Gingival Squamous Cell Carcinoma Mimicking a Dentoalveolar Abscess: Report of a Case

doi:10.1016/j.joen.2006.08.005

Journal of Endodontics

Volume 33, Issue 2, February 2007, Pages 177-180

https://doi.org/10.1016/j.joen.2006.08.005 Get rights and content

Abstract

Because of its close proximity to teeth and periodontium, gingival squamous cell carcinoma (SCC) can sometimes mimic tooth-related benign inflammatory conditions, resulting in misdiagnosis. In this study we report a case of gingival SCC that mimicked a dentoalveolar abscess of endodontic origin in its early presentation. The course and treatment of this case is discussed and a brief review of the literature is presented. Because many patients with gingival SCC visit dentists as their initial professional contact, it is hoped that the case can serve as a reminder for dentists to keep the possibility of carcinoma in mind when examining intraoral lesions.

Section snippets

Case Report

A 46-year-old housewife presented to the screening clinic of the Department of Dentistry, National Taiwan University Hospital with the chief complaint of a gumboil on the labial gingiva of the left maxillary incisor region. The lesion was not preceded by leukoplasia or erythroplasia. The history of her problem can be traced back to 3 months earlier when she was taking a meal and accidentally bit into some hard materials with her left maxillary lateral incisor (tooth #10). Severe pain on tooth

Discussion

Gingival SCCs with atypical clinical appearance have been reported by a few authors (Table 1) (16, 17, 18, 19). Most of the reported cases had an initial presentation mimicking periodontal diseases, making correct diagnoses difficult. The affected sites in these cases were often not the usual site for gingival SCC, the lower posterior region. Their common clinical features were erythematous gingiva with radiographic evidence of alveolar bone destruction. However, gingival SCC with an initial

References (29)

C. La Vecchia et al.
Epidemiology and prevention of oral cancer
Oral Oncol
(1997)
K.C. Soo et al.
Squamous carcinoma of the gums
Am J Surg
(1988)
Y.K. Chen et al.
Primary oral squamous cell carcinoma: an analysis of 703 cases in southern Taiwan
Oral Oncol
(1999)
D.B. Kirkham et al.
Gingival squamous cell carcinoma appearing as a benign lesion: report of a case
J Am Dent Assoc
(1985)
R.M. Craig et al.
Erythroplastic lesion on the mandibular gingival
J Am Dent Assoc
(1989)
A. Barasch et al.
Squamous cell carcinoma of the gingival
Oral Med Oral Pathol Oral Radiol Endod
(1995)
R.B. Chen et al.
Flow cytometric analysis of squamous cell carcinomas of the oral cavity in relation to lymph node metastasis
J Oral Maxillofac Surg
(1993)
D.M. Parkin et al.
Estimates of the worldwide incidence of 25 major cancers in 1990
Int J Cancer
(1999)
Y.C. Ko et al.
Betel quid chewing, cigarette smoking and alcohol consumption related to oral cancer in Taiwan
J Oral Pathol Med
(1995)

P.N. Notani

Epidemiology and prevention of head and neck cancer: a global view

Cancer registry annual report in Taiwan area, 2002. Department of Health. The Executive Yuan...

M.N. Shiu et al.

Impact of betel quid, tobacco and alcohol on three-stage disease natural history of oral leukoplakia and cancer: implication for prevention of oral cancer

Eur J Cancer Prev

(2003)

J.W. Chen et al.

A study on betel quid chewing behavior among Kaohsiung residents aged 15 years and above

J Oral Pathol Med

(1996)

Cited by (22)

Factors influencing delayed referral of oral cancer patients from family dentists to the core hospital
2024, Journal of Dental Sciences
Most oral cancer (OC) cases are identified by family dentists in Japan. However, a significant number of patients with OC in Japan are referred to core hospitals at advanced stages. Therefore, identifying the factors that contribute to delayed referrals from family dentists to core hospitals is crucial for detecting OC in its earlier stages. The aim of this retrospective study was to identify the risk factors for referral delays from family dentists to core hospitals.
The study included 63 patients with OC who were referred by family dentists to the Yamagata University Hospital between 2010 and 2022. The clinical parameters related to referral delays were retrospectively investigated using letters of reference provided by the family dentists and patient charts. Backward multiple regression analysis was performed to identify the relationships between the length of referral delay and potential risk factors. Additionally, backward multivariate logistic regression analysis was performed to examine the independent association between referral delays of >4 weeks and several clinical parameters.
Multiple regression analysis revealed that misdiagnosis of malignant lesions by family dentists (P = 0.047) was significantly associated with longer referral delays. Additionally, misdiagnosis of malignant lesions by family dentists was also an independent risk factor for referral delays of >4 weeks (odds ratio, 10.387; P = 0.006).
Misdiagnosis of malignant lesions by family dentists was a significant risk factor for referral delays from family dentists to core hospitals. Our results will motivate family dentists to improve their ability to diagnose OC.
Nonendodontic lesions misdiagnosed as apical periodontitis lesions: Series of case reports and review of literature
2014, Journal of Endodontics
This study aimed to analyze cases referred from a reference service in oral pathology that were initially misdiagnosed as periapical lesions of endodontic origin and to perform a review of the literature regarding lesions located in the apical area of teeth with a nonendodontic source.
A survey was made of clinical cases derived from the service of oral pathology from 2002 to 2012. The pertinent literature was also reviewed using ScienceDirect and PubMed databases. The lesions were grouped into benign lesions mimicking endodontic periapical lesions (BLMEPLs), malignant lesions mimicking endodontic periapical lesions (MLMEPLs), and Stafne bone cavities. The clinical presentations were divided into lesions with swelling without pain, lesions with swelling and pain, and lesions without swelling but presenting with pain.
The results showed that 66% (37/56) of cases represented benign lesions, 29% (16/56) malignant lesions, and 5% (3/56) Stafne bone cavities. The most commonly reported BLMEPLs were ameloblastomas (21%) followed by nasopalatine duct cysts (13.5%). The most frequently cited MLMEPLs were metastatic injuries (31.5%) followed by carcinomas (25%). The main clinical presentation of BLMEPLs was pain, whereas that of MLMEPLs was swelling associated with pain; Stafne bone cavities displayed particular clinical findings.
Clinical and radiologic aspects as well as the analysis of the patients' medical history, pulp vitality tests, and aspiration are essential tools for developing a correct diagnosis of periapical lesions of endodontic origin. However, if the instruments mentioned earlier indicate a lesion of nonendodontic origin, a biopsy and subsequent histopathological analysis are mandatory.
Metastatic Breast Carcinoma Initially Diagnosed as Pulpal/Periapical Disease: A Case Report
2010, Journal of Endodontics
Citation Excerpt :
Apicoectomy was conducted, and the intraosseous tumor was diagnosed at histopathologic examination. A case of gingival squamous cell carcinoma that mimicked a dentoalveolar abscess of endodontic origin in its early presentation is also reported (16). The radiographic appearance of metastatic disease in the jaws varies from well-circumscribed to poorly circumscribed radiolucencies; the latter also is known as a “moth-eaten” appearance.
Metastatic tumors to oral cavity and jaws are rare, and mandible is the most commonly involved location. Because the most common jaw symptom is pain, these lesions could be misdiagnosed as pathologic entities with dental origin. In this article a case of metastatic breast carcinoma initially diagnosed as pulpal/periapical disease is presented and discussed.
A 40-year-old female patient was referred to our department with vague pain in right mandibular area. Clinical and radiographic examinations were performed, leading to the initial diagnosis. Patient's medical history was reevaluated, and an incisional biopsy was performed to confirm the final diagnosis.
Regarding the initial signs and symptoms, a pulpal/periapical inflammatory process was considered in the differential diagnosis. Because lip paresthesia was also noted, a more aggressive process was suspected. Patient's medical records and histopathologic slides were requested and reviewed carefully. The diagnosis of metastatic breast carcinoma was confirmed by comparing the histopathologic findings of the jaw lesion with previous slides of the breast.
Despite their rarity, metastatic tumors should be considered in the differential diagnosis of inflammatory and reactive lesions of the jaws. These lesions might be diagnosed first by the patient's dentist or by the maxillofacial surgeon. This case emphasized the importance of a complete and careful work-up with particular attention to detailed medical history as well as careful clinical and radiographic inspection for unusual signs and symptoms.
The association between periodontal disease and cancer: A review of the literature
2010, Journal of Dentistry
Periodontal disease has long been linked to many systemic diseases, and recently a link between periodontal disease and cancer has been established. The purpose of this paper is to review the literature to explore the evidence to date of a relationship between periodontal disease and cancer. In addition, the main hypotheses for the association are discussed along with challenges in evaluating the evidence.
In this review, English-language papers studying the relationship between periodontal disease or tooth loss in humans and increased risk of several types of cancers along with overall cancer risk between 1990 and April 2009 were reviewed.
The most consistent increased risk was noted in studies of oral and esophageal cancers and periodontal disease. Gastric and pancreatic cancers had an association in most but not all studies. Lung, prostate, hematologic and other cancers were less consistently associated or did not have sufficient studies to determine a predictable pattern. Studies to date indicate a positive correlation between several forms of cancer and periodontal disease.
Palatal ulcerations and midfacial swelling
2009, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology
Citation Excerpt :
Primary gingival squamous cell carcinoma was included as a diagnostic possibility because squamous cell carcinoma represents 90% of all cancers affecting the oral cavity. It usually appears as an exophytic mass with a granular, papillary, or verrucous surface.15,16 It may also present as an innocuous erythematous lesion with a smooth surface or with an ulcerated surface.
Periradicular Lesions Not of Endodontic Origin: An Online Study Guide
2008, Journal of Endodontics
The Editorial Board of the Journal of Endodontics has developed a literature-based study guide of topical areas related to endodontics. This study guide is intended to give the reader a focused review of the essential endodontic literature and does not cite all possible articles related to each topic. Although citing all articles would be comprehensive, it would defeat the idea of a study guide. This section will present articles related to periradicular lesions not of endodontic origin.

View all citing articles on Scopus

View full text

Case report/clinical techniqueGingival Squamous Cell Carcinoma Mimicking a Dentoalveolar Abscess: Report of a Case

Abstract

Section snippets

Case Report

Discussion

Oral Oncol

Am J Surg

Oral Oncol

J Am Dent Assoc

J Am Dent Assoc

Oral Med Oral Pathol Oral Radiol Endod

J Oral Maxillofac Surg

Estimates of the worldwide incidence of 25 major cancers in 1990

Int J Cancer

Betel quid chewing, cigarette smoking and alcohol consumption related to oral cancer in Taiwan

J Oral Pathol Med

Epidemiology and prevention of head and neck cancer: a global view

Impact of betel quid, tobacco and alcohol on three-stage disease natural history of oral leukoplakia and cancer: implication for prevention of oral cancer

Eur J Cancer Prev

A study on betel quid chewing behavior among Kaohsiung residents aged 15 years and above

J Oral Pathol Med

Case report/clinical technique
Gingival Squamous Cell Carcinoma Mimicking a Dentoalveolar Abscess: Report of a Case