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Díez-Montiel A, Antúnez-Conde R, Navarro Cuéllar C, Tousidonis Rial M, Salmerón JI, Bonsfills N, Pujol CA, Serrano FA, Ochandiano S. Embryonal Rhabdomyosarcoma of the Tongue in Adults. Life (Basel) 2023; 13:1255. [PMID: 37374040 DOI: 10.3390/life13061255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in the first two decades of life. One third of cases appear in the head and neck, with 60% of these being embryonal type. RMS is extremely rare in adults, comprising only 1% of adult malignancies, and of those, only 3.3% are rhabdomyosarcomas. (2) Case report: A 46 y.o. male presented with a 1 cm exophytic pediculated painless lesion on the dorsum of his tongue, with progressive growth for 3 months. An excisional biopsy revealed an "embryonal rhabdomyosarcoma with fusocellular areas, with negative rearrangement for gen FOXO1A, negative MDM2 (only focal positivity), and positive INI-1". Subsequent contrast-enhanced MRI concluded the presence of a lesion with imprecise margins in the right half-tongue, 15 × 8 × 7 mm (longitudinal × transverse × craniocaudal), compatible with a sarcoma. The patient underwent a partial centrolingual glossectomy followed by reconstruction with a buccinator muscle local flap. After surgery, he received chemotherapy with eight cycles of VAC (vincristine, actinomycin, and cyclophosphamide) protocol. The patient is now disease free after 42 months, with good tongue function. (3) Discussion and conclusions: Embryonal RMS is an extremely rare sarcoma in adults, and the location in the tongue is even more exceptional (only two more similar cases are reported in the literature). The prognosis in adults is significantly poorer than in children. A complete margin-free resection with an adequate chemotherapy protocol is the treatment of choice in cases such as these.
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Affiliation(s)
- Alberto Díez-Montiel
- Department of Oral and Maxillofacial Surgery, Instituto de Investigación Sanitaria Gregorio Marañon (liSGM), Gregorio Marañon General University Hospital, 28007 Madrid, Spain
| | - Raúl Antúnez-Conde
- Department of Oral and Maxillofacial Surgery, Instituto de Investigación Sanitaria Gregorio Marañon (liSGM), Gregorio Marañon General University Hospital, 28007 Madrid, Spain
| | - Carlos Navarro Cuéllar
- Department of Oral and Maxillofacial Surgery, Instituto de Investigación Sanitaria Gregorio Marañon (liSGM), Gregorio Marañon General University Hospital, 28007 Madrid, Spain
| | - Manuel Tousidonis Rial
- Department of Oral and Maxillofacial Surgery, Instituto de Investigación Sanitaria Gregorio Marañon (liSGM), Gregorio Marañon General University Hospital, 28007 Madrid, Spain
| | - José Ignacio Salmerón
- Department of Oral and Maxillofacial Surgery, Instituto de Investigación Sanitaria Gregorio Marañon (liSGM), Gregorio Marañon General University Hospital, 28007 Madrid, Spain
| | - Nuria Bonsfills
- ICIRE Institute for Reconstructive and Aesthetic Surgery, 28009 Madrid, Spain
| | - Carolina Agra Pujol
- Department of Pathology, Gregorio Marañon General University Hospital, 28007 Madrid, Spain
| | | | - Santiago Ochandiano
- Department of Oral and Maxillofacial Surgery, Instituto de Investigación Sanitaria Gregorio Marañon (liSGM), Gregorio Marañon General University Hospital, 28007 Madrid, Spain
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Muacevic A, Adler JR. Epithelioid Type Tongue Rhabdomyosarcoma in a Pediatric Patient: A Case Report With Literature Review. Cureus 2022; 14:e30820. [PMID: 36337785 PMCID: PMC9621720 DOI: 10.7759/cureus.30820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2022] [Indexed: 01/24/2023] Open
Abstract
Tongue rhabdomyosarcomas (RMSs) are extremely rare soft tissue tumors in the pediatric age group. The most common reported histopathology type is embryonal. To our knowledge, epithelioid type has not yet been reported in tongue RMSs. We report a case of an eight-year-old boy who presented with a painless tongue mass, and the biopsy demonstrated RMS epithelioid type. Head magnetic resonance imaging (MRI) was performed and showed peripherally enhancing mass with central cystic/necrotic component. Computed tomography (CT) scan of the neck showed involvement of the cervical lymph nodes, while metastatic workup was negative for malignancy. As the biopsy showed a positive margin, the patient underwent secondary resection. Moreover, he received adjuvant chemotherapy and radiotherapy. There was no evidence of the disease, and no metastasis was detected in a follow-up of three years. We also performed a literature review of pediatric tongue RMSs to assess the clinical presentation, histopathology, diagnosis, and management.
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3
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Pediatric Tongue Lesions: An Often-Overlooked but Important Collection of Diagnoses. AJR Am J Roentgenol 2020; 214:1008-1018. [DOI: 10.2214/ajr.19.22121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Rhabdomyosarcoma is the malignant neoplasm of striated muscle and a relatively uncommon tumor of the oral cavity. Embryonal variety is the most common subtype, observed in children below 10 years of age but occasionally seen in adolescents and young adults. The present report describes a case of embryonal rhabdomyosarcoma in the left posterior buccal mucosa, with extension in the adjacent alveolus, soft palate, oropharynx and nasopharynx of a 17-year-old female.
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Affiliation(s)
- Sila Datta
- Department of Oral Pathology, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India
| | - Jay Gopal Ray
- Department of Oral Pathology, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India
| | - Tushar Deb
- Department of Oral Pathology, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India
| | - Santanu Patsa
- Department of Oral Pathology, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India
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5
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Chatopadhayay R, Tiwari P, Gangopadhyay AN, Pandey V. Respiratory Distress Secondary to Rhabdomyosarcoma of the Tongue and Co-existent Choanal Atresia. J Maxillofac Oral Surg 2015; 15:258-61. [PMID: 27408448 DOI: 10.1007/s12663-015-0772-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/28/2015] [Indexed: 11/26/2022] Open
Abstract
Whilst rhabdomyosarcoma (RMS) is the third most common solid tumour in children, congenital RMS of the tongue is extremely rare and usually present as painless progressive mass since birth (Dagher and Helman in Oncologist 4:34-44, 1999; Childs and Goudy in Int J Pediatr Otorhinolaryngol 5:126-128, 2010). In neonates, presentation with respiratory distress is unexpected as neonates are preferential nasal breathers and restricted oral breathing due to tumour usually poses no problem. We herein report a case of rhabdomyosarcoma of the tongue with co-existent unilateral choanal atresia, presenting with respiratory distress. The baby developed upper respiratory tract infection following which developed severe respiratory distress. Airway symptoms were precipitated as there was combined obstruction of both the nostrils due to infection or adenoid enlargement and unilateral chonal atresia. Treatment of respiratory distress in the presence of RMS and bilateral nasal pathology must first prioritise the security of the airway, before taking a multi-factorial approach to the therapy of the lingual mass (Childs and Goudy in Int J Pediatr Otorhinolaryngol 5:126-128, 2010). This case illustrates the importance of vigilance with respect to co-existent nasal pathology, in order to avoid the occurrence of complete airway obstruction. We therefore feel that any diagnosis of lingual RMS should warrant a formal examination of both nasal cavities.
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Affiliation(s)
| | - Preeti Tiwari
- Trauma Centre, Oral and Maxillofacial Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP India
| | - A N Gangopadhyay
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP India
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6
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Abstract
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children under 15 years of age and rare among persons older than 45 years of age. It is considered to result from malignant transformation of primitive mesenchymal cells. Although it has a relative predominance for head and neck region, it is found less often in oral cavity. Here we report a case of RMS of mandible in an adult patient, which was initially diagnosed as carcinosarcoma. Clinical and pathologic findings are described, which were confirmed by histochemical and immunohistochemical stains.
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Affiliation(s)
- Kundendu Arya
- Departments of Oral Pathology and Microbiology, Mahatama Gandhi Dental College and Hospital, RIICO, Sitapura, Jaipur, Rajasthan, India
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7
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Shabbir F, Greenwood M. Chondrolipoma presenting as a lump on the lateral tongue. ACTA ACUST UNITED AC 2011; 38:188-90. [DOI: 10.12968/denu.2011.38.3.188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Fahad Shabbir
- Staff Grade, Oral and Maxillofacial Surgery, Newcastle General Hospital, Newcastle, UK
| | - Mark Greenwood
- Consultant Maxillofacial Surgeon and Honorary Professor, Newcastle General Hospital, Newcastle, UK
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8
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Kebudi R, Ozdemir GN. Rhabdomyosarcoma of the tongue: report of a case and review of the literature. Pediatr Hematol Oncol 2011; 28:60-4. [PMID: 20469976 DOI: 10.3109/08880011003749678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Rhabdomyosarcomas are the most common soft tissue tumors in children. Head and neck is one of the most frequently affected site. Within the nonparameningeal, nonorbital head and neck region, rhabdomyosarcomas of the tongue are very rare. We present a 2-year-old boy diagnosed with rhabdomyosarcoma of the tongue. The child was treated with complete surgical resection and chemotherapy. He is followed up with no evidence of disease 6 months after termination of therapy. The literature on rhabdomyosarcoma of the tongue is reviewed.
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Affiliation(s)
- Rejin Kebudi
- Division of Pediatric Hematology-Oncology, Cerrahpaşa Medical Faculty, and Oncology Institute, Istanbul University, Istanbul, Turkey.
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Abstract
A 3.5-year-old female spayed Rat Terrier was presented for evaluation of a submucosal lingual mass. Fine-needle aspiration of the mass revealed a population of neoplastic cells composed predominantly of small, round cells and large, round to spindle-shaped cells, which occasionally had blunt cytoplasmic borders and multiple nuclei. The neoplastic cells had moderate to marked anisocytosis and anisokaryosis. The cytologic interpretation was malignant neoplasia, most likely sarcoma. Histopathologic examination of a biopsy specimen revealed an unencapsulated, poorly demarcated, moderately cellular neoplasm composed of individualized, infiltrative spindle cells. Elongate skeletal muscle cells with prominent, rectangular borders (strap cells) were observed. A morphologic diagnosis of rhabdomyosarcoma was made. Staining with phosphotungstic acid-hematoxylin revealed haphazardly arranged skeletal muscle cross-striations. Immunohistochemical staining results for vimentin, Myo D1, desmin, and myoglobin were positive, though staining intensity of tumor cells varied with the degree of differentiation. Using transmission electron microscopy, irregular, disorganized Z-bands were identified. Rhabdomyosarcomas are uncommon tumors in the dog, and rarely may involve the tongue or oral cavity. Cytologic evaluation of a rhabdomyosarcoma may reveal a pleomorphic population of cells and definitive diagnosis may require histologic examination, immunohistochemical staining, and electron microscopy.
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Affiliation(s)
- Seth Chapman
- Texas Veterinary Medical Center, Department of Veterinary Pathobiology, Texas A&M University, College Station, TX 77842, USA.
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Abstract
We report a 10-month-old girl who, at 4 months, developed a small, reddish, plaquelike lesion on her tongue. This lesion began to enlarge rapidly, resulting in difficulty in swallowing and breathing. On physical examination, there was a large, red, friable, hard in consistency, irregular tumor over the distal portion of her tongue. The histopathology and immunohistochemical findings were consistent with an embryonal rhabdomyosarcoma. The patient was assigned clinical stage I, group III, and began treatment according to the Intergroup Rhabdomyosarcoma Study guidelines, on triple-agent chemotherapy consisting of vincristine, actinomycin D, and cyclophosphamide. She only received four cycles because her parents then refused this treatment. After the tumor size was reduced by chemotherapy, a partial anterior glossectomy was performed. After 30 months of follow-up she has had no recurrences.
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Affiliation(s)
- Antonietta Cirocco
- Department of Dermatology, Luis Razetti School of Medicine, Central University of Venezuela, Caracas, Venezuela
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11
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van Grotel M, Nowak P, Meeuwis CA, Levendag PC, Madern GC, van den Heuvel-Eibrink MM. Long-term remission after non-radical surgery combined with brachytherapy in an infant with a chemo-resistant rhabdomyosarcoma of the tongue. MEDICAL AND PEDIATRIC ONCOLOGY 2003; 41:558-61. [PMID: 14595714 DOI: 10.1002/mpo.10431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- M van Grotel
- Department of Pediatric Oncology/Hematology, Sophia Children's Hospital, Erasmus University Medical Center (EUMC), Rotterdam, The Netherlands
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12
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Weber AL, Romo L, Hashmi S. Malignant tumors of the oral cavity and oropharynx: clinical, pathologic, and radiologic evaluation. Neuroimaging Clin N Am 2003; 13:443-64. [PMID: 14631684 DOI: 10.1016/s1052-5149(03)00037-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Carcinomas of the oral cavity and oropharynx constitute approximately 2% to 5% of head and neck cancers. Alcohol abuse and tobacco chewing, including chewing Shamma, predispose individuals to the development of cancer in the oral cavity. CT and MR imaging are best suited in the evaluation of cancer of the oral cavity and oropharynx. CT in the axial and coronal planes with 3- to 5-mm sections is the primary modality and is best in the evaluation of bony erosion of the mandible and maxilla. Furthermore, lymph node metastases in the neck are optimally evaluated by contrast CT with 5-mm axial sections. MR imaging is preferred for soft tissue assessment because of the greater contrast resolution. It is therefore the first modality in the assessment of tongue carcinomas, oropharyngeal cancer, and tonsillar lesions. The MR examination should be performed with thin-section imaging, applying T1, T2, and T1-GD-DTPA in the axial and coronal planes, with sagittal sections added for paramidline lesions involving the tongue, lips, anterior floor of the mouth, subdivided according to anatomic locations. The local spread, lymph node metastases, prognosis, and therapeutic approaches vary with the location of the lesion represented by a carcinoma either squamous or undifferentiated in 90% of cases. Some malignant lesions may mimic a benign tumor, such as the adenoid cystic or mucoepidermoid carcinoma. Histopathologic diagnosis is therefore necessary for the final diagnosis before treatment by surgery or radiotherapy. PET scanning is indicated in the following instances: in search of an unknown primary tumor in patients who have a neck mass secondary to carcinoma, if a recurrent carcinoma may be present, when there are metastatic N0 lymph nodes in the neck, or where CT is inconclusive for metastatic lymph nodes in the neck.
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Affiliation(s)
- Alfred L Weber
- Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
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Al-Khateeb T, Bataineh AB. Rhabdomyosarcoma of the oral and maxillofacial region in Jordanians: a retrospective analysis. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 93:580-5. [PMID: 12075208 DOI: 10.1067/moe.2002.123860] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective was to study the clinicopathologic features of rhabdomyosarcoma (RMS) of the oral and maxillofacial region in Jordanians. STUDY DESIGN Data were collected from records of patients treated between 1989 and 2000 at the Maxillofacial Unit of Jordan University of Science and Technology. The main outcome measures were age, gender, location, stage of disease, histopathologic type, treatment received, follow-up period, and eventual outcome. RESULTS Nine patients with RMS aged 4 to 17 years were found, with a male to female ratio of 2:1. Six (67%) bony sites and 7 (78%) soft tissue sites were involved. The extent of disease was locoregional in 8 (89%) cases, nodal in 3 (33%) cases, and distant metastatic in 2 (22%) cases. The Intergroup Rhabdomyosarcoma Study classification of clinical groups was as follows: 2 (22%) cases in stage II, 5 (56%) cases in stage III, and 2 (22%) cases in stage IV. The histopathologic types found were 6 (67%) embryonal, 2 (22%) alveolar, and 1 (11%) undifferentiated. Triple agent chemotherapy was used in the treatment of 8 cases, singly or in combination with surgery or radiotherapy. Two patients are still alive, and 5 patients have died of disease. CONCLUSIONS The clinicopathologic features of maxillofacial RMS in this group of Jordanians are different from those of people from other countries. Further studies are needed to have a better understanding of the behavior of RMS in the oral and maxillofacial area.
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Pandey M, Thomas G, Mathew A, Abraham EK, Somanathan T, Ramadas K, Iype EM, Ahamed IM, Sebastian P, Nair MK. Sarcoma of the oral and maxillofacial soft tissue in adults. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2000; 26:145-8. [PMID: 10744932 DOI: 10.1053/ejso.1999.0758] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS Sarcoma occurring in oral and maxillofacial soft tissue is rare. This study was carried out to evaluate the prevalence of oral soft tissue sarcoma and to record its natural history and survival. METHODS Retrospective analysis of the patients with histologically proven oral and maxillofacial soft tissue sarcoma treated at the Regional Cancer Centre (RCC), Trivandrum, betweeen 1990-1998 was carried out. RESULTS During this period, ten cases of oral and maxillofacial sarcomas were registered. Three lesions were located on the cheek mucosa, two on the tongue and two on the mandibular alveolus, while there was one lesion each in the parotid region, maxilla and face (NOS). Mean age at presentation was 31.3+/-14.1 years (range 15-54 years). Seven of the patients (70%) were males. There were three cases of rhabdomyosarcoma (RMS), three cases of spindle cell sarcoma and one case each of angiosarcoma, haemangioendothelioma, malignant schwannoma and malignant fibrous histiocytoma (MFH). All the patients were treated with surgery as a primary modality. Median follow-up time was 30 months (range 5-94 months). An overall srvival of 87.5% at 5 years was observed; however, 5-year disease free survival was 60.0% (95% CI 19.5-85.2). CONCLUSIONS Soft tissue sarcomas are of comparatively less frequent occurrence in oral and maxillofacial soft tissue than in other tissues. A good survival rate can be achieved by multimodality treatment.
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Affiliation(s)
- M Pandey
- Department of Surgical Oncology, Regional Cancer Centre, Trivandrum, India.
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Tanaka N, Murata A, Yamaguchi A, Kohama G. Clinical features and management of oral and maxillofacial tumors in children. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 88:11-5. [PMID: 10442938 DOI: 10.1016/s1079-2104(99)70186-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To clarify the characteristics of oral and maxillofacial tumors in children, we carried out a clinical study of such tumors and reviewed the relevant procedures for treatment. Study design. Medical records of 105 patients less than 15 years of age who were treated for oral and maxillofacial tumors during the 20 years between 1976 and 1997 were retrieved and analyzed. RESULTS Of the 105 cases, 102 (97.1%) involved tumors that were benign; only 3 patients (2.9%) had tumors that were malignant. With regard to benign soft tissue tumor, the most common type was hemangioma (25/69; 36.2%), the second most common type was papilloma (19/69; 27.5%), and the most common site was the tongue. With regard to bone tumor, the most common type was odontoma (14/33; 42.4%), the second most common type was ameloblastoma (11/33; 33.3%), and the most common site was the mandible. Most of the odontogenic tumors (25/28; 89.3%) developed in patients more than 6 years of age; these tumors may develop after dental crown formation. In each case of benign soft tissue tumor, resection was performed; 4 of these tumors (2 hemangiomas, 1 lymphangioma, and 1 papilloma) recurred, but after re-resection recurrence has not been found for more than 4 years. In the cases of benign jawbone tumor, resection and enucleation were the procedures principally performed; 3 ameloblastomas recurred after enucleation, but after relatively wide resection for these recurrent tumors there has been no recurrence for more than 17 years. With regard to the ameloblastomas, enucleation with preservation of the periosteum was effective and bone regeneration occurred rapidly. CONCLUSIONS Most oral and maxillofacial tumors in children are benign. In any case of such benign tumor, including ameloblastoma, minimal surgical treatment should be the procedure of first choice.
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Affiliation(s)
- N Tanaka
- Department of Oral Surgery, School of Medicine, Sapporo Medical University, Japan
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