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Case Studies | Oncology Science | India | Volume 12 Issue 6, June 2023
Contemporaneous Bilateral Presentation of Oral Primary Carcinoma - A Sporadic Case Report
Dr. Akshay A Byadgi | Dr. Nadimul Hoda | Dr. Mainak Ghosh | Dr. Aparna G | Dr. Amith K P
Abstract: Introduction: The incidence of oral squamous cell carcinoma is increasing in developing countries due to the over - abuse of tobacco and stressful lifestyle. Management of single primary oral carcinoma has been challenging, due to its characteristics of lymphatic spread and loco - regional recurrence even after 3 tier oncological management with surgery, radiation therapy and chemotherapy. Hence multiple primary carcinomas occurring in oral cavity has its own unique presentation and characteristics, due to the incidence of two neoplasms occurring from a single preneoplastic field with common successor progenitor cells. Any primary tumor will show all or a few genetic markers of the other multiple tumors occurring in the region. Rarely contemporaneous occurrence of bilateral oral primary is seen, thus the significance of timely diagnosis, and early intervention is very crucial in deciding the prognosis. Case Presentation: Here we present a rare case of a 48 - year ? old female known case controlled hypertension with a habitual history of betel nut and tobacco abuse for the last 15 years. Patient developed bilateral simultaneous buccal mucosa lesions. CT scan revealed a heterogeneous enhancing lesion involving bilateral gingivobuccal mucosa, and multiple enlarged bilateral level I, II, and left level IV lymph nodes were noted. A wide local excision of bilateral buccal mucosa with bilateral neck dissection and right hemimandibulectomy or segmental mandibulectomy was planned. Discussion: MPCs are usually not aggressive and are never found to be advanced diseases with cervical lymph node metastasis. In our case, the disease was advanced, with radiographic evidence of cervical metastatic lymph node at left level 1b. There is not much literature published about the MPCs occurring in the oral cavity and their management. Thus, it makes this case report very unique for presentation. The diagnostic technique to investigate, which primary oral SCC has occurred first in MPCS is not yet found. Many authors suggested that the characteristic behavior of single primary oral SCC over MPCS is very contrasting. Thus making the management more challenging and requires the team approach. Reliable techniques need to be found or developed to know the occurrence of the first primary in MPCS so that effective management protocol could be followed in the treatment of MPCS to benefit the patient. Conclusion: Early diagnosis and early intervention are keys to success in the treatment of all oral cancers. Similar to the MPCs too, with today's advanced imaging modalities like PET scans, MDCT scans, and MRI scans, early diagnosis is possible. Thus, bilateral primary resection in the oral cavity is surgically challenging for all surgeons, but effective surgical clearance of a 1cm margin is key to success with bilateral neck dissection and reconstruction.
Keywords: OSCC, Oral squamous cell carcinoma, MPCs, Multiple primary carcinomas, CT, computed tomography
Edition: Volume 12 Issue 6, June 2023,
Pages: 1007 - 1010