Mandibular involvement by squamous cell carcinoma of the lower alveolus: Analysis and comparative study of histologic and radiologic features

Abstract

Histologic analysis of squamous cell carcinoma of the lower alveolus shows 2 basic patterns of tumor spread in relation to the mandible: an infiltrative one and an expansive one. While the tumor invades the mandible by destroying the bone or through cortical defects of some spaces in the infiltrative form, the tumor does this only by eroding the bone in the expansive form, in which the degree of bone resorption seems to be proportional to tumor advancement. A comparison between radiologic and histologic features discloses that the radiologically detected bone defects are not necessarily correlated with the patterns of bone involvement. However, most lesions with erosive bone defects show the expansive pattern histologically, and the extent of the radiologically detected bone defect is roughly in accordance with the histologic extent of bone involvement. These results lead us to believe that some squamous carcinoma of the lower alveolus could be treated successfully without sacrificing the continuity of the mandible.

The RANKL/RANK system as a therapeutic target for bone invasion by oral squamous cell carcinoma

“…1A and B) (4)(5)(6). Gingival SCC may eventually directly invade the mandible, a feature associated with a worse prognosis.…”

“…Before invasion of the mandible, SCCs in close proximity to bone initially induce deposition of new bone, especially on the periosteal surface. Two distinct types of invasion of the mandible by oral SCCs have been described (6,8,9). In the erosive pattern the tumor advances on a broad front separated from bone by a layer of connective tissue and osteoclasts are present in the region between bone and stromal tissue.…”

“…1D). Patients with advanced oral SCC have a high mortality, but treatment is complicated by the disruption of speech and swallowing after surgical resection (6)(7)(8)(9)(10)(11). It is generally agreed that patients with mandibular invasion should be treated surgically, although the extent of mandibular resection required remains controversial.…”

“…It is generally agreed that patients with mandibular invasion should be treated surgically, although the extent of mandibular resection required remains controversial. Resection of the mandibular bone leads to physical damage and frequently also to psychological problems for patients (6)(7)(8)(9)(10)(11).…”

Oral squamous cell carcinomas stimulate osteoclast differentiation

“…The pattern of bone involvement and its extent were evaluated and compared to the amplification of PTHrP. The classification of the histopathological patterns and extent of bone involvement were according to Totsuka et al (16).…”