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Introduction 1.

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口腔病理科 On-Line KMU Student Bulletin

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原文題目(出處): Oral squamous cell carcinoma in children; review of an unusual entity. International Journal of Pediatric

Otorhinolaryngology (2008) 72, 127-131

原文作者姓名: SAH. Stolk-Liefferink, AG Dumans, EH van der Meij, PP Knegt, KGH van der Wal

通訊作者學校: Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center. The Netherlands.

報告者姓名(組別): 黃鈺芬 B組 報告日期: 97 / 01 / 15

Introduction

1. Squamous cell carcinoma (SCC) of the oral cavity occurs in males in their sixth

or seventh decade.

2. Younger patients (aged less than 40years) account for approximately 4% of all oral cancers.

3. Only a small sample of this subgroup exists of pediatric patients (≦20 years), making oral SCC in the pediatric age group an extremely rare entity.

Case report

An 11-year-old boy was referred to the Department of Oral and Maxillofacial Surgery by his orthodontist because of a non-tender, progressive growing swelling of the

gingiva of the upper front teeth, noticed by the patient since 6 weeks. The relevant

medical history did not reveal any abnormalities. The patient did not use any

medication at presentation.

Physical examination :

1. A firm, non-tender, verrucous swelling with indurated borders and central

ulceration on the buccal and palatal aspects of the left upper front teeth

measuring 2.5 cm by 2.0 cm.

2. The left upper incisors were mobile but tested positive on vitality tests.

3. Multiple, nontender, mobile submandibular lymph nodes were palpated bilaterally.

Radiographic examination :

1.

Possibly infiltration of several millimeters of the alveolar bone between the two left upper incisors was observed.

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Computed tomogram revealed invasion of the buccal cortex of the left upper incisors

Histopathological examination :

Because of the age of the patient there was some doubt about the diagnosis:

a verruciform xanthoma with haracteristics of pseudoepitheliomatous hyperplasia (PEH)

_____________________________________________________________________

1. Fine needle aspiration cytology of the submandibular lymph nodes as well as a radiograph of the chest there were no signs of regional and/or distant metastasis.

2. Nineteen days after the initial

presentation the tumor was diagnosed as a T4aN0M0 SCC of the gingiva of the left maxilla. A partial maxillectomy was performed. The former diagnosis of a well-differentiated SCC was confirmed on histopathological examination of the

surgical specimen. The margins seemed to be free of tumor.

Discussion

1. Less than 4% of these cancers occur in patients younger than 40 years of age.

[Only a small sample of this subgroup exists of pediatric patients (≦20 years) ]

After nineteen days

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2. Recently it has been observed that there is an increasing incidence of oral SCC in the younger population of several countries.

[ traditional risk factors such as tobacco, alcohol, betel quid chewing, and low consumption of fruits and vegetables]

3. There is a general trend in reported studies for SCC of the oral cavity in young patients to be particularly aggressive and carry a poorer prognosis than older patients

(1) a differing disease etiology and tumor behavior.

(2) delay in presentation and/or diagnosis (patients’ and/or doctors’ delay)

4. As inflammatory lesions in pediatric patients can become highly proliferative and assume neoplasmlike characteristics. Pseudoepitheliomatous hyperplasia (PEH), a

reactive process, may then be difficult to distinguish from SCC.

[ PEH in pediatric patients may exhibit cellular atypia and irregular growth to such extend that this distinction may be less obvious.]

題號 題目

1

Which one of the following is not the precancerous lesion ? (A) Verruciform xanthoma

(B) Proliferative verrucous leukoplakia (C) Oral submucous fibrosis

(D) Erythroleukoplakia

答案(A ) 出處:oral and Maxillofacial pathology P.357

題號 題目

2

Which one of the following is the most common site for intraoral carcinoma?

(A) Gingival (B) Buccal mucosa (C) Tongue

(D) Oral floor

答案(C) 出處:oral and Maxillofacial pathology P.361

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