RETROMOLAR TRIGONE SQUAMOUS CELL CARCINOMA: CASE REPORT

Öz

Squamous cell carcinoma accounts for more than 90 % of malignant tumours of the oral cavity. It is most likely to appear in males over the age of 40. Smoking, alcohol consumption, chronic irritation and poor oral hygiene are identified as the most common etiological factors. The first clinical sign is asymptomatic ulceration. The most frequent involved sites are tongue, followed by mouth floor, alveolar ridge, and hard palate. Retromolar trigone region involvement is rare. Retromolar trigoneis a region that triangulary shaped of which base of the trigone extends from distal surface of the last molar tooth to the posterior mandibular alveolus and the apex of trigone is maxillary alveoler tuberosity. The lateral border of this triangle is coronoid process, medial border is limited to the anterior tonsillar pillars. The carcinomas of this region are invaded to the mandibular periosteum because in retromolar trigone, mucous membrane is firmly connected to the ramus of mandible. In this case report; the clinical, radiological and pathological findings are presented of a 75-yearsold male patient that is diagnosed with squamous cell carcinoma which is widely involved and started with painless swelling in the retromolar trigone

Anahtar Kelimeler

• Squamous Cell Carcinoma,Retromolar Trigone,Oral Cavity,Computed Tomography,Panoramic Radiography

RETROMOLAR TRİGON SKUAMÖZ HÜCRELİ KARSİNOM:

Öz

Skuamöz hücreli karsinom oral kavitede görülen malign tümörlerin % 90’ından fazlasını oluşturmaktadır. Sıklıkla 40 yaş üzerindeki erkeklerde görülür. Tütün, alkol kullanımı, kötü ağız hijyeni ve kronik irritasyon en önemli etyolojik faktörlerdendir. Klinik olarak ilk bulgu ağrısız ülserlerin varlığıdır. En sık tutulum bölgeleri; dil, ağız tabanı, alveolar ark ve sert damaktır. Retromolar trigon bölgesinde ise tutulum nadirdir. Retromolar trigon; üçgen şeklinde, tabanı son molar dişin distal yüzeyinden posterior mandibular alveolusa kadar uzanan ve apeksi tüber maksillada olan bir bölgedir. Lateral sınırı koronoid proses, medial sınırı ise anterior tonsiller plikalardır. Mukoza ile mandibular ramus arasındaki sıkı bağlantıdan dolayı bu bölge karsinomları periosta sıklıkla invaze olur.

Bu olgu sunumunda; retromolar trigon bölgesinde ağrısız şişlik şeklinde başlayan, çok geniş tutulum gösteren skuamöz hücreli karsinom tanısı konulan 75 yaşındaki erkek hastanın klinik, radyolojik ve patolojik bulguları sunulmaktadır.

Anahtar Kelimeler

• Skuamöz Hücreli Karsinom,Retromolar Trigon,Oral Kavite,Bilgisayarlı Tomografi,Panoramik Radyografi

Kaynakça

1. Warnakulasuriya S. Global Epidemiology of Oral and Oropharyngeal Cancer. Oral Oncol 2009;45:309-16. 2. Werning JW. Oral Cancer: Diagnosis, Management, Andrehabilitation. 1st Ed. New York: Thieme Medical Publishers 2007.
2. Başerer N. Oral Kavite Kanserleri In: Engin K, Erişen L (Eds). Baş-Boyun Kanserleri 1. Baskı Nobel Matbaacılık, İstanbul, 2003;237-70.
3. Cawson Ra, Odell Ew, Porter S. Cawson’s Essentials Of Oral Pathology and Oral Medici-Ne. 7. Ed. Churchill Livingstone, Edinburgh 2002;230-54.
4. Epstein Jb. Oral Cancerın: Greennberg Ms, Glick M. (Eds) Burket’s Oral Medicine Diagnosis and Treatment 10th Ed. Bc Deckerınc, Ontario 2003;194-234.
5. Falaki F, Dalirsani Z, Pakfetrat A, Falaki A, Saghravanian N, Nosratzehi T, Pazouki M. Clinical And Histopathological Analysis of Oral Squamous Cell Carcinoma of Young Patients in Mashhad, Iran: A Retrospective Study and Review of Literature. Med Oral Patol Oral Cirbucal 2011;16:473-7.
6. Bilgel N. Baş-Boyun Kanserlerinin Epidemiyo- Lojisiın: Engin K, Erişen L (Eds). Baş-Boyun Kanserler 1.Baskı Nobel Matbaacılık, İstanbul 2003;33-6.
7. Wogan Gn, Hecht Ss, Felton Js, Conney Ah, Loeb Al. Enviromental and Chemical Carcinogenesis. Seminars in Cancer Biology 2004; 14:473-86.
8. Öztürk B, Coşkun U, Yaman E, Kaya Ao, Yildiz R, Benekli M, Büyükberber S. Oral Kavite Kanserlerinde Lezyonlar ve Kemoprevensiyon. UHOD 2009; 19:117- 26. Faktörleri, Premalign

9. Scully C, Hegarty A: The Oral Cavity and Lips. Rook’s Textbook of Dermatology. Eds. Burns T, Breathnach S, Cox N, Griffiths C. 8. Baskı. Massachusetts, Blackwell Publishing 2010; 69.1- 69.129.
10. Demireller A, Serin M, Erkel HŞ, Manavoğlu O, Kurt E. Tedavi Prensipleri In: Engin K, Erişen L (Eds). Baş-Boyun Kanserleri 1. Baskı Nobel Matbaacılık, İstanbul 2003;121-42.
11. World Cancer Report. Lyon, France: International Agency for Research on Cancer 2003.
12. Oyan B, Aksoy S, Yavas O, Kars A, Turker A, Barista I. Thymicmalignancy in a Breast Cancer Patient: Is There an Association with Anti- Estrogenic Effects of Tamoxifen. Actaoncologica 2004;43:115-6.
13. Bulut E, Yılmaz F, Bekçioğlu B, Günhan Ö. Posterior Alveoler Krette Dişeti Yerleşimli Skuamoz Hücreli Karsinoma: Olgu Sunumu. Atatürk Üniv Diş Hek Fak Derg 2013;23:239-43.
14. Mc Dowell JD. An overview of epidemiyology and comman risk factors for squamous cell carcinoma. Otolaryngol Clin North Am 2006; 39:277-94.
15. Bayman NA, Sykes AJ, Bonington S, Blackburn T, Patel M, Swindell R, Slevin NJ. Primary Radiotherapy for Carcinoma of the Retromolar Trigone: A Useful Alternative to Surgery. Clinoncol R Collradiol 2010; 22:119-24.
16. Ayad T, Gélinas M, Guertin L, Larochelle D, Del Vecchio P, Tabet JC, Olivier MJ, Soulièresd, Charpentier D, Nguyen-Tân PF. Retromolar Trigone Carcinoma Treated by Primary Radiation Therapy: An Alternative to the Primary Surgical Approach. Arch Otolaryngol Head Neck Surg 2005;131:576-82.
17. Genden EM, Ferlito A, Shaha AR, Et Al. Management of Cancer of the Retromolar Trigone. Oral Oncol 2003;39:633–7.
18. Blanchaert RH Jr. Contemporary Principles of Surgical Reconstruction of the Oral Cavity. In: Ord RA, Blanchaert RH: (Eds).Oral Cancer the Dentist’s Role in Diagnosis, Management, Rehabilitation, Quintessence 2000;93-109. Prevention. 1th Chicago, Coınc,
19. Epstein JB, Zhangli. Rosin M. Advances in the Diagnosis of Oral Premalignant and Malignant Lesions. J Can Dentassoc, 2002;68:17-21.
20. Lim YC, Kim JW, Koh YW, Kim K, Kim HJ, Kim KM,Choi Lymphnode Metastasis in Squamous Cell Carcinoma of the Tongue and Flor of the Mouth. Eur J Cancersurg 2004;30:692-8.