Oral Surgery Oral Medicine Oral Pathology Oral Radiology最新文献

{"title":"Possible pemphigus vulgaris outbreak: case series","authors":"Kittiphoj Tikkhanarak,&nbsp;Wattawan Wongpattaraworakul,&nbsp;Emily Lanzel,&nbsp;Sherry Timmons,&nbsp;John Hellstein,&nbsp;Nidhi Handoo","doi":"10.1016/j.oooo.2025.04.068","DOIUrl":"10.1016/j.oooo.2025.04.068","url":null,"abstract":"<div><h3>Background</h3><div>Pemphigus vulgaris is an autoimmune disease that causes blisters on skin and/or the mucous membrane. It is the most common suprabasilar splitting disease in the oral cavity, with the oral cavity often showing the first signs of this condition. Though still a serious disease, pemphigus vulgaris can usually be treated with modern medical advances. In clinical practice, pemphigus vulgaris is most often seen in middle-aged female. We describe three cases of pemphigus vulgaris in male patients.</div></div><div><h3>Case description</h3><div>25-year-old, 30-year-old, and 50-year-old healthy male patients presented with multifocal painful erosions and ulcerations in the oral cavity. The second and third patients also had blisters and ulcers on their skin. The lesions appeared a few weeks following the injection of the COVID-19 vaccine. Biopsies were performed from either the oral lesions or skin lesions. All specimens displayed suprabasilar epithelial separation with acantholysis. Further investigation with direct immunofluorescence testing, and anti-desmoglein ELISA were conducted. These tests confirmed the diagnosis of pemphigus vulgaris. The treatment included topical steroids, systemic steroids, and Rituximab (anti-CD20 monoclonal antibody, IV).</div></div><div><h3>Conclusion</h3><div>There may be a rise in immune-mediated diseases in previously healthy patients of atypical age and gender demographics. If pemphigus vulgaris is diagnosed, further clinical history to include asking about COVID-19 infection/vaccination may be of interest to further evaluate any possible connection.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"140 3","pages":"Pages e88-e89"},"PeriodicalIF":2.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nirmatrelvir/ritonavir-induced oral lichenoid mucositis: a case report","authors":"Aubryana Payne,&nbsp;Andres Flores-Hidalgo","doi":"10.1016/j.oooo.2025.04.059","DOIUrl":"10.1016/j.oooo.2025.04.059","url":null,"abstract":"<div><h3>Introduction</h3><div>Lichenoid Mucositis (LM) is a chronic T-cell immune-mediation disorder often characterized by the presence of inflammatory infiltrates present in the subepithelial mucosa. The exact etiology of LM remains unknown, however, medications, local irritants, autoimmunity, and others have been linked to the clinical presentation of LM.</div></div><div><h3>Case Presentation</h3><div>74-year-old female presented to the ECU School of Dental Medicine with a 6 cm x 2 cm flat erythroleukoplakia and focally ulcerated lesion on the right buccal mucosa and the right lateral border of the tongue. No other ulceration was present in the oral cavity at the examination time. The patient reported the presence of a “nodule” on the right buccal mucosa after the administration of Paxlovid for the treatment of a COVID-19 infection. The patient reported the lesion as mildly irritant. Medical history was significant for Type II DM, HTN, and a heart murmur. Other intraoral finding included chronic active periodontitis. An incisional biopsy confirmed the lesion as an inflammatory subepithelial disorder consistent with lichenoid mucositis.</div></div><div><h3>Discussion and Conclusion</h3><div>The clinical presentation and findings of this case show strong correlation to case reports of oral lichenoid mucositis following COVID-19 treatment. Literature suggests that the onset of the lesion is multifactorial, however, there are no reports of direct causation between oral lichenoid mucositis and the administration of Paxlovid. The case report highlights the need for better insight into oral manifestations following COVID-19 infection and treatment.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"140 3","pages":"Pages e85-e86"},"PeriodicalIF":2.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Follicular lymphoma of the maxilla as initial site of presentation","authors":"Dennis Shem,&nbsp;David Koslovsky,&nbsp;Elizabeth Philipone","doi":"10.1016/j.oooo.2025.04.043","DOIUrl":"10.1016/j.oooo.2025.04.043","url":null,"abstract":"<div><div>Follicular lymphomas represent one of the more common B-cell lymphomas, typically involving the lymph nodes. Extranodal presentation is uncommon with intraoral sites rarely involved. We present the case of a 55-year-old female who presented for evaluation of multiple periapical radiolucencies of the maxillary dentition. These teeth had all tested vital previously. She reported a long history of left-sided nasal congestion refractory to antibiotics and steroids but was otherwise healthy. She did not report any constitutional symptoms. On examination, diffuse gingival erythema and edema of the maxilla was noted in addition to the multiple periapical radiolucencies. A biopsy of the maxillary gingiva and vestibule revealed involvement by a CD10+ B-cell lymphoma, favored to represent follicular lymphoma. Treatment is pending medical workup of other potential sites of disease.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"140 3","pages":"Pages e80-e81"},"PeriodicalIF":2.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ewing sarcoma of the head and neck: a histopathologic report of 3 cases","authors":"Min Kyeong Kim,&nbsp;Sook-Bin Woo","doi":"10.1016/j.oooo.2025.04.050","DOIUrl":"10.1016/j.oooo.2025.04.050","url":null,"abstract":"<div><div>Ewing sarcoma is a highly aggressive malignancy of bone and soft tissues that primarily affects the long bones of children and young adults. Approximately 85% of Ewing sarcomas harbor the chromosomal translocation t(11;22), which produces the characteristic oncogenic fusion gene <em>EWSR1</em>::<em>FLI1</em>. Although head and neck Ewing sarcomas (HNESs) are rare and only few extraskeletal cases have been reported, these still present with the usual molecular, microscopic, and immunophenotypic features. This paper reports 3 cases of HNESs in the maxilla of a 71-year-old male, mandible of an 18-year-old female, and floor of the mouth of a 32-year-old male. Microscopically, the tumors consist of a monomorphic population of small round blue cells with indistinct cell borders, scant amounts of pale cytoplasm, and round to ovoid vesicular nuclei with finely dispersed chromatin. Immunohistochemistry reveals diffuse and strong membranous CD99 reactivity and nuclear positivity for NKX2.2 in the tumor cells. There have been 183 reported cases of HNESs, with the mean age at diagnosis of 25 years. The most commonly affected sites are bones of the skull and face (including maxilla) (40%), soft tissues (30%), and mandible (9%). HNESs are uncommon, especially in nonpediatric population but should be considered in the differential diagnosis for tumors composed of undifferentiated small round blue cells. Other tumors that share similar histology include rhabdomyosarcomas, lymphomas, neuroendocrine tumors, primary and metastatic, and BCOR- and CIC-rearranged sarcomas to name a few. Immunohistochemistry with CD99 and NKX2.2 and molecular studies help to differentiate between such tumors.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"140 3","pages":"Page e82"},"PeriodicalIF":2.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoral salivary lymphoepithelial carcinoma: clinicopathologic and immunophenotypic characterization of 3 examples indicates consistently elevated PD-L1 expression","authors":"Prokopios P. Argyris ,&nbsp;Carter Lukenda ,&nbsp;Emilian V. Racila ,&nbsp;James Midtling ,&nbsp;Mansur Ahmad ,&nbsp;Rajaram Gopalakrishnan ,&nbsp;Paul Freedman ,&nbsp;Ioannis Koutlas","doi":"10.1016/j.oooo.2025.04.054","DOIUrl":"10.1016/j.oooo.2025.04.054","url":null,"abstract":"<div><h3>Introduction</h3><div>Head/neck lymphoepithelial carcinoma (LEC) represents a morphologically undifferentiated carcinoma with associated, nonneoplastic, lymphoplasmacytic infiltration. LEC chiefly arises in the nasopharynx and major salivary glands (MSGs), primarily the parotid. Although there is approximately 80% 5-year survival rate, aggressive surgical resection may cause debilitating morbidity. Overexpression of the targetable immunotherapy marker PD-L1 was recently reported in MSG LEC and pulmonary lymphoepithelioma-like carcinoma. PD-L1 expression in intraoral salivary LEC (ISLEC) is vastly understudied.</div></div><div><h3>Materials and Methods</h3><div>Three examples of ISLEC diagnosed between 1985 and 2022 were retrieved from the archives of two oral and maxillofacial pathology laboratories. The specimens were immunohistochemically studied with antibodies against AE1/AE3, CK7, CD3, CD20, p16, p53, Ki67, and PD-L1 (SP263). EBER in situ hybridization (ISH) was also performed.</div></div><div><h3>Results</h3><div>All three cases affected men (age range = 42-84 years; median = 61 years), and involved the floor of mouth, soft palate/uvula, and tongue. Microscopically, the lesions were unencapsulated and showed diffuse infiltration by nonkeratinizing sheets and islands of undifferentiated carcinoma cells with associated dense lymphoplasmacytic inflammation. The overlying mucosal epithelium was unremarkable. By immunohistochemistry, all three tumors showed strong and diffuse AE1/AE3 positivity and selective p53 staining. CK7 and p16 were negative. Ki67 highlighted 20%-80% of lesional cells. The lymphocytic inflammatory infiltrate comprised of a mixed population of T and B lymphocytes. EBER ISH was positive in one case. Notably, all tumors displayed membranous, focal-to-diffuse, PD-L1 staining with tumor proportion score (TPS) &gt; 95% in two and 40%-50% in the third case, and combined positive score (CPS) &gt; 20.</div></div><div><h3>Conclusions</h3><div>ISLECs are rare. Overall, PD-L1 appears to be highly expressed in ISLEC, thus rendering such patients potential candidates for targeted α-PD-1/PD-L1 immunotherapy.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"140 3","pages":"Pages e83-e84"},"PeriodicalIF":2.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathological analysis of odontogenic keratocysts with dysplasia","authors":"Julia Yu Fong Chang ,&nbsp;Yi-Ping Wang ,&nbsp;Pei-Hsuan Lu","doi":"10.1016/j.oooo.2025.04.036","DOIUrl":"10.1016/j.oooo.2025.04.036","url":null,"abstract":"<div><h3>Introduction</h3><div>Odontogenic keratocyst (OKC) with dysplasia is one of the precursor lesions of primary intraosseous carcinoma (PIOC). The aim of this study is to perform clinicopathological analysis of OKC with dysplasia. Be cautious with the clinicopathologic features of OKC with dysplasia and close follow-up might be helpful for early detection and improvement of the prognosis of PIOC.</div></div><div><h3>Materials and Methods</h3><div>This retrospective study included 6 cases. Patients’ age, gender, lesion location, symptoms, radiographic and microscopic findings were reviewed and analyzed.</div></div><div><h3>Results</h3><div>This study included 4 male and 2 female patients of mean age 51 (range 16-81) years. Lesions were slightly more common on the maxilla than the mandible, esp. posterior maxilla. The most common chief complaint was pain and swelling. Two-third of the cases showed an unilocular radiolucency with cortical bone perforation and were associated with impacted tooth. Root resorption was seen in 3 cases while tooth displacement was present in one case. In addition to the classic OKC histopathologic features, budding of the epithelium, basal cell hyperplasia and crowding, increased number and upward located mitotic figures, high columnar palisaded basal cells with frequent reverse polarity, and occasional basal vacuolation were also noted. Heavy inflammation was also frequently present in focal areas.</div></div><div><h3>Conclusions</h3><div>The dysplastic changes in OKC were infrequently concomitant occurred within classic OKC. Therefore, be familiar with the clinicopathologic features of high-risk cases, and careful examination are required for accurate diagnosis.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"140 3","pages":"Pages e78-e79"},"PeriodicalIF":2.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Poorly differentiated spindle cell carcinoma with rhabdomyoblastic differentiation: highlights on immunohistochemistry interpretation","authors":"Rania Younis ,&nbsp;Shahd Alajaji ,&nbsp;Brian Moore ,&nbsp;Joshua Lubek ,&nbsp;Amy Plotkin ,&nbsp;Williams Twaddell ,&nbsp;Jason Molitoris ,&nbsp;John Papadimitriou ,&nbsp;John R. Basile ,&nbsp;Ahmed Sultan","doi":"10.1016/j.oooo.2025.04.070","DOIUrl":"10.1016/j.oooo.2025.04.070","url":null,"abstract":"<div><h3>Introduction</h3><div>Tumors of the head and neck that exhibit rhabdomyoblastic differentiation include rhabdomyosarcoma, leiomyosarcoma, synovial sarcoma, spindle cell carcinoma (SpCC), malignant peripheral nerve sheath tumor, or metastatic disease. Spindle cell carcinoma (SpCC) is a rare subtype of squamous cell carcinoma (SCC) typically seen in the oral cavity and larynx. Cases with ulcerated surface epithelium completely devoid of surface dysplastic epithelium that present entirely of a spindle cell proliferation can pose a diagnostic challenge. Additionally, immunohistochemistry (IHC) can demonstrate evidence of differentiation to variable mesenchymal components. Here we present a poorly differentiated SpCC with rhabdomyoblastic differentiation as evidenced by positivity for the rhabdomyoblastic biomarker MyoD-1.</div></div><div><h3>Case Presentation</h3><div>A 54-year-old female presented to her dentist with a nodular mass on the anterior mandibular gingiva mimicking a pyogenic granuloma. Upon histopathological examination, H&amp;E tissue sections showed an ulcerated mass devoted of any surface epithelium with malignant spindle cells invading the connective tissue. The spindle cells showed several malignant criteria including pleomorphism, hyperchromatism, increased nuclear-to-cytoplasmic ratio, and atypical mitotic figures. They were arranged in short interlacing fascicles. Abundant eosinophilic cytoplasm with rhabdomyoblastic differentiation was featured. Initial IHC analysis showed diffuse positivity for Myo-D1, focal positivity for Desmin, and negativity for Myogenin, SMA, h-Caldesmon. However, Pancytokeratin, was diffusely positive confirming the diagnosis of SpCC. Other cytokeratins, p53, p63, p40, TLE-1, CD99, and neural markers were all negative. Surgical management at the University of Maryland Medical Center included composite mandibulectomy and bilateral neck dissection, followed by adjuvant radiotherapy and chemotherapy. Surgical pathology findings were positive for perineural invasion, negative for all lymph nodes and tissue margins.</div></div><div><h3>Conclusion</h3><div>This case highlights the challenge in diagnosing cases of SpCC devoid of surface epithelium. Pathologists should also be aware of the possibility of rhabdomyoblastic differentiation in SpCC and cautiously interpret skeletal muscle biomarkers given the variable expression patterns.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"140 3","pages":"Page e89"},"PeriodicalIF":2.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case report of benign fibrous histiocytoma","authors":"Hajir Aldaod,&nbsp;Naomi Ramer","doi":"10.1016/j.oooo.2025.04.067","DOIUrl":"10.1016/j.oooo.2025.04.067","url":null,"abstract":"<div><h3>Introduction</h3><div>The benign fibrous histiocytoma is a rare tumor in the oral cavity. It was recognized by the WHO in 1960 as a lesion composed of cells that resemble round histiocytic and spindled fibroblastic morphology. We present a case of a 33-year-old female with extensive carious decay and soft tissue mass.</div></div><div><h3>Materials and Methods</h3><div>Full-text case reports and case series in the English language were searched in PubMed, Ovid, Scopus, and Google Scholar Databases from 1960 to 2023. Results regarding benign fibrous histiocytoma relevant to the case report were reviewed.</div></div><div><h3>Results</h3><div>We present a 33-year-old female with grossly decayed carious teeth in the buccal gingival area of the mandible. The patient presented with a 6-month history of a tissue-colored, pedunculated gingival mass. Immunohistochemistry CD68 and Factor XIIIa were performed and were positive and supportive of the diagnosis. A definitive diagnosis of benign fibrous histiocytoma was made based on the histopathologic findings.</div></div><div><h3>Conclusion</h3><div>The benign fibrous histiocytoma is a rare soft tissue entity in the oral cavity. The age of our patient fits the classical clinical presentation of this entity, however, the gingival location of the lesion is less commonly reported. Histologically, a nodular core of dense and well-vascularized fibrous connective tissue with a stroma of a diffuse infiltrate of mixed inflammatory cell infiltrate was seen. The submucosa demonstrated a benign proliferation of multinucleated giant cells and delicate spindle cells, characteristic for benign fibrous histiocytoma.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"140 3","pages":"Page e88"},"PeriodicalIF":2.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison between NOR-1 and DOG-1 immunohistochemistry staining in the diagnosis of salivary acinic cell carcinoma","authors":"Shawki Abed,&nbsp;Saja Alramadhan,&nbsp;Indraneel Bhattacharyya,&nbsp;Sarah Fitzpatrick,&nbsp;Mohammed N. Islam","doi":"10.1016/j.oooo.2025.04.061","DOIUrl":"10.1016/j.oooo.2025.04.061","url":null,"abstract":"<div><h3>Introduction</h3><div>Acinic cell carcinoma (ACC) of the salivary gland presents diagnostic challenges due to its wide histomorphological variability. DOG-1 has been shown to be sensitive in the diagnosis of ACC but is not specific. DOG-1 positivity can be seen in normal salivary acini, polymorphous adenocarcinoma, and luminal cells of pleomorphic adenoma. A novel rearrangement t(4;9) (q13;q31) leading to the upregulation of nuclear receptor subfamily 4 group A member 3 (NR4A3) has recently been identified in ACC. Immunostaining using an antibody targeting this rearrangement, neuron-derived orphan receptor 1 (NOR-1), has been investigated for reliable diagnosis of ACC. The purpose of this study was to evaluate and compare the performance of NOR-1 antibody with DOG-1.</div></div><div><h3>Materials and Methods</h3><div>An IRB-approved retrospective search of the University of Florida Oral Pathology biopsy service database between 2000 and 2022 was performed for ACC cases. DOG-1, mammaglobin, and NR4A3 immunohistochemical staining was performed on all included cases with appropriate control using the commercially available antibody NOR-1 (sc-393902 [H-7], Santa Cruz Biotechnology Inc.).</div></div><div><h3>Results</h3><div>Eight cases of low-grade ACC were included. Patient age ranged between 40 and 95 years with equal gender distribution. One case was from parotid gland while all other cases were from buccal and labial minor salivary glands. Five cases were conventional solid variant, two were microcystic, and one papillary-cystic variants. Six cases out of eight stained positive for NOR-1 with variable intensity, while DOG-1 stained five cases out of eight. All cases were negative for mammaglobin.</div></div><div><h3>Conclusions</h3><div>NOR-1 staining revealed more sensitivity than DOG-1 for diagnosis of ACC within our case series. However, evaluation of this marker in additional studies with larger number of cases is recommended.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"140 3","pages":"Page e86"},"PeriodicalIF":2.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mucous membrane pemphigoid related to nivolumab immunotherapy: report of a rare case and review of the literature","authors":"Konstantinos Tzanavaris ,&nbsp;Efstathios Pettas ,&nbsp;Erofili Papadopoulou ,&nbsp;Maria Georgaki ,&nbsp;Evangelia Piperi ,&nbsp;Nikolaos Nikitakis","doi":"10.1016/j.oooo.2025.04.079","DOIUrl":"10.1016/j.oooo.2025.04.079","url":null,"abstract":"<div><h3>Background</h3><div>Immune-checkpoint inhibitors (ICIs) have been successfully used in the management of patients suffering from various malignancies; however, these agents have been also blamed for a wide spectrum of adverse events involving several anatomic sites, including the oral mucosa. Herein, we describe a rare case of mucous membrane pemphigoid (MMP) related to PD-1 inhibitor nivolumab and review the English-language literature on immunotherapy-associated MMP.</div></div><div><h3>Case Description</h3><div>A 74-year-old female presented for the evaluation of widespread painful ulcerations affecting the buccal mucosae, lower lip, and tongue. Nine months ago, the patient was diagnosed with lung adenocarcinoma and underwent 4 cycles of chemotherapy followed by radiation therapy; she was concurrently receiving nivolumab, which was also continued as monotherapy. The oral lesions developed after the last nivolumab injection, approximately 8 months after diagnosis and initiation of immunotherapy. With a clinical provisional diagnosis of a vesiculobullous disease of autoimmune or immunotherapy-associated origin, a perilesional diagnostic oral biopsy was performed. Microscopically, subepithelial clefting was observed, while direct immunofluorescence showed linear deposition of immunoreactants at the basement membrane zone. No circulating autoantibodies in patient’s serum were detected by ELISA and a final diagnosis of MMP was rendered. Considering the temporal relationship between the onset of the symptoms and nivolumab administration, an etiologic correlation between immunotherapy and MMP was considered very likely. Systemic prednisolone treatment, along with nivolumab withdrawal following consultation with patient’s oncologist, resulted in rapid remission of oral lesions.</div></div><div><h3>Conclusions</h3><div>Although ICIs have an established role in treatment of several cancers, they have also been associated with side effects of variable severity. Especially, ICI-related MMP seems to be quite rare with only a few cases reported in the English-language literature. Oral health care professionals should be aware of such adverse events, as their prompt recognition, accurate diagnosis, and appropriate management improves patients’ quality of life.</div></div>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"140 3","pages":"Pages e92-e93"},"PeriodicalIF":2.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}