring in the maxillary gingiva: a case without leukemic manifestations

Myeloid sarcoma (MS) is a localized extramedullary mass of immature granulocytic cells that usually occurs in patients with acute myeloid leukemia (AML) or myeloproliferative disorders. It may rarely precede peripheral blood or bone marrow involvement, presenting a diagnostic challenge. Although MS may be found in any location, an intraoral occurrence is rare. In this report we describe a rare case of a patient with nonleukemic MS of the maxillary gingiva. The histologic specimen was first interpreted as non-Hodgkin's lymphoma. The correct diagnosis was reached after extensive immunohistologic studies. The malignant cells were myeloperoxidase positive, lysozyme positive, CD45+, CD68+, CD3-, CD10-, CD19-, CD20-, CD30-, CD34-, CD56-, CD79a-, S100-, and chloroacetate esterase negative. Induction therapy with FLAND (fludarabine, Ara-C, mitoxantrone, and dexamethasone) was started, but the patient did not achieve a remission. Some weeks later, the patient presented pleural effusion and paralysis of the seventh cranial nerve on the left side. She died a few days later. The present case indicates the importance of a correct initial diagnosis for adequate therapy, which is often delayed because of a high misdiagnosis rate. If the MS is treated without intensive chemotherapy for AML as soon as possible, the prognosis will be poor.

Squamous cell carcinoma of the mandibular gingiva

Squamous cell carcinoma is a kind of epithelial tumor and the most common malignant tumor of the oral cavity. Clinically, it may be misdiagnosed because of its variable appearances. Carcinomas of the gingiva especially tend to present as having benign features, and this leads to delays in diagnoses or even to misdiagnoses. We had a patient with squamous cell carcinoma (SCC) of the gingiva, and our initial impression was hyperplastic inflammatory tissue. This case demonstrates the importance of being highly suspicious of oral lesions which undergo malignant change, especially when they do not promptly respond to conventional therapy.

Resolution of oral non-Hodgkin's lymphoma by reduction of immunosuppressive therapy in a renal allograft recipient: a case report and review of the literature

A case of oral non-Hodgkin's lymphoma arising in a patient with insulin-dependent diabetes who had undergone renal allograft transplantation is described. The resolution of the disease was achieved by a reduction in her immunosuppressive therapy. The differential diagnosis is discussed, and the management of posttransplantation lymphoproliferative disorders is reviewed.

Expression of Rb, pRb2/p130, p53, and p16 proteins in malignant melanoma of oral mucosa

We previously reported that pRb2/p130 gene, one of the Rb family members, was immunohistochemically abundantly expressed in well-differentiated oral squamous cell carcinomas, whereas in undifferentiated ones the expression was low. Oral malignant melanoma is extremely rare, however the prognosis is poor because it tends to locally invade tissue or metastasize and its biological behavior appears to be different from cutaneous malignant melanoma. The present study dealt with the expression of pRb2/p130, Rb, p53, and p16 in 13 cases of malignant melanoma of oral mucosa as revealed by immunohistochemical staining. The stage classification of the 13 patients was as follows; stage II: eight patients, stage III: three patients, and stage IV: two patients. pRb2/p130 was expressed in only two stage II-cases, neither of which have shown any evidence of recurrence or metastasis for over 14 years. Positive staining for Rb was found in three cases consisting of one stage II-case, one stage III-case, and one stage IV-case. p53 was expressed in two cases, one a stage II and the other a stage IV. Positive staining for p16 was found in seven cases consisting of four stage II-cases, two stage III-cases, and one stage IV-case. pRb2/p130 may be inversely correlated with the malignancy of oral malignant melanoma, but further study is needed.

[Lung cancer metastasis to the gingiva]

A 70-year-old man was referred to our hospital complaining of left gingival tumors with bleeding, halitosis and impediments to eating and speaking. Tumors were also found in both lungs, the stomach, the intestines and the right adrenal gland. Biopsies of the gingiva and the stomach pointed to undifferentiated carcinoma. Although the patient was treated with carboplatin plus 5-fluorouracil, the gingival tumors did not change in size. Subsequently, the gingival tumors were irradiated with a total dose of 39 Gy, and disappeared completely. The patient died 78 days later of hemorrhage of the digestive tract. Postmortem examination revealed that the primary tumor was in the left lung. Nineteen cases of lung cancer metastatic to the gingiva have been reported. The prognosis in all was very poor, and the QOL was compromised. However, several cases have improved with therapy to the gingiva. We believe that initial therapy should be directed at metastatic gingival tumors of the lung.

Unusual gingival presentation of post-transplantation lymphoproliferative disorder: a case report and review of the literature

Post-transplantation lymphoproliferative disorder is a well-documented complication of solid organ or bone marrow transplantation. Histologically, it is characterized by an abnormal proliferation of lymphocytes, which can range from benign B-cell hyperplasia to malignant lymphoma. Non-Hodgkin's lymphoma (NHL) is associated with several risk factors, such as congenital or acquired immunodeficiency states, autoimmune disorders, and infectious agents (eg, Epstein-Barr virus). Primary sites of presentation in the head and neck are Waldeyer's ring, paranasal sinuses, salivary glands, the oral cavity, and the larynx. Clinical appearance of gingival NHL varies but is usually found to be an asymptomatic gingival enlargement or mass resembling a pyogenic granuloma. We present a patient with a gingival ulceration that was subsequently diagnosed as Epstein-Barr virus malignant lymphoma resulting from the immunosuppression needed to prevent graft-versus-host disease after bone marrow transplantation.

Antisense oligonucleotides against protein kinase CK2-alpha inhibit growth of squamous cell carcinoma of the head and neck in vitro

BACKGROUND

Human squamous cell carcinomas of the head and neck (SCCHN) overexpress the protein kinase CK2, and elevated CK2 activity correlates with aggressive tumor behavior and poor clinical outcome. We therefore investigated whether interference with CK2 expression would inhibit SCCHN cell growth in vitro.

METHODS

We targeted the catalytic (alpha) subunit of CK2 using an antisense oligodeoxynucleotide (ODN) strategy. Human Ca9-22 cells derived from SCCHN were transfected with CK2-alpha sense, nonsense, or antisense ODN; CK2 activity was measured; and the effect on CK2 activity and on cell growth was determined.

RESULTS

Transfection of Ca9-22 cells with antisense CK2-alpha ODN resulted in significantly decreased CK2 kinase activity associated with nuclear chromatin and in dose-dependent growth inhibition of Ca9-22 cells in vitro.

CONCLUSIONS

Interference with the protein kinase CK2 signal in SCCHN cells may offer a novel anticancer strategy for this malignancy.

A study of the association between the prognosis of carcinoma of the mandibular gingiva and the pattern of bone destruction on computed tomography

OBJECTIVE

To clarify whether the pattern of bone destruction seen on CT is more closely associated with the outcome of carcinoma of the mandibular gingiva than that derived from panoramic radiographs (PR).

METHOD

Axial bone window CT scans and PR of 62 patients with carcinoma of the mandibular gingiva were evaluated retrospectively by two oral radiologists for the pattern of bone destruction. Patterns were classified into the three types: erosive, invasive and mixed. The relationship between these patterns with each imaging modality and cumulative recurrence rate, cumulative metastasis rate and cumulative survival rate, calculated by the Kaplan-Meier method, were statistically analysed by the log rank test.

RESULTS

The pattern of bone destruction derived from CT was closely associated with the cumulative metastasis rate (P < 0.05), the cumulative recurrence rate and the cumulative survival rate. In contrast, the pattern of bone destruction based on the PR was not associated with the cumulative metastasis rate (P = 0.43), the cumulative recurrence rate (P = 0.44), or the cumulative survival rate (P = 0.5).

CONCLUSION

The prognosis of patients with carcinoma of the mandibular gingiva is more closely related to a classification derived from the pattern of bone destruction on CT rather than PR. However, the number of subjects investigated in this study was not large enough to confirm our conclusions statistically. Further studies by other investigators are therefore needed.

Apparent pokeweed mitogen cure of metastatic gum melanoma in an older dog

Immunotherapy with plant mitogens has been of increasing interest to both authors, although their mutual attraction to these substances over the past two decades occurred independently and has taken divergent pathways from the start. Because of their clinical unavailability, Wimer's efforts have been confined to writing theoretical concepts on potential applications of the mitogens focusing on the L4 isolectin of PHA. Alternatively, Mann has worked actively with laboratory and experimental research involving PWM that he has extracted himself. As a sequel to a pilot study of PWM cancer treatment in pets whereby he supplies the mitogen, protocol, and data sheets and veterinarians supervise the administration, Mann acquiesced to widespread requests for inclusion in an extended investigation. Unfortunately, this arrangement has left Mann with little control over data submission, and until recently, only verbal reports have been received. The recent documentation of a three-year remission and apparent cure of gum melanoma metastatic to regional and hilar lymph nodes and to the lungs in an aged dog following PWM therapy has prompted this case report. The incredible response has inspired more aggressive attempts to obtain information from other recipients of the mitogen. The small total dose of 300 micrograms inducing a remission does speak for the remarkable potency of PWM that may be 500 or more times that of PHA. However, the possibility that melanoma is a uniquely responsive tumor is suggested by a 1971 article indicating complete remission of metastatic melanoma in an 18-year-old lad to an unexpectedly low total dose of 50 mg PHA. Preliminary reports on other tumors treated with PWM indicate some impressive responses have occurred, although they also suggest that Mann's regimen may sometimes require adjustments in dosages and other variables previously reviewed in theoretical PHA-L4 models, to which this case report now contributes validity.

Metallothionein immunoreactivity in head and neck carcinomas; special reference to clinical behaviors and chemotherapy responses

Metallothionein (MT), has selectively binding affinity for heavy metal ions and over expression of MT has a potential against resistance for CDDP anticancer agents and radiation treatment. The role of MT immunoreactivity of squamous cell carcinoma in oral and pharyngeal regions (n = 28) and in the maxillary sinus region (n = 3) was evaluated for distribution patterns of MT and clinicopathologic behaviors. All the sections were examined in 400x and counted for MT positive cells over 5 fields of tumor growing foci. MT immunoreactivity was expressed in both tumor cell cytoplasm and nuclei, and showed heterogeneous localization in tumor epithelial cells and in the stroma. Immunohistochemical localizations showed mosaic patterns as the highest MT staining tumor cells intermingled with negative or low staining cells in neoplastic foci, and in stromal cells. Histiocytic and fibrocytic cells in both peripheral and interstitial stromas were also not stained homogeneously. In oral and pharyngeal carcinomas (n = 28), MT positive cell index in treated cases (n = 11) was 17.85% and that in non treated tumors (n = 17) was 25.19%. In maxillary sinus carcinomas (n = 3), MT positive index was 4.56% and showed lowers levels as compacted to other SCC sites. Among histological grading in oral and pharyngeal SCCs, MT index of well differentiated SCC (n = 9) was 17.04%, of moderately differentiated SCC (n = 13) 21.92% and poorly differentiated SCC (n = 6) was 31.06%. There is no significant correlation of positive index of metallothionein between treated and untreated samples taken in oral and pharyngeal SCCs.

Oral malignant melanoma: long-term follow up in three patients

Three patients with oral malignant melanoma, who survived for at least ten years after initial examination, are presented. The depth of tumor invasion was 5 mm or less in all patients. The first patient received surgery and postoperative immunotherapy and she had no recurrence more than 18 years after treatment. The second patient underwent surgery but had local recurrence after 11 years. He underwent resection and postoperative chemotherapy and was still alive more than 14 years after initial examination. The third patient received radiotherapy and had metastasis nine months after treatment. Resection and radiotherapy were performed and the patient was alive more than 14 years after first presentation.

Prognostic factors affecting outcome in lower gingival carcinoma

Squamous cell carcinoma of the lower gingiva is a rare lesion that frequently invades the mandible. To determine the factors that affect local disease control and overall survival, a retrospective review of 155 previously untreated patients was performed. Primary lesions larger than 3 cm (P = .021) and persistently disease-positive surgical margins (P = .027) were found to be associated with decreased local control rates. Survival was adversely affected by advanced T stage (P = .001), positive initial and final surgical margins (P = .004), mandibular invasion (P = .014), and cervical metastases (P<.001). Extent of mandibular resection, tumor extension beyond the lower gingiva, recent dental extractions in the region of the primary, perineural invasion, and histologic grade did not affect local control or survival. Although lower gingival carcinoma tends to involve the mandible, our findings indicate that tumor size is more important than mandibular invasion in predicting local disease control. Larger tumors that have a greater propensity for local recurrence and poorer survival require a more extensive surgical resection.

[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.

Treatment of verrucous carcinoma with recombinant alfa-interferon

BACKGROUND

Verrucous carcinoma is an uncommon neoplasm whose medical treatment is not well defined.

OBJECTIVE

We report the clinical effects of recombinant alpha-interferon (IFN) with varying dispensing routes on the tumor size in 3 patients exhibiting three different subtypes of verrucous carcinoma.

OBSERVATIONS

In case 1, an oral florid papillomatosis of the upper gingiva, a stabilization of the lesion size was observed after the administration of a cumulative dose of 45 million IU of IFN alfa-2b. The patient died after discontinuation of the treatment due to hepatic toxicity. In case 2, a giant condyloma acuminatum of the penis, treatment with a cumulative dose of 522 million IU of IFN alfa-2a first resulted in stabilization of the disease, and no evidence of recurrence was observed after surgical treatment. In case 3, a verrucous carcinoma of the leg, a mild decrease in lesion size was observed after the administration of a cumulative dose of 174 million IU. Surgery was finally required.

CONCLUSION

In reducing the growth of the tumor, treatment by IFN appears to be an adjuvant therapy of verrucous carcinoma, but it never prevents surgery or death.

Squamous cell carcinoma of the gingiva. A review

The main predictor of survival is clinical stage at diagnosis. If diagnosed early enough, squamous cell carcinoma of the gingiva is curable. It is important that dentists be aware of the early signs of disease. They are often the first professional seen by these patients, and are the most skilled among health care workers at performing oral examinations.

Malignant lymphoma of the mucosa-associated lymphoid tissue (MALT)--consecutive unusual manifestation in the rectum and gingiva

Non-Hodgkin's lymphomas (NHL) of the mucosa-associated lymphoid tissue (MALT) are characterized by a preferential mucosal manifestation. Each organ system may be involved. Exclusively local growth is usually treated with surgical tumour reduction, combined with radiotherapy. In cases of tumour dissemination, chemotherapy is warranted. Follow-up should be performed closely. This case report highlights an unexpected recurrence of NHL in the oral MALT, four years after primary manifestation in the rectum.

[Clinical, radiological and histopathological studies of squamous cell carcinoma of lower gingiva]

In order to improve the treatment results of the lower gingival carcinoma, the treatment results were analysed based on the X-ray views, histopathological findings and mode of treatment. A series of 152 cases of primary lower gingival carcinomas treated at the First Department of Oral and Maxillofacial Surgery, Tokyo Medical and Dental University, during the 25 years between 1964 and 1988 was surveyed. The lesions with the invasive type of bone resorption on the X-ray picture often had unclear tumor margin histopathologically and those of the pressure type had a smooth front, with a small number of exceptions. The five-year cumulative survival rate was 76.7% for the pressure type, 64.6% for those without bone resorption, 53.9% for the invasive type. The deeper the resorption was, the higher the death rate was in the invasive type. Grade II of WHO classification and Grade 3 of the mode of invasion had the least recurrence rate and the least frequency of delayed cervical metastases. Grade 4D showed the highest recurrence rate and Grade 4C a high frequency of cervical metastases. Five-year cumulative survival rate was 77.8% for the cases treated by surgery, 65.6% for those by the combination of surgery and radiation, 57.1% for those by chemotherapy and 29.5% for those by radiation.

[Treatment of tumors of the oral cavity. Long-term follow up of 1223 cases. Clinico-experimental computerized processing using BMDP program]

The study assesses a series of 1223 patients treated for oral cavity neoplasm at the Institute of Oncology of Turin. It confirms the proportional deterioration of the survival rate in correlation with the advanced stage of the carcinoma. It shows the influence of the different types of treatment on survival, particularly referring to tumor site and stage at the time of first treatment.

Nd:YAG laser-induced hyperthermia treatment of spontaneously occurring veterinary head and neck tumors

Conventional hyperthermia treatment of superficial tumors in the oral cavity is troublesome due to difficulty in accessing the lesion. A new hyperthermia technique employing near-infrared radiation delivered through a flexible silica optical fiber is described. The system consisted of an Nd:YAG laser for tissue heating, a He-Ne laser for aiming beam, a computer-controlled optical shutter, an interstitial thermometer, computer, and a printer. A 3-m-long 600-microns silica fiber delivered laser energy to the tumor via surface illumination. Using the aiming beam, the spot size was adjusted to include 5 mm of surrounding normal tissue. A thermocouple implanted in the tumor base provided temperature feedback to maintain desired hyperthermic temperature within the lesion. Three spontaneously occurring canine (two squamous cell carcinomas on the gum, one pigmented melanoma on the hard palate) and one feline tumor (squamous cell carcinoma on the nose) have been treated with Nd:YAG laser hyperthermia. Hyperthermia was delivered at 43.5 degrees C for 1 h. All animals received standard radiation treatment prior to hyperthermia. Nd:YAG laser hyperthermia allowed effective and efficient delivery of heat to veterinary nasal and oral lesions otherwise not treatable with conventional heating techniques.

Capillary hemangioma of the maxilla. A report of two cases in which angiography and embolization were used

This article presents two clinical cases of capillary hemangiomas of the maxilla. Such lesions are rare, as demonstrated by the review of the literature included in this article. The presentation, differential diagnosis, histopathology, management, and follow-up for each case are discussed. Our rationale for approaching these types of lesions, as well as our opinion that microembolization should be considered as a first line approach to treatment, is presented.

[Neoplasms of the floor of the mouth. Case reports]

The authors study a group of 61 patients treated for floor of the mouth neoplasms at the Istituto di Oncologia di Torino. They confirm a high incidence of deaths in the first 2 years after treatment in patients T greater than 2 N+, and better survival in patients with stage I-II tumours. The survival does not tend to fall between 5 and 10 years after treatment.

Kaposi's sarcoma in patients with AIDS

All health care providers must become increasingly aware of the early signs and symptoms of AIDS as KS frequently appears in the head, neck, and oral regions. Dentists are responsible for recognizing these lesions, especially the early lesions, providing dental treatment as appropriate, and for referring patients with AIDS for counseling and treatment that cannot be provided in their office. Early detection of KS is particularly important for patients receiving dental treatment. The dentist must be careful not to further compromise the patient's health by extensive or stressful dental treatment and to prevent intraoperative or postoperative complications. Early supportive and palliative care will improve the patient's prognosis. Dental care will help HIV-infected patients and those with AIDS to avoid caries and periodontal disease. In addition, regular dental care will enable the dentist in the early diagnosis of the disease's oral manifestations, such as candidiasis, hairy leukoplakia, KS, or other oral opportunistic infection. Treatment of these conditions can significantly improve the patients' quality of life and their chances for survival. When universal precautions are used for infection control in the dental office there is no reason that comprehensive dental care cannot be provided for HIV infected patients--both for those that we know are infected and for those that are infected and we don't know about.

[The current treatment of maxillary carcinoma]

Several characteristics of maxillary sinus and oral maxillary squamous cell carcinoma have been discussed, After trimodal combination therapy have been introduced to both cancers, improved local control have been obtained. In addition to elevation of survival rate, neck metastases and double cancers have become the problems to be solved.

[Therapy of carcinoma of the oro-maxillo-facial region. 3. Hard palate and upper gums]

The Authors describe the therapeutic modalities for the care of epidermoid carcinoma of the hard palate and superior gingiva. Surgery and radiotherapy are equally effective for the early stages, while in the advanced disease therapy should be always combined.

Spontaneous regression of congenital epulis of the newborn

An infant with congenital gingival epulis which spontaneously regressed over the first year of life is reported. A policy of conservative management should be adopted in this condition unless there are feeding problems in the newborn period or reasons to doubt the diagnosis.

[A case of erythroplakia of the palate, tongue and gingiva]

A case of a 58-year-old man with erythroplakia, which occurred in the palate, tongue and gingiva, is reported. The histological diagnosis of a biopsy specimen was carcinoma in situ. The patient was treated with irradiation (60Co, 5060 cGy) and chemotherapy (5-FU, arterial infusion, 6400 mg). The erythema completely disappeared following a 6-week therapy, and no atypical cells were histologically recognized. There were no signs suggesting recurrence or metastasis during the follow-up period of 5 months.