Pós Graduate Program in Dental Sciences, Federal University of Espírito Santo, Av. Marechal Campos, 1468 - Maruípe CEP 29, Vitoria (City), 040-090, Brazil.
Nacional Cancer Institute José Alencar Gomes da Siva-INCA, Rio de Janeiro (City), Brazil.
Oral Maxillofac Surg. 2024 Sep;28(3):1423-1429. doi: 10.1007/s10006-024-01264-9. Epub 2024 Jun 1.
We report a case of difficult-to-control mycosis fungoides (MF), where the role of the dental surgeon was crucial for the control and prognosis of the disease. A 62-year-old female patient diagnosed with MF had a previous record of red patches and small raised bumps on the face, along with a cancerous growth in the cervical and vulvar region. The patient was initially treated with methotrexate and local radiotherapy without resolution. Chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone was then started (CHOP protocol). The dental team of a reference hospital was consulted to evaluate swelling in the anterior region of the palate, which had been developing for two months, reporting discomfort when eating. The role of the dentistry team was fundamental in the differential diagnosis of oral lesions with dental infections, second neoplasia, or even a new site of disease manifestation, in addition to controlling mucosal changes resulting from chemotherapy. After ruling out dental infection, the dentistry team performed a lesion biopsy to confirm the diagnosis. The histopathological and immunohistochemical analysis showed atypical lymphoid infiltration of T cells (CD3+/CD4+/CD7-/CD8-), coexpression of CD25, and presence of CD30 cells, corresponding to the finding for MF. Identifying CD30 + allowed for a new chemotherapy protocol with brentuximab vedotin (BV) combined with gemcitabine. This protocol effectively controlled MF, which previous protocols had failed to do. The diagnosis by the dental team was essential for therapeutic change and improvement of the patient's clinical condition without the need for invasive medical procedures.
我们报告了一例难治性蕈样真菌病（MF）病例，其中牙医的作用对疾病的控制和预后至关重要。一名 62 岁女性患者被诊断患有 MF，此前面部有红斑和小丘疹，颈部和外阴有癌性生长。该患者最初接受甲氨蝶呤和局部放疗治疗，但未得到缓解。随后开始使用环磷酰胺、多柔比星、长春新碱和泼尼松（CHOP 方案）进行化疗。参考医院的牙科团队被咨询以评估在前庭区域出现的肿胀，该肿胀已经持续了两个月，并伴有进食时的不适感。牙科团队的作用对于口腔病变的鉴别诊断至关重要，包括与牙科感染、第二肿瘤或甚至疾病表现的新部位相关的病变，此外还需要控制化疗引起的黏膜变化。在排除牙科感染后，牙科团队进行了病变活检以确认诊断。组织病理学和免疫组织化学分析显示 T 细胞的非典型淋巴样浸润（CD3+/CD4+/CD7-/CD8-），共表达 CD25，并且存在 CD30 细胞，这与 MF 的发现相符。鉴定出 CD30+允许采用新的化疗方案，即结合博来霉素和吉西他滨的 Brentuximab vedotin（BV）。该方案有效地控制了 MF，而之前的方案未能做到这一点。牙科团队的诊断对于治疗改变和改善患者的临床状况至关重要，而无需进行侵入性医疗程序。
