Carcinoma de seno maxilar en paciente con liquen plano oral: presentación de un caso clínico

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Abstract

Mujer de 55 años de edad, fumadora, depresiva, con Liquen Plano Oral (LPO) de control clínico difícil, de más de 10 años de evolución. La paciente ha presentado períodos de remisión y exacerbación de las lesiones, de forma paralela presentó aumento de volumen intraoral en región maxilar izquierda, la superficie de la nueva lesión estaba ulcerada, y desprendía olor fétido en región alveolar sometida a exodoncias previas. El diagnóstico clínico inicial fue de una probable transformación maligna del LPO preexistente. Una biopsia incisional confirmó la presencia de carcinoma de células escamosas. Los exámenes tomográficos revelaron una amplia imagen destructiva dentro del seno maxilar, con zonas de erosión ósea en las estructuras adyacentes. Con la asociación de datos clínicos y de imagen llegamos al diagnóstico de carcinoma de células escamosas en seno maxilar. La paciente fue sometida a maxilectomía parcial y radioterapia adyuvante. Después de algunos meses, se manifestó la recidiva local con el agravamiento del cuadro clínico del paciente. Se instauró la quimioterapia paliativa adyuvante, sin éxito clínico. La paciente murió después de un año de tratamiento, debido a trombosis.

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Nasal and paranasal sinus carcinoma: are we making progress? A series of 220 patients and a systematic review.

Pavel Dulguerov, Michael S. Jacobsen, Abdelkarim S Allal … (2001)

The authors reviewed treatment results in patients with nasal and paranasal sinus carcinoma from a large retrospective cohort and conducted a systematic literature review. Two hundred twenty patients who were treated between 1975 and 1994 with a minimum follow-up of 4 years were reviewed retrospectively. A systematic review of published articles on patients with malignancies of the nasal and paranasal sinuses during the preceding 40 years was performed. The 5-year survival rate was 40%, and the local control rate was 59%. The 5-year actuarial survival rate was 63%, and the local control rate was 57%. Factors that were associated statistically with a worse prognosis, with results expressed as 5-year actuarial specific survival rates, included the following: 1) histology, with rates of 79% for patients with glandular carcinoma, 78% for patients with adenocarcinoma, 60% for patients with squamous cell carcinoma, and 40% for patients with undifferentiated carcinoma; 2) T classification, with rates of 91%, 64%, 72%, and 49% for patients with T1, T2, T3, and T4 tumors, respectively; 3) localization, with rates of 77% for patients with tumors of the nasal cavity, 62% for patients with tumors of the maxillary sinus, and 48% for patients with tumors of the ethmoid sinus; 4) treatment, with rates of 79% for patients who underwent surgery alone, 66% for patients who were treated with a combination of surgery and radiation, and 57% for patients who were treated exclusively with radiotherapy. Local extension factors that were associated with a worse prognosis included extension to the pterygomaxillary fossa, extension to the frontal and sphenoid sinuses, the erosion of the cribriform plate, and invasion of the dura. In the presence of an intraorbital invasion, enucleation was associated with better survival. In multivariate analysis, tumor histology, extension to the pterygomaxillary fossa, and invasion of the dura remained significant. Systematic review data demonstrated a progressive improvement of results for patients with squamous cell and glandular carcinoma, maxillary and ethmoid sinus primary tumors, and most treatment modalities. Progress in outcome for patients with nasal and paranasal carcinoma has been made during the last 40 years. These data may be used to make baseline comparisons for evaluating newer treatment strategies. Copyright 2001 American Cancer Society.

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Immune activation and chronic inflammation as the cause of malignancy in oral lichen planus: is there any evidence ?

Eduardo Bucci, Lorenzo Lo Muzio, Lucio Lo-Russo … (2004)

The association of chronic inflammation with a variety of epithelial malignancies has been recognised for centuries. Well established examples include, among many others, oesophageal adenocarcinoma associated with chronic oesophagitis and bowel cancer associated with chronic inflammatory bowel diseases. By now no data, other than clinical observation, have been available in understanding the pathogenesis of these inflammation-related tumours. However, recent molecular studies on the relationship between solid malignancies and the surrounding stroma have given new insights. There is now enough evidence to accept that the chronic inflammatory process per se is able to provide a cytokine-based microenvironment which is able to influence cell survival, growth, proliferation, differentiation and movement, hence contributing to cancer initiation, progression, invasion and metastasis. Here it is discussed whether also oral lichen planus (OLP), being a chronic inflammatory autoimmune disease which has been clinically associated with development of oral squamous cell carcinoma, might be categorised among these disorders. With this aim, we critically reviewed and detailed the presence, in OLP subepithelial infiltrate, of inflammatory cells and cytokine networks that might act to promote squamous tumorigenesis.

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Oral lichen planus: clinical presentation and management.

R Kelsch, Robert Edwards (2002)

Oral lichen planus (OLP) is a chronic mucosal condition commonly encountered in clinical dental practice. Lichen planus is believed to represent an abnormal immune response in which epithelial cells are recognized as foreign, secondary to changes in the antigenicity of the cell surface. It has various oral manifestations, the reticular form being the most common. The erosive and atrophic forms of OLP are less common, yet are most likely to cause symptoms. Topical corticosteroids constitute the mainstay of treatment for symptomatic lesions of OLP. Recalcitrant lesions can be treated with systemic steroids or other systemic medications. However, there is only weak evidence that these treatments are superior to placebo. Given reports of a slightly greater risk of squamous cell carcinoma developing in areas of erosive OLP, it is important for clinicians to maintain a high index of suspicion for all intraoral lichenoid lesions. Periodic follow-up of all patients with OLP is recommended.