Secondary Squamous Cell Carcinoma of the Tongue Complicated with Bronchiolitis Obliterans as a Manifestation of Graft-versus-Host Disease following Peripheral Blood Stem Cell Transplantation

Abstract

Peripheral blood stem cell transplantation (PBSCT) has increasingly been used for hematologic cancer therapy, resulting in improved survival rates. However, risks include graft-versus-host disease (GVHD) and secondary solid tumors. Here, we describe a case of tongue squamous cell carcinoma (SCC) complicated by bronchiolitis obliterans (BO) following PBSCT. A 42-year-old man with a history of acute lymphocytic leukemia treated with PBSCT presented with multiple white lesions and erosions on the tongue and buccal mucosa that are compatible with oral chronic GVHD (NIH criteria: score 2). The lesions were presented for 8 years. The patient had a history of BO manifested as GVHD. During follow-up, an exophytic mass was rapidly developed on the left dorsum of the tongue. Biopsy of this lesion confirmed SCC (cT2N0M0). Pulmonary function testing for general anesthesia was almost normal. Hemiglossectomy, supraomohyoid neck dissection, and tongue reconstruction were performed. Thirteen months after surgery, the patient showed neither recurrence of tumor nor progression of oral GVHD. However, the patient died of respiratory failure due to repeated pneumothoraxes and deterioration of BO.

Oral potentially malignant disorders: A consensus report from an international seminar on nomenclature and classification, convened by the WHO Collaborating Centre for Oral Cancer

“…Since our previous Workshop Report on OPMDs (Warnakulasuriya et al, 2007), progression to cancer in OGVHD-related oral lichenoid lesions has subsequently been reported in several case studies (Demarosi et al, 2005;Frydrych et al, 2019;Hashimoto et al, 2019;Mawardi et al, 2011). Atsuta et al, (2014) analyzed a database of 17,545 adult recipients of an allogeneic stem cell transplantation between 1990 and 2007 in Japan.…”

Oral squamous cell carcinoma arising from areas of Graft-versus-host disease: A systematic review

“…GVHD is a reaction of the immune system that occurs when cells from an immunocompetent patient are transplanted into an immunodeficient patient. The risk of developing malignancies secondary to HSCT is multifactorial and after transplantation the incidence of secondary malignancies increases over time ( 1 , 6 , 31 - 33 ). In this sense, the objective of this paper is to present a study on OSCC developed in areas of oral mucosa that had GVHD.…”

“…The presence of inflammatory cells in areas affected by GVHD can provide a favorable environment for the evolution of carcinoma, due to the release of several molecules that participate in the initial stages of carcinogenesis ( 20 , 24 ). Other associated risk factors include pre- and post-transplant immunosuppressed status, immunosuppressive medication for GVHD prophylaxis, radiotherapy and chemotherapy for the treatment of the primary disease, immunoincompatibility between recipient and donor that leads to antigenic stimulation and interaction of these aspects in association with genetic predisposition ( 5 , 31 , 33 ). In this sense, oral squamous cell carcinomas arising from areas of graft-versus-host disease in the mouth showed a better prognosis than classic oral squamous cell carcinomas with a smoking-associated etiology.…”

How ChatGPT performs in Oral Medicine: The case of oral potentially malignant disorders

“…Since our previous Workshop Report on OPMDs, progression to cancer in OGVHD-related oral lichenoid lesions has subsequently been reported in several case studies (Demarosi et al, 2005;Frydrych et al, 2019;Hashimoto et al, 2019;Mawardi et al, 2011). Multi-system GVHD was a significant risk factor for the development of all solid tumors, significantly higher for oral cancer among adult recipients of an allogeneic stem cell transplantation (Atsuta et al, 2014).…”