major risk factor : chronic GVHD ‧ other risk factors ~ prolonged immunosuppressive therapy(major risk factor for SCC

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口腔病理科 On-Line KMU Student Bulletin

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原文題目(出處)： Squamous Cell Carcinoma of the Tongue After Bone Marrow Transplant and Graft-Versus-Host Disease: A Case Report and Review of the Literature J Oral Maxillofac Surgy 2008;66-144-7.

原文作者姓名： June-Ho Byun, Bong-Wook Park, Jong-Ryoul Kim, Gyeong-Won Lee, Jeong-Hee Lee

通訊作者學校： Department of Oral and Maxillofacial Surgery, College of Medicine and Institute of Health Sciences, Gyeongsang, National University, Jinju, Korea.

報告者姓名(組別)：劉冠宏(Int L 組)

報告日期： 97-03-18

內文：

Introduction

Allogenic bone marrow transplantation (BMT)

~ Curative therapy for malignant and nonmalignant lymphohematopoietic diseases and other disorders

~ Complication: secondary malignancies(2~8- folds higher rate than general population)

Secondary malignancies after BMT

~ Lymphoma、leukemia: arise in hematopoietic tissue, develop relatively early during the post-transplantation period

~ Secondary solid tumors (such as SCC): uncommon, but appear to increase with time

Potential risk factors of secondary cancers after BMT

~ Chronic graft-versus-host disease(GVHD)

~ Prolonged immunosuppressive therapy

~ Pretransplantation radiation and chemotherapy

~ Antigen stimulation arising from histocompatibility differences between recipient and donor

~ Other factors such as oncogenic virus infection

Report of a Case A 17-year-old woman First visit: August 2005

Chief Complaint

Referred by her hematologist/oncologist for the evaluation of a tongue lesion

Present Illness April 2000

‧ chronic myeloid leukemia was diagnosed December 2000

‧ Allogenic BMT was performed

‧ The conditioning regimen included busulfan and cyclophosphamide, with cyclosporine and prednisolone as GVHD prophylaxis

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Six months after transplantation

‧ Chronic GVHD involving the oral cavity, skin, liver, eyes, and the lungs occurred, and required treatment with

cyclosporine and prednisolone

‧ Recurrent episodes of oral mucositis and xerostomia

Oral Examination

‧ An ulcerative lesion, 1x2 cm in size, involving the left lateral border of the tongue, among areas of mild mucositis

Treatment course H-P report

‧ squamous cell carcinoma

‧ The metastatic work-up was negative

‧ T2N0M0, stage II September 2005

‧ ipsilateral supraomohyoid neck dissection

‧ partial glossectomy with reconstruction using a cervical myocutaneous regional flap

Histopathologic examination

~ A moderately differentiated SCC with epithelial koilocytosis(black arrow)

~ No metastasis was found in cervical lymph nodes Polymerase Chain Reaction

~ HPV-16 DNA was detected in the excised lesion Five months after surgery

‧ The patient had been followed up for 5 months without any evidence of recurrence or metastasis

Discussion

Solid cancer occurrence after BMT recipients:

‧ 1/3:skin and mucosal neoplasm(50% SCC)

‧ major risk factor : chronic GVHD

‧ other risk factors

~ prolonged immunosuppressive therapy(major risk factor for SCC)

~ radiation-based pretransplantation

~ oncogenic viruses infection Chronic GVHD

‧accompanied by chronic inflammation

(NC, negative control; PC, positive control; M, 100 bp ladder; CC, current case)

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‧Inflammatory cells

1. Form a tumor microenvironment that facilitates the initial steps of carcinogenesis

2. Alternatively, these inflammatory cells may be co-opted by neoplastic cells during tumor progression.

Prolonged immunosuppressive therapy

Azathioprine, combined with cyclosporine and steroidsÆ risk factor of SCC development

Radiation-based pretransplantation

The risk of cancer in transplant recipients that underwent irradiation has been reported to be elevated 18.4-fold

Oncogenic viruses in many post-transplant solid cancers

‧ HPV-16 (most common in HPV positive)

‧ Hermann et al reported a case of oral SCC coinfected with HPV-18 and EBV

21 oral SCC cases that developed in patients who had undergone allogenic BMT ~ The tongue was the most commonly affected site (11 cases)

~ The great majority of cases (18 cases) had chronic GVHD, which was being treated mostly with cyclosporine, prednisolone, and azathioprine

~ Reasons for BMT were leukemia (8 cases), aplastic anemia (6 cases), Fanconi’s anemia (6 cases), and non-Hodgkin’s lymphoma (1 case) ~ Fanconi’s anemia

-several studies have reported that SCC develops in Fanconi’s anemia patients before the administration of any treatment for anemia

-in this context, it remains unanswered as to whether carcinoma is caused by BMT factors, the nature of Fanconi’s anemia, or by both

~ Oncogenic virus infection was evaluated in 11 cases (HPV:4 cases, no EBV) We recommend that BMT recipients should be closely followed to ensure

the early detection of oral cancer, particularly in those with a chronic GVHD and/or HPV infection.

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題號題目

1 Which type of HPV has been found to be associated with oropharyngeal squamous-cell carcinoma?

(A) HPV 2

(B) HPV 6

(C) HPV 11

(D) HPV 16

答案(D) 出處：Oral and Maxillofacial Pathology 2^nd edition/Sapp. Eversole.

Wysocki. p223

題號題目

2 Which of the following is the most common location for intraoral squamous cell carcinoma?

(A) Upper labial mucosa, maxillary gingival, and hard palate (B) Lower labial mucosa, maxillary gingiva, and buccal mucosa (C) Lower lip, ventrolateral tongue, and floor of the mouth (D) Anterior tongue, mandibular gingiva, and retromolar area 答案(C) 出處：Oral Pathology for the Dental Hygienist 4^th edition p290