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Mandibular Carcinoma Cuniculatum around the Dental Implant in a Patient with Concurrent Management for Pemphigus Vulgaris: A Case Report

Authors :
Chika Murai
Ken-ichiro Sakata
Chisato Ouchi
Masanao Sonobe
Kazuhito Yoshikawa
Jun Sato
Akira Satoh
Aya Matsuda
Yoshimasa Kitagawa
Source :
Oral, Vol 2, Iss 1, Pp 49-61 (2022)
Publication Year :
2022
Publisher :
MDPI AG, 2022.

Abstract

Background: Carcinoma cuniculatum (CC) is a rare subtype of squamous cell carcinoma that is difficult to diagnose owing to the lack of cellar atypia and/or associated oral epithelial dysplasia. The prognosis is good given proper resection, but it often has a poor prognosis with recurrence. We present the case of a 78-year-old man who visited our department with an ulcer around the implant in tooth 35. With Nikolsky’s phenomenon in the gingiva, a detailed examination revealed pemphigus vulgaris. Steroid administration remarkably improved the oral symptoms but caused osteomyelitis and rapid bone destruction, leading to pathological fracture. After multiple biopsies, mandibular segment resection was performed with a diagnosis of mandibular osteomyelitis, and no malignant findings were found. Four months later, the wound reopened, a white keratinized lesion appeared, and a biopsy revealed CC. Unresectable tumor infiltration was already observed, but the patient died of aspiration pneumonia 15 months after diagnosis. Conclusions: It took 20 months to make a definitive diagnosis of CC in this case. Pemphigus vulgaris may have made the diagnosis particularly difficult. Since other CCs are often diagnosed with osteomyelitis or odontogenic keratocyst preoperatively, we recommend keeping in mind the possibility of CC in refractory cases.

Details

Language :
English
ISSN :
26736373
Volume :
2
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Oral
Publication Type :
Academic Journal
Accession number :
edsdoj.7842d5b65ae3419e8e6c1d166b42a1b1
Document Type :
article
Full Text :
https://doi.org/10.3390/oral2010007