Oral cavity
Squamous cell carcinoma
Gingiva

Author: Anshu Jain, M.D. (see Authors page)

Revised: 25 April 2018, last major update January 2014

Copyright: (c) 2004-2018, PathologyOutlines.com, Inc.

PubMed Search: Squamous cell carcinoma gingiva[TI]

Cite this page: Jain, A. Squamous cell carcinoma - gingiva. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/oralcavitysccgingiva.html. Accessed July 21st, 2018.
Definition / general
  • Frequently mimics reactive and inflammatory conditions affecting the periodontium (Wikipedia: Periodontium [Accessed 25 April 2018]), delaying diagnosis and impairing prognosis
  • Aggressive with high risk of metastases and subsequent death
  • Squamous cell carcinoma (SCC): malignant epithelial neoplasm exhibiting squamous differentiation characterized by formation of keratin or presence of intercellular bridges
  • SCC of gingiva is categorized under SCC of oral cavity
Epidemiology
  • Age: fourth - sixth decade
  • Gender: male > female
  • More common in Southeast Asia, especially India, compared to United States
Sites
  • Occurs in mandibular bicuspid and molar areas at free gingival margin or at alveolar ridge in edentulous patients
  • 70% at mandibular gingival buccal sulcus; 30% at maxillary gingival buccal sulcus
Pathophysiology
  • Most frequent premalignant lesions are leukoplakia, erythroplakia or both
  • Buccal space is a critical site for gingival cancer spread
Etiology
Diagrams / tables

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Extension pathways of lower gingival cancer

Clinical features
  • Often asymptomatic
  • Intraoral mass or swelling, ulceration, pain
  • Ill fitting dentures, mobility of teeth or unhealed extraction wounds
  • Careful examination and routine biopsy are crucial for accurate diagnosis
Grading
  • Grade 1: Well differentiated
  • Grade 2: Moderately differentiated
  • Grade 3: Poorly differentiated
  • Grade X: Cannot be assessed
Staging / staging classifications
  • Primary tumor:
    • TX: Cannot be assessed
    • T0: No evidence of primary tumor
    • Tis: Carcinoma in situ
    • T1: Tumor 2 cm or less in greatest dimension
    • T2: Tumor more than 2 cm but not more than 4 cm in greatest dimension
    • T3: Tumor more than 4 cm in greatest dimension
    • T4a: Moderately advanced local disease
      • Tumor invades adjacent structures (e.g. through cortical bone [mandible, maxilla], into deep [extrinsic] muscle of tongue [genioglossus, hyoglossus, palatoglossus and styloglossus], maxillary sinus, skin of face)
    • T4b: Very advanced local disease
      • Tumor invades masticator space, pterygoid plates or skull base or encases internal carotid artery
  • Regional lymph nodes:
    • NX: Cannot be assessed
    • N0: No regional lymph node metastasis
    • N1: Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension
    • N2a: Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension
    • N2b: Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension
    • N2c: Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
    • N3: Metastasis in a lymph node more than 6 cm in greatest dimension
    • Superior mediastinal lymph nodes are considered regional lymph nodes (level VII)
    • Midline nodes are considered ipsilateral nodes
  • Distant metastasis:
    • M0: No distant metastasis
    • M1: Distant metastasis
Radiology description
  • Resorption of adjacent bone has "moth eaten" appearance on radiographs
  • CT and MR imaging are most helpful to monitor cancer extension (AJNR Am J Neuroradiol 2002;23:468)
Radiology images

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Lower gingival cancer

Gingival cancer of left molar region

Upper gingival cancer

Orthopantomogram

Intraoral periapical radiograph

Prognostic factors
  • Tumor size, extent, histological differentiation, neck node status, margins and involvement of underlying bone are important in surgical prognosis and survival rate
Case reports
Treatment
  • Surgical resection is primary treatment
  • Radiotherapy and chemotherapy may be used adjunctively and for palliative purposes
Clinical images

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Postbiopsy

Preoperative view

Clinical presentation of the lesion

Keratotic lesion of marginal gingiva

SCC of lower gingiva

Gross description
  • May be exophytic (verrucous or papillary), endophytic, ulcerated
Gross images

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SCC of gingiva (dog)

Microscopic (histologic) description
  • Usually well differentiated, often invades bone
  • Metastases to submandibular lymph nodes, often less well differentiated
Microscopic (histologic) images

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Keratin peals, pleomorphism

Positive stains
Negative stains