Page 38 - AAOMP Meeting 2019

POSTER ABSTRACTS - TUESDAY, JUNE 11, 2019

#27 AN ANALYSIS OF UTAH’S MOST COMMON ORAL LESIONS
Mr. Carter Bruett (University of Utah School of Dentistry), Dr. Bryan Trump (University of Utah School
of Dentistry)
Introduction: Data gathered from the inception of a new oral pathology biopsy database located at the
University of Utah (the only oral pathology service in Utah) was used to demonstrate the frequency of
submitted lesions and the resultant diagnoses. The main objective was to compare the biopsy data of Utah to
nationwide reported data. It could be used to guide clinical presumptive diagnoses.
Materials and Methods: The database was analyzed by cross-sectional comparison of 4,032 submitted
biopsies. These biopsies came largely from Utah, with surrounding states also contributing. Results were
compiled relative to age, ethnicity, gender, and biopsy location. Prevalence rates per 1000 were also
calculated to help guide clinical presumptions.
Results: Fibroma was the most common histopathological diagnosis, followed by hyperkeratosis and then
chronic apical periodontitis. Biopsies were most commonly taken from the maxillary alveolar ridge. The
contrast between females and males is minor. When compared by age, mucoceles dominate the first two
decades of life. This is followed by a rise in dentigerous cysts, which is then followed by a rise in periapical
granuloma and fibroma diagnoses. In the last two decades of life, hyperkeratosis, squamous cell carcinoma,
and ulcerations become most common.
Conclusions: This ebb and flow of pathology tells an interesting story and can be used to help set
expectations clinically. Certainly, the prevalence of cancer warrants a thorough head and neck exam that
should be conducted at every visit with a patient and, following appropriate clinical guidelines, biopsied for a
definitive histopathological diagnosis. Based on patient age, various atypical tissue types should be closely
monitored, and vigilance is of the utmost importance. Importantly, clinicians should submit for
histopathological analysis any excised tissue to a board certified oral and maxillofacial pathologist in order
to receive an accurate histopathologic diagnosis.

#28 ORAL SQUAMOUS CELL CARCINOMA IN FANCONI ANEMIA: REPORT OF FOUR
CASES
Mr. Grayson Cole (University of Minnesota School of Dentistry), Dr. John Wagner (University of
Minnesota Medical School), Dr. Margaret MacMillan (University of Minnesota Medical School), Ms.
Karla Olesen (University of Minnesota School of Dentistry), Dr.
Shanti Kaimal (University of Minnesota School of Dentistry), Dr. Rajaram Gopalakrishnan (University
of Minnesota School of Dentistry)
Introduction: Fanconi anemia (FA) is a rare predominantly autosomal recessive condition characterized by
progressive bone marrow failure, congenital anomalies, and increased risk of cancer. FA patients have
demonstrated a
>500 fold increase risk of developing head and neck cancers including oral squamous cell carcinoma
(OSCC). These rates increase in FA patients treated by allogeneic hematopoietic cell transplantation
(HCT). Risk factors include graft-versus-host disease (GVHD), a common complication that causes
immunodeficiency and tissue injury in the oral cavity. The incidence of cancer in such patients is estimated
to be >80% by age 50 years with few long-term survivors. The main objective of this study is to describe
the clinical presentation and histological characteristics of OSCC lesions in 4 cases that illustrate the
diagnostic challenges. Materials and Methods: Four FA patients who are seen regularly at the University of
Minnesota Medical Center and subsequently developed OSCC were selected. Clinical and histological
features of oral lesions were systematically documented over time. Results:Two males and 2 females with
FA successfully underwent a HCT for severe aplastic anemia (n=3) and advanced myelodysplastic
syndrome (n=1). OSCC diagnosis was made 1, 4, 13 and 14 years after transplant. In 3 of 4 cases, abnormal
lesions were monitored for a prolonged period of time before SCC was considered. SCCs were found in the
sublingual space (n=1), lateral tongue (n=2), and gingiva (n=1). Two had metastatic disease at diagnosis and
died rapidly. No patient had evidence of HPV and none had typical OSCC risk factors. Conclusions: FA
patients develop oral cancer at an extremely high rate and at a much younger age than non FA patients.
Lower threshold for biopsy and histological evaluation should be considered. Considering the high
incidence, chemoprevention strategies might be considered well before the development of dysplasia.