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153:What are we Dealing with: Benignancy or Malignancy?[AAOM2021]
EP36065
Poster Title: 153:What are we Dealing with: Benignancy or Malignancy?[AAOM2021]
Submitted on 29 Mar 2021
Author(s): Temitope T Omolehinwa, Adeyinka Dayo, Rabie Shanti
Affiliations: University of Pennsylvania School of Dental Medicine, United States of America
This poster was presented at 2021 American Academy of Oral Medicine Virtual Conference
Poster Views: 329
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Poster Information
Abstract: Background:

Cuniculatum carcinoma (CC) of the oral cavity is an uncommon form of locally aggressive squamous cell carcinoma, with the mandibular gingivae as the most predominant oral site of presentation. It could present as a diagnostic challenge to clinicians as reported below.

Case Summary:

An 81-year-old Caucasian male presented to the Oral Medicine Family Practice Clinic at Penn Dental Medicine with a 3-month history of persistent gum swelling in his posterior lower right quadrant. He was referred by his general practice dentist (GP). Medical history included Hashimoto’s disease, hyperlipidemia, hypertension, and a history of lymphoma treated with chemotherapy.

He reports intermittent discomfort with no benefits from home remedies including saline mouth rinse, change of toothpaste brand and peroxyl use. He also reports tenderness of right submandibular lymph nodes. He had informed his GP via teleconference call but could not be seen till 3 months later due to the COVID pandemic.

Examination revealed an 8 X 13mm (lingual) and 8 X 8mm (buccal) speckled white and red lesion on attached gingivae between #31 and #32. Also noted was creamy wipeable lesion unassociated with speckled lesion. An immediate incisional biopsy was done, and patient was placed on Nystatin oral rinse and magic mouthwash while awaiting biopsy report. Histologic diagnosis was consistent with verrucous hyperplasia with mild dysplasia and candida. At the 2-week post biopsy follow up, lesion had grown to 1.2cm with grade-1 mobility of #32, not present at previous visit. Periapical radiograph showed significant bone loss between #31 and #32. A second soft tissue biopsy showed a similar report. Extraction with bone biopsy within extraction socket was done 3 weeks after initial biopsy due to increasing pain and extrusion of #32. Histologic diagnosis was CC. Patient had a partial mandibulectomy and is recovering well.

Conclusion:

Histologic diagnosis of verrucous hyperplasia has to be closely correlated with clinical characteristic of presenting lesion (pre and post op). This helps determine if obtained histologic report suffices or if further investigation is needed to arrive at an accurate diagnosis. This case also shows the importance of in-person post biopsy follow up.
Summary: Cuniculatum carcinoma (CC) of the oral cavity is an uncommon form of locally aggressive squamous cell carcinoma, with the mandibular gingivae as the most predominant oral site of presentation. It could present as a diagnostic challenge to clinicians as reported below.

Ask the author questions about this poster:omote@upenn.edu
References: 1. Padilla RJ, Murrah VA. Carcinoma cuniculatum of the oral mucosa : a potentially underdiagnosed entity in the absence of clinical correlation . OOOO. 2014; 118(6):684 693Report abuse »
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