Zisis Vasileios, Andreadis Dimitrios, Iliadis Anastasios, Angelopoulos Christos, Poulopoulos Athanasios
Oral Medicine/Pathology, Aristotle University of Thessaloniki, Thessaloniki, GRC.
Oral and Maxillofacial Radiology, National and Kapodistrian University of Athens, Athens, GRC.
Cureus. 2023 Jul 28;15(7):e42619. doi: 10.7759/cureus.42619. eCollection 2023 Jul.
Oral squamous cell carcinoma (OSCC) may arise in the the alveolar ridge (in a minority of cases). Smoking, chronic mucosal injuries, and poor oral hygiene are involved in its pathogenesis. It mostly occurs to men instead of women and affects the mandible on a 3:2 ratio to the maxilla. The objective of the current study is to present an interesting case of an OSCC of the alveolar ridge mimicking jaw osteonecrosis due to denosumab, resulting in differential diagnostic dilemmas. A 78-year-old female patient, edentulous and bearing total dentures, was referred with a persistent (four months), severely painful, ulcerative lesion in the anterior lateral (right) region of the residual alveolar ridge of the mandible. Medical history referred to a long-term systemic steroid use due to sarcoidosis as well as the subcutaneous use of denosumab for osteoporosis one/month for one year. Cone-beam CT (CBCT) examination was performed where bone resorption was detected and a differential diagnosis of osteonecrosis of the jaws (ONJs) from denosumab or neoplasia was made. A biopsy was carried out, and the histological examination showed that soft tissues and underlying bone were infiltrated by abnormal, confluent, compact islands of malignant squamous cells with intense atypia and numerous mitoses indicating a moderately differentiated OSCC. Denosumab inhibits the binding of receptor activator of nuclear factor ligand (RANKL) to receptor activator of nuclear factor-kappa (RANK); this decreases bone resorption and results in increased bone density. However, denosumab may induce ONJ. The area of exposed bone and abnormal soft tissue alterations may resemble both benign and malignant diseases. Osteonecrosis may mimic OSCC or may even provide the suitable substrate for the development of OSCC. Biopsy as well as bone imaging examination are required to accurately determine the possibility of neoplastic formation and its boundaries in cases of osteonecrosis especially in patients under treatment with denosumab or bisphosphonate-related ONJ (BRONJ).
口腔鳞状细胞癌（OSCC）可能发生于牙槽嵴（少数病例）。吸烟、慢性黏膜损伤和口腔卫生不良参与其发病机制。其多见于男性而非女性，下颌骨与上颌骨受累比例为3:2。本研究的目的是呈现一例有趣的牙槽嵴OSCC病例，该病例因地诺单抗导致类似颌骨骨坏死，从而造成鉴别诊断困境。一名78岁女性患者，无牙且佩戴全口义齿，因下颌骨残余牙槽嵴前外侧（右侧）区域持续（4个月）、剧痛、溃疡性病变前来就诊。病史显示因结节病长期全身使用类固醇，以及因骨质疏松皮下使用地诺单抗1年，每月1次。进行了锥形束CT（CBCT）检查，检测到骨吸收，并对地诺单抗或肿瘤形成导致的颌骨骨坏死（ONJ）进行了鉴别诊断。进行了活检，组织学检查显示软组织和下方骨组织被异常、融合、紧密的恶性鳞状细胞岛浸润，细胞具有明显异型性和大量有丝分裂，提示为中分化OSCC。地诺单抗抑制核因子配体受体激活剂（RANKL）与核因子κB受体激活剂（RANK）的结合；这会减少骨吸收并导致骨密度增加。然而，地诺单抗可能诱发ONJ。暴露骨区域和异常软组织改变可能类似于良性和恶性疾病。骨坏死可能模仿OSCC，甚至可能为OSCC的发展提供合适的基质。在骨坏死病例中，尤其是在用 地诺单抗或双膦酸盐相关颌骨坏死（BRONJ）治疗的患者中，需要活检以及骨成像检查来准确确定肿瘤形成的可能性及其边界。
