-
Asian Pacific Journal of Cancer... Aug 2023This study aims to analyze the risk factors for BRONJ in patients taking zoledronic acid (ZA) for metastatic breast and prostate cancer. (Observational Study)
Observational Study
Risk Factors for Bisphosphonate-Related Osteonecrosis of the Jaws in Bone Metastatic Breast and Prostate Cancer under Zoledronate Treatment: A Retrospective Analysis from 10 Years of Evaluation.
OBJECTIVE
This study aims to analyze the risk factors for BRONJ in patients taking zoledronic acid (ZA) for metastatic breast and prostate cancer.
METHODS
For this, a retrospective, quantitative, observational cohort study was conducted using data on adverse effects in the oral cavity in patients during chemotherapy for treatment of solid tumors available in the electronic patient record system of the Haroldo Juaçaba Hospital/Ceará Cancer Institute in the period from 2010, to 2019. Data were tabulated in Excel and exported to SPSS v20.0 software for statistical analysis, with 95% confidence.
RESULTS
Thus, it can be observed that the prevalence of BRONJ in patients under treatment for breast cancer and prostate cancer was <7%, with age <50 years of age (p=0.009), cytotoxic chemotherapy such as methotrexate (p=0.023), paclitaxel (p=0.005), capecitabine (p<0.001), gemcitabine (p=0.007) and bicalutamide (p=0.016), amount of ZA infusions (p<0.001) and hormone therapy (p=0.007), in addition, a slight reduction in survival and increased use of antidepressants (p=0.014) were observed. The reduced overall survival and increased use of antidepressants in patients who developed BRONJ, reinforcing the need for further research to study the mechanisms involved in the unconventional risk factors for BRONJ.
CONCLUSION
Thus, increasing the attention to these patients to prevent this condition from compromising the prognosis of these individuals.
Topics: Male; Humans; Middle Aged; Zoledronic Acid; Retrospective Studies; Bisphosphonate-Associated Osteonecrosis of the Jaw; Prostatic Neoplasms; Breast
PubMed: 37642054
DOI: 10.31557/APJCP.2023.24.8.2681 -
International Journal of Applied &... 2023Lymphoma in the jaw bone is a rare malignant neoplasm with heterogeneous nature diagnosis of which requires utmost knowledge of cellular morphology and tissue...
Lymphoma in the jaw bone is a rare malignant neoplasm with heterogeneous nature diagnosis of which requires utmost knowledge of cellular morphology and tissue architecture. The lineage of the neoplastic lymphocytes, whether it is B- or T-cell or mixed in nature, is designated by cluster of differentiation numbers. Broad classification of malignant lymphoma includes Hodgkin's and non-Hodgkin's lymphoma which have various subtypes. An unusual case of a B-cell lymphoma in the mandible in a middle-aged male patient is presented herewith clinicopathological and immunohistochemical features.
PubMed: 37614843
DOI: 10.4103/ijabmr.ijabmr_39_23 -
Cancer Medicine Sep 2023Assessing the incidence of Medication Related Osteonecrosis of the Jaw (MRONJ) in cancer patients with bone metastases receiving Denosumab (Dmab) and identifying... (Observational Study)
Observational Study
AIM
Assessing the incidence of Medication Related Osteonecrosis of the Jaw (MRONJ) in cancer patients with bone metastases receiving Denosumab (Dmab) and identifying potential risk factors.
METHODS
A retrospective observational study on consecutive cancer patients with bone metastases, who received at least one dose of Dmab and one follow-up visit. MRONJ crude cumulative incidence (CCI) was estimated considering death without MRONJ as competing event. Multiple regression models were used to study the association between MRONJ incidence and potential risk factors: age, cancer diagnosis, previous bisphosphonates, dental treatments before starting Dmab, extraction or other dental treatment during Dmab, chemotherapy, hormone therapy, and antiangiogenic (AA) agents concurrent use.
RESULTS
On 780 patients included (median follow-up 17 months), 54% and 18% had, respectively, breast and prostate cancer. The mean number of Dmab administration was 12. Fifty-six patients developed MRONJ with a 24- and a 48-month crude cumulative incidence of 5.7% (95% Cl: 4.2%-7.8%) and 9.8% (95% CI: 7.6%-12.7%), respectively. Higher MRONJ incidence was significantly associated with middle aged group (>56 and ≤73), both at univariate and multivariate analysis (p = 0.029 and 0.0106). Dental treatments (Hazard Ratio [HR] = 3.67; p = 0.0001), dental extractions (HR = 23.40; p < 0.0001), and previous BP administration (HR = 2.62; p = 0.0024) were significantly associated with higher MRONJ incidence at multivariate Cox analysis. Although not statistically significant, MRONJ incidence was lower for patients receiving chemotherapy or hormone therapy and higher for those receiving AAs.
CONCLUSIONS
The results confirm a clinically relevant incidence of Dmab-induced MRONJ. Dental treatments, especially extraction, during and before Dmab, constitute a serious risk factor. The role of AA concurrent administration deserves further investigations.
Topics: Male; Middle Aged; Humans; Denosumab; Bone Density Conservation Agents; Bisphosphonate-Associated Osteonecrosis of the Jaw; Prevalence; Diphosphonates; Bone Neoplasms; Angiogenesis Inhibitors; Risk Factors; Hormones; Retrospective Studies
PubMed: 37559413
DOI: 10.1002/cam4.6429 -
The Journal of Pathology. Clinical... Nov 2023Sporadic giant cell granulomas (GCGs) of the jaws and cherubism-associated giant cell lesions share histopathological features and microscopic diagnosis alone can be...
Sporadic giant cell granulomas (GCGs) of the jaws and cherubism-associated giant cell lesions share histopathological features and microscopic diagnosis alone can be challenging. Additionally, GCG can morphologically closely resemble other giant cell-rich lesions, including non-ossifying fibroma (NOF), aneurysmal bone cyst (ABC), giant cell tumour of bone (GCTB), and chondroblastoma. The epigenetic basis of these giant cell-rich tumours is unclear and DNA methylation profiling has been shown to be clinically useful for the diagnosis of other tumour types. Therefore, we aimed to assess the DNA methylation profile of central and peripheral sporadic GCG and cherubism to test whether DNA methylation patterns can help to distinguish them. Additionally, we compared the DNA methylation profile of these lesions with those of other giant cell-rich mimics to investigate if the microscopic similarities extend to the epigenetic level. DNA methylation analysis was performed for central (n = 10) and peripheral (n = 10) GCG, cherubism (n = 6), NOF (n = 10), ABC (n = 16), GCTB (n = 9), and chondroblastoma (n = 10) using the Infinium Human Methylation EPIC Chip. Central and peripheral sporadic GCG and cherubism share a related DNA methylation pattern, with those of peripheral GCG and cherubism appearing slightly distinct, while central GCG shows overlap with both of the former. NOF, ABC, GCTB, and chondroblastoma, on the other hand, have distinct methylation patterns. The global and enhancer-associated CpG DNA methylation values showed a similar distribution pattern among central and peripheral GCG and cherubism, with cherubism showing the lowest and peripheral GCG having the highest median values. By contrast, promoter regions showed a different methylation distribution pattern, with cherubism showing the highest median values. In conclusion, DNA methylation profiling is currently not capable of clearly distinguishing sporadic and cherubism-associated giant cell lesions. Conversely, it could discriminate sporadic GCG of the jaws from their giant cell-rich mimics (NOF, ABC, GCTB, and chondroblastoma).
Topics: Humans; Cherubism; Granuloma, Giant Cell; Chondroblastoma; DNA Methylation; Giant Cells; Giant Cell Tumor of Bone; Bone Neoplasms; Jaw
PubMed: 37555357
DOI: 10.1002/cjp2.337 -
Archives of Iranian Medicine Nov 2022
Topics: Humans; Odontogenic Tumors; Immunohistochemistry; Carcinoma; Mandibular Neoplasms
PubMed: 37543901
DOI: 10.34172/aim.2022.119 -
European Archives of... Dec 2023To explore the feasibility of making a submental perforator flap distal to the connecting line between the mastoid and the sternoclavicular joint under the guidance of...
OBJECTIVES
To explore the feasibility of making a submental perforator flap distal to the connecting line between the mastoid and the sternoclavicular joint under the guidance of neck-enhanced CT and repairing the postoperative defect of upper airway malignancy.
MATERIALS AND METHODS
This study retrospectively analysed 19 cases of upper airway malignant tumours treated in our department from January 2021 to September 2022, including 17 males and 2 females, aged 43-70 years.
SITE OF LESIONS
15 cases were in the laryngopharynx, 2 cases in the nasal cavity and paranasal sinus and 2 cases on the soft palate. All the lesions were malignant and at stages TNM.
SURGICAL METHOD
The extended submental perforator flap (size 22-15 × 6-7 cm) was prefabricated distal to the connecting line between the mastoid and the sternoclavicular joint. After tumour resection, the flap was used to repair the postoperative defect. Fifteen cases of laryngopharyngeal malignant tumours were repaired using the extended submental perforator flap with the vascular pedicle located on the opposite side of the tumour body. Two cases of nasal cavity and paranasal sinus tumours were repaired using the extended submental perforator flap combined with the temporalis muscle flap. The soft palate was completely removed in two patients with soft palate cancer and repaired using the folded extended submental perforator flap.
RESULTS
Before the surgery, the reflux vein was observed by neck-enhanced CT, including 12 cases returning to the internal jugular vein and 7 cases to the external jugular vein. All 19 cases in which flaps were used survived, and 1 case had a postoperative infection. All the patients had nasal feeding removed after surgery. The tracheal cannula was removed from the patients with laryngeal preservation, and the pronunciation was satisfactory. Among them, patients with soft palate cancer repair had mild nasal reflux symptoms with smooth breathing. During the follow-up period of 4-24 months, 18 patients had no tumour recurrence or metastasis, and 1 patient had cervical lymph node metastasis.
CONCLUSIONS
This study highlights the use of a submental perforator flap distal to the connecting line between the mastoid and the sternoclavicular joint to repair postoperative defects for upper airway malignancy as an innovative surgical approach that provides more tissue and good arteriovenous blood supply to adjacent sites. This method has high clinical value and provides an effective option for repairing postoperative defects of upper airway malignancy.
Topics: Male; Female; Humans; Perforator Flap; Plastic Surgery Procedures; Skin Transplantation; Retrospective Studies; Neoplasm Recurrence, Local; Palatal Neoplasms; Treatment Outcome
PubMed: 37530858
DOI: 10.1007/s00405-023-08131-5 -
Medicine Jul 2023Multiple myeloma (MM) is a malignant disease characterized by abnormal proliferation of plasma cells, which usually occurs in middle-aged and elderly male patients....
RATIONALE
Multiple myeloma (MM) is a malignant disease characterized by abnormal proliferation of plasma cells, which usually occurs in middle-aged and elderly male patients. Bisphosphonates (BP) are commonly used for the treatment of MM bone disease. Long-time use of BP may cause medication-related osteonecrosis of the jaw (MRONJ). MRONJ occurs in jaw exclusively, and Multiple myeloma can also invade the jaw. The 2 diseases have similar clinical manifestations and imaging findings. This report present a case of MM identified in surgical specimen at the site that had been previously pathologically diagnosed as MRONJ in a patient with MM.
PATIENT CONCERNS
A 57-years-old male patient visited our clinic on October 16, 2020 because of gingival swelling and pain in the right mandible for 1 month after extraction of the lower right premolar. The patient had a long-time illness history of multiple myeloma, and received intravenous zoledronic acid treatment.
DIAGNOSES
Based on the clinical characteristics, imaging, and pathological findings of sequestrum formation and high inflammatory cell infiltration, the patient was diagnosed with MRONJ. After 1 year, a mandibular osteotomy was performed and pathological analysis showed the presence of necrotic bone and a large number of abnormal plasma cell infiltration, suggesting the presence of MM in the mandible.
INTERVENTIONS
The patient was treated with a series of conservative treatments including antibiotic treatment, saline irrigation and laser irradiation, as well as superficial sequestration was. One year later, a mandibular osteotomy was performed.
OUTCOMES
For the patient, the symptoms of gingival swelling, pain and discharge disappeared after surgery.
LESSONS
These findings suggested MRONJ and MM could occur simultaneously at same site, so patients with MM presenting with symptoms of MRONJ should be screened for concurrent or disease relapse of multiple myeloma to prevent misdiagnosis or inadequate management. Meanwhile, this also suggests long-term inflammatory may lead to invasion of multiple myeloma.
Topics: Humans; Male; Middle Aged; Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density Conservation Agents; Diphosphonates; Mandible; Multiple Myeloma; Neoplasm Recurrence, Local; Pain
PubMed: 37478232
DOI: 10.1097/MD.0000000000034260 -
Cureus Jul 2023Cemento-ossifying fibroma (COF) is a benign odontogenic neoplasm. It is considered an ossifying fibroma with traces of interspersed cementum fragments. Here we present...
Cemento-ossifying fibroma (COF) is a benign odontogenic neoplasm. It is considered an ossifying fibroma with traces of interspersed cementum fragments. Here we present a case report of the occurrence of COF in the maxillary anterior region of an elderly woman. A 61-year-old female reported with a painless, progressive, slow-growing swelling on the upper front jaw region for the past five years. A single, localized, swelling on the anterior region of the maxilla which was non-tender and bony hard in consistency. Radiological examination consisting of orthopantomagram (OPG) and cone-beam computed tomography (CBCT) revealed increased thickness of bone over frontal, parietal and maxilla with alteration of trabecular pattern - cotton wool/ground glass. Serum alkaline phosphatase level was found to be 865 U/l, however, serum calcium level and other routine blood investigations (hemogram) were within normal limits. The above radiological and laboratory findings are more in favour of primary bone pathology and with a biopsy later correlating with histopathological findings; it was diagnosed as COF. Under conscious sedation, surgical excision of the bony mass was done along with extraction of associated teeth. The patient is currently on regular follow-up and planning for a dental prosthesis is in progress.
PubMed: 37457603
DOI: 10.7759/cureus.41799