Che-Shoa Chang

Genome-wide profiling of oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) is a common malignancy, the incidence of which is particularly high in some Asian countries due to the geographically linked areca quid (AQ) chewing habit. In this study, array‐based comparative genomic hybridization was used to screen microdissected OSCCs for genome‐wide alterations. The highest frequencies of gene gain were detected for TP63, Serpine1, FGF4/FGF3, c‐Myc and DMD. The highest frequencies of deletion were detected for Caspase8 and MTAP. Gained genes, classified by hierarchical clustering, were mainly on 17q21–tel; 20q; 11q13; 3q27–29 and the X chromosome. Among these, gains of EGFR at 7p, FGF4/FGF3, CCND1 and EMS1 at 11q13, and AIB1 at 20q were significantly associated with lymph node metastasis. The genomic profiles of FHIT and EXT1 in AQ‐associated and non‐AQ‐associated OSCCs exhibited the most prominent differences. RT‐PCR confirmed the significant increase of TP63 and Serpine1 mRNA expression in OSCC relative to non‐malignant matched tissue. A significant increase in Serpine1 immunoreactivity was observed from non‐malignant matched tissue to OSCC. However, there was no correlation between the frequent genomic loss of Caspase 8 and a significant decrease in Caspase8 expression. These data demonstrate that genomic profiling can be useful in analysing pathogenetic events involved in the genesis or progression of OSCC. Copyright

Alterations of Adenomatous Polyposis Coli (APC) gene in oral squamous cell carcinoma

The present study assessed the roles of Adenomatous Polyposis Coli (APC) tumor suppressor gene during oral carcinogenesis. Reduction of APC transcript levels and APC loss of heterozygosity (LOH) were found in 39% (7/18) and 29% (10/34) cases of oral squamous cell carcinoma (OSCC), respectively. The apparent APC heterozygosity (27%) in non-cancerous matched oral tissue (NCMOT) adjacent to OSCC at an exon 11 locus was significantly lower than normally found in the Taiwanese population (49%). These findings suggest that the allelic status of APC could indicate a cancer risk. No polymorphism of 11307 allele of APC was identified in NCMOT or OSCC. Our data indicated that alterations of APC are frequent molecular changes of OSCC. Advances in understanding of the APC alterations that accompany OSCC development might provide a means for early diagnosis and possibly new therapeutic strategies.

Vascular endothelial growth factor 936 C/T polymorphism is associated with vascular invasion in oral squamous cell carcinoma

OBJECTIVE The objective of this study was to analyze the relation of VEGF 936 C/T polymorphisms in progression of oral squamous cell carcinoma (OSCC) patients and healthy subjects in Taiwan. STUDY DESIGN We genotyped 218 patients with OSCC, comparing the genotypes and gene frequencies with those of 121 control subjects. VEGF 936 C/T polymorphisms were determined by using polymerase chain reaction and restriction fragment length polymorphism. RESULTS There were no significant differences in genotype, phenotype, or gene frequency between the OSCC and control groups. Among patients with OSCC, there were also no significant differences in the polymorphism between those with and without cervical lymph node metastases or in survival. However, 21 of the 218 patients had vascular invasion by their OSCC, and these patients were significantly more likely to have a C/C (P = .033) or C/T genotype (P = .026) than were those without vascular invasion. CONCLUSIONS This study suggests that the VEGF 936 C allele is associated with vascular invasion in OSCC.

Angioleiomyoma in Right Lingual Gingiva-A Case Report

Leiomyomas are benign soft tissue neoplasms that arise from smooth muscle. There are three distinct types of leiomyomas: piloleiomyomas, angioleiomyomas, and genital leiomyomas, which reflect the most origin of the smooth muscle tumor and correspond to the histologic or anatomic site. Angioleiomyomas, as we present here, originate from smooth muscle within the walls of arteries and veins. Although some cases are reported in the gastrointestinal tract, larynx, and brain, oral angioleiomyomas are infrequently found. Malignant transformation probably does not occur, and therefore, they do not affect mortality directly. However, careful histologic examination is still necessary to distinguish these benign lesions from their malignant counterparts due to different prognosis. Here, we present a case of angioleiomyoma found attached to the lower gingival. Clinical and histological presentation of angioleiomyomas with its treatment will be discussed in this article.

Implant Rehabilitation of Severely Traumatised Anterior Alveolar Ridge

Abstract Objective: To propose a sequential treatment approach for implant rehabilitation of a traumatised and deficient maxillary or mandibular alveolar ridge. Patients and Methods: Patients with severely deficient alveolar ridge and loss of teeth due to injury underwent sequential reconstructive procedures at the maxillary or mandibular edentulous areas with autogenous symphyseal bone or allogeneic bone graft with guided bone regeneration; vestibuloplasty with or without keratinised palatal mucosal graft to rebuild the vestibule; and implant rehabilitation. Postoperative followup consisted of clinical and radiographic examinations. Results: Thirty six implant fixtures were placed in the maxilla or mandible in 12 patients. The average follow-up period after treatment was 4 years. Before surgery, all patients had severely deficient ridges with a compromised shallow vestibule. Satisfactory results were observed in regard to the long-term stability of the rehabilitation result, contour of the reconstructed ridge, morphology of the vestibule, health of the periimplant tissue, and functionality of the implant-retained prostheses. Conclusion: The proposed sequential reconstructive treatment approach for both hard and soft tissues offers a reliable method of implant rehabilitation after traumatic injury.

Cervical Vertebrae Metastases in Oral Squamous Cell Carcinoma: A Case Report

Cervical vertebrae metastases is rare in oral squamous cell carcinoma (OSCC). Due to the improvement of locoregional control in advanced OSCC by the advancement of treatment modality, more patients are faced with the risk of developing distant metastases. The lung, skeleton and liver are the most frequent sites of distant metastases in OSCC. Vertebrae metastases is relatively rare, and the most frequent site of vertebrae metastases is thoracic vertebrae, followed by lumbar vertebrae. In this article, a case of advanced OSCC who received local wide excision ± neck dissection and adjuvant concurrent chemo-radiotherapy with cervical vertebrae metastases is reported. A literature review on the diagnosis, possible mechanism, therapeutic modalities and prognosis is mentioned in this article.

Spindle Cell Carcinoma in the Oral Cavity

Abstract A 32-year-old male presented with an exophytic, pink, raw-surfaced mass over the gingiva, 4 × 4 × 3 cm in size and extending from the right upper central incisor to the first molar. A biopsy revealed a rarely occurring spindle cell carcinoma of the oral cavity. As past medical history and pathological reports bore little relation to the present illness, the patient received radical surgery and postoperative radiotherapy and chemotherapy. Even so, the local aggressiveness and early metastatic behaviour of the tumour eventually proved fatal. Spindle cell carcinoma is an uncommon tumour of uncertain histogenesis that typically arises as a biphasic polypoid tumour. Dual expression of cytokeratin and vimentin make its differential diagnosis difficult. We describe this rarely occurring tumour, with early bilateral neck, bone and lung metastases, that warrants clinical attention for correct diagnosis at an early stage.

Comparison of Positron Emission Tomography and Computed Tomography for the Detection of Cervical Lymph Node Metastases of Oral Squamous Cell Carcinoma

Abstract Objective: To investigate the use of positron emission tomography for the detection of cervical metastases of oral squamous cell carcinoma. Materials and Methods: Twenty four patients with histologically confirmed oral squamous cell carcinoma, without previous surgery, radiation therapy, or chemotherapy, and with pretreatment computed tomography and positron emission tomography scans, were included. In this retrospective chart review, data were collected for computed tomography and positron emission tomography findings, treatment, and outcomes. The findings for computed tomography, positron emission tomography, and histopathology were analysed by paired Fishers exact t test. Results: A statistically significant correlation was noted between computed tomography and positron emission tomography findings (p = 0.033) as judged by the histopathology results of 8 neck dissections. No correlation was found between computed tomography findings or positron emission tomography and histopathology. Among the 14 patients with positive computed tomography and positron emission tomography scans, 9 were ultimately documented to have cervical metastases. Among the 6 patients with negative computed tomography and positive positron emission tomography, 5 had neck lymph node metastases (p = 0.048) during followup, while patients with negative positron emission tomography did not show neck metastases. Conclusion: In comparison with conventional computed tomography, positron emission tomography provided additional information for the detection of cervical lymph node metastases of oral squamous cell carcinoma. The importance of positron emission tomography for the early detection of neck lymph node metastases is emphasised.

Peripheral T-cell Lymphoma of the Maxillary Gingiva

Abstract A peripheral T-cell lymphoma in a 58-year-old man presenting in the right maxillary gingiva with invasion of bone is reported. Treatment was chemotherapy with cyclophosphamide, vincristine, and prednisolone, followed by right maxilla sequestrectomy due to necrosis of soft tissue and bone. Pathological examination of the tumour tissue showed a T-cell lymphoma with characteristic large pleomorphic lymphoid cell infiltration with angio-invasion. The neoplastic lymphoid cells were positive for leukocyte common antigen, CD3, and Epstein-Barr virus stain and negative for L-26, CD2, CD5, and CD56.

An Overview of the Detection and Screening of Oral Cancer and Precancer

Oral cancer is a fatal disease, which accounts for the 5th highest incidence of malignancy of male and the 7th in general population in Taiwan. The relative high prevalence of oral cancer in Taiwan is mainly because a 2.5 million high-risk group of population with smoking as well as betel nut chewing exist. Unfortunately, the new cases being found in medical center often present with a TNM stage III or IV level leading to a low 5-year survival. Therefore, it is generally accepted that prevention and screening or oral cancer at early stages or premalignant levels for the high-risk group of population are equally important to treatment. In this review article, we describe the nature of oral cancer and highlight the importance as well as various conventional and novel methods of screening of this disease.