Dental Tribune Middle East & Africa Edition

significant decreases in death rates from heart disease, cerebrovascu- lar disease and infections over the previous 50 years for many forms of cancer, death rates remain essen- tially unchanged during that same time period.1 Squamous cell carcinoma (SCC) is the most common malignant neo- plasm affecting the head and neck. Mucosal cases account for more than 90 percent of all malignant neoplasms affecting oropharyngeal structures, with oral squamous cell carcinoma (OSCC) being the most common oral malignancy.2 Several variants of OSCC exist and histopathologic classifications for variants of OSCC include papil- lary, spindle cell, adenosquamous, Approximately one in three Americans will develop a malig- nancy in their lifetime.1 The chances of developing certain malignancies increase with age and several con- tributing risk factors such as tobac- co and alcohol use. Notwithstanding Papillary squamous cell carcinoma of the hard palate By Paul C. Lee, BA; Justin Olsen, BS; Joshua Adcox, BS and Parish P. Sedghizadeh, DDS, MS Report of a rare case affecting the oral cavity and basaloid carcinoma; it is also possible to categorize types of OSCC based on clinical descriptors such as ulcerative, flat, polypoid and verru- coid.2 OSCC variants can have differ- ent growth patterns, ranging from small mucosal thickenings to large masses, and can appear endophytic or exophytic. These tumors are erythematous to white to tan, frequently feeling firm on palpation. Conventional OSCC is composed of variable degrees of squamous differentiation, with well- differentiated cells closely recapitu- lating normal squamous epithelium but demonstrating some degree of basement membrane violation by nests of tumor cells, to poorly differ- entiated cells with more anaplastic- like appearances. As a result of its complex exo- phytic papillary architecture, the Fig. 1: Clinical image of the palate of a 63-year-old female showing an erythematous exophytic mass with a cauliflower-like or papillary surface architecture. (Photos/Provided by Paul Lee) papillary variant of SCC can be a challenge to accurately diagnose and histologic assessment of under- lying invasion can be very difficult.3 Risk factors and pathogenesis for papillary SCC are unclear although human papilloma virus subtypes are thought to play a role in some cases.3 The purpose of this paper is to (a) present a rare case of papil- lary OSCC affecting the hard palate, and (b) describe the clinical and histologic features of this tumor in supporting the dentist’s role in early detection. Case report A 63-year-old female presented to the dental clinic at the Herman Ostrow School of Dentistry, Univer- sity of Southern California with the chief complaint of a growth appear- ing on the roof of her mouth approx- imately two months prior to her pre- sentation to our clinic. The patient’s past medical history included type II diabetes mellitus controlled with diet and exercise, and denial of any alcohol or tobacco use. The remainder of her medical and social history was non-contribu- tory; she was not taking any medica- tions and a review of systems was unremarkable. Intraoral examina- tion revealed a 3.5 cm exophytic mass in the anterior midline region of the hard palate (Fig. 1). The lesion appeared vascularized with ill-defined borders and no evidence of ulceration or erosion. The patient had mild sensitivity upon palpation of the lesion. No cer- vical or submandibular lymphade- nopathy was observed during the extraoral examination of the head and neck. Panoramic radiography revealed no abnormalities of the palatal area. The patient was informed that a biopsy must be taken to obtain a definitive diagnosis; informed con- sent was obtained for incisional biopsy with local anesthesia. During the administration of local anes- thesia, the cortical bone under the tumor felt intact with the end of the needle. A representative wedge of tissue was removed and placed in 10 percent formalin for microscopic evaluation. The biopsy site was cauterized to obtain postoperative hemostasis due to the high degree of vascularity. The biopsy site was closed with four 3.0 chromic gut interrupted sutures. Hemostasis was achieved, postop- erative instructions were given and the patient’s postoperative condition was good. The gross examination of the specimen consisted of a soft, tan papillary and friable mass. The his- Media CME DENTALTRIBUNE Middle East & Africa Edition6 (mCME articles in Dental Tribune (always page 6) has been approved by HAAD as having educational content acceptable for (Category 1) CME credit hours. Term of ap- proval covers issues published within one year from the distribution date (September, 2010). This (Volume/Issue) has been approved by HAAD for 2 CME credit hours. 2 Hours Dental Tribune Middle East & Africa in collaboration with CAPP introduce to the market the new project mCME - Self Instruction Program. mCME gives you the opportunity to have a quick and easy way to meet your continuing education needs. mCME offers you the flexibility to work at your own pace through the material from any location at any time. The content is international, drawn from the upper echelon of dental medicine, but also presents a regional outlook in terms of perspective and subject matter. How can professionals enroll? They can either sign up for a one-year (10 exercises) by subscription for the magazine for one year ($65) or pay ($20) per article. After the payment, participants will receive their membership number and will be able to attend to the program. How to earn CME credits? Once the reader attends the distance-learning program, he/she can earn credits in three easy steps: 1. Read the articles. 2. Take the exercises 3. Fill in the Questionnaire and Submit the answers by Fax (+971 4 36868883) or Email :info@cappmea.com After submission of the answers, (name and membership number must be included for processing) they will receive the Certificate with unique ID Number within 48 to 72hours. Articles and Questionnaires will be available in the website after the publication. www.cappmea.com MEDIA CME Self-Instruction Program