Oral precancerous and malignant lesions associated with graft-versus-host disease: Report of 2 cases

Abdelsayed, Rafik; Sumner, Ty; Allen, Carl M.; Treadway, Antwan; Ness, Gregory M.; Penza, Sam

doi:10.1067/moe.2002.119736

Cited by 54 publications

(33 citation statements)

References 18 publications

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“…Moreover, in three cases where detailed examination of the surrounding noncancerous areas was performed, mucosal dysplasia was present [8,9]. In one case, a spectrum of pre-neoplastic lesions varying from dysplasia to carcinoma in situ was present as well [9]. These findings further support the proposition that chronic GVHD might be linked to carcinogenesis.…”

Section: Discussionsupporting

confidence: 73%

“…On the other hand, oral GVHD was present in the majority of the cases. Moreover, in three cases where detailed examination of the surrounding noncancerous areas was performed, mucosal dysplasia was present [8,9]. In one case, a spectrum of pre-neoplastic lesions varying from dysplasia to carcinoma in situ was present as well [9].…”

Section: Discussionmentioning

confidence: 99%

“…Details of 11 other cases of oral SCC in HSCT patients have been described to date (Table I) [2][3][4][5][6][7][8][9]. A review of these cases showed that Fanconi's anemia was an apparent risk factor.…”

Section: Discussionmentioning

confidence: 99%

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Squamous cell carcinoma of the tongue complicating chronic oral mucosal graft‐versus‐host disease after allogeneic hematopoietic stem cell transplantation

Szeto

Shek

et al. 2004

American J Hematol

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Two patients underwent allogeneic hematopoietic stem cell transplantation (HSCT) for acute myeloid leukemia. Chronic graft-versus-host disease (GVHD) developed, with persistent symptomatic oral lesions. At 2 and 6 years post-HSCT, both patients developed squamous cell carcinoma (SCC) of the tongue in areas previously involved by chronic GVHD. None had any known risk factor for SCC. Histologically, moderate to severe dysplasia was present in noncancerous oral mucosa. Oral SCC is rarely described after HSCT, and a review of the reported cases showed chronic GVHD to be a common risk, suggesting that the chronic inflammation associated with GVHD might be of pathogenetic significance. Am. J. Hematol. 77:200-202, 2004. ª 2004 Key words: squamous cell carcinoma; tongue; GVHD; HSCT The development of secondary malignancies is an important complication after haematopoietic stem cell transplantation (HSCT) and curtails the survival of patients otherwise cured of their original malignancies. The commonest secondary malignancies are therapyrelated myelodysplastic syndrome/acute myeloid leukemia, lymphomas, and solid tumors including squamous cell carcinoma (SCC), melanomas, and sarcomas [1].The occurrence of secondary malignancies has been attributed to cumulative toxicity of previous chemotherapy and radiotherapy. Risk factors include young age at the time of HSCT, and the use of total body irradiation during conditioning [1].We present two cases of carcinoma of the tongue, with chronic oral mucosal graft-versus-host disease (GVHD) as a possible risk factor. CASE REPORTS Case 1A 45-year-old man, non-smoker and non-drinker, presented with acute myeloid leukemia in 1995, which relapsed in 1996. Allogeneic HSCT was performed, the donor being an HLA-identical sister. The conditioning was busulphan (Bu), cyclophosphamide (Cy), and total body irradiation (TBI), with cyclosporine and methotrexate as GVHD prophylaxis. He developed severe GVHD affecting the liver as well as extensive oral mucosal and skin GVHD (grade III), requiring steroid, thalidomide, and azathioprine for control. Subsequently, chronic GVHD affecting the skin and mouth supervened. Six years later, an ulcerative growth at the dorsum of the tongue was found in a background of lichenoid mucositis, which on biopsy showed welldifferentiated SCC. The tumor was T3N0M0, stage III. Total glossectomy, right functional neck dissection, and left submandibular gland dissection was

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

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Squamous cell carcinoma of the tongue complicating chronic oral mucosal graft‐versus‐host disease after allogeneic hematopoietic stem cell transplantation

Szeto

Shek

et al. 2004

American J Hematol

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“…Most patients who develop malignancy after BMT also have chronic GVHD (5,13). Additionally, some authors have observed the development of such tumors on sites initially involved with GVHD-related inflammatory processes (7,14). The patient presented in this case report showed a white plaque on the tongue in addition to erosive areas with striated borders on other oral sites, which persisted for almost 4 years until SCC development.…”

Section: Discussionmentioning

confidence: 78%

“…This disease is a common complication in patients treated with allogeneic BMT. There is an attack of donor T lymphocytes in various recipient tissues because of differences in major and minor histocompatibility antigens (7).…”

Section: Introductionmentioning

confidence: 99%

Squamous cell carcinoma of the tongue after bone marrow transplantation in a patient with Fanconi anemia

Salum

Martins²,

Figueiredo

et al. 2006

Braz. Dent. J.

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Fanconi anemia (FA) is an autosomal recessive disorder that might cause a variety of congenital and developmental abnormalities. The most important features of FA are progressive bone marrow failure and development of malignancies, particularly acute myeloid leukemia and solid tumors. This paper reports the case of a 12-year-old patient with FA assisted at the Stomatology and Bucomaxillofacial Cancer Prevention Service of São Lucas Hospital, Brazil, who had been submitted to bone marrow transplantation (BMT) at the age of 5 and exhibited oral lesions characteristic of chronic graft versus host disease (GVHD). The patient was treated and followed-up for the oral lesions. Eleven years after the BMT, he developed squamous cell carcinoma of the tongue with an aggressive behavior, which was considered an untreatable condition. The patient died few months later from asphyxia at the age of 16. The reasons for development of these malignant conditions are unknown. However, chromosomal instability typically observed in FA cases, BMT factors and GVHD have been considered. Systematic follow-up of these patients allows early and less invasive therapeutic approaches.

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The Oral Cavity and Lips

Scully

2004

Rook's Textbook of Dermatology

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Oral precancerous and malignant lesions associated with graft-versus-host disease: Report of 2 cases

Cited by 54 publications

References 18 publications

Squamous cell carcinoma of the tongue complicating chronic oral mucosal graft‐versus‐host disease after allogeneic hematopoietic stem cell transplantation

Squamous cell carcinoma of the tongue complicating chronic oral mucosal graft‐versus‐host disease after allogeneic hematopoietic stem cell transplantation

Squamous cell carcinoma of the tongue after bone marrow transplantation in a patient with Fanconi anemia

The Oral Cavity and Lips

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