Concomitant-chemoradiotherapy-associated oral lesions in patients with oral squamous-cell carcinoma

Objective:Oral squamous-cell carcinoma(OSCC)accounts for >90% of oral cancers affecting adults mostly between the fourth to seventh decades of life.The most common OSCC treatment is concomitant chemoradiotherapy(CCRT)having both locoregional and distant control,but CCRT has acute and chronic toxic effects on adjacent normal tissue.This study aimed to determine the side effects of CCRT on the oral mucosa and to characterize the clinicopathology of oral lesions in patients with OSCC.Methods:This descriptive,cross-sectional study was certified by the Ethical Review Committee(UHS/Education/126-12/2728)of the University of Health Sciences,Lahore,Pakistan.OSSC patients(n=81)with various histological subtypes,grades,and stages were recruited,and findings on their oral examination were recorded.These patients received 70,90,and 119 Gy of radiotherapy dosages in combination with the chemotherapy drugs cisplatin and 5-fluorouracil.Data were analyzed using SPSS 20.0.Results:The most common presentation of OSCC was a nonhealing ulcer(63%) involving tongue(55.6%).Clinical findings included mucositis(92.6%)and xerostomia of mild,moderate,and severe degrees in 11.1%,46.9%,and 35.8% cases,respectively.Ulcers(87.7%),palpable lymph nodes(64.2%),limited mouth opening(64.2%)and fistula(40.7%) were also observed.In females,the association of radiotherapy dosage with limited mouth opening,xerostomia,and histological grading was statistically significant(P<0.05).The association of chemotherapy drugs with xerostomia(P=0.003)was also statistically significant.Conclusions:CCRT induced mucositis,xerostomia,and trismus in patients with OSCC.

The clinical effectiveness of reflectance optical spectroscopy for the in vivo diagnosis of oral lesions

Optical spectroscopy devices are being developed and tested for the screening and diagnosis of oral precancer and cancer lesions. This study reports a device that uses white light for detection of suspicious lesions and green–amber light at 545 nm that detect tissue vascularity on patients with several suspicious oral lesions. The clinical grading of vascularity was compared to the histological grading of the biopsied lesions using specific biomarkers. Such a device, in the hands of dentists and other health professionals, could greatly increase the number of oral cancerous lesions detected in early phase. The purpose of this study is to correlate the clinical grading of tissue vascularity in several oral suspicious lesions using the IdentafiH system with the histological grading of the biopsied lesions using specific vascular markers. Twenty-one patients with various oral lesions were enrolled in the study. The lesions were visualized using IdentafiH device with white light illumination, followed by visualization of tissue autofluorescence and tissue reflectance. Tissue biopsied was obtained from the all lesions and both histopathological and immunohistochemical studies using a vascular endothelial biomarker（CD34） were performed on these tissue samples. The clinical vascular grading using the green–amber light at 545 nm and the expression pattern and intensity of staining for CD34 in the different biopsies varied depending on lesions, grading ranged from 1 to3. The increase in vascularity was observed in abnormal tissues when compared to normal mucosa, but this increase was not limited to carcinoma only as hyperkeratosis and other oral diseases, such as lichen planus, also showed increase in vascularity. Optical spectroscopy is a promising technology for the detection of oral mucosal abnormalities; however, further investigations with a larger population group is required to evaluate the usefulness of these devices in differentiating benign lesions from potentially malignant lesions.

Oral Lesions Observed in Tobacco Consumers: Socio-Demographical and Clinical Aspects in the Prefectures of Kankan and Siguiri Republic of Guinea

Introduction: Oral lesions observed in Chewing Tobacco (CT) consumers are histological alterations caused by direct contact with the tissues of the oral cavity. The objectives of this study were to determine the socio-demographic status of consumers and describe the clinical characteristics of the oral lesions observed. Material and Method: It was a descriptive cross-sectional study lasting 12 months (January 2017 to January 2018), in the prefectures of Kankan and Siguiri as a framework. Individuals who use chewing tobacco and whose oral examination revealed oral lesions were included in this study. Results: The frequency of oral lesions induced by the consumption of chewing tobacco was 90%. Dental pain was the most cited reason for using CT by respondents, i.e., 25.41%. The most concerned age group was that of 50 - 64 years or 23.81 with a male predominance of 84.13% (n = 53). A number of 61 respondents came from rural areas. Farmers were the predominant socio-professional group, i.e., 63.49% (n = 40). In 60.32% (n = 38) of respondents, the duration of CT consumption was greater than 10 years. Black villous tongues followed by neoplastic ulcerations were the most common oral lesions with 32 (50.79%) and 14 (22.22%) cases, respectively. The site of the lesion was the tongue in 47 consumers (74.61%) and in the lower vestibule in 15 users (23.80%). Among the oral diseases, mylolysis was the most common, i.e., 95.24% (n = 60). In 82.54% of cases (n = 52), Simplified Oral Hygiene Index (SOHI) was low and in 12.70% (n = 8) of respondents, SOHI was good. Conclusion: Chewing tobacco predisposes to a high risk of damage to the oral cavity and the development of potentially malignant lesions. In addition, it exerts some detrimental effects on the teeth and adjacent structures.

The Prevalence of Oral Lesions among Palestinian Dental Patients Attending Oral Medicine Dental Clinics at Al-Quds University

Objectives: In Palestine, there are no data about the prevalence of oral lesions or their associated risk factors. Thus, this study came to assess the prevalence and the risk factors of oral lesions among adult dental patients visiting Al-Quds University (AQU) Dental Clinics. Materials and Methods: Three hundred Twenty patients were diagnosed clinically for the presence of oral lesions at oral medicine clinics at Al-Quds University in the period between 2015 to 2016. Their age ranged from 21 to 60 years old (mean age: 40.2 ± 17.6). Senior students were trained to conduct the oral exam under the direct supervision of Oral Medicine specialist. Trained students also collected data on patients’ demographics, dental history, medical history and other health related habits. Descriptive and bivariate analyses were generated to describe lesions prevalence and associations with other suggested factors. Results: A total of 68 lesions were found in this study (29.4% of study’s sample). Recurrent aphthous ulcer, traumatic ulcer and geographic tongue were the most common oral lesions. Ten oral potentially malignant lesions were diagnosed (8 cases were Leukoplakia, 2 cases were erythroplakia). Non filtered smoking cigarettes were associated with reported lesions. Oral lesions were noticed to increase with age. Oral lesions were more common on the Tongue, labial and buccal mucosain this study. Conclusions: This study revealed high prevalence of apthous and traumatic ulcer while potentially malignant lesions like leucoplakia and erythroplakia were also seen in patients who were smokers. Dentists should have a high level of awareness during oral examination and intervention should be performed to raise awareness among the population about the harmful effects of smoking on oral health.

Analgesic Appraisal of Bidens pilosa (Asteraceae) Leaf Extracts Used in Management of Oral Lesion Pain in HIV/AIDS Patients in Rodents

Oral lesions, diarrhoea, Pneumocystis carinii pneumonia, tuberculosis and urinary tract infections are some of the opportunistic infections (OIs) which arise when the CD4 cells of the HIV/AIDS patient fall below 200 cells/mm3. HIV/AIDS infection complications include tissue damage from oral lesions accompanied with pains. Pain is a disagreeable sensory and sensitive experience associated with actual or potential tissue damage. This condition requires immediate treatment with analgesics and antibiotics. However, the inability of rural dwellers to afford readily available drugs is a consequence for using herbs like Bidens pilosa whose local usefulness in the management of oral lesions of HIV/AIDS has not been proven scientifically. Therefore, the objective of this study was to provide the scientific basis in rats for the traditional healers’ use of Bidens pilosa leaves’ extracts in managing pain associated with oral lesions of HIV/AIDS patients in South Western Uganda. Assessment of the analgesic effects of Bidens pilosa was conducted using acetic acid in mice, formalin-induced pain and tail flick methods in rats. Both aqueous and ethanolic extracts of the leaves of Bidens pilosa produced statistically significant dose dependent inhibition of acetic acid induced pain, non dose dependent pain reduction in formalin induced pain, (p < 0.05;student t-test) and non dose dependent tail withdrawal pattern (p < 0.05, Multivariate ANOVA test). Hence, we conclude that extracts of Bidens pilosa have an analgesic basis for their local use in treatment of oral lesions associated pain in HIV/AIDS patients in South-Western Uganda.

Prevalence of oral lesions and the effects of HAART in adult HIV patients attending a tertiary hospital in Lagos, Nigeria

Background: Oral lesions have been reported to be early clinical features of HIV infection. The objective of this study was to establish the prevalence of oral lesions and the management outcome using HAART in HIV Seropositive patients attending a tertiary hos- pital in Lagos, Nigeria. Methods: This was a prospective study in 114 newly diagnosed adult HIV infected patients (not on antiretroviral therapy), who attended the PEPFAR clinic at Lagos University Teaching Hospital. They were assessed for oral lesions which were evaluated using EEC/WHO—Classification on the diagnostic criteria for oral lesions in HIV. Data were collected using an interviewer administered questionnaire. Oral examination was carried out and oral lesions detected were recorded. Presence or absence of oral lesions was evaluated following 3 months use of HAART. Results: 114 patients were enrolled into the study, 49(43.0%) males and 65(57.0%) females, with age range of 18-63 years. 42 (36.8%) presented with oral lesions, 19 (45.2%) of which had multiple lesions. Oral Candidiasis which accounted for 47.7% was the most common oral lesion observed followed by Oral Hairy Leukoplakia (21.6%) and oral hyperpigmentation (10.8%). Pseudomembraneous Candidiasis was the most common variant of oral Candidiasis seen. Prevalence of oral lesions was significantly associated with low CD4 count and high viral load. Eighty four percent (84%) of oral lesions disappeared following 3 months of HAART treatment. Conclusion: Oral lesions are common features of HIV and a marker for progression of the disease to AIDS. There was significant reduction in oral lesions following 3 months treatment with HAART.

Oral lesions after COVID-19 vaccination:Immune mechanisms and clinical approach

COVID-19 vaccination,although is a promising tool to overcome the pandemic,has side effects.There are in-creasing reports of oral lesions after COVID-19 vaccination.The aim of this review is to identify the occurrence of some oral lesions after COVID-19 vaccination,and highlight the underlying immune mechanisms involved.A narrative literature review was performed by searching electronic databases including PubMed,Scopus and Web of Science to investigate the oral lesions after COVID-19 vaccination.The inclusion criteria were original stud-ies,including the case reports,case series,letter to the editor,and cross-sectional studies.The exclusion criteria included the studies which examined the oral lesions caused by COVID-19 infection.The information,including the number of participant(s)receiving vaccine,type of vaccine,dose number,side effect(s),time of onset fol-lowing vaccination,healing time,treatment strategies for the existing lesions,and related mechanisms were then summarized in a data extraction sheet.The results of this review showed that some vaccines had side effects with oral involvement such as pemphigus vulgaris,bullous pemphigoid,herpes zoster,lichen planus,Stevens-Johnson syndrome and Behçet’s disease.Future research needs to elucidate the physiopathology of oral manifestations after the COVID-19 vaccination,and better understand the risk factors associated with such responses.Sometimes vaccine’s side effects may be due to the nocebo effect,which means that the person expects some adverse events to occur following the vaccine administration.

Review of oral and pharyngolaryngeal benign lesions detected during esophagogastroduodenoscopy

Recent advancements in endoscopy equipment have facilitated endoscopists’detection of neoplasms in the oral cavity and pharyngolaryngeal regions.In particular,image-enhanced endoscopy using narrow band imaging or blue laser imaging play an integral role in the endoscopic diagnosis of oral and pharyngolaryngeal cancers.Despite these advancements,limited studies have focused on benign lesions that can be observed during esophagogastroduodenoscopy in the oral and pharyngolaryngeal regions.Therefore,this mini-review aimed to provide essential information on such benign lesions,along with representative endoscopic images of dental caries,cleft palate,palatal torus,bifid uvula,compression by cervical osteophytes,tonsil hyperplasia,black hairy tongue,oral candidiasis,oral and pharyngolaryngeal ulcers,pharyngeal melanosis,oral tattoos associated with dental alloys,retention cysts,papilloma,radiation-induced changes,skin flaps,vocal cord paresis,and vocal fold leukoplakia.Whilst it is imperative to seek consultation from otolaryngologists or dentists in instances where the diagnosis cannot be definitively ascertained by endoscopists,the merits of attaining foundational expertise pertaining to oral and pharyngolaryngeal lesions are unequivocal.This article will be a valuable resource for endoscopists seeking to enhance their understanding of oral and pharyngolaryngeal lesions.

Comparison of Oral Manifestations in Hospitalized COVID-19 Positive Patients and COVID-19 Negative Dental Outpatients. A Case Series Study and Literature Review

Background: The Coronavirus disease 2019 (COVID-19) is a respiratory infectious disease, also named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which can cause various systemic manifestations that pose a threat to human life. Oral lesions in patients with COVID-19 may appear during or after the illness and may or may not be a consequence of the viral infection. Objective: In this case series we compare the oral manifestations in hospitalized COVID-19 positive patients and COVID-19 negative dental outpatients. Methods: 60 hospitalized COVID-19 patients and 41 control patients, were examined for oral signs and symptoms. The controls were dental patients who visited the hospital for dental care without complaining of any problems related to the oral cavity itself. Results: We have observed a strong association between certain clinical findings and COVID-19, including alterations in taste (ageusia, dysgeusia, and hypogeusia), anosmia, hairy tongue, tongue imprints, red tongue, erythematous candidiasis, pseudomembranous candidiasis, and exfoliative cheilitis. A trend but not statistically significant association at the level of 5% was also noted for colored tongue, linea alba, and pale mucosa. On the contrary, fissured tongue and oral mucosa pigmentation were more frequent in the controls, statistically significant at the level of 5%. Conclusion: COVID-19 has been found to impact the oral cavity, resulting in various oral lesions that can be attributed to either the direct action of the virus or the patient’s immune response.

Precancerous lesions of oral mucosa

Precancerous lesions of oral mucosa, known as potentially malignant disorders in recent years, are consists of a group of diseases, which should be diagnosed in the early stage. Oral leukoplakia, oral submucous fibrosis, and oral erythroplakia are the most common oral mucosal diseases that have a very high malignant transformation rate. Oral lichen planus is one of the potentially malignant disorders that may be seen in six different subtypes including papular, reticular, plaquelike, atrophic, erosive, and bullous type, clinically. Atrophic and erosive subtypes have the greater increased malignant transformation risk compared to another subtypes. Although there are various etiological studies, the etiology of almost all these diseases is not fully understood. Geographically, etiologic factors may vary.The most frequently reported possible factors are tobacco use, alcohol drinking, chewing of betel quid containing areca nut, and solar rays. Early diagnosis is very important and can be lifesaving, because in late stages, they may be progressed to severe dysplasia and even carcinoma in situ and/or squamous cell carcinoma. For most diseases, treatment results are not satisfactory in spite of miscellaneous therapies. While at the forefront of surgical intervention, topical and systemic treatment alternatives such as corticosteroids, calcineurin inhibitors, and retinoids are widely used.

Histopathological and Immunohistochemical Study of the Distinction between Oral Lichen Planus and Oral Lichenoid Lesions

Background: Oral potentially malignant disorders, which include oral lichen planus (OLP), are clinical presentations that carry a risk of development to cancer in the oral cavity. Oral lichenoid lesions (OLLs) are also termed interface/lichenoid mucositis. Malignant transformation of them remains controversial, but distinct clinical and histological criteria for how to differentiate OLP from OLLs have not been developed. Objectives: The purpose of this study was to elucidate findings that can allow histopathological differentiation of OLP and OLLs using histomorphological and immunohistochemical analyses. Materials and Methods: Analyses were performed in 10 cases diagnosed with OLP and 9 cases diagnosed with OLLs. Cytokeratin 19 (CK19), Ki-67 and CD3 were used as primary antibodies to detect basal cells, proliferative activity and T-cell distribution, respectively, and Perlecan and COX-2 to evaluate epithelial intracellular arrangements and interstitial distributions of proteoglycans and enzymes. Results: For CK19, positive cells were significantly found in OLLs at both the prominent area and site adjacent to the lesion comparison with those of OLP’s. The number of COX-2 positive cells was significantly higher in spinous and basal layers in OLLs of the prominent area. Additionally, OLLs showed mild to moderate expression for perlecan in the basal to spinous layers and in subepithelial tissue. Conclusion: Almost no basal cells were noted in the prominent area in OLP. COX-2 and perlecan were found in the basal to spinous layers in OLLs. Although there are restrictions, these suggested the possibility of helping to distinguish between OLP and OLLs.

Oral lichenoid lesion:A review of the literature

The oral lichenoid lesion(OLL) is response that occurs on the oral mucosa. The OLL include allergic responseto the dental materials, drugs, and on graft-vs-host disease(GVHD). OLL to dental material happen when restorative materials, most commonly amalgam, are in direct contact with the mucosa in sensitized individuals. Medications that produce OLL are oral hypoglycemic agents, angiotensin-converting enzyme inhibitors, and nonsteroidal anti-inflammatory agents. GVHD is a complication in bone marrow transplantation and OLL is a common lesion observed in this disease especially in chronic GVHD. The clinical and histological aspects of OLL are similar to oral lichen planus and turn it difficult to make a differential diagnosis. The purpose of this paper is review about OLL related to the dental materials, drug use and GVHD.

Oral and perioral herpes simplex virus infection type I in a fivemonth- old infant: A case report

BACKGROUND Herpes simplex virus(HSV)is a highly infectious pathogen that is easily transmitted via the bodily fluids of an infected individual.This virus usually affects individuals older than six months of age,and rarely causes lesions or symptoms in younger patients.CASE SUMMARY We present the case of a five-month-old healthy girl who presented with painful herpetic gingivostomatitis and perioral vesicles.We discuss the pathophysiology of primary HSV infection and the effect of maternal antibodies on the infant’s immune system.In addition,we explain the diagnosis,management,and prognosis of HSV infection in young infants.CONCLUSION This case highlights the importance of early diagnosis and management of HSV infections to decrease the risk of developing severe complications and death.

Pyoderma Gangrenosum with Oral Involvement–Case Report and Review of the Literature

Pyoderma gangrenosum （PG） is a rare, noninfectious neutrophilic dermatosis. Clinically, it begins with sterile pustules that rapidly progress into painful ulcers of variable depth and size with undermined violaceous borders. The diagnosis of PG is based on the history of an underlying disease, a typical clinical presentation, histopathology, and exclusion of other diseases. The peak incidence occurs between the ages of 20 to 50 years with women being more often affected than men. There have been very few reports of pyoderma gangrenosum with oral mucosal involvement. Oral lesions in previously reported cases have included ulcers of varying sizes from a few mm to several cm and have been reported to have been found on the tongue, soft and hard palate, buccal mucosa, and gingiva. Some of these oral lesions have been associated with ulcerative colitis, inflammatory bowel disease, and polycythemia rubra vera. A few cases were reported with biopsy findings, the histological picture being nonspecific, showing ulceration, and necrosis with inflam- matory cell infiltrate. A peculiar case of pyoderma gan- grenosum with an oral lesion is presented here, and the differential diagnosis is discussed.

Habitual khat chewing and oral melanoacanthoma: A case report

BACKGROUND Habitual khat(Catha edulis) chewing has been proven to cause numerous oral tissue changes. However, oral melanoacanthoma triggered by chronic khat chewing is rare. Oral melanoacanthoma is an uncommon, sudden, asymptomatic, benign pigmentation of the oral cavity. Under the microscope, the epithelial layer of the oral mucosa showed dendritic melanocyte proliferation and acanthosis. The study aimed to highlight chronic khat chewing as a trigger for oral melanoacanthoma.CASE SUMMARY In the current study, we report a case of a 26-year-old male patient with a rare presentation of oral melanoacanthoma triggered by regular khat chewing. Many intrinsic and extrinsic factors can cause oral pigmentation. Chewing khat is an extrinsic factor that can cause several diseases, including oral pigmentation. In this case, the definitive diagnosis was oral melanoacanthoma. This diagnosis was made based on the patient’s history, clinical lesion presentation, and microscopic biopsy results.CONCLUSION Habitual khat(Catha edulis) chewing causes many oral tissue changes including oral melanoacanthoma. The study aimed to highlight chronic khat chewing as a trigger for oral melanoacanthoma.

Palliative oral care in terminal cancer patients:Integrated review

BACKGROUND Palliative care(PC)aims to improve quality of life in patients and its families against life threatening diseases,through suffering’s prevention and relief.It is the duty of the dental surgeon to possess the knowledge needed to treat a patient with little life span,in order to establish an adequate treatment plan for each situation.AIM To synthesize the published evidence on oral conditions,impact,management and challenges in managing oral conditions among palliative patients.METHODS Articles were selected from PubMed and Scopus electronic platforms,using a research strategy with diverse descriptors related to“palliative care”,“cancer”and“oral health”.The article’s selection was done in two phases.The first one was performed by the main researcher through the reading of the abstracts.In the second phase two researchers selected eligible articles after reading in full those previous selected.Data was tabulated and analyzed,obtaining information about what is found in literature related to this subject and what is necessary to be approached in future researches about PC.RESULTS As results,the total of 15 articles were eligible,being one a qualitative analysis,13(92.8%)clinical trials and one observational study.Of the 15 articles,8(53.4%)involved questionnaires,while the rest involved:one systematic review about oral care in a hospital environment,2 oral exams and oral sample collection,one investigation of terminal patient’s(TP)oral assessment records,2 collection of oral samples and their respective analysis and one treatment of the observed oral complications.CONCLUSION It can be concluded that the oral manifestations in oncologic patients in terminal stage are,oral candidiasis,dry mouth,dysphagia,dysgeusia,oral mucositis and orofacial pain.Determining a protocol for the care of these and other complications of cancer–or cancer therapy–based on scientific evidence with the latest cutting-edge research results is of fundamental importance for the multidisciplinary team that works in the care of patients in PC.To prevent complications and its needed to initial the dentist as early as possible as a multidisciplinary member.It has been suggested palliative care protocol based on the up to date literature available for some frequent oral complications in TP with cancer.Other complications in terminal patients and their treatments still need to have further studying.

Diagnostic aids for detection of oral precancerous conditions

Oral cancer has a tendency to be detected at late stage which is detrimental to the patients because of its high mortality and morbidity rates. Early detection of oral cancer is therefore important to reduce the burden of this devastating disease. In this review article, the most common oral precancerous lesions are discussed and the importance of early diagnosis is emphasized. In addition, the most common non-invasive oral cancer devices that can aid the general practitioners in early diagnosis are also discussed.

Role of the Chinese Herbal Medicine Xianhuayin on the Reversal of Premalignant Mucosal Lesions in the Golden Hamster Buccal Pouch

Aim To investigate the role of the Chinese herbal medicine Xianhuayin on the reversal of 7,12-dimethylbenz[a]anthracene （DMBA）-induced premalignant mucosal lesions in the oral buccal pouch of golden hamsters. Methodology The animals were randomly divided into a non-diseased control group （n=5） and an experimental group including 50 animals in which the buccal mucosa had been painted with DMBA （0.5% in acetone） to generate an oral mucosa premalignant lesion. Animals in the experi- mental group were further divided into Xianhuayin-treated group （n=30）, untreated prem＇alignant lesion group （n=10） and normal saline （NS）-treated group （n=10）. The cheek （buccal） pouch mucosa of the golden hamsters in each group was observed with light and electron microscopy eight weeks after intragastric administration with NS or Xianhuayin. Results In the non-diseased control group, the buccal mucosa was keratinized and stratified squamous epithelium under a light microscope. In the untreated premalignant lesion group, variable degrees of epithelial dysplasia was observed. The irregular epithelial mucosa gradually became distinct in the Xianhuayin-treated group. Scanning electronic microscopic （SEM） analysis showed that surface of the cells exhibited honeycomb structures in the hamster of untreated- group. The cells were morphologically irregular, overlapped and loosened in the untreated premalignant lesion group. Most of the cell surface exhibited honeycomb structure in the Xianhuayin-treated group. Transmission electronic micro- scopic （TEM） analysis showed that buccal mucosal epithelial cells were morphologically regular in the non-diseased control group. Desmosomes and tonofibrils were reduced and the nucleus was morphologically irregular in the untreated premalignant lesion group. In the Xianhuayin-treated group, the widening intercellular gap was gradually reduced, desmosomes and the cells becoming morphologically regular. No significant difference was observed between the hamsters in NS-treated group and those in the untreated premalignant lesion group. Significant therapeutic efficacy was observed in the group receiving Xianhuayin. Conclusion Xianhuayin is effective in the reversal of DMBA-induced premalignant lesions in the buccal pouch of golden hamsters.

Analysis of clinical symptoms and signs in cases of oral submucous fibrosis which have transformed into squamous cell carcinoma

To analyze the clinical symptoms and signs in cases of oral submucous fibrosis which has transformed into squamous cell carcinoma, twenty-nine patients with squamous cell carcinoma correlated with oral submucous fibrosis, leukoplakia, lichen planus were taken biopsy for positive diagnosis. The clinical and pathological diagnosis of oral submucous fibrosis depended on clinical and pathological diagnostic standards. The oral submucous fibrosis involving different portions and size in the mouth was observed and recorded. The portions of oral cancer, clinical findings and symptoms, cancerous size, the conditions of the local lymphatic nodes and of oral submucous fibrosis correlated with squamous cell carcinoma in the mouth, oral leukoplakia, lichen planus were also observed and recorded. In twenty-nine patients with oral squamous cell carcinoma, duration from oral submucous fibrosis transformed into oral cancer ranged from 2 to 15 years with an average year of 6.69. The serious degrees of oral submucous fibrosis in the patients with oral cancer were that the moderately advanced stage was found in 3 cases (10.34%) and the advanced stage was found in 26 cases (89.65%). The cancerous portion was that the buccal mucosa was found in 9 cases (31.03%);the tongue was found in 14 cases (48.27%);the other portion was found in the rest 6 cases (20.68%). Among the twenty-nine patients twenty-three patients with squamous cell carcinoma were associated with leukoplakia (79.31%), five patients were associated with lichen planus (17.24%). Twenty-seven patients (93.1%) had habits of betel quid chewing, smoked cigarette and drank alcohol, the rest two patients had habits of betel quid chewing and cigarette smoking. The present study demonstrates that oral submucous fibrosis is a real precancerous lesion and may transform into squamous cell carcinoma in the mouth.

Hepatic Adenoma Secondary to Long-Term Oral Contraception Use in a Young Female

Hepatic adenomas are a rare byproduct of oral contraceptive pill (OCP) use. Laboratory workup is often inconclusive. Diagnosis can be made via MRI;however, select cases may require further testing such as fine needle aspiration or core needle biopsy. We report a case of a 36-year-old female who was referred to gastroenterology for further evaluation of several liver lesions found incidentally on imaging. Due to risk factors, such as age, long-term oral contraceptive use and obesity, adenoma was high on the differential. Although infrequent, this case emphasizes the importance of a detailed history, including medication review, and physical examination.