Consalvo Francesca, De Simone Matteo, Scarpa Alfonso, Acerra Alfonso, Salzano Francesco Antonio, Fineschi Vittorio, Santurro Alessandro
Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy.
BrainLab s.r.l., Mercato San Severino, 84085 Salerno, Italy.
J Clin Med. 2024 Sep 2;13(17):5198. doi: 10.3390/jcm13175198.
Oropharyngeal squamous-cell carcinoma (OPSCC) poses significant challenges in diagnosis, treatment, and management and has important medico-legal and forensic implications. In particular, the management of OPSCC and its treatment-related complications can often be challenging. In cases with advanced OPSCC, a loco-regional extension of the tumor can contribute to the destruction of oral cavity tissues, while the radiotherapy treatment can induce profound changes in tissue morphology and structure. These changes, which resemble tumor neoplasms and endovascular effects, are related to a higher risk of fatal bleeding, as reported in the case study illustrated, in which a hemorrhage occurred from a lingual artery, originating from an ulcerative, necrotic, hemorrhagic lesion on the tongue. Bleeding complications in OPSCC and prolonged radiotherapy are associated with high mortality and require comprehensive management strategies to improve survival and quality of life. Autopsy investigations, contributing to the definition of post-mortem diagnosis, can provide valuable insights into the pathogenetic mechanisms underlying bleeding and guide therapeutic decisions and preventive measures. The integration of autopsy and histopathological investigation into clinical practice should be considered as a necessary support to optimize the management of complications in advanced OPSCC patients, emphasizing the importance of a patient-centered approach and continued research.
口咽鳞状细胞癌（OPSCC）在诊断、治疗和管理方面面临重大挑战，并且具有重要的医学法律和法医意义。特别是，OPSCC的管理及其治疗相关并发症往往具有挑战性。在晚期OPSCC病例中，肿瘤的局部区域扩展会导致口腔组织破坏，而放射治疗会引起组织形态和结构的深刻变化。如案例研究所示，这些类似于肿瘤性病变和血管内效应的变化与致命性出血的较高风险相关，其中一例舌动脉出血源自舌头上的溃疡性、坏死性、出血性病变。OPSCC中的出血并发症和长时间放疗与高死亡率相关，需要综合管理策略来提高生存率和生活质量。有助于死后诊断定义的尸检调查可以为出血的发病机制提供有价值的见解，并指导治疗决策和预防措施。应将尸检和组织病理学调查纳入临床实践，作为优化晚期OPSCC患者并发症管理的必要支持，强调以患者为中心的方法和持续研究的重要性。
