ORAL MEDICINE e350 Abstracts practitioners should be aware of the clinical diagnostic criteria of this condition, as well as the oral manifestations, to improve recognition and early diagnosis of the disease.
CR0384 DIAGNOSTIC DILEMMA: DRUG REACTION OR PARANEOPLASTIC AUTOIMMUNE MULTIORGAN SYNDROME? John C. Steele, Alan Mighell, Department of Oral Medicine, University of Leeds, Leeds, United Kingdom Background: We present the case of a 71-year-old white man with chronic lymphocytic leukemia (CLL) referred to the Department of Oral Medicine by his hematologist regarding persistent ulcerated oral and labial lesions of unknown cause. Summary: The chief complaint was of a 7-month history of a sore mouth and lips that had progressively worsened over the last few weeks. An associated widespread cutaneous rash developed in the weeks before presentation. He had been treated with ibrutinib, a tyrosine kinase inhibitor, as part of a clinical trial for his underlying hematologic malignancy after relapse. There was a good response. The drug was withdrawn 3 weeks before presentation in our department. Examination found blood crusted lips with no extension to skin and intraoral ulceration on all mucosal surfaces. An extensive maculopapular rash with excoriations was also noted. The differential diagnosis was paraneoplastic autoimmune multiorgan syndrome (PAMS) drug reaction and persistent erythema multiforme. There was no suitable ulcerfree oral tissue to biopsy. A skin punch biopsy found erythema multiforme-like changes. Indirect immunofluorescence was weakly positive (1 of 10) for pemphigus antibodies. Review of the clinical features and test results concluded that the mucocutaneous lesions were consistent with a drug reaction rather than the other differential diagnoses. This conclusion was reported to the clinical trial. Topical preparations for symptomatic treatment and systemic corticosteroids were commenced. Unfortunately, over the next few weeks the patient’s general health deteriorated while he remained an inpatient, without improvement in the orolabial lesions. He died of a relapse of his underlying malignancy and the associated complications 10 weeks after presentation to Oral Medicine. Conclusions: This case highlights the challenges in differentiating between PAMS and drug reactions in a patient participating in a clinical drug trial.
CR0379 SQUAMOUS CELL CARCINOMA OF THE TONGUE: A CASE REPORT Rui Amaral Mendes, Patrícia Couto, Pedro Coelho, Dental Medicine, Universidade Católica Portuguesa, Viseu, Portugal Background: Squamous cell carcinoma (SCC) is a malignancy originating on the epithelial lining of the oral cavity and represents 90% of all oral cancers. SCC is more common among men aged between 50 and 70 years. The tongue is the most affected place, representing about 50% of oral carcinomas. It is a multifactorial disease, generated in extrinsic factors such as tobacco and alcohol, as well as in intrinsic factors such as malnutrition, candidiasis, syphilis, and oncogenic viruses. It can present as an exophytic or endophytic lesion, leukoplakia, erythroplakia, or erythroleukoplakia. Summary: A patient attending oral screening conducted for the early diagnosis of head and neck cancer was diagnosed with a white plaque on the left posterolateral border of the tongue. The histopathologic analysis led to a diagnosis of squamous cell carcinoma. The early detection of this cancer allowed the lesion excision by surgery alone.
OOOO May 2014 Conclusions: Because squamous cell carcinoma is often preceded by premalignant lesions with clinically detectable symptoms, it is very important to reach an early diagnosis and to educate the population about the risk factors associated with this condition.
OI0435 ASSESSMENT OF DNA REPAIR MECHANISMS IN ORAL POTENTIALLY MALIGNANT DISORDERS Nikolaos G. Nikitakis, Georgios Rassidakis, Jason Tasoulas, Argyris Daskalopoulos, Georgios Kamperos, Alexandra Sklavounou, Department of Oral Medicine and Pathology, Dental School, University of Athens, Athens, Greece Objectives: This study aimed to investigate the alterations in DNA damage and response (DDR) mechanisms in oral carcinogenesis, during the evolution from normal mucosa to invasive cancer through epithelial hyperplasia and various degrees of dysplasia. Methods: The expression of DDR molecules H2 AX, pChk2, 53 BP1, p53 and phosphorylated p53 was assessed immunohistochemically in 41 cases of oral potentially malignant disorders (PMDs) with a clinical appearance of leukoplakia varying from hyperplasia (EH) (n ¼ 9) to various degrees of dysplasia (ED) (n ¼ 32). Control cases of normal oral mucosa (NM) (n ¼ 5) and oral squamous cell carcinoma (OSCC) (n ¼ 10) were included. Comparative statistical analysis was performed. Results: gH2 AX expression showed a progressive increase and extension to the upper epithelial layers from NM toward ED; OSCC exhibited higher expression levels compared with precancerous lesions. pChk2 expression was minimal/absent in NM, showed variation among premalignant lesions with an increasing tendency from EH to ED, and was more intense in OSCC. We found that 53 BP1 had higher levels in OSCC compared with NM and a wide range of expression among EH and ED. p53 presented the highest levels of positivity in OSCC; it showed more expression in ED compared with NM and EH with a tendency for extension to a higher level of the spinous layer according to the degree of ED. Phosphorylated p53 expression was absent in NM and relatively low in ED and OSCC. Conclusions: DNA damage-related molecules are expressed in oral PMDs with escalating intensity according to the presence and degree of epithelial dysplasia supporting their participation in oral carcinogenesis. Although DNA repair mechanisms may play an important role in the inhibition of carcinogenesis in the early stages of oral PMDs, they probably undergo a progressively worsening failure as a result of mutations under the influence of activated oncogenes or other mechanisms of continuous genomic instability.
OI0231 INTRODUCTION OF AN EPORTFOLIO INTO ORAL MEDICINE TRAINING Roddy McMillan, Department of Oral Medicine and Facial Pain, Eastman Dental Hospital, University College London Hospitals and Eastman Dental Institute, University College London, London, United Kingdom Objectives: The aim of this action research project was to facilitate the successful implementation of an electronic portfolio (ePortfolio) into oral medicine training within the British Isles. The objectives were (1) to garner a consensus of opinion from trainees about the proposed ePortfolio, (2) to facilitate the adaption of an existing surgical ePortfolio to produce an oral medicine ePortfolio, and (3) to have the participants in the trainee focus group demonstrate reflective practice and deeper learning.