8348  Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No.

Oral Squamous Cell Carcinoma: A Clinical Case Report

Basanta Kumar Choudhury1, Saswati Priyadarsini2, Sandeep Mohanty3, Shayeri Niyogi4, Pinali Das5
1
Assistant Professor, 2Post Graduate Trainee, Department of Oral Medicine & Radiology, Institute of Dental
Sciences, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India, 3Senior Lecturer,
Hitech Dental College & Hospital, Bhubaneswar, Odisha, India, 4Former Post Graduate Trainee, Department
of Oral Medicine & Radiology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan (Deemed to be University),
Bhubaneswar, Odisha, India, 5Senior Resident, SCB Dental College & Hospital, Cuttack Odisha, India

Abstract
The most common carcinoma affecting the oral mucosa is oral squamous cell carcinoma, with prevalence
seen in the age groups above 50 years in males and with rare occurrence below 30 years. Studies reveal
approximately 30-40 % of deaths in oral squamous cell carcinoma occur due to various tissue abuse habits.
The present case definesa classic incident of oral squamous cell carcinoma concerning the alveolo-buccal
sulcus in a male having 50 years of age.

Keywords:  Alveolobuccal Sulcus, Oral Squamous Cell Carcinoma, Mandible.

Introduction inadequate fresh fruits and vegetables was reported in

OSCC patients.(4)
One of the potential scarring and incapacitating
disorder which harms the physical stature and mental Since, the oral mucosa is more approachable to
health of patients is Oral Squamous cell carcinoma the comprehensive investigation; early perception of
(OSCC).(1) It is the most familiar malignant mucosal potentially malignant and cancerous lesions can be
neoplasm of head and neck accounting for over 90% of easily marked. But sometimes due to unawareness
all malignant neoplasm.(2) The frequency and mortality or unapproachability of therapeutic facilities, the
rates of OSCC arise with the age of the patient and males carcinoma gets diagnosed in the advanced stages.
are affected more than females.(1) It typically affects the Thus, an enhancement in primary recognition of oral
older age groups throughout the fifth-eighth span of life carcinoma should be adopted, by adopting the chairside
with less occurrence reported in the younger age groups diagnostic procedures like toluidine blue, brush biopsy,
below 40 years.(3) The maximum prevalent threat for the etc.(5) In the current paper, we represent a case of a small
occurrence of oral SCC is due to the habit of tobacco swelling which grew to a larger size after 2 months.
or betel intake, ingestion of intoxicating drinks, and
contamination with human papilloma virus (HPV) Case Report: A male patient of age 50 years came
having high-risk factors. Also a nutrition comprising of with a history of pain in the left side mandibular back
tooth region for 8 days. The patient had tuberculosis and
is under medication for 2 months and he has undergone
extraction in the left side mandible before 12 years. The
patient had a habit of pan and khaini chewing 10-15/day
Corresponding Author: for 20 years and has left the habit since 4-5 years. Extra-
Saswati Priyadarsini orally there was presence of a single, submandibular
Post Graduate Trainee, Department of Oral Medicine lymph node measuring approximately 1x1cm in
& Radiology, Institute of Dental Sciences, Siksha ‘O’ size, non-tender and mobile on palpation. Intraoral
Anusandhan (Deemed to be University), Bhubaneswar, examination showed localized growth present in the
Odisha, India left lower edentulous region on the alveolar ridge with
e-mail: mishrasaswati5@gmail.com relation to 36, measuring 1x0.5 cm approximately having
 Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4  8349
irregular borders. On palpation, the tumor was soft in was firm in consistency and tender with no secondary
consistency, non-pedunculated, tender on palpation changes or symptoms associated with it. Skin over the
which bleeds on probing with slight obliteration of swelling was warm to touch and was non-pinchable.
gingivo-buccal sulcus.(Figure-1.1) (Figure-2.1)

Hence a provisional diagnosis of gingival epulis Left submandibular lymph node measuring 1x1 cm
was given along with differential finding of pyogenic was palpable which is tender on palpation and fixed to
granuloma and peripheral giant cell granuloma, but the underlying structures. A single, ulcero-proliferative
patient didn’t reported to the department, had not taken growth present in the left gingivo-buccal sulcus with
any medications, or performed any investigations relation to 34 35 36 37 region, measuring 3x2 cm in size
advised. After approximately 2 months,the patient having irregular margins and erythematous in appearance
again reported to the hospital with the same complaint with no secondary changes present. On palpation,
(as he had previously) of pain along with swelling in growth was firm to touch, having indurated margins
the mandibular left side back tooth region. Extra-orally and remained tender on palpation with obliteration of
swelling present in the left lower 1/3rd of face measuring gingivo-buccal sulcus with relation to 34-37 regions.
2x2 cm in size approximately of normal skin color, (Figure-2.2)
appears shiny and stretched. On palpation swelling

Figure 1. 1. Extra-oral view of patient; 1.2-Intra-ora view showing a localized growth

Figure 2.1. Extra-oral view of patient after 2 months; Figure 2.2. Clinical view of ulcerative growth which
increased in size in the gingiva-buccal sulcus.
8350  Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4
The patient was further advised to do radiographic Panoramic radiograph reveals a localized, ill-
investigations. An intraoral periapical radiograph and defined radiolucency involving the left side body of
panoramic radiograph was done.Intraoral periapical mandible, measuring 3x2 cm in sizewith loss of buccal
radiograph reveals a single diffused radiolucency with cortical plate and intact lingual cortical plate.Missing
relation to 34 35 36 measuring 1x2 cm in size. There tooth present i.r.t 36 with mesially tilted 37.(Figure-3.2)
is vertical and inter-radicular bone loss,with widened
pdl space i.r.t 35 36, and loss of lamina dura i.r.t
34.(Figure-3.1)

Figure 3.1-Inra-oral periapical radiograph; Figure 3.2- Panoramic radiograph

the presence of dysplastic cells. Further incisional

biopsy of the lesion was done under local anesthesia
and was submitted for histopathological examination.
Histopathology revealed hyperplastic proliferated para
keratinized stratified squamous epithelium invading
into the underlying moderately dense fibro collagenous
stroma as strands and cords.(Figure-04)

The definite diagnosis was moderately differentiated

SCC patient was further sent for complete excision of
the lesion to the department of oral surgery.

Discussion
This case report described an unusual case of oral
SCC of alveolo-buccal sulcus of a 50-year-old male
Figure 4. Histopathological slide showing para- patient who has previously reported with a small growth
keratinized stratified squamous epithelium, which gradually increased in size over 2 months. World
withtumorislands, nests and cords along with Health Organization(WHO) described carcinoma of the
diffusely arranged chronic inflammatory cells. oral cavity as the 6th most commonest cancer in males in
Correlating the clinical features, radiographic developing countries, the first being lung, followed by
findings a provisional diagnosis of Malignant ulcer- prostate cancer and involvement of carcinoma of other
proliferative with clinical staging of tumor T1N1M0 organs, while studies revealed that in women, it is the
was presented. A chairside investigation was carried 10thusualspot for cancer, the first being breast cancer,
out by applying toluidine blue staining which showed followed by colorectal cancer and carcinoma of the
stomach.(6)
 Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4  8351
Risk factor associated are tobacco (smokeless Ethical Issues: Approved
and smoking), alcohol, betel quid, agents containing
phenols, emission of radiation, lack of iron and Vitamin Funding: None
A in diet, syphilis, environmental and occupational
factors, oncogenic viruses (HPV and EBV), Candidial
References
infection, genetic predisposition, immunosuppression(2). 1. Asio J, Kamulegeya A, Banura C. Survival
It has been reported that tobacco and alcohol intakeis and associated factors among patients with oral
not only prime risk factors for oral carcinoma but also squamous cell carcinoma (OSCC) in Mulago
hasrobust effects on the morbid­ity, mortality, recurrence hospital, Kampala, Uganda. Cancers Head Neck.
and second primary tumor in patients.(3) 2018;3:9.
2. Nishant R. et al,Oral Squamous Cell Carcinoma
A plethora of clinical forms of Oral SCC have
Variants - A Clinico-Pathologic Relevance, IOSR
been reviewed. It may be in the form of leukoplakia,
Journal of Dental and Medical Sciences,2018;
leukoplakia with verrucous growth, an erythroplakia,(7)
17(5): 25-30
some of them may exaggerate in the future into a
necrotic type of ulcer comprising of indurated edges. It 3. Kayal L, Jayachandran S, Bhaskar YB. Squamous
may perhaps give rise to a comprehensive mass having cell carcinoma of tongue – a case report and review
papillary projections with irregular superficialtexture.(4) of literature, Int J Cur Res Rev,2016; 8(9): 64-67.
There is the presence of bleeding in oral SCCin case 4. Feller L, Lemmer J Oral Squamous Cell
of trauma with pain after they become superficially Carcinoma: Epidemiology, Clinical Presentation
secondarily infected whereas otherwise oral SCC is and Treatment,Journal of Cancer Therapy, 2012; 3:
usually painless in nature(4). 263-268
5. Wong HM. Oral Complications and Management
The sites with the most frequent occurrence of OSCC
Strategies for Patients Undergoing Cancer Therapy.
are the inner side of the tongue along with the floor of
Scientific World J 2014;581795.
the mouth due to the presence of thin non-keratinized
epithelium. The oral sites with less frequent occurrence 6. Mehrotra R, Yadav S. Oral squamous cell
are the gingivae, palatal mucosa, retromolar region along carcinoma: Etiology, pathogenesis and prognostic
with the buccal and labial surface of the oral cavity.(4) value of genomic alterations. Indian J Cancer
Patients who have a positive histopathologic report for 2006;43:60-6
oral squamous cell carcinoma should undergo contrast- 7. Nicolás B et al, Oral Squamous Cell Carcinoma
enhanced computed tomography of the head and neck Clinical Aspects, Oral Cancer. 2016
to help in the physiological examination to know 8. Falaki F, Delavarian Z, Pakfetrat A, Mohtasham N,
the extent of tumor and involvement of lymph node. Shirazian S. Oral Squamous cell carcinoma with an
Magnetic resonance imaging should be indicated in case unusual clinical manifestation: a case report. Cases
of involvement of soft tissues especially in the tongue.(9) J. 2009;2:6608.
Surgery is considered the first line of treatment. Always
9. Kimple AJ, Welch CM, Zevallos JP, Patel SN. Oral
a multidisciplinary approach should be made including
cavity squamous cell carcinoma--an overview. Oral
chemotherapy, radiotherapy or surgery or a combination
Health Dent Manag. 2014;13(3):877–882.
of all of these for the better prognosis of Oral SCC.(9)

Conflict of Interests: The authors declare they have

no conflicts of interest.