Pediatric Squamous Cell Carcinoma: Case Report and Literature Review

Resident: Roberts

Date: 12/22/10

Title: Pediatric Squamous Cell Carcinoma: Case Report and Literature Review

Author: Sidell, Douglas, et al

Journal: Laryngoscope

Year: 2009

volume: 119

pages: 1538 - 1541

Case report and Discussion:

A six year old male was referred to the University of California, Los Angeles head and neck clinic by oral surgery with a 2 month history of an enlarging oral lesion involving the anterior gingiva with extension to the hard palate. The lesion was initially noted by the patients dentist, who extracted a tooth near the mass. Persistence of the lesion after tooth extraction led to a consultation by oral surgery for biopsy. The biopsy results were initially interpreted as SCC. A follow up review was performed by a multidisciplinary team and a second review of the biopsy revealed an inconclusive result as to the diagnosis. A second deep tissue biopsy was obtained, This biopsy indicated invasive, well-differentiated, exophytic SCC with perineural and angiolymphatic invasion. An MRI and CT scan performed demonstrated a 2.7 x 3.0 cm poorly marginated infiltrative mass involving the gingival aspect of the superior alveolar ridge and the adjacent bony marrow, to the right of the midline. Evaluation of the neck revealed multiple small sub-centimeter lymph nodes. The patient denied dysphagia, pain, weight loss, bleeding or loosing of teeth.

There are several differences with regard to adult and pediatric SCC of the oral cavity that have been described. Unlike adults, there is no sexual predilection for children. It has also been described as being more aggressive and is thought to carry a worse prognosis than the adult version. Although exposures such as alcohol and tobacco are commonly suggested as possible links to the etiology, this is not the case in pediatrics. Some identified possible causes have been linked to some genetic conditions such as xeroderma pigmentosum, keratitis, icthyosis, and deafness syndrome. A condition called Fanconi anemia, an aplastic anemia is said to add a 50 fold increase to all cancers. Other predisposing factors include polyvinyl chloride(found in plastics), the Epstein Barr virus and the human papilloma virus.

In pediatric populations, SCC accounts for fewer than 2% of all head and neck malignancies. The most frequent location for it to be found is on the tongue or the lip. The diagnosis of SCC is based on a histological biopsy and the method of treatment is a wide local resection while attempting to avoid the significant impact of radiotherapy in the pediatric population. This case documents the youngest person to have been found with SCC.

Assessment: Good article, I hope to never have to tell some poor mom or dad that their child has this.