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Sarcomatoid is a rare variant of squamous cell carcinoma. We present here the case of a 15-year-old female patient; she presented with an extra-oral fungation on the right side of her face and restricted tongue movements, diagnosed as sarcomatoid squamous cell carcinoma of the tongue on incisional biopsy. A positron emission tomography scan was advised on the first visit to rule out distant metastasis. Due to the previous history of no improvement after medical oncology management and the extent of the lesion, which made the disease inoperable, the patient was planned for the best supportive care.

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Introduction: Oral cancer is one of the most common cancers not only in India but also in South Asia. Treatment of oral cancer is not only limited to cure but also requires good reconstruction of the surgical defects for a better quality of the life. There are many well-proven options for reconstruction purposes for the defects of the oral cavity including local regional flaps to microvascular-free flaps. After resections of mobile parts of the tongue (up to 50%) speech and swallowing are impaired significantly, however, even after sophisticated plastic reconstruction, serious swallowing and speech problems persist. Material and Methods: The pilot study was carried out after the allocation of fourteen patients with carcinoma of the tongue into two treatment test groups; the Radial forearm flap (RFF) and Infrahyoid neuromuscular flap (IHF) group to evaluate and compare the treatment outcome for reconstruction using two different treatment modalities. The pilot study was carried out after the allocation of fourteen patients with carcinoma of the tongue into two treatment test groups. the clinical parameters likewise swallowing reflex, speech analysis, donor site complication, time taken for the surgery, and cost-effectiveness of the flap was evaluated using IBM SPSS Statistics for Windows software, 20.0 (IBM Corp., Armonk, USA). The data were numerically coded and entered into the program. Both the descriptive statistics and the inferential statistics involving one-way ANOVA and Tukey's Post Hoc test were analyzed to compare both intergroup and intragroup comparisons at different time intervals. Results: The swallowing and aspiration analysis showed a highly statistically significant difference at 3 months and 6 months by Post Hoc test between the groups. The speech analysis scores at all intervals were not statistically significant while for tongue movements the results were significant. The time taken and expenditure for surgery by IHF were less in comparison to RFF. Conclusion: The infrahyoid flap is a quick, easy, and reliable reconstructive method, which is cost-effective when used with knowledge of its clinical utility and limitations, the functional results are excellent with great patient satisfaction.

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Background: Head and neck cancer represents 5-10% of all malignancies. Squamous cell carcinoma (SCC) of the oral cavity represents about 2% of overall malignant neoplasms and 47% of the head and neck region. Squamous cell carcinoma of tongue has a peculiar behavior of occult and skips metastasis to regional lymph nodes. It occasionally occurs along with floor of the mouth. The purpose of this study is to evaluate the significance of correlation between, depth of invasion of the primary tumor, its proximity with the neurovascular bundle and subsequent perineural invasion and cervical lymph node metastasis in squamous cell carcinoma tongue and floor of the mouth and the sites involving both. Materials and Methods: A total of 108 patients with carcinoma tongue (59), floor of the mouth (20) and involving both together (29) who underwent treatment during January 2015 to June 2017 that were followed up until December 2019 were assessed. Out of 108 patients that were included in the study, 71 patients underwent primary surgery and 37 patients were inoperable (tongue-17, floor of the mouth-9 and involving both together-11). Results: Perineural invasion was seen in 15 cases of pT1-2 where depth of invasion was less than 1 cm and in 28 cases of pT3-4 where depth of invasion was more than 1cm (p-0.075). Skip metastasis was accounted for 61.9% overall. Conclusion: The triad of perineural invasion, depth of invasion and tumor size is interrelated and was responsible for cervical lymph node metastasis and prognosis of the disease. Obtaining clear deep margins of the tumor from the mucosal margin and removal of lympho-fatty tissue at the floor of the mouth is an important aspect which gives the indication about prognostic factors like depth of invasion, tumor size, cervical nodal metastasis and recurrence of the disease. High-grade tumors (T3-4), depth of invasion of tumor at 1 cm or > 1 cm, increase the propensity of perineural invasion highly.

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BACKGROUND: Carcinoma of tongue is a common site of oral cancer. It usually occurs at mean age of 61.1 years and is more common in males when compared with females. It commonly spreads directly and through lymphatics to the surrounding structures. It has a low incidence of hematogenous metastasis. Lung is the usual distant metastasis site for carcinoma of tongue and other head and neck cancers. Metastases to vertebrae are rare and very few cases have been reported. CASE DESCRIPTION: We report a rare case of carcinoma of tongue spreading to lumbar vertebrae causing destruction of the body and thecal sac compression. A patient underwent posterior transpedicular approach, tumor decompression, and titanium cage placement. The patient had good relief of symptoms and could be mobilized on first postoperative day. CONCLUSION: Hematogenous spread to the spine is a rare phenomenon but should be kept in mind particularly in advanced stage of oral cancers.

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BACKGROUND: This study compared the adverse effects of open surgery (OS) including lateral pharyngotomy and supraglottic laryngectomy vs. transoral robotic surgery (TORS) in the treatment of stage T1 and T2 carcinomas of the tongue base and supraglottis. METHODS: A retrospective study involving a 49 (13 female and 36 male) patients with untreated T1 or T2 carcinomas. Twenty two were operated on using TORS and 27 underwent conventional OS. The indicators for comparison were: total blood loss during surgery, post-operative pain measured with the Visual Analog Scale (VAS); global, emotional and physical post-operational states assessed with the standardized M.D. Anderson Dysphagia Inventory (MDADI) and psychosocial distress (PD) questionnaire. Apart from blood loss, subjective symptoms were evaluated 1 and 6 weeks and 6 months after surgery. The differences in indicators between groups were analyzed using Fisher's Least Significant Difference (LSD) test at the 5% significance level. RESULTS: Mean general OS and TORS associated blood loss were 405 and 29 ml, respectively. The mean MDADI score in TORS vs. OS patients one week, six weeks and six months postoperatively was 60.01 vs. 44.93, 91.01 vs. 62.19 and 94.18 vs. 93.56. The mean VAS score in the TORS vs. OS group at the same time intervals were 5.09 vs. 5.56, 2.09 vs. 3.11 and 1.27 vs. 1.33. All differences between TORS and OS were statistically significant with the exception of 6 month values for particular scores. The mean PD score in TORS vs. OS patients in one week, six weeks and 6 months was 26.82 vs. 25.11, 39.95 vs. 29.22 and 44.73 vs. 44.52. Only the six week distinctions were significant. The both methods were comparable in terms of the risk of locoregional tumour recurrence. CONCLUSIONS: The study confirmed the assumption of the TORS as a minimally invasive procedure significantly reducing the intraoperative blood loss, pain, swallowing and psychosocial distress as late as 6 weeks postoperatively in patients with early staged carcinomas of the tongue base and supraglottis.

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Objective To study the effects of deoxycytidine (5-aza-2 deoxycytidine, DAC) on DNA Methylation state and expression of mRNA and protein of pl6 gene in human squamous lingual carcinoma SCC-9 cells in vitro. Methods The SCC-9 cells were divided into four groups, group 0, 1, 2 and 3 which processed using three gradients concentration of DAC. The group 0 without DAC was as the control group. Q-MSP was used to detect the state of methylation of the p16 in SCC-9 cells treated by DAC after 48 hours. Real-time fluorescence quantitative PCR was used to detect mRNA expression level changing of the p16 in SCC-9 cells treated by DAC. Immunohistochemical method was used to detect the expression of p16 protein. Results The hypermethylation and non-methylated p16 gene in SCC-9 was mixed with the results of Q-MSP. The results of Real-time PCR showed that mRNA expression of p16 in SCC-9 cells which treated by the different concentration of DAC for 48 hours was higher the control group. And difference was statistically significant (P < 0.05). The high expression of p16 protein was found in the experimental group with immunohistochemical method. Conclusion The p16 gene methylation states of SCC-9 may be suppresses and the recovery of mRNA and protein expression of p16 gene must be prompted by DAC.

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One of the most distressing and dramatic causes of xerostomia is radiotherapy for the cure of maxillofacial and neck carcinomas. Patient with radiotherapy induced xerostomia presents with challenges in prosthodontic management and in unique radiation caries control. This clinical report illustrates step by step execution of complex treatment planning that lead to successful outcome in 34-year-old man, who had been treated with Radical Neck Dissection (RND) and therapeutic radiotherapy for squamous cell carcinoma of tongue and due to radiation caries, was presented with chief complaint of difficulty in mastication. Rehabilitation was carried out with metal-ceramic fixed restorations and cast removable prostheses after extensive endodontic intervention. This article also discusses the maintenance strategies for radiation caries patient requiring complete occlusal reconstruction, who certainly presents with special needs in post-treatment management.

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BACKGROUND: The squamous cell carcinoma (SCC) of the oral tongue is a common cancer in India. Elective lymphadenectomy is generally performed in all patients with T2-T4 tumors. In this study we have tried to analyze the pattern and risk factors associated with lymph node metastasis in T1 tongue cancers. METHODS: A retrospective review of the records of 57 patients undergoing surgery for treatment of T1 sqamous cell carcinoma of oral tongue was carried out. The clinicopatological features of the tumor, pattern of nodal metastasis and the risk factors associated with lymph node metastasis were studied. RESULTS: Totally 57 patients with T1 tumor underwent excision of the primary and modified neck dissection (MND). Lymph node metastasis was found in 36.8 % of the patients. Level I to Level II was the commonest site of metastasis. Skip metastasis at level III and IV was found in 8.5 % of the patients and isolated skip metastasis at level IV in 1.5 % of the patients. The risk factors associated with the lymph node metastasis on univariete analysis were; higher grade, tumor size >1 cm and tumor thickness >3 mm. On multivariate analysis only the tumor thickness was found to be a risk factor for the lymph node metastasis (hazard ratio of 21.59). CONCLUSIONS: T1 sqamous cell carcinoma of tongue is associated with a high incidence of lymph node metastasis. Elective neck dissection should be considered in all patients with tumors more than 3 mm in thickness.

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Granular cell tumour, also known as Abrikossoff tumour, is a relatively uncommon benign neoplasm, which is more commonly found in females in the 4th to 6th decades of life even though it can occur in all ages. It occurs in all areas of the body but about 45-65% of all lesions are reported in the head and neck region. Intraoral lesions represent about 70% of the granular cell tumours of the head and neck, and account for 1/3 of all cases affecting the whole body. Most of the intraoral lesions occur on the tongue, usually on the lateral aspect, followed by the buccal mucosa and hard palate. Although majority of granular cell tumours are benign, some are clinically aggressive and a few frankly malignant forms have been reported. Some benign lesions exhibit surface ulcerations and this clinical appearance, combined with the overlying pseudoepitheliomatous hyperplasia, seen histologically, may lead to misdiagnosis of malignancy if adequate biopsy material was not taken. A case of granular cell tumour which occurred on the midline area of the dorsum of the posterior 1/3 of the tongue is reported in a 20-year-old female patient. It is interesting because the patient was younger than the average age of occurrence and the tumour occurred in a similar site to that of a lingual thyroid.

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Objective To evaluate the dose distribution in clinical target volume (CTV) and organs-at-risk (OARs) in three dimension therapy plans in patients with squamous cell carcinoma of tongue receiving postoperative intensity-modulated radiotherapy (IMRT) or conventional radiotherapy (CRT) by dosimetric study. Methods Thirty-five patients with squamous cell carcinoma of tongue were divided into CRT group(n=17) and IMRT group(n=18). All patients underwent head-and-neck immobilization with a thermoplastic mask and planning CT scan, and target volume and OARs were contoured. Dose calculation and plan optimization were performed. All three dimension plans passed quality assurance before treatment. The dosimetry of therapy plans with IMRT or CRT in target volume and OARs dose distribution was compared by dose-volume histogram (DVH), conformity index (CI) and homogeneous index (HI). Results There were significant differences in D95 (isodose line to cover 95 percent target volume), CI, HI, minimum dose and maximum dose in CTV of therapy plans between patients with IMRT and CRT(P < 0.01), and there was no significant difference in mean dose of CTV(P > 0.05). The radiation dose on salivary glands (both parotid glands and contralateral submandibular gland) in patients with IMRT was significantly lower than that in patients with CRT(P < 0.01). Conclusion Compared with dose distribution of CRT plans, there are more advantages in improving dose distribution at the target volume and sparing salivary glands in IMRT therapy plans in patients with squamous cell carcinoma of tongue.

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O carcinoma epidermóide oral é uma neoplasia maligna de alta incidência e uma importante causa de morbidade e mortalidade, que exibe, entretanto, variável comportamento biológico, em função de diversos fatores. O objetivo do presente estudo consistiu em avaliar a expressão imuno-histoquímica de MMP-1, MMP-2, MMP-7, MMP-9 e MMP-26 em carcinomas epidermóides, em relação à localização da lesão e ao seu grau histológico de malignidade. Foram selecionados 15 carcinomas epidermóides de lábio inferior e 15 de língua, que, após avaliação morfológica, foram classificados em neoplasias de baixo grau de malignidade (n=17) e alto grau (n=13), e subseqüentemente submetidos à marcação imuno-histoquímica para as MMPs. Todos os espécimes investigados expressaram pelo menos duas das metaloproteinases pesquisadas, que foram mais evidentes no citoplasma das células tumorais localizadas no front de invasão. Os carcinomas epidermóides de língua exibiram maior marcação imuno-histoquímica de MMPs pelas células neoplásicas que aqueles de lábio inferior, com diferença significativa estatisticamente para a MMP-9 (p=0,030). Os carcinomas epidermóides de alto grau demonstraram maior expressão de metaloproteinases, exceto para MMP-2, em comparação às lesões de baixo grau, com diferença significativa estatisticamente para MMP-7 (p=0,0001) e MMP-26 (p=0,016). Adicionalmente foi evidenciada uma relação direta entre os escores morfológicos de malignidade e a imunopositividade às MMPs, com significância estatística para MMP-7 e MMP-26. Com base nestes resultados, pode-se concluir que a maior expressão de MMPs pelas células tumorais, especialmente MMP-9, pode contribuir para o maior potencial invasivo dos carcinomas de língua em comparação aos labiais. Além disso, a gravidade histológica dos carcinomas epidermóides parece estar relacionada à marcação imuno- histoquímica de metaloproteinases, especialmente matrilisinas, o que sugere que a capacidade de degradar membrana basal parece ser determinante no padrão de diferenciação histológica das neoplasias pesquisadas. Os altos índices de positividade às MMPs encontrados nos espécimes estudados refletem a marcante participação destas enzimas no desenvolvimento dos carcinomas epidermóides de lábio inferior e língua (AU).

The oral epidermoid carcinoma is a malignant neoplasty with high incidence and an important cause of morbidity and mortality that presents, however, a variable biological behavior, due to several factors. The aim of this study has consisted in evaluating the immunohistochemical expression of MMP-1, MMP-2, MMP-7, MMP-9 and MMP-26 in epidermoid carcinomas, regarding the location of the lesion and its histological grade of malignancy. 15 squamous cell carcinomas of lower lip and 15 of tongue were selected and, after morphological evaluation, they were classified in low malignancy grade (n=17) and high malignancy grade neoplasties (n=13), and subsequently submitted to immunohistochemical study for the MMPs. All the specimens investigated expressed at least two of the researched metalloproteinases, hat were more evident in the cytoplasm of tumor cells located in the invasion front. The tongue epidermoid carcinomas presented greater immunohistochemical expression of MMPs by neoplastic cells than those of lower lip, with statistically significant difference for MMP-9 (p=0.030). The high grade epidermoid carcinomas presented greater expression of metalloproteinases, except for MMP-2, in comparison to the low grade lesions, with statistically significant difference for MMP-7 (p=0,0001) and MMP- 26 (p=0,016). In addition it was evidenced a direct relation between the morphological scores of malignancy and immunoreactivity to MMPs, with statistic significance for MMP-7 and MMP-26. Based on these results we can conclude that a greater expression of MMPs by tumor cells, especially MMP-9, may contribute to a higher invasive potential of tongue carcinomas in comparison to lip carcinomas. Besides, the histological severity of epidermoid carcinomas seems to be related to immunohistochemical expression of metalloproteinases, especially matrilysins, which suggests that the capacity of degrading basal membrane seems to be determinant in the pattern of histological differentiation of neoplasties studied. The high levels of reactivity to MMPs found in the specimens studied reflect the outstanding participation of these enzymes in the development of epidermoid carcinomas in lower lip and tongue (AU).

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Purpose:To study the effect of inhibition of telomerase activity and cell cycle by transcriptase telomerase inhibitors (3′ azido 3′ deoxythymidine, AZT) on squamous cell carcinoma of tongue in vitro.Methods:Human squmous cell carcinoma of tongue cell line Tca8113 was used as target cell. Telomerase activity was determined by TRAP PCR ELISA in untreated and treated Tca8113 by AZT, cell cycle phases were analyzed by flow cytometry. Results:Telomerase activity of Tca8113 was significantly inhibited when treated with AZT, and the effect of inhibition was dose dependant (rate of telomerase activity treated with AZT in 0.3, 0.6, 1.0, 1.5mol 10 -1 was 0.69 0.03, 0.61 0.08, 0.53 0.11, 0.50 0.02 respectively, rate of telomerase activity treated without AZT was 0.76 0.06). Cell cycle of treated Tca8113 was changed with marked increase in G 2 /M phase compared with untreated Tca8113 (62.8% vs 19.7%, P