Congenital Epulis: A Two-Case Report

Congenital epulis is a rare benign tumor of the newborn that could be detected in the prenatal period. Females are more often affected than males and the premaxillary region is usually the predilection site for this oral mass. Excision is the treatment of choice and no recurrences have been reported so far. We present our experience with two cases of congenital epulis, detected in the second trimester of gestation and treated shortly after birth with no further complications. Histopathology should differentiate between congenital epulis and other congenital oral tumors even if its clinical appearance is usually enough to make a tentative diagnosis. A multidisciplinary assessment in the management of this tumor can avoid unwanted complications such as airway obstruction or bleeding.

KMT2D Loss Promotes Head and Neck Squamous Carcinoma Through Enhancer Reprogramming and Modulation of Immune Microenvironment

ABSTRACTHead and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide, with 5-year survival of ∼50%. Genomic profiling studies have identified important somatic mutations in this disease which presents an opportunity for precision medicine. We demonstrate that KMT2D, a histone methyltransferase harbors somatic mutations in ∼17% of HNSCC and is associated with 2-year recurrence in TCGA data. Consistent with algorithmic prediction of bring a driver tumor-suppressor event, its loss results in larger oral tumors in immune-proficient orthotopic models. Mechanistically, we find that KMT2D knockdown or KMT2D mutation causes loss of H3K4me1-marked enhancers harboring IRF7/9 binding sites, which is known to regulate interferon signaling. Indeed, KMT2D loss in human and murine cell lines deregulated transcriptional levels of cytokine expression and impacted numerous immune signaling pathways, including interferon signaling. Consistently, Kmt2d knockdown in murine tumors exhibited decrease in IFNγ-producing effector T cells and an increase in T-cells with an exhausted phenotype. Epistasis experiments showed that exogenous treatment with IFNγ abrogated the increased tumor growth in Kmt2d-deficient oral tumors. Together, these results support the role of KMT2D as a tumor suppressor in HNSCC that regulates the tumor microenvironment by modulating H3K4me1-marked enhancers controlling interferon signaling.

Spontaneous emergence of non-convertible cell states with CD24-High phenotype results in phenotypic heterogeneity that associates with poor prognosis in oral cancer

Cancer cells within individual tumors often exist in distinct phenotypic states contributing to intratumoral heterogeneity (ITH). However, studies on cell state dynamics among oral cancer cells are largely missing. Here, we have multiplexed phenotypic markers of putative oral-stem-like cancer cells (SLCCs) and characterized diversity among CD44-positive oral cancer cell subpopulations with respect to distinct expression of CD24 and aldehyde dehydrogenase (ALDH)-activity. Our in vitro experimental observations were explained by a Markov model where subpopulations followed two distinct patterns of spontaneous repopulation dynamics. Cells showed stochastic inter-conversions on ALDH-axis, harnessed by cancer cells to enrich ALDHHigh subpopulations in response to Cisplatin treatment. However, these cells followed a strict non-interconvertible transition of CD24Low to CD24High subpopulations, even in response to chemotherapy-induced stress. Using phenotype-specific RNAseq, we suggest the organization of subpopulations into hierarchical structure with possible maintenance of intermediate alternate states of stemness within the differentiating oral cancer cells. We also show that the population dynamics described here may influence tumor behaviour by increasing ITH in aggressive oral tumors. Overall, the described phenotypic subgroups not only reliably exhibited spontaneous or Cisplatin-driven cellular dynamics but also the distinct transcription states of oral cancer cells. Most importantly, our in vitro model system derived observations emphasized the prognostic power which may be translated for betterment of oral cancer patients.Graphical AbstractWe have characterized diversity among CD44-positive oral cancer cells lines with respect to distinct expression of CD24 and ALDH-activity. Cells showed stochastic inter-conversions on ALDH-axis but a strict non-interconvertible transition of CD24Low to CD24High phenotype, even in response to chemotherapy-induced stress. RNAseq study suggested the organization of subpopulations into hierarchical structure with possible maintenance of intermediate alternate states of stemness within the differentiating oral cancer cells. The described population dynamics may influence tumor behaviour by increasing intratumoral heterogeneity in aggressive oral tumors.

The role of the oral microbiome in the diagnosis and prognosis of tumors of the oral cavity

Despite advancement in tumors treatment, oral cancer has a poor prognosis and is often detected at late stage. Recent advancement in metagenomic technologies may be useful in identifying oral tumors–related microbiome, their genomes, virulence properties, and their interaction with host immunity. Alteration in the oral commensal microbial communities have potential application as a diagnostic tool to predict oral tumors. To develop highly precise and effective therapeutic approaches, identification of specific oral microbiomes may be required. In this review, we narrate the role of microbiome in the progression of oral tumors and its role as an early diagnostic and prognostic biomarker for oral tumors.

Evaluation of Postoperative Repair Effect of Oral Tumors Based on Free Ultrasound Flap Transplantation

In this paper, the treatment of oral tumors with free flap transplantation based on ultrasound contrast is studied, and the repair effect is analyzed and evaluated in-depth, the postoperative quality of life of patients with oral malignant tumors is evaluated, and the factors affecting their quality of life are analyzed. 120 patients with oral malignant tumors were selected. The continuity of the jaws, neck clearance method, clinical stage, tumor recurrence, radiotherapy, and chemotherapy all have varying degrees of impact on the postoperative quality of life. Multivariate analysis suggests that tumor recurrence has the greatest impact on the quality of life of patients followed by jaw continuity, tumor stage, with or without neck clearance. First, the early detection rate of tumors should be improved, and the tumors should be removed as completely as possible during the operation to avoid residues. If necessary, cervical lymph node dissection can be performed. Patients with discontinuous jaws should be reconstructed and repaired in time to restore the maxillofacial shape and function of the patients, to greatly reduce the impact on the quality of life of patients after surgery.

Peripheral Ossifying Fibroma: A Case Report

The gingiva is often considered as one of the most common sites of localized growths that are considered to be reactive rather than malignant in nature. Clinically, the majority of these lesions are difficult to identify, and therefore histopathology is useful in diagnosing these lesions as specific entities only on the basis of typical and consistent features. Focal gingival enlargements are quite frequent lesions in the oral cavity amounting to almost 3.1% of all oral tumors and 9.6% of gingival lesions. Peripheral ossifying fibroma (POF) is one of the reactive lesions that have typical histopathological features. Since the late 1940s, intraoral ossifying fibromas have been discussed in the literature. The term “Peripheral ossifying fibroma” is usually used to describe a fibroma of the gingiva which shows areas of calcification or ossification. They are usually classified as non-neoplastic enlargement of the gingiva. Many POFs are thought to develop initially as a pyogenic granuloma that undergoes fibrous maturation and subsequent calcification. However, many authors have suggested that rather than a transitional form of pyogenic granuloma or irritation fibroma, POF represents a separate clinical entity. Different lesions with clinical presentations similar to POF make it difficult to arrive at an appropriate diagnosis. Usually, the treatment of POF includes excision of the lesion surgically with minimal chances of recurrence. This paper describes a case report of a 32 year old female patient who reported growth on gingiva in the mandibular left anterior region of the mouth for three years.

Clinical Features and Management of Oral Nonodontogenic Masses in Children

Background: There are numerous clinical reports of oral tumors in children. However, the clinical features and management of oral nonodontogenic masses in children were rare reported. The aim of this article is to present a large series of oral nonodontogenic masses in children, analyzing the clinical characteristics of such masses and reviewing the relevant procedures for treatment.Methods: We conducted an observational retrospective study, reviewing medical records of 171 patients who were treated for oral nonodontogenic masses between 2014 and 2019 at the Department of Pediatric Surgery, Children’s Hospital of Nanjing Medical University. Data collected included age, gender, site, pathologic diagnosis and treatment strategy.Results: All patients were hospitalized in our department. Of the 171 cases, all of them were benign, however, only 1 case diagnosed as inflammatory myofibroblastic tumor showed a malignant process. The most frequent type was hemangioma (63.7%), followed by lymphangioma (16.4%), ranula (7.6%). The most common location of oral masses in the buccal mucosa. The second common location was in tongue. 16 cases of hemangioma were located in two or more sites in cavity. And 29 patients (26.6%) of hemangioma and 11 patients (39.3%) lymphangioma of were found other extraoral lesions. With regard to some cases of hemangioma, the other patients commonly undergone surgical resections or sclerotherapy. The follow-up period ranged from 1 to 5 years. The recurrence rate of hemangioma and lymphangioma were 8.3%, 17.9%, respectively.Conclusion: Most of oral nonodontogenic masses are benign, few oral masses are malignant or mimic a malignant process. Surgical resections are the most common treatment with excellent success.

Current Problems in the Diagnosis of Head and Neck Tumors

The article presents the literature review of modern approaches in the diagnosis and treatment of squamous cell cancer of the oropharyngeal region and larynx. Various views on the treatment of patients with oropharyngeal tumors are presented. Special attention is paid to the ultrasound examination of patients with laryngeal tumors and to the possibilities of ultrasound in assessing the integrity of the laryngeal cartilage. Various ultrasound techniques for assessing the thickness and depth of invasion of oral tumors are highlighted. The features of regional anatomy that affect the informative value of visualization techniques are discussed. In the article presents criteria for assessing the prevalence of the tumor process in the adjacent organs and tissues, metastasis in regional lymph nodes.