Abstract
BackgroundMajor risk factors for oral squamous cell carcinoma (SCC) are tobacco smoking, a betel quid chewing habit, and heavy alcohol consumption. However, around 15% of oral SCCs cannot be explained by these risk factors. Although oral SCC associated with dental implants is quite rare, there has been a recent gradual accumulation of reports about it. Here, we report a case of primary peri-implant oral intra-epithelial neoplasia/carcinoma in situ (OIN/CIS) in a woman without the major risk factors for oral SCC.Case presentationA 65-year-old woman was referred to our clinic with a tumor in the right lower gingiva. She had no history of tobacco smoking and only drank socially. Ten years previously, mandibular right posterior teeth had been replaced with an implant-supported porcelain-fused-to-metal restoration in a dental clinic. About 7 years later, she noticed swelling on the lingual side of the gingiva around the implant-supported restoration, and was eventually referred to our clinic with the suspicion of a neoplasia around the dental implant. The upper part of the implant body was exposed on the implant corresponding to the first molar of the right side of the mandible; this was associated with painless, elastic soft, and relatively well circumscribed gingival swelling on the lingual site. A panoramic radiograph showed slight vertical bone resorption around the implants. An incisional biopsy was conducted under the suspicion of neoplasia. Pathological microscopic examination of the biopsy specimen revealed thickened squamous epithelia with slight nuclear atypism and disorders of the epithelial rete pegs. Immunohistochemical findings showed positive staining for keratin 17 and a negative staining mosaic pattern for keratin 13. High p53, p63, and Ki-67 reactivity was also observed. From these findings, OIN/CIS of the gingiva was pathologically diagnosed, and a wide local excision with rim resection of the mandible, including the implants, was performed. The pathological findings for the resected specimen were same as those for the biopsy specimen. After 1 year of follow-up, there was no evidence of recurrence.ConclusionIn this case, prolonged peri-implant mucositis or peri-implantitis may have been a plausible risk factor for carcinogenesis.
Highlights
Major risk factors for oral squamous cell carcinoma (SCC) are tobacco smoking, a betel quid chewing habit, and heavy alcohol consumption
The squamous epithelium goes into irreversible change, including epithelial dysplasia and oral intraepithelial neoplasia/carcinoma in-situ (OIN/CIS) [2], resulting in the development of invasive carcinoma through the accumulation of genetic abnormalities caused by persistent exposure to a carcinogen
We report a case of intra-epithelial neoplasia arising from peri-implant mucosa in a woman without a history of tobacco smoking or excessive alcohol consumption, and without predisposing factors for oral SCC, including leukoplakia, erythroplakia, or previous oral cancer
Summary
Oral cancer ranks sixth among the malignancies in terms of worldwide prevalence, with more than 90% being pathologically squamous cell carcinoma (SCC) [1]. We report a case of intra-epithelial neoplasia arising from peri-implant mucosa in a woman without a history of tobacco smoking or excessive alcohol consumption, and without predisposing factors for oral SCC, including leukoplakia, erythroplakia, or previous oral cancer. The lesion around the central of the three implants did not improve, and changes to its surface properties were observed, leading to the suspicion of transformation to neoplasia She was referred to our clinic 3 months after the flap surgery. Case presentation A 65-year-old woman was referred to our clinic with a tumor in the right lower gingiva Her medical history included breast cancer without metastatic lesion, diabetes mellitus, hyperlipidemia, and hypertension. She had taken orally aspirin, amlodipine, pravastatin, and bepotastine for 2 years. About 10 years prior to her attendance at our clinic, her mandibular right posterior teeth had been replaced with an implant-supported porcelain-fused-to-metal
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