Incidence of oral cavity and pharyngeal cancers by anatomical sites in population-based registries in Puerto Rico and the United States of America

OBJECTIVE

Puerto Rico's (PR) epidemiological data on each oral cavity and pharynx cancer (OCPC) site is yet largely unexplored. Our aim was to compare OCPC incidence in PR, by anatomical site, with that of non-Hispanic whites (NHW), non-Hispanic blacks (NHB), and Hispanic (USH) individuals in the USA.

METHODS

Data from the Surveillance Epidemiology and End Results program and the PR Central Cancer Registry were collected and analyzed. Age-standardized rates, percent changes, and standardized rate ratios were estimated with 95% confidence intervals.

RESULTS

Although declining incidence rates were observed for most anatomical sites in most racial/ethnic groups and in both sexes, the incidence of oropharynx cancers slightly increased for cancers in the oropharynx among PR women, both in the base of tongue and soft palate/other oropharynx (p>0.05). The incidence of soft palate/other oropharynx cancers in PR men was about 2.8 times higher than in USH men (p<0.05) and about 1.4 times higher than in NHW men but 21% lower than in NHB men (p>0.05). Significant interactions terms formed with racial/ethnic group and age were shown in various sites. The largest differences between sexes were consistently noted in PR.

CONCLUSION

Further research in PR should assess the effect of the HPV infection, as well as of other risk factors, in OCPC incidence by anatomical site in younger populations. These data could explain more precisely the reasons for the differences observed in this study, particularly among sexes in PR.

Clinico-histopathologic types of maxillofacial malignancies with emphasis on sarcomas: a 10-year review

BACKGROUND

Sarcomas are malignant neoplasms that occur anywhere in the human body. Though their occurrence in the head and neck region is rare vis-a-vis other malignancies, their presence is of tremendous concern due to their often grave prognosis.

OBJECTIVE

To determine the pattern of occurrence, histopathologic types of maxillofacial sarcomas and their proportion to other malignant neoplasms of this region based on archival material accumulated over 10 years (2000-2009).

DESIGN

A combined retrospective and prospective cross-sectional study.

SETTING

The University of Nairobi Dental Hospital (UNDH).

SUBJECTS

All cases with a diagnosis of sarcoma registered between 2000-2009 were evaluated.

RESULTS

Of the 528 malignancies recorded over the ten-year period, 427 (80.9%) were of epithelial origin while 101 (19.1%) were sarcomas. Patients with epithelial malignancies were older (54.16 +/- 15.94 years) than patients with sarcomas (31.73 +/- 16.78) with the differences having been statistically significant. Osteosarcoma was the most commonly occurring sarcoma (29.7%), followed by Kaposi's sarcoma (KS) (28.7%), fibrosarcoma (FBS) (18.8%), and rhabdomyosarcoma (RMS) (9.9%). Sarcomas peaked in the third decade with 70% occurring below the age of 40 years. The maxilla and the mandible were the most afflicted sites in the maxillofacial region accounting for 52%. The patients on average presented to medical personel about nine months after noticing the lesion with the most frequent complaint having been swelling.

CONCLUSION

The present study confirms the relative rarity of maxillofacial sarcomas. It also provides data on the histopathologic types and demographic characteristics of maxillofacial sarcomas in a select Kenyan population. This information is a contribution to the comprehensive documentation of sarcomas that occur globally and is useful in the provision of baseline data upon which future prospective analytical protocols may arise.

Malignant minor salivary gland tumors: a retrospective study of 27 cases

PURPOSE

Malignant tumors of the intra-oral minor salivary glands are uncommon. The aim of this study was to give information concerning the clinical features of these tumors, the distribution of location, treatment opportunities, and outcome.

METHODS

Twenty-seven patients with malignant salivary gland tumors that were treated between January 1999 and December 2008 were evaluated retrospectively.

RESULTS

Of the 27 minor salivary gland carcinomas, 48.1% were adenoid cystic carcinomas (ACC), 29.7% mucoepidermoid carcinomas (MEC), 22.2% adenocarcinomas (ADCA). The most common first symptom was a painless swelling in 60% of the cases, with the second most common symptom being ulcers (28%). Four recurrences and two metastases were found. No recurrence was observed in ADCA. All four patients experiencing a recurrence developed it in the first 3 years after treatment.

CONCLUSION

Wide excision with a clinical margin of 1 cm and in large tumors, positive surgical margins or perineural infiltration and postoperative radiotherapy (RT) can be recommended; but in order to give exact information concerning the possible benefit from postoperative RT, it needs large prospective multicenter studies. Long-term follow-up controls and in particularly longer than 5 years in ACC including yearly chest X-rays should be offered to these patients because of late metastasis and recurrences.

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.

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.

Salivary gland neoplasms in Maiduguri, north-eastern Nigeria

OBJECTIVE

To document the pattern of salivary gland neoplasia in Maiduguri, Nigeria.

DESIGN AND SETTING

A retrospective clinical and histopathological review (January 1987-December 2002) of cases diagnosed at a tertiary care hospital.

MATERIALS AND METHODS

Information on demographics, diagnosis and cancer management in the hospital were retrieved from biopsy reports and case notes of patients.

RESULTS

The palatal (71.9%) and parotid (78.3%) glands were the most common minor and major salivary glands involved, with a benign-malignant ratio of 1:1 and 1.4:1, respectively. Pleomorphic adenoma (44.3%) was the most common salivary gland neoplasm recorded. It was commonly reported in the third decade (mean 30.4 years) and among males (M:F, 1.4:1). Ectopic lesions (17.1%) were reported in the neck, nose and cervical nodes. Mucoepidermoid carcinoma (10.1%) was the most common salivary gland malignancy, occurring in the second and sixth decades; of equal gender distribution and predominantly in the palate (50%). The squamous cell carcinoma (10.9%) and adenoidcystic carcinoma (21.9%) were the most common malignancies in the major and minor glands respectively. There was a higher prevalence of malignancies of the parotid than previously reported for northern Nigeria (P = 0.036).

CONCLUSION

Pleomorphic adenoma and mucoepidermoid carcinoma were the most commonly reported benign and malignant neoplasia in this series. The prevalence of mucoepidermoid carcinoma contrasts with reported findings in other African studies.

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.

Relative frequency of solitary melanocytic lesions of the oral mucosa

BACKGROUND

Solitary pigmented lesions of melanocytic origin are uncommon in the oral mucosa. These lesions include the oral and labial melanotic macule, oral melanocytic nevus, oral melanoacanthoma, oral melanoma and atypical melanocytic proliferation. The purpose of the study was twofold: to report a large series of solitary melanocytic lesions from one source, and to determine the relative frequency of these lesions.

METHODS

The study was based on a systematic search of the files of the Pacific Oral and Maxillofacial Pathology Laboratory, University of the Pacific, San Francisco for solitary pigmented melanocytic lesions (benign and malignant) accessed during the years 1984-2002.

RESULTS

Of the 89 430 biopsies accessed during the 19-year period, 773 (0.83%) cases of solitary pigmented melanocytic lesions in the oral mucosa were identified. Oral and labial melanotic macules were the most common melanocytic lesions comprising 86.1% of the entire group and 0.7% of the total number of accessed biopsies. The vermilion border and gingiva were the most common sites (31.1% and 31.0% respectively). Oral melanocytic nevi comprised 11.8% of the entire melanocytic group and 0.1% of the total number of biopsies. The most common site was the palate (44%). Intramucosal nevi were the most common (64%), followed by compound nevi (16.5%) and common blue nevi (16.5%). Junctional nevi were uncommon (3.0%). Oral melanoacanthoma comprised only 0.9% of the entire melanocytic group and 0.008% of the total number of biopsies. Oral melanoma and atypical melanocytic proliferation were the least common lesions each comprising 0.6% of the entire melanocytic group and 0.006% of the total number of biopsies. The most common site for oral melanoma was the palate (60%).

CONCLUSION

The palate was the most common location for both melanocytic nevi and oral melanoma. Thus, all melanocytic lesions in the palate should be viewed with caution and biopsy is recommended to rule out melanoma. Further studies are required to elucidate the entity of oral atypical melanocytic proliferation.

[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.

Minor salivary gland carcinoma involving the oral cavity or oropharynx

BACKGROUND

Minor salivary gland carcinomas are uncommon but most often occur in the oral cavity, particularly the hard palate. Dental examination may provide an opportunity for early detection.

METHODS

Patients referred to the multidisciplinary head and neck clinic at Westmead Hospital between 1980-2002 with a diagnosis of minor salivary gland carcinoma of the oral cavity or oropharynx were retrospectively identified. Data were collected on histology, treatment, outcome and the referring practitioner.

RESULTS

A total of 30 patients diagnosed with a malignant minor salivary gland carcinoma were identified. Many patients, 16/30 (53 per cent), were referred by dentists. There were 15 males and 15 females with a mean age of 62 years (range, 22-86 yrs). Most (73 per cent) presented with early stage disease (stage 1/11). Adenoid cystic carcinoma was the most common histological subtype (40 per cent) followed by mucoepidermoid carcinoma (30 per cent) and polymorphous low-grade adenocarcinoma (20 per cent). All but two patients underwent surgery with 12/30 (40 per cent) also receiving adjuvant radiotherapy usually in the setting of an incomplete/close margin. One patient developed local recurrence and one developed widespread metastatic disease. At last follow-up 83 per cent of patients were alive and disease free.

CONCLUSIONS

Early diagnosis and treatment of minor salivary gland carcinoma is likely to lead to a better outcome. In our study dentists were responsible for half of all referrals to our multidisciplinary head and neck clinic. Awareness of this uncommon entity is important for dental practitioners.

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.

Smoking and chewing habits of oral cancer patients in the Solomon Islands

A 5-year retrospective study (1994-97 and 1999) on the prevalence of oral cancer was conducted using patients' records at the Dental Department in the Solomon Islands, National Referral Hospital. The aim of the study was to investigate the relationship between smoking and betel nut chewing in patients with oral cancer. Relevant information regarding patient's smoking and betel nut chewing, site of oral cancer and personal history were extracted from patient's dental records and analyzed. There were 48 cases of oral cancer reported at the hospital over the 5-year period. Males aged 45 years and over were mostly affected with the distribution showing 31.5% of the cases from Malaita, 20.8% from Temotu and 14.6% from the Western Provinces. Ninety percent (90%) of the oral cancer patients practice both smoking and betel nut chewing, compared to those who only practice one habit and this was highly significant (p<0.001). Chewing of high levels of betel quid per day (>5) showed statistical significance (p<0.001) for oral cancer patients (83%) compared to those individuals (17%) who chewed lesser (<5) betel quid. About 62% of these patients smoked cigarette rolls and tobacco stick rolls. However, there was no significance in the relationship of oral cancer and those individuals who smoke (p > 0.05). Buccal mucosa (3 1 %) and buccal mucosa+adjacent comer of the mouth (25%) are the most common affected site in the oral cavity. This study has shown that the combinations of tobacco smoking and chewing of betel quid are the main risk factors for oral cancer. Therefore, these factors are to be emphasized in the public and preventive education of communities in the Solomon Islands.

[Palatine tonsil lymphoma in ENT department in Bełchatów for the of 1987-1998]

The authors present 10 cases of malignant lymphomas of the head and neck hospitalized in ENT Department of Regional Hospital in Belchatów. The two cases of tonsil lymphomas were described in detail calling attention to diagnostic difficulties. The false result of aspiration biopsy caused prolongation of diagnostic procedure.

Midfacial tumours: a review of 72 cases

We review 72 midfacial tumours managed during the 10-year period between 1985 and 1995. We describe presenting features, sites of lesions and histology, treatment regimens and outcomes, as well as the various surgical approaches for the resection of midfacial tumours, and their indications and contraindications. The choice of approach should be based on type of tumour, its site, and extent.

Histological and epidemiological profile of oral cancer in Congo (Zaire)

From the files of the Department of Pathology at Kinshasa University Hospital, D.R. Congo, we have studied the histological and epidemiological profile of oral cancer in Congo. The relative frequency of oral cancer in Congo is 2.1%. The palate is the most common site (28.8%) and the squamous cell carcinoma the most frequent histological type (57.6%). People between 50 and 59 years old (27%) (Means: 48.39 +/- 15.43 years) and females (M/F = 0.47/1 are more affected).

Kaposi's sarcoma in women: A clinicopathologic study

BACKGROUND

Although all epidemiologic subsets of Kaposi's sarcoma (KS) (i.e., sporadic, endemic, epidemic, and iatrogenic) have an association with human herpes virus 8 (HHV8), these subsets occur in patient populations with distinctive clinical features. To a variable degree men outnumber women in all subsets.

OBJECTIVE

A retrospective study of women with histologically proven cutaneous KS was undertaken to determine the clinical and histopathologic features, as well as any associations.

METHODS

Two hundred and fifty cases of cutaneous KS in women from 1975 to 1993 were reviewed.

RESULTS

Of the patients, 80% were more than 60 years of age, and of the patients less than 60 years old, 28 were from areas of the world with endemic KS. All HIV+ patients but one were from areas of endemic KS. Two patients were renal transplant patients. Sixty-four percent of the patients had single lesions and 21% recurrent lesions. Twelve patients had, or were known to develop, internal involvement, and in six patients the cause of death was KS. All but four cases histologically showed areas of solid proliferations of tumour cells consistent with plaque or tumour stage. An angiosarcoma-like histologic pattern appeared to be associated with more aggressive epidemiologic subsets. High mitotic rates were rarely seen and did not correlate with aggressive epidemiologic subsets.

CONCLUSION

Kaposi's sarcoma in women is diagnosed almost exclusively in plaque or tumour stage. The majority of women within our study fit within the epidemiologic subset of sporadic KS.

Intraoral minor salivary gland tumors: a retrospective study of 129 cases

From 1970 to 1996, 129 cases of intraoral minor salivary gland tumors were diagnosed at the Department of Pathology, Nihon University School of Dentistry. The diagnosis of each case was based on the 1991 WHO classification. Eighty benign and 49 malignant minor salivary gland tumors were found in the approximately 9,300 oral biopsies submitted during the 27-year period. Pleomorphic adenomas were the most commonly histologic type of the benign tumors identified and 51% of the malignant tumors were diagnosed as mucoepidermoid carcinoma. The most common primary location of the tumors was the palate. Sixty percent of all tumors occurred in females and the peak age for incidences of all tumors was found in the third, fourth, sixth and seventh decades. These results were compared with those of the studies in different world population groups.

Intraoral minor salivary gland tumors: a retrospective study of 62 cases in a Venezuelan population

From 1968 to 1992 sixty-two cases of tumors of minor salivary glands were diagnosed from a Venezuelan population at the Oral Histopathology Laboratory of the Central University of Venezuela School of Dentistry. The diagnosis of individual tumors was based on the 1991 World Health Organization classification. Tumors were analyzed considering histological type, age and sex of the patient, and intraoral location. Pleomorphic adenomas constituted the most common histological diagnosis of the benign sample (71%), and 62% of the malignant tumors were diagnosed as mucoepidermoid carcinomas. The principal location was the palate, and a marked female prevalence was observed. Geographic differences appear to exist when compared with results of studies representing a cross-section of different world population groups.

Epstein-Barr virus (EBV) in Malaysian upper-aerodigestive-tract lymphoma: incidence and sub-type

Epstein-Barr virus (EBV) type B, a less potent transformer of B lymphocytes than type A, has rarely been detected in EBV-associated neoplasms except in AIDS-related lymphomas, in which about 50% of the cases contained this sub-type. In this study we analyzed the association of EBV and the distribution of virus sub-types in Asian non-Hodgkin's lymphoma (NHL) of the upper aerodigestive tract. We studied archival material of 29 NHL cases from Malaysia. B- and T-cell associated antigens were demonstrated by immunohistochemistry, and EBV early RNA EBER-1 was demonstrated using the RNA in situ hybridization technique. EBV was detected in the majority of tumour cells in 11/13 T-NHL but in only 1/16 B-NHL. EBV was sub-typed by single-step polymerase chain reaction of the EBNA-2 gene. This was successful in 9/10 cases of EBER-1-positive tumours and all contained type-A virus only. Our results showed a preponderance of T-cell lymphoma of the upper aerodigestive tract in the ethnic Chinese group of Malaysian patients, and EBV was strongly associated with T-NHL but not with B-NHL. Our results suggest that type-A EBV is the prevalent sub-type in Asian NHL of the upper aerodigestive tract, similarly to findings in Asian nasopharyngeal carcinoma.

Reverse smoking as a risk factor for palatal cancer: a cross-sectional study in rural Andhra Pradesh, India

A cross-sectional study of reverse smoking and its association with pre-malignant and malignant lesions of the palate was conducted in the north coastal areas of Andhra Pradesh, India. A total of 480 randomly selected persons were interviewed. Information about smoking status, diet and access to mass media was obtained in each case and an examination of the oral cavity was performed. Reverse smoking of chutta was practised by 33% of the total rural population. The prevalence rate of all palatal lesions was 55%. The prevalence rates of the separate lesions: leukoplakia palatii, palatal keratosis and palatal cancer, were 9.8%, 18.1% and 1.9%, respectively. The presence of these (pre-)malignant lesions was strongly associated with reverse smoking and also associated with conventional chutta smoking. Reverse smoking induced significantly more lesions than conventional chutta smoking, and was a major determinant of subsequent palatal cancer: all 9 newly diagnosed palatal cancers were observed within the group of reverse smokers. There was an inverse relationship between the incidence of palatal lesions and vitamin A intake. The study of access to mass media indicated that the most favourable medium for promoting a prevention campaign would be the cinema.

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.

Angiocentric T-cell lymphoma of the nose, paranasal sinuses and hard palate

Sixty-five cases of malignant lymphoma of the nose, paranasal sinuses and hard palate were retrospectively analysed to identify the presence or absence of angiocentric lesions. We observed that the 23 patients with angiocentric lesions had a worse prognosis with a shorter duration of response and also a shorter duration of survival, compared with 42 cases of malignant lymphoma of the same anatomical region but without angiocentric lesions. Patients with angiocentric lymphoma were associated with other bad prognostic factors such as elevated levels of lactic dehydrogenase and beta 2 microglobulin, local bone destruction and lymphopenia. Immunophenotyping studies showed that most patients with angiocentric lesions had T cell lymphomas (18 of 23, 78 per cent). We believe that patients with angiocentric T cell lymphomas of the nose, paranasal sinuses and hard palate represent a distinctive clinico-pathological entity with different clinical presentation and outcome. Patients with angiocentric T cell lymphomas had frequent relapse at extranodal sites and combined therapy should be considered as the initial therapeutic approach.

Carcinoma of the soft palate and uvula

Carcinoma of the soft palate and uvula is a rare form of oropharyngeal neoplasm with incidence ranging from 5% to 12% of all oropharyngeal carcinomas. The lesions are more commonly found in men in the sixth and seventh decade of life. Because of the high incidence of potential velopharyngeal incompetence, surgical resections are usually reserved for the lesions confined to the uvula, where larger lesions are treated with radiation therapy.

Lip and intraoral tumours: a local perspective

Lip and intra-oral cancer is an uncommon disease in Singapore among the local population. The incidence is less than 1.5% of all cancers reported to the Singapore Cancer Registry which recorded a total of 18,049 cases of all types of cancer in a 5-year period from 1978 to 1982. The Department of Plastic Surgery at Singapore General Hospital has been conducting a multidisciplinary clinic for the management of head and neck tumours since 1984. The results of the distribution, age, sex and racial differences, risk factors and modalities of treatment of the various types of cancer affecting the lip and intraoral region were analysed in a prospective study. A total of 69 cases were analysed and of these 59 (85.5%) were squamous cell carcinoma (SCC) of varying grades of malignancy, the remaining comprising adenoidcystic and mucoepidermoid carcinoma, malignant melanoma and a single case of ameloblastoma. A number of predisposing factors such as smoking, alcohol and the chewing of betel nuts could be identified in the history of patients suffering from cancers involving the buccal mucosa and tongue. As the numbers involved in non-SCC are small in this study, the discussion will be confined to patients presenting with squamous cell carcinoma only.

Intervention study for primary prevention of oral cancer among 36 000 Indian tobacco users

In a house-to-house survey, 36 471 tobacco chewers and smokers were selected from the rural population in three areas of India. These individuals were interviewed for their tobacco habits and examined for the presence of oral leukoplakia and other precancerous lesions, first in a baseline survey, and then annually over a 5-year period. By personal advice and via the mass media they were encouraged to give up their tobacco habits. The follow-up rate was 97%. The control cohort was provided by the first 5-year results from a 10-year follow-up study conducted earlier in the same areas with the same methodology but on different individuals without any educational intervention. In Ernakulam district (Kerala) and Srikakulam district (Andhra) substantially more people stopped their tobacco habit and reduced the frequency of tobacco use in the intervention cohort than in the control cohort; in Bhavnagar district (Gujarat) the intervention group showed only a slightly higher proportion stopping their tobacco habits and no difference in the proportion reducing them. The 5-year age-adjusted incidence rate of leukoplakia in Ernakulam district was 11.4 in the intervention group versus 47.8 among men, and 5.8 versus 33.0 among women; and for palatal lesions in Srikakulam district the corresponding figures were 59.8 versus 260.8 among men and 289.5 versus 489.5 among women. In Bhavnagar the incidence rate of leukoplakia did not differ between the cohorts. Since most oral cancers are preceded by precancerous lesions, education on tobacco habits should be a feasible and effective approach to primary prevention of oral cancer.

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.

Age-specific and age-standardised incidence rates for intraoral squamous cell carcinoma in blacks on the Witwatersrand, South Africa

All new cases of intraoral squamous cell carcinoma which occurred in Blacks resident on the Witwatersrand during the 10-yr period 1971-80 were traced by examining the records of all the hospital pathology departments in this area. The population at risk at the mid-point of the study (1975) was calculated from the National Population Censuses of 1970 and 1980, and consisted of 1125960 men and 880269 women. Age-specific incidence rates and age-standardised incidence rates were calculated for each intraoral site for men and women. In the latter calculation a standard World population was used. All rates are expressed as average number of cases per 100000 population per annum. The age-specific incidence rates and age-standardised incidence rates (in brackets) for men and women respectively are: tongue, 1.43 and 0.26 (2.69 and 0.41); gingiva and alveolar ridge, 0.04 and 0.01 (0.07 and 0.01); floor of mouth, 0.87 and 0.22 (1.64 and 0.38); buccal mucosa, 0.05 and 0.04 (0.13 and 0.05); hard and soft palate, 0.34 and 0.05 (0.63 and 0.08). There appears to have been an increase in the incidence of intraoral cancer in Black South Africans since the first survey in 1953-55, which can probably be ascribed to the urbanization process. In Europe, North America and in other population groups in South Africa, the palate is least frequently affected. In contrast, in Black South Africans lesions of the palate are much more common, being less frequent only than tongue and floor of mouth lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Tumours of the minor (oropharyngeal) salivary glands: a demographic study of 336 cases

There are 2410 primary epithelial salivary gland tumours in the files of the British Salivary Gland Tumour Panel. Of these tumours, 336 (14%) involved the minor (oropharyngeal) salivary glands, and these were studied in the present investigation. Individual tumours were diagnosed according to the WHO Classification. The percentage of malignant or potentially malignant tumours (46%) was much higher than in major glands (18%), and in some of the less common intraoral sites all the tumours were malignant. The principal sites were the palate (54%), lips (21%) and buccal mucosa (11%), and, in these sites, pleomorphic adenoma was the most common tumour. Monomorphic adenomas accounted for 6% of palatal tumours, but 30% of lip salivary gland tumours. The most common malignant tumour was the adenoid cystic carcinoma. The results are compared with several other large surveys and with tumours of major salivary glands.

Pedunculated malignant melanoma of the hard palate

We report the case of a primary malignant melanoma arising from the mucosa of the hard palate on a fibrovascular stalk. This is to our knowledge the first report of a pedunculated melanoma in this location. The possibility of a more favorable prognosis, because of the stalk, which shows no signs of invasion by the neoplasm, is considered.

Primary oral malignant melanoma

A fifteen year review (1968-1982) of all cases of malignant melanomas seen in Singapore revealed nine cases in the oral region. The cases were analysed and the literature reviewed. The cases usually presented late and the hard palate is the commonest site involved. The highest incidence is around the 4th-6th decade. Oral melanomas have a poorer prognosis when compared to cutaneous melanomas and this is similar to other reported series. No difference in sex incidence was seen in this series and the estimated incidence of oral to all other cases of malignant melanomas was about 6%.

Muco-epidermoid carcinoma of the palate

Muco-epidermoid carcinoma is the second most frequently occurring malignancy of the minor salivary glands representing 25 per cent of all malignancies, adenoid cystic being the more common tumor. It invariably presents as an asymptomatic lung without mucosal ulceration, 50 per cent of which occur on the palate. It is of great interest to the physician because it may be divided into two distinct categories dependent upon its cell composition - low grade malignancy or high grade. These have widely differing prognostic significance and require different modes of therapy. This is illustrated by five case histories which span the past seven years of the author's experience.

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.

Evaluation of oral, pharyngeal, laryngeal and esophageal cancer risk in reverse smokers of chuttas

Reverse smoking of chuttas seems to have no significance for the development of cancer of the hypopharynx, esophagus, larynx and nasopharynx. The conventional chutta smoker runs a slight risk of developing hypopharyngeal cancer. Other smoking and chewing habits do not seem to play any role in our area as these habits are very uncommon.

Oral carcinoma in situ

Oral carcinoma in situ (CIS) as a histopathologic entity was studied in seventy-seven patients to determine the clinical and histologic parameters of the disease. There were forty-nine male and twenty-eight female patients, with 45.1 per cent of the lesions being described clinically as white, 15.9 per cent as red, and 8.5 per cent as a combination of the two. The high-risk sites for CIS were floor of the mouth (23.2 per cent of all lesions), tongue (22.0 per cent), and lips (in males only, 19.5 per cent). Histologically, there was a considerable range of variation in surface keratinization, thickness of epithelium, and certain cytologic alterations. The most consistent of all cytologic changes was loss of orientation of cells. There is no information available concerning possible regression of oral CIS, as is known for CIS of uterine cervix. Furthermore, there is no information concerning the frequency of or the period of transition from oral CIS to invasive carcinoma or whether all oral carcinoma is preceded by CIS. Further studies on this disease are essential.