[A Case of Severe Skin Disorder during Pembrolizumab Treatment for Recurrent Maxillary Gingival Carcinoma]

Immune checkpoint inhibitors are known to produce immune-related adverse events(irAE)that require medical management. Herein, we report a case of a patient treated with pembrolizumab who experienced a Grade 3 interrupted skin disorder. The patient is a 67-year-old female diagnosed with right maxillary gingival squamous cell carcinoma(cT4aN0M0, Stage ⅣA)and underwent partial right maxillectomy, right extended supra-omohyoid neck dissection, and maxillary reconstruction using a forearm flap. Six months postoperatively, late lymph node metastases with extracapsular spread was found in the right buccal lymph node and the left neck, and the patient underwent right buccal lymphadenectomy and left modified radical neck dissection. After postoperative combined chemoradiotherapy(cisplatin plus IMRT)followed by 13 courses of cetuximab plus paclitaxel, a recurrent lesion was found in the right buccal region. After 8 courses of pembrolizumab, a skin rash appeared on the forearm, chest, and back, which was diagnosed as Grade 3 irAE, requiring hospitalization. The patient was re-instituted after waiting for improvement of the skin disorder. The pembrolizumab at 75% reduction dose was re-administrated, and the patient has been followed up so far.

Role of collagen and immunostaining for TGF-β in the clinical and microscopic findings of pyogenic granuloma and peripheral ossifying fibroma

BACKGROUND

Collagen is a component of Pyogenic Granuloma (PG) and Peripheral Ossifying Fibroma (POF) and performs different functions in these lesions. The objective of this study is to evaluate the role of collagen and immunostaining for Transforming Growth Factor beta (TGF-β) in the clinical and microscopic findings of PG and POF.

MATERIAL AND METHODS

PG (n=20) and POF (n=20) were selected for clinical evaluation (sex, age, localization, size and evolution time) and microscopic analysis (picrosirius red staining for collagen analysis and immunohistochemistry for TGF-β) performed in the superficial and deep areas of the two lesions. ANOVA/Bonferroni and t-test, Pearson correlation and χ2 were used to compare the sites and parameters analyzed (p<0.05, GraphPad Prism 5.0).

RESULTS

The depth of PG presented the highest amount of collagen (p<0.001), and its surface showed the lowest amount of type 1 collagen (yellow-red strong birefringence). Type 1 collagen gradually increased in depth of PG, surface and depth of POF (p<0.001). The number of TGF-β+ cells was lower on the surface of PG compared with the depth of PG and the two areas of POF (p<0.001). Sex and localization did not affect these parameters, but the profile of collagen and immunostaining for TGF-β suffered from modifications by the time of evolution and the size of the lesion.

CONCLUSIONS

Although PG and POF are reactive gingival lesions, the expression of TGF-β and its role in collagen showed different biological behaviors in these lesions, suggesting different biological origins for its components.

A case of synchronous double cancers consisting of maxillary gingival carcinoma and intraductal papillary mucinous carcinoma, invasive: case report

BACKGROUND

The development of synchronous multiple primary cancers is one of the major causes of death in patients with head and neck cancer. Herein, we report a case of synchronous intraductal papillary mucinous carcinoma (IPMC), invasive in a patient with maxillary gingival carcinoma.

CASE PRESENTATION

A 73-year-old female visited our hospital complaining of a mass on the left side of the maxillary gingiva. Intraorally, an exophytic tumor, 50 × 25 mm in size, was found on the gingiva of the left maxillary posterior, and a diagnosis of squamous cell carcinoma was revealed by cytology. Emission tomography/ computed tomography with 18 Fluorodeoxyglucose-Positron (18FDG- PET/ CT) showed increased accumulation in the left maxillary gingiva, the left side of cervical lymph nodes, and the main pancreatic duct. The pancreatic ductal tumor was performed the biopsy at esophagogastroduodenoscopy (EGD) and resulted in a pathological diagnosis of IPMC, invasive. The patient was diagnosed as synchronous double primary cancers consisting of maxillary gingival carcinoma cT4aN2bM0 and IPMC, invasive cT3N0M0. She refused radical treatment, and died 11 months later.

CONCLUSION

18FDG- PET/ CT, EGD and multidisciplinary approach is required for the detection and determining the treatment strategy of synchronous double primary cancers.

Giant Aggressive Odontogenic Fibroma in a 15-month-old Female: Case Report and Review of Literature

INTRODUCTION

Odontogenic fibroma (OF) is a rare benign tumor of mesenchymal odontogenic tissue with variable global incidence. Two variants comprising extraosseous /peripheral (POF) and intraosseous /central (COF) have been identified based on the anatomical origin of the tumor. OF isslow growing, and often asymptomatic with characteristic radiographic appearance of a unilocular or multilocular cyst frequently associated with unerupted or displaced teeth while histologically, varying amount of inactive odontogenic epithelium embedded in a mature relatively dense collagenous stroma is diagnostic. The absence of odontogenic epithelium does not exclude the diagnosis of odontogenic fibroma.

CASE REPORT

A 15 months old female presented with 3 months history of left lower jaw swelling which showed aggressive growth following incisional biopsy. Parents said lesion was noticed for the first time as pinpoint on the submandibular area and was too small to warrant any worries. Initial radiograph revealed absence of bony involvement but the second showed evidence of bony involvement. An impression of soft tissue sarcoma was made and incisional biopsy was sent for pathological diagnosis which revealed peripheral odontogenic fibroma. The rapidity of growth following incisional biopsy bellied a benign lesion.

CONCLUSION

An aggressive odontogenic fibroma with multifocal points in a 15months old girl.

Diode laser-assisted management of intraoral soft tissue overgrowth: a case series

The conventional method of managing intraoral soft tissue overgrowth involves surgical excision using a scalpel under local anesthesia. These procedures are often associated with excessive bleeding that leads to complications. Now, minimally invasive methods such as laser excision are available for the management of intraoral soft tissue lesions. The objective of the present case series is to describe the use of a 980-nm diode laser to treat 4 cases of soft tissue enlargement of the oral cavity. Two women and 2 men with an age range of 21-73 years presented with chief complaints of intraoral swelling. The overgrowth was located on the tongue in 2 patients and in the gingival region in 2 patients. In all 4 patients, the overgrown tissues were excised with a 980-nm gallium-arsenide diode laser at a power of 1.0-4.0 W in continuous-wave contact mode. Excised tissues were sent for histopathologic examination to confirm the clinical diagnosis. Each lesion was excised with adequate hemostasis in 15-20 minutes. At the recall examination after 10 days, patients did not report any postoperative complications. There was no sign of recurrence in any patient at the 3-month follow-up. Based on the histopathologic reports, 2 lesions were diagnosed as pyogenic granuloma, 1 as capillary hemangioma (a form of pyogenic granuloma), and 1 as peripheral ossifying fibroma. The results of this limited case series suggest that a 980-nm diode laser may be an advantageous surgical modality for treating benign proliferative lesions of the oral mucosa with negligible postoperative adverse sequelae.

[Role of Bcl-2 and MIF proteins in senile patients with gingival cancer]

PURPOSE

To investigate the expression of Bcl-2 protein and macrophage migration inhibitory factor (MIF) protein in gingival carcinoma of the elderly and its clinical significance.

METHODS

Sixty-two gingival cancer tissue specimens in the elderly diagnosed in our hospital from January 2015 to September 2017 were selected as the experimental group, and 31 normal gingival tissues were selected as the control group. Immunohistochemical staining was used to detect the expression of Bcl-2 protein and MIF protein in two groups. The differences of Bcl-2 protein and MIF protein in different clinical stages, cervical lymph node metastasis and histological differentiation were analyzed. The data were analyzed with SPSS 16.0 software package for Chi-square test.

RESULTS

The positive expression rates of Bcl-2 protein and MIF protein in the gingival cancer samples of the experimental group were 67.74% and 70.97%, respectively. The positive expression rates of Bcl-2 protein and MIF protein in the gingival tissues of the control group were 16.13% and 22.58%, respectively. The difference was statistically significant (P<0.05). The positive expression rate of Bcl-2 protein in gingival carcinoma tissues with different degrees of differentiation was statistically significant (P<0.05). In different degrees of differentiation, gingival carcinoma with cervical lymph node metastasis, there was significant difference in the positive expression rate of MIF protein in gingival cancer tissues (P<0.05).

CONCLUSIONS

The expression of Bcl-2 and MIF protein is up-regulated in gingival cancer tissues of the elderly, which has certain relationship with the degree of tumor differentiation and cervical lymph node metastasis.

4β-Hydroxywithanolide E selectively induces oxidative DNA damage for selective killing of oral cancer cells

Reactive oxygen species (ROS) induction had been previously reported in 4β-hydroxywithanolide (4βHWE)-induced selective killing of oral cancer cells, but the mechanism involving ROS and the DNA damage effect remain unclear. This study explores the role of ROS and oxidative DNA damage of 4βHWE in the selective killing of oral cancer cells. Changes in cell viability, morphology, ROS, DNA double strand break (DSB) signaling (γH2AX foci in immunofluorescence and DSB signaling in western blotting), and oxidative DNA damage (8-oxo-2'deoxyguanosine [8-oxodG]) were detected in 4βHWE-treated oral cancer (Ca9-22) and/or normal (HGF-1) cells. 4βHWE decreased cell viability, changed cell morphology and induced ROS generation in oral cancer cells rather than oral normal cells, which were recovered by a free radical scavenger N-acetylcysteine (NAC). For immunofluorescence, 4βHWE also accumulated more of the DSB marker, γH2AX foci, in oral cancer cells than in oral normal cells. For western blotting, DSB signaling proteins such as γH2AX and MRN complex (MRE11, RAD50, and NBS1) were overexpressed in 4βHWE-treated oral cancer cells in different concentrations and treatment time. In the formamidopyrimidine-DNA glycolyase (Fpg)-based comet assay and 8-oxodG-based flow cytometry, the 8-oxodG expressions were higher in 4βHWE-treated oral cancer cells than in oral normal cells. All the 4βHWE-induced DSB and oxidative DNA damage to oral cancer cells were recovered by NAC pretreatment. Taken together, the 4βHWE selectively induced DSB and oxidative DNA damage for the ROS-mediated selective killing of oral cancer cells.

[Myeloid sarcoma occurring in the gingiva: a case report]

Myeloid sarcoma (MS) is a localized extramedullary mass of immature granulocytic cells. MS may be found in any location, but intraoral occurrence is rare. This report presents a case of MS in the gingiva.

[Peripheral ameloblastoma in mandibular gingiva: Report of one case]

The ameloblastoma mainly occurs in the mandible, rarely seen in the soft tissues. This paper reported 1 case of mandibular gingival peripheral ameloblastoma, and discussed its treatment based on literature review.

Characterization of zinc-alpha(2)-glycoprotein as a cell adhesion molecule that inhibits the proliferation of an oral tumor cell line

Zn-alpha(2)-glycoprotein (Znalpha(2)gp) is a soluble protein widely distributed in body fluids and glandular epithelia. We have found it to be expressed in stratified epithelia as well. Znalpha(2)gp is clinically correlated with differentiation in various epithelial tumors, including oral and epidermal tumors. We have cloned epidermal Znalpha(2)gp and report the preparation of the recombinant protein in a Baculovirus expression system. Like the native molecule, recombinant Znalpha(2)gp has RNase activity. Znalpha(2)gp functions as a matrix protein for the Tu-138 oral squamous cell carcinoma cell line. Cell attachment to Znalpha(2)gp is comparable to that for fibronectin and is inhibited by the synthetic RGD peptides RGD, RGDV, and RGDS. Attachment is also inhibited by the antibody to integrin alpha(5)beta(1) (the fibronectin receptor), but not by antibodies to integrins alpha(v)beta(3), alpha(3)beta(1), and alpha(2)beta(1). We find that the proliferation of Tu-138 cells is inhibited on a Znalpha(2)gp matrix, as compared with other matrix proteins (fibronectin, vitronectin, laminin, and collagens I and IV) on which growth resembles that on the BSA control. We believe that the role of Znalpha(2)gp in differentiation and its RNase activity are two likely suspects as agents of the inhibition of proliferation.

[Endobronchial metastasis. Clinical aspects, diagnosis and course in a series of 27 cases]

Our 10-year experience is reviewed of 27 cases of endobronchial metastasis diagnosed by bronchoscopy. Primary tumors were breast (15 cases), kidney, bladder, rectum and melanoma (two cases each), and stomach, gingiva, amygdala and penis (one case each). Their presentation was prior to primary neoplasm in two patients, simultaneously in three, and posterior in the remaining patients (mean 64 +/- 52 months). Half of patients also had extrathoracic metastasis. In cases of breast cancer systemic chemotherapy was administered and the median survival rate was 24 months, significantly longer than in the remaining group (3 months); in the later, symptomatic therapy predominated due to the common involvement of lung parenchyma and functional deterioration of patients.

Ameloblastoma of attached gingiva

A case of a rare extra-osseous ameloblastoma is presented. It meets identical histological criteria as intra-osseous ameloblastoma, but its clinical presentation and behaviour are very different. It is non-invasive and may be locally excised without recurrence.

Peripheral fibroma/fibrous epulis with and without calcifications. A clinical evaluation of 204 cases in Singapore

Peripheral fibroma/fibrous epulis accounts for the great majority of localised gingival swellings as was substantiated by various reports in the literature. A study was undertaken to investigate the clinical features of a series of 204 localised fibrous gingival swellings received by the Histopathology Laboratory, Department of Oral Surgery, National University of Singapore. The female patients were more affected than the male patients and the lesions occurred predominantly among the Chinese. The lesions were mainly pedunculated and most commonly occurred in anterior maxilla. The recurrence rate was about 10.3%. In conclusion the results obtained in this study were overall in agreement with those of other authors.

The fibromatoses: a clinicopathological concept

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