Nadya Purwanty (04121004052) Rkg4

8102019 Nadya Purwanty (04121004052) Rkg4

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Hindawi Publishing CorporationCase Reports in Dentistry Volume 983090983088983089983091 Article ID 983090983094983090983092983089983088 983096 pageshttpdxdoiorg983089983088983089983089983093983093983090983088983089983091983090983094983090983092983089983088

Case Report The Correlation between Chronic Periodontitis and Oral Cancer

Maximilian Kruumlger1 Torsten Hansen2 Adrian Kasaj3 and Maximilian Moergel1

983089 Department of Oral and Maxillofacial Surgery-Plastic Surgery Johannes Gutenberg University of Mainz Medical Center Augustusplatz 983090 983093983093983089983091983089 Mainz Germany

983090 Institute of Pathology University of Mainz Medical Surgery Langenbeckstraszlige 983089 983093983093983089983091983089 Mainz Germany 983091 Department of Operative Dentistry and Periodontology Johannes Gutenberg-University Augustusplatz 983090 983093983093983089983091983089 Mainz Germany

Correspondence should be addressed to Maximilian Kruger maximiliankruegerunimedizin-mainzde

Received 983089983094 May 983090983088983089983091 Accepted 983097 June 983090983088983089983091

Academic Editors D W Boston A C B Delbem and A Milosevic

Copyright copy 983090983088983089983091 Maximilian Kruger et al Tis is an open access article distributed under the Creative Commons AttributionLicense which permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited

Inections are increasingly considered as potential trigger or carcinogenesis apart rom risk actors like alcohol and tobacco Tediscussion about human papilloma virus (HPV) in oral squamous cell carcinoma (OSCC) points at a general role o inection orthe development o oral carcinomas Furthermore 1047297rst studies describe a correlation between chronic periodontitis and OSCCthus characterizing chronic in1047298ammation as being a possible trigger or OSCC In ront o this background we present ourwell-documented clinical cases All patients showed a signi1047297cant anatomical relation between OSCC and clinical signs o chronicperiodontitis Te interindividual differences o the clinical 1047297ndings lead to different theoretical concepts two with coincidental

appearance o OSCC and chronic periodontitis and two with possible de novo development o OSCC triggered by chronicin1047298ammation We concludethat the activation o differentin1047298ammatory cascades by chronic periodontitis negatively affects mucosaand bone Furthermore the in1047298ammatory response has the potential to activate carcinogenesis Apart rom a mere coincidentaloccurrence two out o our patients give 1047297rst clinical hints or a model wherein chronic periodontitis represents a potential risk actor or the development o OSCC

1 Introduction

Squamous cell carcinoma is the most requent malignancy in the oral cavity and with nearly 983092983088983088983088983088983088 new diagnosedpatients worldwide each year it represents the sixth re-quent malignant tumor Despite multimodality approaches

or the treatment comprising surgery and adjuvant chemo-and radiation therapy the disease still has a low overallsurvival rate o about 983093983088 [983089 983090] Te development o new therapeutic strategies with improved treatment options orpossible prevention o oral squamous cell carcinoma (OSCC)requests a substantial understanding o its etiology Telast years have revealed more detailed inormation aboutdifferent risk actors or the development o OSCC Impor-tant risk actors o the general accepted multistep carcino-genesis model are genetic predisposition [983091] presence o premalignant lesions [983092] and environmental or behaviouralcarcinogenic triggers or example the ingestion o tobaccoand alcohol [983093] Recently the in1047298uence o inection and

in1047298ammation or cancer development has been discussedAssociations between human papilloma virus (HPV) inec-tion and oropharyngeal carcinomas have been documented[983094] Tese patients are typically Caucasians nonsmokersnondrinkers and one decade younger on average than peo-ple suffering rom HPV negative carcinomas Intriguingly

patients with HPV-positive oropharyngeal carcinomas had asigni1047297cant better prognosis than the HPV negative collective[983095 983096] Tis 1047297nding might point at subtypes o inection-induced carcinomas with different clinical behaviours thusstressing the need o urther characterization Comparablythe predominant inection within the oral cavity is chronicperiodontitis and its role or the development o oral cancerwas likewise recently discussed [983097 983089983088] Herein periodon-titis occurs as chronic in1047298ammatory process characterizedby speci1047297c bacteria and the loss o attached gingiva andalveolar bone with consecutive development o periodontalpockets and loss o teeth [983089983089] A recently published work by ezal et al ound the loss o bone as clinical sign or



983090 Case Reports in Dentistry

chronic periodontitis being an independent risk actoror thedevelopment o carcinoma within the oral cavity [983089983090] Inronto this background the case series at hand comprises ourpatients treated at our clinical Department or OSCC Withinthese the synopsis o clinical appearance radiologic 1047297ndingsand cross-sectional resection specimen offer an association o

the carcinoma to the periodontal space with signs o chronicin1047298ammation Te different clinical aspects are discussedcomprising the available literature on this topic

2 Case Presentations

Case 983089 A 983093983097-year-old woman presented hersel with an exo-phytic mass o 983090 cm adherent to the mandible and localizeddistally o tooth 983091983094 Te tooth revealed signs o chronicperiodontitis with bleeding on probing attachment loss anda 983093 mm deep pocket and signi1047297cant mobility on clinicalexamination Polymerase chain reaction (Micro-ident HainLiescienceGmbHD-983095983090983089983092983095 Nehren) (PCR)revealed an inec-

tion with Porphyromonas gingivalis and annerella forsythia(red complex ) Te expansion o the tumor reached rom thesulcus glossoalveolaris with its center along the alveolar crestto the adjacent buccalmucosa (Figure 983089) Te patient reportedhersel to be a never smoker and never ingested alcohol Oralhygiene habits were sufficient No other precursor lesionslike leukoplakia erythroplakia or signs o oral lichen planuswere ound on examination Te visit o our department wasinduced by progressive pain and increasing swelling Tepreoperatively taken orthopantomography (OPG) revealeda considerable generalized horizontal type o bone loss withinthe upper and the lower jaw as also a distinct inter- andperiradicular osteolytic lesion at the region o 983091983094 (Figure 983090) A

both-sided selective neck dissection [983089983091] and partial resectiono the mandible ollowed Te clinical appearance (Figure 983089)showed an exophytic mass with contact to the distal root o 983091983094 Intriguingly the OPG showed no arrosion o the distalmandible but apparently an inhomogeneous radiolucency between the roots o the molar Te cross-section specimen(Figure 983091) urthermore highlights the interradicular spread-ing o the tumor without an in1047297ltration o cancellous bone orthe distal alveolar crest HPV status by p983089983094 immunostainingwas negative

aking all clinical 1047297ndings together the present casesupports the hypothesis o a possible de novo developmento malignancy rom the interradicular periodontium

Case 983090 A 983092983096-year-old man presented himsel with a histo-logical veri1047297ed squamous cell carcinoma o the lef mandibleadjacent to the partially retained tooth 983091983095 surrounded by a bony deect o 983091 mm Analysis o the bacteria (Micro-ident Hain Liescience GmbH D-983095983090983089983092983095 Nehren) inside thepocket showed an inection with Peptostreptococcus microsand Fusobacterium nucleatum (orange complex ) as well asEikenella corrodens and Capnocytophaga sp ( green complex )Te patient reported recurring in1047298ammation in the leflower quadrant or a period o six weeks Prior to theplanned osteotomy o the wisdom tooth the dentist hadtaken a scalpel biopsy giving evidence or OSCC Clinicalexamination revealed an ulcerous lesion with dominant signs

F983145983143983157983154983141 983089 Case 983089mdashresection specimen o the mandible Te probereveals the loss o clinical attachment within the periodontal spaceandthe tumor seems to emerge rom the periodontal compartment

F983145983143983157983154983141 983090 Case 983089mdashthe preoperative OPG exhibits severe horizontalandvertical bone loss o the jaws In addition peri- and interradicu-lar osteolytic lesions around tooth 983091983094 are present A sof radiopacity as projection o the tumor mass can be identi1047297ed along the intactalveolar crest distal o 983091983094 Radiolucency suspect or bone invasion issolely present at the interradicular and distal aspect o the roots

lowast

F983145983143983157983154983141 983091 Case 983089mdashcross section specimen Te black arrow high-lights the close relation o the distal root to the tumor mass (lowast) withpreservedcortical bone distal to the tooth Te white arrow points ata tumorormation along themesial root 1047297llingout theinterradicularspace



Case Reports in Dentistry 983091

lowast

F983145983143983157983154983141 983092 Case 983090mdashthe clinical aspect consists o a 1047297brin-coatedulcer in region o the wisdom tooth at the lef lower mandible Teadjacent mucosa shows periocal signs o in1047298ammation (lowast)

F983145983143983157983154983141 983093 Case 983090mdashPreoperative OPGmdashA large ormation o enhanced translucency is ound in projection o the radices 983091983094 and983091983095 as also at the pericoronal aspect o the partially retained wisdomtooth

o periocal in1047298ammation Te ulcer was delineated by a rigidwall o mucosa attached to the alveolar crest related to 983091983095and 983091983096 (Figure 983092) Te patient declared to be a nonsmokerbut admitted occasional alcohol consumption Oral hygienewas assessed to be average and no other precursor lesionswere present Te preoperatively taken OPG (Figure 983093)

revealed considerable periradicular bone loss in regions 983091983095and 983091983094 analogous to typical radiologic 1047297ndings in patientswith moderate to advanced chronic periodontitis Te patientunderwent radical intended resection o the tumor Figure 983094shows the resection specimen rom a distal view Te tumoris mainly localized in the interdental space o 983091983095 and 983091983094 withdistinct relation to the periodontal space o the crown 983091983094Tebeginning in1047297ltration o the mouth 1047298oor becomes apparentFigure 983095 shows the microscopic view with arrosion o thebone by the tumor cells HPV status by p983089983094 immunostainingwas negative

Case 983091 A 983093983088-year-old man was reerred to our clinic by a maxilloacial surgeon with diagnosis o a squamous cell

F983145983143983157983154983141 983094 Case 983090mdashcross section specimen with a sectional view

rom distal afer removal o the bony aspect that contained thewisdom tooth Te tumor is in broad contact to the periodontium(arrow) with in1047297ltration o the adjacent cancellous bone and the1047298oor o the mouth

lowast

F983145983143983157983154983141 983095 Case 983090mdashhistological view o the cross section specimenafer Haematoxglin-Eosin staining Te arrows mark the arrosion o the bone (lowast) by the tumor cells

carcinoma o the right mandible Te clinical examinationrevealed a tumor o 983092 cm in diameter localized at the alveolarcrest distal o 983092983094 with extensions to the adjacent 1047298oor o themouth Around the ulcer 1047297elds o homogeneous leukoplakia

were detectable (Figure 983096) Te patient suffered rom gen-eralized advanced chronic periodontitis exhibiting pocketdepths up to 983095 mm with bleeding on probing Analysis o bac-teria (Micro-ident Hain Liescience GmbH D-983095983090983089983092983095 Nehren)revealed inection with Porphyromonas gingivalis annerella

forsythia reponema denticola (red complex ) Peptostrepto-coccus micros Fusobacterium nucleatum (orange complex )and Campylobacter rectus (orange-associated complex ) Oralhygiene was extremely poor with high amounts o sof andhard debris on the urthermore carious teeth Te patientreported to be a heavy smoker (983094983088 pack years) and drinker(gt983091L beer a day) Te OPG (Figure 983097) exhibited severegeneral bone loss with a basin-like translucency comprising




F983145983143983157983154983141 983096 Case 983091mdashclinical situation A partially ulcerous tumour

ormation covered the lingual aspect o the alveolar crest adjacent tothe two distal molars (983092983094 and 983092983095) Nearly all teeth o this quadrantshow clearly the sequelae o nearly nonexistent oral hygiene habitsStriae o leukoplakia are ound on the wall o the ulcer the tongueand also along the vestibular papillae

F983145983143983157983154983141 983097 Case 983091mdashpreoperative OPG Beside multiple cariouslesions the present X-ray examination reveals signs o chronic

periodontal disease with a general loss o horizontal bone levelliberationo both dental roots and biurcationsTe localmaximumo destruction is ound in the region o the last two molars Teretromolar triangle however appears to be intact

the last distal molars o the right mandibleA radicalintendedoperation ollowed Figure 983089983088 shows a transverse section o the resected mandible rom a lingual view Herein the tumorsurrounds the empty alveoli o the arti1047297cially removed rightmolars with considerable in1047297ltration o the alveolar boneHPV status by p983089983094 immunostaining was negative

daggerdagger

dagger Alveolus

F983145983143983157983154983141 983089983088 Case 983091mdashthe sagittal split preparation o the resectionspecimen rom a lingual view clearly shows the association o thetumor (borders marked with lines) to the dental alveoli (dagger) o thedistal molars Te teeth 983091983094 and 983091983095 are lost due to the preparation

process

Case 983092 A 983093983091-year-old man was admitted to our clinic with thehistological veri1047297ed diagnosis o a squamous cell carcinomao the anterior 1047298oor o the mouth Te patient noticed anindolent growing mass 1047297ve weeks beore admission Figure 983089983089gives a picture o the clinical situation Beside a spaceconsuming sublingual mass with deviation o the lingualrenulum a small erosive lesion lingual rom the lef loweranterior teeth (region teeth 983091983089 to 983091983092) with subtle periocalleukoplakia around the center o the lesion is shown Te

examination revealed a solid tumor ormation with its centermainly on the lef 1047298oor o mouth Te tumor expanded romthe lef angle o the mandible with a midline crossing to theregion o the 1047297rst right lower incisor Adherence to the bonewas detectable in the region o the lef lower canine and the1047297rst premolar Te oral hygiene status was moderate Inves-tigation o periodontal pockets revealed depths up to 983092 mmand bleeding on probing Te patient smoked 983089983088 cigarettesper day or ten years and occasionally drank a glass o wineTe OPG (Figure 983089983090) revealed a generalized horizontal typeo bone loss within both jaws with additional vertical bony deects and translucency as radiologic 1047297nding or an erosiveprocess in the lef anterior lower jaw Te radical intended

surgery consisted o a bloc resection including parts o themandible tongue 1047298oor o mouth and hyoid with completebilateral selective unctional neck dissection [983089983091] Te split-resection specimen (Figure 983089983091) shows a periradicular tumorormation along the root o the canine with in1047297ltrationo the neighboring cancellous bone HPV status by p983089983094immunostaining was positive as shown in Figure 983089983092

A brie summary o all cases is given in able 983089

3 Discussion

Our study presents our thoroughly documented cases withalveolar squamous cell carcinomas being directly associated




983137983138983148983141 983089 Summary o the presented cases

Patient 983089 983090 983091 983092

Gender Female Male Male Male

Age 983093983097 983092983096 983093983088 983093983091

Smoking Never Never 983094983088 py 983093 py

Alcohol Never Occasionally Regularly Occasionally Oral hygiene Sufficient Sufficient Worse Moderate

umor localization 983091983094 983091983095 983092983094 983091983090

Radiologic signs o periodontal disease Yes Yes Yes Yes

Probing depths 983093 mm 983090 mm 983095 mm 983093 mm

NM classi1047297cation p983090 pN983090b pMx G983090 R983088 p983092 pN983088 pM983088 G983090 R983089 p983092a pN983090b pM983088 G983090 pR983088 p983092a pN983090c pM983088 G983091 R983090

Bleeding upon probing Yes No Yes Yes

Periodontal marker bacteria Red complex Orange and green

complex

Orange andorange-associated

complexNot identi1047297ed

HPV status (p983089983094) Negative Negative Negative Positive

F983145983143983157983154983141 983089983089 Case 983092mdasha super1047297cial ulcerous lesion atop o a mass atthe lef sublingual space with extension to the lingual aspect o the alveolar crest comprising the teeth 983091983089 to 983091983092 and surroundingleukoplakia

to teeth that show considerable signs o chronic periodontitisChronic periodontitis represents the most common inectionworldwide with high clinical relevance or the dentist Inront o this clinical setting our different models o chronicperiodontitis with alveolar squamous cell carcinomas arediscussed as ollows Te 1047297rst patient had no precursor

lesions and no other risk actors had been identi1047297ed exceptclinical signs o chronic periodontitis In this patient a denovo development caused by genomic instability as conse-quence o chronic in1047298ammation caused by gram-negativebacteria as postulated by Guerra et al appears possible [983089983092]In this model chronic periodontitis itsel would trigger thedevelopment o oral squamous cell carcinoma Recentlythere is improving interest in the development o varioustypes o cancer and their association to in1047298ammation asalso the underlying pathophysiological mechanisms thatlead to malignant transormation [983089983093] One important actorin cancer-related in1047298ammation is the transcription actorNF-B Beside its unction as key coordinator o innate

F983145983143983157983154983141 983089983090 Case 983092mdashpreoperative OPG A general horizontal loss o bone in both jaws with additional vertical translucencies in therontaspect o the mandible and signs o erosion o the alveolar crest atthe lef lower quadrant

in1047298ammation and immunity by activated expression o in1047298ammatory cytokines adhesion molecules and angiogenic

actors it has also been identi1047297ed as endogenous tumourpromoter [983089983094] Moreover it is substantially involved in thein1047298ammatory process o chronic periodontitis [983089983095] In addi-tion an association between oral cancerand chronic mechan-ical trauma was also described [983089983096] suggesting that in1047298am-mation independent o its cause may predispose to cancerHereby malignant transormation o oral epithelium wouldbe a consequence o the immune response like macrophageand -cell activation and cytokine release (eg IL-983089 IL-983096and NF-1038389) [983089983097] Aside malignant transormation as sequelo unspeci1047297c in1047298ammation a speci1047297c bacterial or viral agentmay also promote malignancies Tis sequence is supposedor gastric lymphomas [983090983088] H pylori inection and gastric




F983145983143983157983154983141 983089983091 Case 983092mdashthe split resection specimen rom a lingual view demonstrates the association o tumor ormation along the root o the lef lower canine (white arrows) as also urther invasion o thecancellous bone

lowast

F983145983143983157983154983141 983089983092 Case 983092mdashhistological view o the tumor afer immune-histochemical staining against p983089983094 Te brown signal (lowast) proves theinection with HPV

cancer [983090983089] Hepatitis B Virus (HBV) and HCV inection inliver cancer [983090983090] and HPV 983089983094983089983096 inection in head and neck [983090983091] or cervical cancer [983090983092] Herein microbial activation o in1047298ammatory cells leads to a respiratory burst and release o ree radicals which can contribute transormation to malig-nancy by DNA damage peroxidation o lipids or disturbanceo physiological posttranslational modi1047297cation o proteins

[983090983093] aken together either genomic instability directly induced by the bacterial agent itsel or as consequence o immunological response to chronic in1047298ammation both aremain characteristics o chronic periodontitis Te clinicalrelevance o chronic periodontitis or the development o OSCC was investigated by ezal et al In a case control modelthe loss o bone as clinical sign or chronic periodontitiswas an independent risk actor or tongue carcinomas andwas still o signi1047297cance in a multiple regression model [983089983090]Particularly these patients would bene1047297t rom periodontaltherapy in terms o primary prevention Te second caseoffers another possible scenario Here chronic periodontitisacts as promoter or the invasion o tumor cells into the bone

During the course o chronic periodontitis the loss o clinicalattachment level and the underlying bone is substantially triggered Te periodontal-localized in1047298ammation maceratesthe cancellous bone by enhanced osteoclastic activity whichmay constitute a potential route or invasion o an adjacentcarcinoma Osteoclastic activity is enhanced by proin1047298am-

matory molecules like IL-983089 or LPS [983090983094] which can be ound ingingival crevicular 1047298uid (GCF) during chronic periodontitis[983090983095] Furthermore seven potential routes or invasion o the mandible by OSCC have been reviewed by Brown [983090983096]Beside the occlusal route neural oramina attached gingivacortical bone deects in the edentulous ridge or in1047297ltration by secondary tumors in the neck through the lower border theperiodontal membrane in the dentate mandible was hypoth-esized as a possible way or tumor invasion by Bhattathiriand Nair in 983089983097983097983089 [983090983097] Supposing the periodontal space aweak point or tumor invasion the instance o periodontalin1047298ammation may promote an invasion o the mandible by a neighbored tumor [983089983093 983089983097] Te cross- sectional specimeno the second case underlines this possible scenario witha tumor in1047297ltrating the periodontal space the surroundingadjacent cancellous bone and the neighbored 1047298oor o themouth

Te third case is an example or chronic periodontitisbeing a well-known comorbidity in oral cancer patients Tepatient was a heavy smoker and drinker with insufficientoral hygiene All these habits are or themselves potentialrisk actors or the development o oral cancer and chronicperiodontitis [983093 983091983088ndash983091983090] In this patient chronic periodontitisand OSCC seem to be a coincidence without an option touncover cause and effect

An accredited model or the development o OSCC isthe multistep theory [983091983091] Herein the oral mucosa under-goes different developmental stages rom hyperkeratosis overdifferent degrees o dysplasia to invasive cancer while eachlevel shows consecutive accompanying alterations withinthe genetic pro1047297le [983091983092] Accordingly it appears possiblethat chronic periodontitis may trigger the pathogenesis o precancerous lesions In case our the clinical inspection o the oral cavity revealed a vast 1047297eld o leukoplakia at theanterior 1047298oor o mouth Besides the clinical maniest OSCCand multiple teeth were affected by chronic periodontitis Across-interaction between the special in1047298ammatory milieuwith enhanced levels o proin1047298ammatory cytokines and achange in the bacterial environment may induce the develop-ment and progression o precancerous lesions in the alveolar

mucosa Tis thesis was reinorced recently by Meisel et alwho identi1047297ed chronic periodontitis as a risk actor or thedevelopment o leukoplakia predisposing ororal cancer [983091983093]

4 Conclusion

We presented our clinical scenarios o OSCC in theneighbourhood o teeth affected by chronic periodontitisor discussion o the clinical relevance Clinical experi-ence characterizes most OSCC as coincidence since chronicperiodontitis and the oral malignancy share multiple risk actors impeding a de1047297nition o cause and effect On the




other hand we ound clinical hints or an interaction o OSCC and chronic periodontitis by means o invasion routepreormation or a promotive effect on present precursorlesions Finally we give an example or a possible de novosynthesis o the OSCC in a patient without other risk actorsTese patients in particular would greatly bene1047297t rom early

therapy o the underlying chronic periodontitis in terms o aprimary prevention

Conflict of Interests

Te authors declare that they have no con1047298ict o interestsTere are no 1047297nancial or personal relationships with otherpeopleor organisationsinappropriatelyin1047298uencingour workFurthermore the authors state that there were no sources o unding

References

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[983090] D M Parkin F Bray J Ferlay and P Pisani ldquoGlobal cancerstatistics 983090983088983088983090rdquo CA A Cancer Journal for Clinicians vol 983093983093 no983090 pp 983095983092ndash983089983088983096 983090983088983088983093

[983091] P Rusin L Markiewicz and I Majsterek ldquoGenetic predetermi-nations o head and neck cancerrdquo Postępy Higieny i Medycyny Doswiadczalnej vol 983094983090 pp 983092983097983088ndash983093983088983089 983090983088983088983096

[983092] P-O Rodstrom M Jontell U Mattsson and E HolmbergldquoCancer and oral lichen planus in a Swedish populationrdquo Oral Oncology vol 983092983088 no 983090 pp 983089983091983089ndash983089983091983096 983090983088983088983092

[983093] C Pelucchi S Gallus W Garavello C Bosetti and C LVecchia ldquoAlcohol and tobacco use and cancer risk or upper

aerodigestive tract and liverrdquo European Journal of Cancer Prevention vol 983089983095 no 983092 pp 983091983092983088ndash983091983092983092 983090983088983088983096

[983094] M ezal M S Nasca D L Stoler et al ldquoChronic periodontitis-human papillomavirus synergy in base o tongue cancersrdquo Archives of Otolaryngology vol 983089983091983093 no 983092 pp 983091983097983089ndash983091983097983094 983090983088983088983097

[983095] C Fakhry W H Westra S Li et al ldquoImproved survival o patients with human papillomavirusmdashpositive head and neck squamous cell carcinoma in a prospective clinical trialrdquo Journal of the National Cancer Institute vol 983089983088983088 no 983092 pp 983090983094983089ndash983090983094983097983090983088983088983096

[983096] S Marur G DrsquoSouza W H Westra and A A ForastiereldquoHPV-associated head and neck cancer a virus-related cancerepidemicrdquo Te Lancet Oncology vol 983089983089 no 983096 pp 983095983096983089ndash983095983096983097 983090983088983089983088

[983097] M S Meyer K Joshipura E Giovannucci and D S MichaudldquoA review o the relationship between tooth loss periodontaldisease and cancerrdquo Cancer Causes and Control vol 983089983097 no 983097pp 983096983097983093ndash983097983088983095 983090983088983088983096

[983089983088] D S MichaudK Joshipura E Giovannucci andC S Fuchs ldquoAprospective study o periodontal disease and pancreatic cancerin US male health proessionalsrdquo Journal of the National Cancer Institute vol 983097983097 no 983090 pp 983089983095983089ndash983089983095983093 983090983088983088983095

[983089983089] B Burt and Research Science and Terapy Committee o theAmerican Academy o Periodontology ldquoPosition paper epi-demiology o periodontal diseasesrdquo Journal of Periodontology vol 983095983094 no 983096 pp 983089983092983088983094ndash983089983092983089983097 983090983088983088983093

[983089983090] M ezal M A Sullivan A Hyland et al ldquoChronic periodontitisand the incidence o head and neck squamous cell carcinomardquo

Cancer Epidemiology Biomarkers and Prevention vol 983089983096 no 983097pp 983090983092983088983094ndash983090983092983089983090 983090983088983088983097

[983089983091] K Robbins G Clayman P A Levine et al ldquoNeck dissec-tion classi1047297cation update revisions proposed by the Ameri-can Head and Neck Society and the American Academy o Otolaryngology-Head and Neck Surgeryrdquo Archives of Otolaryn- gology vol 983089983090983096 no 983095 pp 983095983093983089ndash983095983093983096 983090983088983088983090

[983089983092] L Guerra R Guidi and Frisan ldquoDo bacterial genotoxinscontribute to chronic in1047298ammation genomic instability andtumor progressionrdquo FEBS Journal vol 983090983095983096 no 983090983091 pp 983092983093983095983095ndash983092983093983096983096 983090983088983089983089

[983089983093] S F Moss and M J Blaser ldquoMechanisms o disease in1047298am-mation and the origins o cancerrdquo Nature Clinical PracticeOncology vol 983090 no 983090 pp 983097983088ndash983097983095 983090983088983088983093

[983089983094] M Karin ldquoNuclear actor-B in cancer development andprogressionrdquo Nature vol 983092983092983089 no 983095983088983097983090 pp 983092983091983089ndash983092983091983094 983090983088983088983094

[983089983095] Y Nagahama Obama M Usui et al ldquoOxidized low-density lipoprotein-induced periodontal in1047298ammation is associatedwith the up-regulation o cyclooxygenase-983090 and microsomalprostaglandin synthase 983089 in human gingival epithelial cellsrdquo

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[983089983097] A Mantovani P Allavena A Sica and F Balkwill ldquoCancer-related in1047298ammationrdquo Nature vol 983092983093983092 no 983095983090983088983091 pp 983092983091983094ndash983092983092983092983090983088983088983096

[983090983088] M Lecuit M C Peterson F Suarez and O LortholaryldquoImmunoprolierative small intestinal disease associated withCampylobacter jejunirdquo Te New England Journal of Medicine vol 983091983093983088 no 983091 pp 983090983091983097ndash983090983092983096 983090983088983088983092

[983090983089] N Uemura S Okamoto S Yamamoto et al ldquoHelicobacter

pylori inectionand the development o gastric cancerrdquo Te NewEngland Journal of Medicine vol 983091983092983093 no 983089983089 pp 983095983096983092ndash983095983096983097 983090983088983088983089

[983090983090] D M Parkin ldquoGlobal cancer statistics in the year 983090983088983088983088rdquo TeLancet Oncology vol 983090 no 983097 pp 983093983091983091ndash983093983092983091 983090983088983088983089

[983090983091] M L Gillison and K V Shah ldquoHuman papillomavirus-associated head and neck squamous cell carcinoma mountingevidence or an etiologic role or human papillomavirus in asubset o head and neck cancersrdquo Current Opinion in Oncology vol 983089983091 no 983091 pp 983089983096983091ndash983089983096983096 983090983088983088983089

[983090983092] H zur Hausen ldquoPapillomaviruses and cancer rom basicstudies to clinical applicationrdquo Nature Reviews Cancer vol 983090no 983093 pp 983091983092983090ndash983091983093983088 983090983088983088983090

[983090983093] S P Hussain L J Hoseth and C C Harris ldquoRadical causes o

cancerrdquo Nature Reviews Cancer

vol 983091 no 983092 pp 983090983095983094ndash983090983096983093 983090983088983088983091[983090983094] Katagiri and N akahashi ldquoRegulatory mechanisms o osteoblast and osteoclast differentiationrdquo Oral Diseases vol 983096no 983091 pp 983089983092983095ndash983089983093983097 983090983088983088983090

[983090983095] C M E Champagne W Buchanan M S Reddy J S PreisserJ D Beck and S Offenbacher ldquoPotential or gingival crevice1047298uid measures as predictors o risk or periodontal diseasesrdquoPeriodontology 983090983088983088983088 vol 983091983089 pp 983089983094983095ndash983089983096983088 983090983088983088983091

[983090983096] J Brown ldquoMechanisms o cancer invasion o the mandiblerdquoCurrent Opinion in Otolaryngology amp Head and Neck Surgery vol 983089983089 no 983090 pp 983097983094ndash983089983088983090 983090983088983088983091

[983090983097] V N Bhattathiri and M K Nair ldquoPeriodontal space a majorroute to bone involvement in oral cancerrdquo Medical Hypotheses vol 983091983092 no 983089 pp 983093983096ndash983093983097 983089983097983097983089




[983091983088] D Kademani ldquoOral cancerrdquo Mayo Clinic Proceedings vol 983096983090no 983095 pp 983096983095983096ndash983096983096983095 983090983088983088983095

[983091983089] D M Laronde G Hislop J M Elwood and M P RosinldquoOral cancer just the actsrdquo Journal of the Canadian Dental Association vol 983095983092 no 983091 pp 983090983094983097ndash983090983095983090 983090983088983088983096

[983091983090] K Rosenquist J Wennerberg E-B Schildt A Bladstrom BG

Hansson and G Andersson ldquoOral status oral inections andsome liestyle actors as risk actors or oral and oropharyngealsquamous cell carcinoma A population-based case-controlstudy in southern Swedenrdquo Acta Oto-Laryngologica vol 983089983090983093no983089983090 pp 983089983091983090983095ndash983089983091983091983094 983090983088983088983093

[983091983091] A Argiris M V Karamouzis D Raben and R L Ferris ldquoHeadand neck cancerrdquo Te Lancet vol 983091983095983089 no 983097983094983090983093 pp 983089983094983097983093ndash983089983095983088983097983090983088983088983096

[983091983092] J CalianoPvan der Riet W Westraet al ldquoGenetic progressionmodel or head and neck cancer implications or 1047297eld cancer-izationrdquo Cancer Research vol 983093983094 no 983089983089 pp 983090983092983096983096ndash983090983092983097983090 983089983097983097983094

[983091983093] P Meisel B Holtreter R Biffar W Suemnig and KocherldquoAssociation o periodontitis with the risk o oral leukoplakiardquoOral Oncology vol 983092983096 no 983097 pp 983096983093983097ndash983096983094983091 983090983088983089983090



Submit your manuscripts at

httpwwwhindawicom




chronic periodontitis being an independent risk actoror thedevelopment o carcinoma within the oral cavity [983089983090] Inronto this background the case series at hand comprises ourpatients treated at our clinical Department or OSCC Withinthese the synopsis o clinical appearance radiologic 1047297ndingsand cross-sectional resection specimen offer an association o

the carcinoma to the periodontal space with signs o chronicin1047298ammation Te different clinical aspects are discussedcomprising the available literature on this topic

2 Case Presentations

Case 983089 A 983093983097-year-old woman presented hersel with an exo-phytic mass o 983090 cm adherent to the mandible and localizeddistally o tooth 983091983094 Te tooth revealed signs o chronicperiodontitis with bleeding on probing attachment loss anda 983093 mm deep pocket and signi1047297cant mobility on clinicalexamination Polymerase chain reaction (Micro-ident HainLiescienceGmbHD-983095983090983089983092983095 Nehren) (PCR)revealed an inec-

tion with Porphyromonas gingivalis and annerella forsythia(red complex ) Te expansion o the tumor reached rom thesulcus glossoalveolaris with its center along the alveolar crestto the adjacent buccalmucosa (Figure 983089) Te patient reportedhersel to be a never smoker and never ingested alcohol Oralhygiene habits were sufficient No other precursor lesionslike leukoplakia erythroplakia or signs o oral lichen planuswere ound on examination Te visit o our department wasinduced by progressive pain and increasing swelling Tepreoperatively taken orthopantomography (OPG) revealeda considerable generalized horizontal type o bone loss withinthe upper and the lower jaw as also a distinct inter- andperiradicular osteolytic lesion at the region o 983091983094 (Figure 983090) A

both-sided selective neck dissection [983089983091] and partial resectiono the mandible ollowed Te clinical appearance (Figure 983089)showed an exophytic mass with contact to the distal root o 983091983094 Intriguingly the OPG showed no arrosion o the distalmandible but apparently an inhomogeneous radiolucency between the roots o the molar Te cross-section specimen(Figure 983091) urthermore highlights the interradicular spread-ing o the tumor without an in1047297ltration o cancellous bone orthe distal alveolar crest HPV status by p983089983094 immunostainingwas negative

aking all clinical 1047297ndings together the present casesupports the hypothesis o a possible de novo developmento malignancy rom the interradicular periodontium

Case 983090 A 983092983096-year-old man presented himsel with a histo-logical veri1047297ed squamous cell carcinoma o the lef mandibleadjacent to the partially retained tooth 983091983095 surrounded by a bony deect o 983091 mm Analysis o the bacteria (Micro-ident Hain Liescience GmbH D-983095983090983089983092983095 Nehren) inside thepocket showed an inection with Peptostreptococcus microsand Fusobacterium nucleatum (orange complex ) as well asEikenella corrodens and Capnocytophaga sp ( green complex )Te patient reported recurring in1047298ammation in the leflower quadrant or a period o six weeks Prior to theplanned osteotomy o the wisdom tooth the dentist hadtaken a scalpel biopsy giving evidence or OSCC Clinicalexamination revealed an ulcerous lesion with dominant signs

F983145983143983157983154983141 983089 Case 983089mdashresection specimen o the mandible Te probereveals the loss o clinical attachment within the periodontal spaceandthe tumor seems to emerge rom the periodontal compartment

F983145983143983157983154983141 983090 Case 983089mdashthe preoperative OPG exhibits severe horizontalandvertical bone loss o the jaws In addition peri- and interradicu-lar osteolytic lesions around tooth 983091983094 are present A sof radiopacity as projection o the tumor mass can be identi1047297ed along the intactalveolar crest distal o 983091983094 Radiolucency suspect or bone invasion issolely present at the interradicular and distal aspect o the roots

lowast

F983145983143983157983154983141 983091 Case 983089mdashcross section specimen Te black arrow high-lights the close relation o the distal root to the tumor mass (lowast) withpreservedcortical bone distal to the tooth Te white arrow points ata tumorormation along themesial root 1047297llingout theinterradicularspace




lowast








lowast













daggerdagger

dagger Alveolus


process





3 Discussion






Patient 983089 983090 983091 983092


Age 983093983097 983092983096 983093983088 983093983091









complex














lowast









4 Conclusion









References
















































httpwwwhindawicom




lowast








lowast













daggerdagger

dagger Alveolus


process





3 Discussion






Patient 983089 983090 983091 983092


Age 983093983097 983092983096 983093983088 983093983091









complex














lowast









4 Conclusion









References
















































httpwwwhindawicom









daggerdagger

dagger Alveolus


process





3 Discussion






Patient 983089 983090 983091 983092


Age 983093983097 983092983096 983093983088 983093983091









complex














lowast









4 Conclusion









References
















































httpwwwhindawicom





Patient 983089 983090 983091 983092


Age 983093983097 983092983096 983093983088 983093983091









complex














lowast









4 Conclusion









References
















































httpwwwhindawicom





lowast









4 Conclusion









References
















































httpwwwhindawicom








References
















































httpwwwhindawicom














httpwwwhindawicom

Nadya Purwanty (04121004052) Rkg4

Documents

Transcript of Nadya Purwanty (04121004052) Rkg4