Epidemiology and types of oral cancer

Oral cancer is a subset of head and neck cancer and usually refers to different neoplastic conditions that impact any tissue within the oral cavity. Evidence shows that these malignancies are associated with different complications over the affected patients. The present literature review will discuss the epidemiology and types of oral cancer based on evidence from relevant studies within the literature. Estimates show that oral cancer is a common condition with high prevalence rates globally. However, we have identified several factors across the different relevant investigations, including smoking, alcohol intake, age, socioeconomic status, immunocompromised state, and genetics. This might explain the inconsistent findings regarding the prevalence and mortality rates of the conditions among worldwide studies. Moreover, squamous cells carcinoma is the commonest type of oral cancer. However, other types might also be identified as adenocarcinoma, sarcoma, melanoma, and lymphoma. These lesions can also be found at different places within the mouth cavity, including lips, tongue, and salivary glands. Therefore, healthcare authorities should plan adequate interventional strategies targeting the risk factors to properly control the disease and reduce its burden.

Gene of the month: Cornulin

Cornulin (CRNN) gene encodes a 495 amino acid long protein and is located on chromosome 1q21.3. Primarily, it functions as the marker of differentiation. Initially, it was found to be specific for the squamous cells of oesophagus. However, later on, several studies have revealed the presence of Cornulin downregulation in various epithelial squamous cell carcinomas of the head and neck, oesophagus and cervix and clinically associated it with worsening of cancer and the poor prognosis. Cornulin levels also showed dysregulation in other diseases such as Eczema and Psoriasis. Besides the differentiation marker, it was identified to be involved in the stress response. The studies, in psoriasis and oesophageal squamous cell carcinoma, has elucidated that the dysregulation in the Cornulin is associated with the cell cycle events such as G1/S transition. However, the actual function of Cornulin is still yet to be explored in detail.

A Case Report of Mucoepidermoid Carcinoma With Extensive Keratinization in Parotid: Expanding the Morphologic Spectrum

Mucoepidermoid carcinoma (MEC) is the most common malignant tumor of salivary glands in children and young adults. Typically, it is composed of squamoid, mucin-producing and intermediate-types cells. However, overt keratinization is rare. To the best of our knowledge, extensive keratinization or keratin pearls in MEC has never been reported. Keratinization or keratin pearls are regard “practically never seen in low-grade MEC”. Herein, we report a case of a 34-year-old woman who presented with a tumor in right parotid gland for 2 months. Microscopically, the tumor was composed of extensive squamous cells with overt keratin pearls, intermediate cells and few scattered mucous cells. MAML2 gene break-apart and CRTC1-MAML2 gene fusion were detected by fluorescence in situ hybridization. This is the first report to describe a MEC case with extensive squamous metaplasia and overt keratin pearls formation, which expands the morphologic spectrum of MEC.

Intravesical ichthyosis: a rare case report

Background Ichthyosis is a rare skin disorder, in which the shedding of squamous cells is altered. Intravesical ichthyosis is an extremely rare condition. There is evidence for an association with intravesical condylomata accuminata, caused by urogenital infections of the human papilloma virus. These lesions are generally benign but known to be of a carcinogenic potential and therefore should be treated immediately and followed-up closely. Case presentation We present the case of a 39-year-old woman who presented with recurrent urinary tract infections. During cystoscopy diffuse black pigmented flat bladder tumours were visualized. After transurethral resection the pathological report diagnosed an ichthyosis vesicae. Conclusion We recommend a complete resection with frequent clinical and cystoscopic follow-up. Furthermore, testing for the human papilloma virus should be performed and a vaccination should be offered to the patient. As ichthyosis vesicae is a rare phenomenon, there is an evident lack of clinical data regarding therapy, prognosis and follow-up. With our report, we want to emphasize the need for further research.

The Disulfiram/Copper Complex Induces Autophagic Cell Death in Colorectal Cancer by Targeting ULK1

Colorectal cancer (CRC) is highly prevalent worldwide, but there has been limited development of efficient and affordable treatment. Induced autophagy has recently been recognized as a novel therapeutic strategy in cancer treatment, and disulfiram (DSF), a well-known antialcohol drug, is also found to inhibit tumor growth in various malignancies. Recently, DSF has been reported to induce excessive autophagy in oral squamous cells; however, little is known about whether it can induce autophagy and suppress proliferation in CRC. In this study, we investigate the effect of DSF with copper (DSF/Cu) on CRC both in vitro and in vivo and find that the combination significantly inhibits CRC cell viability and mainly induces autophagy instead of apoptosis. Furthermore, we use whole genome CRISPR library screening and identify a new mechanism by which DSF triggers autophagy by ULK1. Overall, these findings provide a potential CRC treatment.

Case Report and Highlight Clues on the Diagnosis of Pilomatrical Carcinoma

Pilomatrical Carcinoma (PC) is a rare malignant adnexal tumor with matrical differentiation. Its benign counterpart (Pilomatrixoma) is diagnosed much more frequently in daily pathological practice. Both entities share genetic alterations but the malignant counterpart acquires mutations that make it develop an aggressive behavior [1]. We describe a 33-year-old man who presented with a 7 x 6 cm nodular ulcerated lesion in the left ear with markedly accelerated growth in the last month. Incisional biopsy was referred to us with suspicion of squamous cell carcinoma versus pyogenic granuloma. Histologic sections showed ulcerated fragments infiltrated by a basaloid cell proliferation interspersed with groups of “ghost cells”. The neoplastic cells were arranged in irregular sheets with infiltrative borders. Groups of Squamous cells with trichilemmal keratinization and foci of necrosis were also identified. The biopsy was diagnosed as an adnexal neoplasm with pilomatrical differentiation, suggesting its complete resection with safety margins due to the presence of aggressive characteristics. The subsequent study of the excisional biopsy showed similar characteristics to those previously described. Notoriously, focal infiltration of the auricular cartilage was identified, leading us to the undoubted diagnosis of pilomatrical carcinoma.

Comparison between Urine and Cervical High-Risk HPV Tests for Japanese Women with ASC-US

Most uterine cervical cancers are caused by the persistent infection of the high-risk human papillomavirus (hrHPV). Thus, the hrHPV-DNA test, which examines specimens from the cervix, is the standard screening method as well as cytology in western countries. Urine sampling for the hrHPV-DNA test would be easier and help improving screening rates. This study prospectively investigated the concordance between urine and cervical hrHPV tests for patients with atypical squamous cells of undetermined significance (ASC-US) in cervical cytology. We recruited 338 women with the cytologic diagnosis of ASC-US and performed hrHPV-DNA tests to both samples from the uterine cervix and first void urine, using the Cobas 4800 system. In all hrHPV genotypes, the simple concordance rate was 90.8% (307/338) and the Kappa statistic value was 0.765, which shows substantial concordance. The positive concordance rate was 70.5% (74/105), which was the rate excluding women who had negative results in both tests. When limited to types 16 and 18, the simple concordance rate was 98.8% (334/338), and the Kappa statistical value was calculated to be 0.840, which showed almost perfect concordance. The positive concordance rate resulted in 81.8% (18/22). We conclude that the urine hrHPV-DNA test could substitute the cervical test in women with ASC-US.

Histologic Findings in Gynecologic Tissue From Transmasculine Individuals Undergoing Gender-Affirming Surgery

Context.— Gender-affirming surgery is part of a multidisciplinary approach in gender transitioning. Deeper histologic examination may strengthen care for transmasculine individuals and increase the understanding of the influence of hormonal therapy in specific organs. Objective.— To evaluate and catalogue histologic findings of tissue obtained from gender-affirming gynecologic surgery and cervical cytology specimens. Design.— This is an institutional review board–approved retrospective study that included transmasculine individuals who underwent gender-affirming gynecologic surgery from January 2015 to June 2020. All surgical gynecologic pathology and cervical cytology slides were reviewed by 2 pathologists. Results.— Fifty-five patients were included, which represented 40 uteri, 35 bilateral ovaries, 15 vaginectomy specimens, and 24 cervical cytology results. The median age was 27 years (range, 18–56) and 94% (50 of 53) of patients were receiving testosterone for at least 1 year. Seventy-five percent (30 of 40) of endometria were inactive, while 25% (10 of 40) showed evidence of cycling. Transitional cell metaplasia was the most common finding in the cervix (17 of 40) and vagina (15 of 15), reflecting a high percentage (4 of 24) of unsatisfactory or ASC-US (atypical squamous cells of undetermined significance) cervical cytologies. Prostatic-type glands were identified in 20% (8 of 40) of cervices and 67% (10 of 15) of vaginectomy specimens. Multiple bilateral cystic follicles and evidence of follicular maturation were present in 57% (20 of 35) of cases. Four cases showed paratubal epididymis-like mesonephric remnant hypertrophy. Conclusions.— A comprehensive evaluation of tissue from gender-affirming surgery increases knowledge of the changes following androgen therapy in transmasculine individuals and may contribute to optimal patient care by raising awareness of normal histologic variations in this population.

Complex Fibroadenoma with Pronounced Squamous Metaplasia: A Rare Case Report, Differential Diagnostic Considerations, and Associated Breast Cancer Risk

Squamous metaplasia of the breast is a rare and unusual finding. A number of benign and malignant differential entities exist when squamous cells are present in a breast lesion. Our patient was found to have pronounced squamous metaplasia and keratin cysts arising in a complex fibroadenoma. The rare nature of squamous metaplasia arising in such a lesion poses some diagnostic challenges, as squamous epithelium and squamous metaplasia in the breast may raise suspicion for malignancy. Herein we present a unique case and discussion of benign and malignant differential entities. We also retrospectively reviewed a series of complex fibroadenomas in our institution, including the demographic and histologic features, and more importantly the associated breast cancer risk.

Squamous Cell Metastasis of Cancer from Cervix to Breast: A Case Report

Squamous cell metastasis from cervical cancer to breast is an extremely rare entity, approximately 29 cases have been documented worldwide since 1947 and it is the second documented case in Ecuador, the incidence is very low, it represents only 1,2 of all malignant neoplasms of the breast, which limits the expertise in the diagnosis and treatment of this metastasis, with the outermost quadrant of the breasts being the most frequent site of presentation. We present the clinical case of a 46-year-old married woman with a history of stage IVB squamous cell cancer of the cervix, who received chemotherapy, a Paclitaxel/Carboplatin regimen for 6 cycles. There was no good response and we had radiotherapy and brachytherapy treatment. The second line of chemotherapy with monodroga Gemcitab is proposed, the scheme is completed for 8 cycles. There is no favorable response, so a second-line chemotherapy treatment with Ifosfomide is proposed. The same metastases are present in the breast as after imaging and pathology examinations, it is concluded that the patient presents cervical Ca squamous cell metastases (cancer) from the cervix, 6 months after the diagnosis of the deceased patient. Metastasis to the breast from a neoplasm of other organs is very rare, the incidence of which is very low and the prognosis is gloomy. Keywords: metastasis, squamous cells, cancer of the cervix. RESUMEN La metástasis de células escamosas de cáncer de cérvix a mama es una entidad extremadamente rara, se ha documentado a nivel mundial aproximadamente 29 casos desde 1947 y es el segundo caso documentado en el Ecuador, la incidencia es muy baja, representa tan solo el 1,2 de todas las neoplasias malignas de la mama, lo que limita la experticia en el diagnóstico y tratamiento de esta metástasis, siendo el sitio más frecuente de presentación el cuadrante superior externo de las mamas. Se presenta el caso clínico de una paciente de 46 años, casada, con antecedentes de cáncer de cérvix de células escamosas en estadio IVB por lo que recibió tratamiento de quimioterapia, esquema Paclitaxel/Carboplatino por 6 ciclos. No hubo buena respuesta y recibió tratamiento de radioterapia y braquiterapia. Se propone segunda línea de quimioterapia con monodroga Gemcitab, se completa el esquema por 8 ciclos. No existió respuesta favorable por lo que se propone tratamiento de segunda línea de quimioterapia con Ifosfomida. Presenta metástasis en mama la misma que posterior a exámenes de imagen y patología se concluye que la paciente presenta metástasis de células escamosas de Ca (cáncer) de Cérvix a mama, 6 meses posterior al diagnóstico la paciente fallece. La metástasis en la mama de una neoplasia de otros órganos es muy raro cuya incidencia es muy baja y de pronóstico sombrío. Palabras claves: metástasis, células escamosas, cáncer de cérvix.