In situ buccal carcinoma in a teenager after hematopoietic stem cell transplantation

Abstract

Rationale: Hematopoietic stem cell transplantation (HSCT) is the most effective treatment for the majority of patients who have malignant haemolytic disease. Although the success rate of HSCT has increased, the increasing number of cases suffering from secondary solid malignancies after HSCT has attracted more interest recently. Patient concerns: A 16-year-old female patient from China presented with a crusty and painful lesion on the left buccal mucosa with a history of chronic graft-versus-host disease following allogeneic HSCT for acute myeloid leukaemia. Diagnosis: An incisional biopsy of the lesion showed stratified squamous epithelium mucosa with severe dysplasia (carcinoma in situ). Subsequently, a wide local excision was performed and histological examination revealed early infiltrating squamous epithelial mucosa (carcinoma in situ). Interventions: She was being treated in the oral and maxillofacial surgery clinic with an incisional biopsy of the left buccal mucosa. She also received a wide local excision. Outcomes: Follow-up for 4 years showed no recurrence. Lessons: This case helps raise awareness of the diagnosis of oral symptoms in young patients after HSCT. Due to the increasing application of HSCT, raising awareness in oral and dental physicians may be required to improve long-term clinical outcome of patients who underwent HSCT.

Diversity of the Origin of Cancer Stem Cells in Oral Squamous Cell Carcinoma and Its Clinical Implications

“…It has been reported that some patients develop OSCC from oral lichenoid lesions caused by chronic graft-versus-host disease after hematopoietic stem cell transplantation in the treatment of hematopoietic malignancies [ 69 , 70 ]. As a hypothesis to explain these cases, Hasegawa et al in our research group proposed that bone marrow (BM)-derived stem cells could be the origin that causes the development of OSCC [ 43 ].…”

Oral Cancer in HSCT Pediatric Patients Arising on GVHD: A Comprehensive Review

“…Hematopoietic stem cell transplantation (HSCT) represents an effective procedure, widely used as a therapeutic treatment for patients diagnosed with various malignant haematological disorders, bone marrow failure disease, and congenital immune deficiencies [ 1 ].…”

“…Hematological malignancies and lymphoproliferative diseases are relatively common and usually present early after the HSCT [ 6 ]; solid cancers (involving the skin, oral cavity, genitourinary tract, breast, bone, connective tissue, brain, liver, lung, and thyroid) are less frequent with an incidence rate of 2 to 6% at 10–15 years after HSCT and account for approximately 5% to 10% of late death in patients after HSCT [ 1 , 2 ]. The risk of secondary solid tumors begins to increase around 10 years after transplantation and continues even 20 years later [ 1 ]. In fact, the cumulative incidence of secondary solid malignancies is 2.5% (95% CI: 2.0–3.0%) at 10 years, 5.8% (95% CI: 4.3–7.0%) at 15 years, and 8.8% (95% CI: 6.2–12.3%) at 20 years after HSCT, respectively [ 2 ].…”

“…Oral cGVHD has a reported prevalence ranging from 45% to 83%, and it comprises three different patterns that can coexist: oral lichenoid lesions, mostly affecting the labial and buccal mucosa, the tongue, and the palate, manifesting as hyperkeratotic striae, patches, plaques, papules, atrophy, erosions, and ulcerations; salivary dysfunction with xerostomia; perioral fibrosis with restricted mouth-opening ( Figure 1 and Figure 2 ) [ 1 , 10 ]. Furthermore, some clinical changes of oral cGVHD such as vasculitis-like features or a telangiectatic appearance of the mucosa, inflammation, and loss of the stippling of the attached gingiva may represent early alterations of oral cGVHD [ 13 ].…”

“…OSCC generally occurs with a latency period of 1.0 to 20.8 years after HSCT, which results in poor life quality and non-relapse mortality [ 1 ]. The preferential sites of onset are the tongue, buccal mucosa, and lips, with clinical phenotypes resembling other forms of OSCC with exophytic or endophytic ulcerated lesions [ 10 ].…”