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102:From a Non-Specific Inflammatory-Like Gingival Lesion to a Rapidly Progressing Oral Squamous Cell Carcinoma: A Case of Deceptive Presentation of Oral Cancer[AAOM2021]
Poster Title: 102:From a Non-Specific Inflammatory-Like Gingival Lesion to a Rapidly Progressing Oral Squamous Cell Carcinoma: A Case of Deceptive Presentation of Oral Cancer[AAOM2021]
Submitted on 15 Apr 2021
Author(s): Ayelet Zlotogorski Hurvitz1,2, Marilena Vered1,3, Alex Dobriyan4, Ran Yahalom4, Ilana Kaplan1,5
Affiliations: 1: Oral Pathology and Oral Medicine, School of Dentistry, Tel Aviv University, Tel Aviv, Israel; 2: Oral and Maxillofacial Surgery, Rabin Medical Center, Petah Tikva, Israel; 3: Institute of Pathology, The Chaim Sheba Medical Center, Tel Hashomer, Israel; 4: Oral and Maxillofacial Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel; 5: Institute of Pathology, Rabin Medical Center, Petah Tikva, Israel
This poster was presented at 2021 American Academy of Oral Medicine Virtual Conference
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Poster Information
Abstract: Background: White/red lesions, exophytic masses with or without ulceration are well recognized typical presentations of oral squamous cell carcinoma (OSCC). Rarely, clinical characteristics may mimic benign lesions. We aim to report an unusual case of OSCC of anterior maxillary gingiva and hard palate, with an initial non-specific clinical and histological presentation mimicking benign inflammatory lesions.

Case summary: A 58-year-old otherwise healthy woman was referred with mild pain and a reddish, papillary gingivo-palatal inflammatory-like lesion, of 6 months duration. Medications, systemic medical conditions, tobacco-use and parafunctional habits that could generate the appearance were excluded. Radiographs did not reveal any bone involvement. Repeated periodontal treatment, improvement of oral hygiene, topical applications of disinfectant, antifungal and corticosteroids all failed to yield any improvement. During a period of 18 months, three biopsies were taken from the affected gingiva, showing only benign epithelial hyperplasia with dense chronic inflammation, devoid of any evidence for malignancy. Following rapidly progressing tooth mobility of the lateral incisor, concomitant with accelerated overgrowth of the anterior palatal gingiva, dental radiographs were repeated, and computed tomography performed. Both revealed extensive osteolytic lesion in the pre-maxilla. A new biopsy, taken from the affected gingiva and adjacent maxillary alveolar bone yielded a diagnosis of OSCC. Treatment included resection of the pre-maxilla and floor of the nose, with bilateral neck dissection.

Conclusion: This case emphasizes the possibility of deceptive initial appearance of OSCC, the sudden burst and rapid disease progression and the importance of close follow-up of unusual non-specific inflammatory-like processes in the oral cavity.
Summary: Occasionally, OSCC can initiallydisplay non-specific clinical/histological findings, mimicking benigninflammatory lesions, such as periodontal diseases. Close supervision ismandatory in lesions devoid of clinico-pathological correlations or unsatisfactorytreatment outcomes. 

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