Oral Adenosquamous Carcinoma Mimicking a Pyogenic Granuloma: a Challenging Diagnosis

Evaluation of Dental Professionals' Knowledge and Attitude Regarding the Diagnosis of Oral Cancer Through Histopathological Examination of Granulation Tissue

INTRODUCTION

The current cancer trend in India has reported an alarming increase in cancer of the lip, throat, and oral cavity. Few dentists are aware that malignant neoplasms can also occur in the form of granulation tissue and periapical granulomas. However, most dentists agree that biopsies are essential to diagnose oral cancer. This makes the timely diagnosis of oral cancer dependent upon the histopathological examination of the granulation tissue by the dentist.

AIM

 The main aim of this study was to evaluate the knowledge and attitudes of dentists regarding the diagnosis of oral cancer through histopathological analysis of granulation tissue.

METHOD

A cross-sectional study was conducted on dentists who were residents of Uttar Pradesh, India. Two hundred and fifty study participants enrolled to complete a self-structured questionnaire containing 15 closed-ended questions. The study was conducted over a period of three months, from June to August 2020. Descriptive statistics were analyzed using IBM SPSS Statistics for Windows, Version 21.0 (Released 2012; IBM Corp., Armonk, New York, United States, and the t-test was performed. A significance level of P ≤ 0.05 was used to determine the statistical significance of quantitative variables.

RESULTS

The study findings revealed that only a small percentage of dentists (47.2%) were aware of the importance of biopsies in diagnosing oral cancer. Moreover, a minority (14.4%) had conducted biopsies and submitted samples for histopathological analysis. Of them, 10% were aware that in clinical practice, malignant tumors can also manifest as periapical granulomas, granulation tissue, gingivitis, and other conditions.

CONCLUSION

Dentists should proactively submit any granulation tissue for histopathological examination. Oral healthcare providers must maintain a high level of suspicion, develop a range of potential or differential diagnoses for oral cancer, and take necessary measures to attain a definitive diagnosis. This may include considering a referral to a specialist for the treatment of oral cancer.

Adenosquamous carcinoma of the tongue: A case report and an overview of histogenetic concepts

Adenosquamous carcinoma (ASC), a rare variant of squamous cell carcinoma, is an aggressive and highly infiltrating epithelial neoplasm, which has a distinct histomorphological features comprising simultaneous areas of squamous cell carcinoma and adenocarcinoma. Some researchers consider it as a controversial neoplasm, as it may arise from the ducts of the minor salivary gland or from the overlying surface epithelium. In the head-and-neck region, commonly affected sites include paranasal sinuses, larynx and oral cavity. Areas of occurrence in the oral cavity include palate, tonsillar pillar areas, tongue and floor of the mouth. The prognosis of the neoplasm is considered poor due to its early recurrence, local and distant metastasis and low survival rate. This article reports a case of ASC affecting the posterior part of the tongue in a 50-year-old male patient and an overview of its histogenetic concepts.

Pyogenic granuloma associated with conjunctival epithelial neoplasia: report of nine cases

Aims

To systematically describe the clinical and histopathological features of a case series of conjunctival carcinomatous lesions underlying as—and also masquerading—pyogenic granuloma.

Methods

Nine cases of conjunctival carcinomatous lesions underlying a pyogenic granuloma (which were clinically predominant) were retrospectively identified. Patients’ records were analysed for demographic data, clinical appearance and the postoperative course. Formalin-fixed paraffin-embedded specimens were routinely processed and stained with H&E and periodic acid-Schiff. Immunohistochemical stains for cytokeratin were performed in selected cases.

Results

All nine tumours were located in the conjunctiva (bulbar, tarsal, limbal conjunctiva) of patients between 44 and 80 years. The lesions exhibited clinical features of pyogenic granuloma which dominated the clinical appearance. Additional features comprised a papillomatous appearance of the adjacent conjunctiva, a more whitish aspect of the lesion and a history of squamous cell carcinoma (SCC) respectively surgery for other entities. Histopathological analysis revealed a carcinomatous lesion (conjunctival intraepithelial neoplasia or SCC) at the base of a classic pyogenic granuloma in all nine cases. Surgical removal (R0 resection) was performed. Three cases received adjuvant mitomycin C or interferon α2b treatment. Two lesions locally recurred within 2 years after initial presentation.

Conclusion

Carcinomatous lesions may be accompanied by a pyogenic granuloma which may dominate the clinical pictures. As the tumour is usually located at the base of the lesion, a complete surgical excision followed by histopathological analysis is mandatory for each lesion appearing as conjunctival pyogenic granuloma.

Adenosquamous carcinoma, a rare and unknown tumor

Introduction: Adenosquamous carcinoma (ASC) of the head and neck is a rare malignant tumor, with one hundred cases diagnosed so far in the literature. Observation: A 66 years old female patient had a ASC of the right posterior floor of the mouth with a classification T1N0M0. Treatment consisted of surgical management and active surveillance. Discussion: Through this case report, we present this type of tumor and we discuss the main differential diagnosis from a clinical and histological point of view. Conclusion: This entity was described for the first time in 1968 by Gerughty. The CAS is defined by the World Health Organization as “a tumor of the upper respiratory tract, with two distinct squamous and glandular components.” The CAS is considered as an aggressive tumor with a redoubtable prognosis should not be ignored.