Development of morphologically diverse benign neoplasms preceding metachronous oral squamous cell carcinoma: A rare case report

Abstract

Eighteen months after the resection and micro-vascular reconstruction of central ossifying fibroma of the right mandible in a 54-year-old male patient, there occur two synchronous neoplasms, basal cell adenoma (BSA) and oral squamous cell carcinoma (OSCC). Two years after reconstructive surgery, the patient reported a second primary OSCC on the left retromolar mucosa. This case reports two morphologically diverse benign neoplasms preceding metachronous OSCC in one individual. While field cancerization makes the entire mucosa susceptible to the development of multiple primary malignant neoplasms, this case would address the necessity to extrapolate further the fact that whether genetic instability in the head and neck area can make the individual susceptible to develop both benign and malignant neoplasms. This case report also generates the importance of follow-up in even a benign fibro-osseous head and neck neoplasm.

Keywords: Benign neoplasms; central ossifying fibroma; fibro-osseous neoplasm; metachronous oral squamous cell carcinoma.

Figure 1

Computerized tomography 3-D reconstruction showing expansile lesion with multiple areas of cortical perforation in right side mandible

Figure 2

Hematoxylin and eosin-stained section showing irregular bony trabeculae in the background of highly cellular fibro-collagenous stroma. (original magnification X 10)

Figure 3

Submandibular swelling of 6 × 6 cm in size with smooth and shiny overlying skin

Figure 4

Hematoxylin and eosin-stained section showing well differentiated tumor epithelial in the connective tissue stroma (original magnification X 10)

Figure 5

(a) Computerized tomography with 3D reconstructed view showed marked cortical bony erosion on the anterosuperior aspect of the free fibula. (b) Orthopantomogram showing mandibulized fibula with cortical erosion on anterosuperior aspect

Figure 6

Composite resected specimen of neo-mandible

Figure 7

Hematoxylin and eosin-stained section showing hyperchromatic cuboidal epithelial cells in strands and ducts with eosinophilic coagulum within ducts. (original magnification X 10)

Figure 8

Follow-up photograph at 6 months post-operatively

Figure 9

(a) Intra-oral photograph showing small ulceration on left retromolar region. (b) Follow-up orthopantomogram after 2 years of second surgery