Early Oral Tongue Squamous Cell Carcinoma: Sampling of Margins From Tumor Bed and Worse Local Control

Maxwell JH, Thompson LD, Brandwein-Gensler MS, Weiss BG, Canis M, Purgina B, Prabhu AV, Lai C, Shuai Y, Carroll WR, Morlandt A, Duvvuri U, Kim S, Johnson JT, Ferris RL, Seethala R, Chiosea S.
JAMA Otolaryngol Head Neck Surg. 2015 Dec 1;141(12):1104-10.
IMPORTANCE: Positive margins are associated with poor prognosis among patients with oral tongue squamous cell carcinoma (SCC). However, wide variation exists in the margin sampling technique.
OBJECTIVE: To determine the effect of the margin sampling technique on local recurrence (LR) in patients with stage I or II oral tongue SCC.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective study was conducted from January 1, 1986, to December 31, 2012, in 5 tertiary care centers following tumor resection and elective neck dissection in 280 patients with pathologic (p)T1-2 pN0 oral tongue SCC. Analysis was conducted from June 1, 2013, to January 20, 2015.
INTERVENTIONS: In group 1 (n = 119), tumor bed margins were not sampled. In group 2 (n = 61), margins were examined from the glossectomy specimen, found to be positive or suboptimal, and revised with additional tumor bed margins. In group 3 (n = 100), margins were primarily sampled from the tumor bed without preceding examination of the glossectomy specimen. The margin status (both as a binary [positive vs negative] and continuous [distance to the margin in millimeters] variable) and other clinicopathologic parameters were compared across the 3 groups and correlated with LR.
MAIN OUTCOMES AND MEASURES: Local recurrence.
RESULTS: Age, sex, pT stage, lymphovascular or perineural invasion, and adjuvant radiation treatment were similar across the 3 groups. The probability of LR-free survival at 3 years was 0.9 and 0.8 in groups 1 and 3, respectively (P = .03). The frequency of positive glossectomy margins was lowest in group 1 (9 of 117 [7.7%]) compared with groups 2 and 3 (28 of 61 [45.9%] and 23 of 95 [24.2%], respectively) (P < .001). Even after excluding cases with positive margins, the median distance to the closest margin was significantly narrower in group 3 (2 mm) compared with group 1 (3 mm) (P = .008). The status (positive vs negative) of margins obtained from the glossectomy specimen correlated with LR (P = .007), while the status of tumor bed margins did not. The status of the tumor bed margin was 24% sensitive (95% CI, 16%-34%) and 92% specific (95% CI, 85%-97%) for detecting a positive glossectomy margin.
CONCLUSIONS AND RELEVANCE: The margin sampling technique affects local control in patients with oral tongue SCC. Reliance on margin sampling from the tumor bed is associated with worse local control, most likely owing to narrower margin clearance and greater incidence of positive margins. A resection specimen-based margin assessment is recommended.
PubMed ID: 26225798
Article Size: <1 MB

Malacoplakia of the tongue: a case report and clinicopathologic review of 6 cases.

Diapera MJ, Lozon CL, Thompson LD.
Am J Otolaryngol. 2009 Mar-Apr;30(2):101-5.
BACKGROUND: Extra-urogenital tract malacoplakia is uncommon, with tongue malacoplakia being exceptionally rare. The nonspecific clinical presentation and variable histologic patterns can make recognition of this lesion and separation from other lesions challenging. There are only a few reported cases in the English literature.
MATERIALS AND METHODS: Five case reports of tongue malacoplakia were compiled from the literature (MedLine 1960-2008) and integrated with this case report.
RESULTS: The patients included 4 males and 2 females, ranging in age from 9 to 98 years (mean, 64 years). Patients presented with difficulty swallowing, foreign body sensation, a mass lesion, or referred pain (neck or ear). Symptoms were present from a few days up to 18 months. The base of the tongue was the most frequent site, although midline tongue and half of the tongue were also affected. Radiographic studies demonstrated a mass, with a single lesion showing positron emission tomography positivity. Two patients had previous cancers (prostate and colorectal; larynx). This case report was a farm hand for horses, with gram-negative rods, suggestive of Rhodococcus equi identified. The lesions were 1 to 2 cm in greatest dimension. Histologically, there is pseudoepitheliomatous hyperplasia or ulceration with a heavy acute and chronic inflammatory infiltrate. The subepithelial spaces are completely filled with eosinophilic histiocytes, most of which contain granular material in their cytoplasm. Well-formed, blue, calcific bodies are noted, a few showing a ‘targetoid appearance’ and concentric lamination. These Michaelis-Gutmann bodies are positive with von Kossa, iron, and periodic acid-Schiff stains. These findings support a diagnosis of malacoplakia. The differential diagnosis includes granular cell tumor, poorly differentiated carcinoma, and Langerhans histiocytosis. Patients are managed with antibiotic therapy and excision.
CONCLUSIONS: Tongue malacoplakia is rare, often presenting as a mass lesion. Histologic recognition of this abnormal phagocytic disorder will prevent potentially disfiguring surgery.
PubMed ID: 19239951
Article Size: 3 MB

Oral Alveolar Soft Part Sarcoma in Childhood and Adolescence: Report of Two Cases and Review of Literature.

Argyris PP, Reed RC, Manivel JC, Lopez-Terrada D, Jakacky J, Cayci Z, Tosios KI, Pambuccian SE, Thompson LD, Koutlas IG.
Head Neck Pathol. 2013 Mar;7(1):40-9.
Alveolar soft part sarcoma (ASPS) constitutes a rare soft tissue malignant neoplasm comprising less than 1 % of all soft tissue sarcomas. ASPS demonstrates a strong predilection for adolescents and young adults, with a female predominance reported. The head and neck region is the most commonly affected region in pediatric patients with the tongue and orbit affected most commonly. Herein we present the clinical, radiographic, histopathologic, immunohistochemical and molecular features of two examples of ASPS affecting the oral cavity of 4 and 13 year-old boys, along with a focused review of the literature on intraoral ASPS in pediatric patients.
PubMed ID: 22961078
Article Size: <1 MB

Spindle Cell Lipoma of the Tongue: A Clinicopathologic Study of 8 Cases and Review of the Literature.

Lau SK, Bishop JA, Thompson LD.
Head Neck Pathol. 2015 Jun;9(2):253-9.
Spindle cell lipoma is a histologically distinct variant of lipoma characteristically arising in the subcutis of the posterior neck, upper back, or shoulder. Spindle cell lipomas infrequently occur within the oral cavity and, in particular, rarely involve the tongue. The clinical and pathologic features of eight cases of spindle cell lipoma affecting the tongue were analyzed. The study group included five men and three women ranging in age from 35 to 80 years (mean 57.4 years). Most lesions presented as either a painless or slowly growing lingual mass. The tumors were well circumscribed and characterized microscopically by a mixture of mature adipocytes, cytologically bland spindle cells, and interspersed bundles of thick collagen fibers in variable proportions. Myxoid stroma was a prominent feature in three lesions. The spindle cells were positive with CD34, while negative with S-100 protein, desmin, and smooth muscle actin. Treatment consisted of local excision in all cases. There have been no recurrences to date, with clinical follow up information available for all patients (range 11-118 months; mean 50.8 months). Lingual examples of spindle cell lipoma should be distinguished from other fat containing spindle cell neoplasms that can arise at this anatomic site.
PubMed ID: 25319950
Article Size: 2 MB

Cervical lymph node metastasis in adenoid cystic carcinoma of oral cavity and oropharynx: A collective international review

Suárez C, Barnes L, Silver CE, Rodrigo JP , Shah JP, Triantafyllou A, Rinaldo A, Cardesa A, Pitman KT, Kowalski LP, Robbins KT , Hellquist H, Medina JE, de Bree R, Takes RP, Coca-Pelaz A , Bradley PJ, Gnepp DR, Teymoortash A, Strojan P, Mendenhall WM, Anderson Eloy J, Bishop JA, Devaney KO, Thompson LDR, Hamoir M, Slootweg PJ, Vander Poorten VV, Williams MD, Wenig BM, Skálová A, Ferlito A.
Auris Nasus Larynx. 2016 Oct;43(5):477-484.
The purpose of this study was to suggest general guidelines in the management of the N0 neck of oral cavity and oropharyngeal adenoid cystic carcinoma (AdCC) in order to improve the survival of these patients and/or reduce the risk of neck recurrences. The incidence of cervical node metastasis at diagnosis of head and neck AdCC is variable, and ranges between 3% and 16%. Metastasis to the cervical lymph nodes of intraoral and oropharyngeal AdCC varies from 2% to 43%, with the lower rates pertaining to palatal AdCC and the higher rates to base of the tongue. Neck node recurrence may happen after treatment in 0–14% of AdCC, is highly dependent on the extent of the treatment and is very rare in patients who have been treated with therapeutic or elective neck dissections, or elective neck irradiation. Lymph node involvement with or without extracapsular extension in AdCC has been shown in most reports to be independently associated with decreased overall and cause-specific survival, probably because lymph node involvement is a risk factor for subsequent distant metastasis. The overall rate of occult neck metastasis in patients with head and neck AdCC ranges from 15% to 44%, but occult neck metastasis from oral cavity and/or oropharynx seems to occur more frequently than from other locations, such as the sinonasal tract and major salivary glands. Nevertheless, the benefit of elective neck dissection (END) in AdCC is not comparable to that of squamous cell carcinoma, because the main cause of failure is not related to neck or local recurrence, but rather, to distant failure. Therefore, END should be considered in patients with a cN0 neck with AdCC in some high risk oral and oropharyngeal locations when postoperative RT is not planned, or the rare AdCC-high grade transformation.
PubMed ID: 27017314
Article Size: <1 MB

Management of melanotic neuroectodermal tumor of infancy.

Gaiger de Oliveira M, Thompson LD, Chaves AC, Rados PV, da Silva Lauxen I, Filho MS.
Ann Diagn Pathol. 2004 Aug;8(4):207-12.
Melanotic neuroectodermal tumor of infancy is a rare congenital neoplasm involving the head and neck in young patients. The clinical assessment, histologic diagnosis, and management is reviewed, with an emphasis on different treatment alternatives in two new case reports.
PubMed ID: 15290671
Article Size: <1 MB

Lobular capillary hemangioma (pyogenic granuloma) of the oral cavity.

Thompson LD.
Ear Nose Throat J. 2017 Jul;96(7):240.
FIRST PARAGRAPH: Lobular capillary hemangioma (LCH), sometimes also called pyogenic granuloma or epulis gravidarum, is a benign overgrowth of capillaries showing a vascular phenotype. There are several etiologic factors, including hormones (increased in pregnancy and in patients using oral contraceptives), localized trauma (biting, fractured tooth, poor restorations), and when there is poor oral hygiene.
PubMed ID: 28719705
Article Size: <1 MB

Cherubism.

Thompson LD.
Ear Nose Throat J. 2015 Jan;94(1):22-4.
FIRST PARAGRAPH: Cherubism is an autosomal-dominant inherited disease with variable expression. It is characterized by a progressive, painless, and symmetric expansion of the jaws. The disease is caused by a point mutation in the SH3BP2 gene (chromosome 4p16.3), which leads to dysregulation of the Msx-1 gene; this gene is involved in regulating mesenchymal interaction in craniofacial morphogenesis.
PubMed ID: 25606831
Article Size: <1 MB

Osteosarcoma.

Thompson LD.
Ear Nose Throat J. 2013 Jul;92(7):288-90.
FIRST PARAGRAPHS: Osteosarcoma affects the mandible and the maxilla differently, with mandibular tumors tending to arise from the body of the mandible while maxillary tumors arise from the alveolar ridge and sinus. Osteosarcoma is a mesenchymal malignancy in which the neoplastic cells synthesize and secrete the organic components of bone matrix. While it is the most common primary tumor of bone, it is very uncommon overall.
PubMed ID: 23904301
Article Size: <1 MB

Oral Traumatic Ulcer.

Thompson LD.
Ear Nose Throat J. 2011 Nov; 90(11):518-34.
FIRST PARAGRAPH: A traumatic ulcer is a chronic traumatic ulceration of the oral mucosa that shows unique histopathologic features. Also known as traumatic granuloma, eosinophilic granuloma, and Riga-Fede disease, this lesion is usually caused by some sort of mechanical injury. The most common causes include accidental trauma from biting, malposed teeth, and even sharp foodstuffs. However, self inflicted wounds caused by nocturnal clenching or tongue and lip biting, electrical and thermal injuries, hot foods or beverages, and even factitial injuries yield a similar finding. Ulceration of the ventral tongue as a result of tongue thrusting in infants with natal or neonatal teeth is referred to as Riga-Fede disease.
PubMed ID: 22109918
Article Size: <1 MB

Keratocystic odontogenic tumor.

Thompson LD.
Ear Nose Throat J. 2014 Sep;93(9):386-8.
FIRST PARAGRAPH: Keratocystic odontogenic tumor (KCOT; formerly known as odontogenic keratocyst) is a distinct developmental odontogenic cyst that may be locally aggressive and may be part of the nevoid basal cell carcinoma syndrome (NBCCS, or Gorlin syndrome). Inherited as an autosomal dominant trait, there is high penetrance, although with variable expression, associated with loss of function of the PTCH gene (chromosome 9q22.3-q31), a tumor suppressor gene.
PubMed ID: 25255344
Article Size: <1 MB

Ameloblastoma.

Thompson LD.
Ear Nose Throat J. 2003 Jan;82(1):19.
FIRST PARAGRAPH: Ameloblastomas are locally aggressive gnathic tumors that have a high propensity for recurrence. They are believed to arise from remnants of the odontogenic epithelium or the developing enamel organ. They occur in patients over a wide spectrum of ages and equally among the sexes, as a slow-growing, often asymptomatic, locally invasive tumor. Radiographic images usually demonstrate a multilocular, expansile radiolucency of bone, usually of the posterior mandible.
PubMed ID: 12610896
Article Size: <1 MB

Fibrous dysplasia of bone.

Nelson BL, Thompson LD.
Ear Nose Throat J. 2003 Apr;82(4):259.
FIRST PARAGRAPH: Fibrous dysplasia (fibro-osseous metaplasia) is one of a diverse group of diseases that are characterized by alterations in bone growth. It is a developmental, tumor-like process of unknown etiology. Its initial clinical sign is usually a painless enlargement of the affected bone. It occurs in equal proportions in males and females, most often during the first two decades of life.
PubMed ID: 12735156
Article Size: <1 MB

Oral cicatricial pemphigoid.

Nelson BL, Thompson LD.
Ear Nose Throat J. 2004 Jan;83(1):22.
FIRST PARAGRAPH: Cicatricial pemphigoid is a vesiculobullous disease of the skin that may be found in the oral cavity. Previously designated ‘benign mucous membrane pemphigoid,’ cicatricial pemphigoid is a chronic, blistering, autoimmune disease that affects mucous membranes. Tissue-bound autoantibodies are directed against one or more components of the basement membrane in an affected individual. Cicatricial pemphigoid initially occurs in the fifth to seventh decades of life, and it is observed more frequently in women. Patients usually describe oral pain and/or ulceration, often of many years’ duration. Clinically, the disease is characterized by the formation of bullae, which can be found anywhere in the oral cavity. The bullae rupture and produce ulceration, which may cause a scar (cicatrix) upon healing.
PubMed ID: 14986753
Article Size: <1 MB

Median rhomboid glossitis.

Nelson BL, Thompson L.
Ear Nose Throat J. 2007 Oct;86(10):600-1
FIRST PARAGRAPH: Median rhomboid glossitis — also known as central papillary atrophy and posterior midline atrophic candidiasis — is a type of erythematous candidiasis unique to the midline posterior tongue. It occurs in as many as 1% of adults.
PubMed ID: 17990677
Article Size: <1 MB

Ossifying fibroma of the jaw.

Gannon FH, Thompson L.
Ear Nose Throat J. 2004 Jul;83(7):458.
FIRST PARAGRAPH: Ossifying fibroma of the jaw is a benign, fibro-osseous lesion that is part of a larger family of fibro-osseous lesions that includes juvenile active ossifying fibroma, psammomatous ossifying fibroma, and extragnathic ossifying fibroma of the skull. Ossifying fibromas of the jaw are well-circumscribed, slowly growing lesions. They are often mentioned in the same differential diagnosis as fibrous dysplasia, but it is important to make the distinction because the former lends itself to ready enucleation, while the latter can be admixed with surrounding tissues, making surgery more complicated.
PubMed ID: 15372914
Article Size: <1 MB

Melanotic neuroectodermal tumor of infancy.

Nelson BL, Thompson LD.
Ear Nose Throat J. 2006 Jun;85(6):365.
FIRST PARAGRAPH: Melanotic neuroectodermal tumor of infancy is a rare, neural-crest-derived neoplasm that is believed to be congenital. The tumor has a marked predilection for the head and neck — particularly the maxilla, where approximately 70% of these tumors are located. The anterior maxilla is most commonly affected. There is no predilection for either sex. Nearly all patients present with an enlarging mass, usually within a few years of birth. Intraoral lesions may appear ‘blue,’ suggesting the presence of pigment. Radiographic images will often show a destructive lesion with tooth displacement, but they are nonspecific. Laboratory studies show high urinary levels of vanillylmandelic acid.
PubMed ID: 16866106
Article Size: <1 MB