Abstract
BackgroundAutofluorescence imaging is used widely for diagnostic evaluation of various epithelial malignancies. Cancerous lesions display loss of autofluorescence due to malignant changes in epithelium and subepithelial stroma. Carcinoma of unknown primary site presents with lymph node or distant metastasis, for which the site of primary tumour is not detectable. We describe here the use of autofluorescence imaging for detecting a clinically innocuous appearing occult malignancy of the palate which upon pathological examination was consistent with a metastatic squamous cell carcinoma.Case DescriptionA submucosal nodule was noted on the right posterior hard palate of a 59-year-old white female during clinical examination. Examination of this lesion using a multispectral oral cancer screening device revealed loss of autofluorescence at 405 nm illumination. An excisional biopsy of this nodule, confirmed the presence of a metastatic squamous cell carcinoma. Four years ago, this patient was diagnosed with metastatic squamous cell carcinoma of the right mid-jugular lymph node of unknown primary. She was treated with external beam irradiation and remained disease free until current presentation.ConclusionThis case illustrates the important role played by autofluorescence tissue imaging in diagnosing a metastatic palatal tumour that appeared clinically innocuous and otherwise would not have been biopsied.
Highlights
Autofluorescence imaging is used widely for diagnostic evaluation of various epithelial malignancies
We report of a case to highlight the value of tissue autofluorescence visualization in diagnosing a squamous cell carcinoma, metastatic to the palate, which clinically presented as an innocuous appearing submucosal nodule
Light-induced tissue fluorescence visualization technologies are being used increasingly as non-invasive diagnostic aids to characterize biochemical and structural changes associated with neoplastic transformation [7,11,14]. These diagnostic tests vary depending on the type of fluorophores being visualized: 1) endogenous fluorophores; 2) fluorophores synthesized in tissue after administration of a precursor drug; 3) fluorophores injected as exogenous drug
Summary
Light-induced tissue autofluorescence examination is currently considered as a standard of care for screening and diagnostic evaluation of early neoplastic changes of the skin, cervix, lung, bladder, gastrointestinal tract and oral cavity [1,2,3,4,5,6,7,8,9,10,11]. A 59-year-old white female was receiving regular dental treatment at the Special Patient Clinic of the University of Texas Dental Branch at Houston During her recent clinic visit, we noticed a submucosal nodule on her posterior hard palate during routine oral examination. Our clinical differential diagnosis for this palatal nodule included traumatic fibroma and epidermoid cyst Because of her past medical history of metastatic disease, we examined this nodule using a multispectral oral cancer screening device (IdentafiTM 3000). This submucosal nodule revealed decreased autofluorescence at 405 nm illumination (Figure 1A-C). Written informed consents were obtained from all participants of this clinical study
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