Co-existence of Head and Neck Squamous Cell Carcinoma with Sinonasal Mucormycosis: Therapeutical Challenges

Pandemic was new experience for entire humanity. Medical fraternity was no exception. The cases of mucormycosis were on the rise during the second wave of the pandemic. Presented here are two cases which were combination of two diseases, one of which was squamous cell carcinoma of head and neck region (49-year-old male) and other one was sinonasal mucormycosis (56-year-old male). Both patients were diabetics and had history of Coronavirus Disease-2019 (COVID-19) infection in past. Our literature search doesn’t reveal any previously reported cases of this rare combination. There were certain challenges in management. Both diseases were lethal and treatment of one cannot be prioritised over other. Challenges in managing those cases were, reconstruction planning, perioperative management and postsurgery adjuvant therapy. In absence of previous experience to treat this combination or any literature available new treatment protocol were formulated. Cases were discussed in multidisciplinary team meetings and treatment plans were formulated. Mucormycosis and oral squamous cell carcinoma both were operated and reconstructed in same sitting. In one patient revision endoscopic debridement had to be done. Amphotericin B was started once diagnosis was confirmed. Patients were followed-up on weekly basis during first month and imaging was done every 15 days. Both patients had satisfactory recovery without any sign of progression of mucormycosis. Adjuvant radiation was given in both cases at appropriate time. At follow-up both patients were free from disease for six months. From these unique experiences it can be recommended that combination of sinonasal mucormycosis and squamous cell carcinoma of head and neck is very rare. Both diseases can be treated simultaneously. excision and reconstruction can be done in single sitting. There is no need to delay or avoid adjuvant radiation. Multidisciplinary team approach is the key for treatment

Salivary Exosomal miRNA-1307-5p Predicts Disease Aggressiveness and Poor Prognosis in Oral Squamous Cell Carcinoma Patients

Background: Salivary exosomal miRNAs as biomarkers facilitate repeated sampling, real-time disease monitoring and assessment of therapeutic response. This study identifies a single salivary exosomal miRNA prognosticator that will aid in improved patient outcome using a liquid biopsy approach. Method: Small RNA and transcriptome sequencing profiles of tumour tissues (n = 12) and salivary exosomes (n = 8) from oral cancer patients were compared to their non-cancerous counterparts. We validated these results using The Cancer Genome Atlas database and performing Real-time PCR on a large patient cohort (n = 19 tissue samples; n = 12 salivary exosomes). Potential target genes and the miRNA–mRNA networks and enriched biological pathways regulated by this microRNA were identified using computational tools. Results: Salivary exosomes (size: 30–50 nm) demonstrated a strong expression of CD47 and detectable expression of tetraspanins CD63, CD81 and CD9 by flow cytometry. miR-1307-5p was exclusively overexpressed in tissues and salivary exosomes of oral cancer patients compared to their non-cancerous counterparts. Enhanced expression of miR-1307-5p clinically correlated with poor patient survival, disease progression, aggressiveness and chemo-resistance. Transcriptome analysis suggested that miRNA-1307-5p could promote oral cancer progression by suppressing THOP1, EHF, RNF4, GET4 and RNF114. Conclusions: Salivary exosomal miRNA-1307-5p is a potential prognosticator for predicting poor survival and poor patient outcome in oral cancers

Squamous cell carcinoma of gingivobuccal complex: Literature, evidences and practice

Gingivobuccal cancer (GBC) is the most common oral cavity cancer (OCC). Its incidence is increasing with increased use of tobacco and areca nut chewing in third world countries especially the Indian subcontinent. It comprises buccal mucosa, gingivobuccal sulcus, alveolus and retromolar area cancers. OCCs comprise 12% of all male cancers in India, 40% of these are GBCs. Certain precancerous conditions and lesions such as submucous fibrosis, leukoplakia and erythroplakia are known. In special situations such as trismus, examination and early detection becomes difficult. Computed tomography scan is an investigation of choice. Tumor node metastasis staging gives adequate information for treatment selection and prognosis. Surgery remains the mainstay of curative treatment. Due to its unique proximity to mandible and posteriorly infratemporal fossa, extent of surgery remains critical to provide cure with satisfactory functional and esthetic outcomes. Marginal mandibulectomy has consistently provided these results in carefully selected patients. More advanced cancers need segmental or hemimandibulectomy and appropriate reconstruction-preferably free microvascular bone and soft-tissue transfer. Radiotherapy is used in adjuvant setting to reduce locoregional recurrences. It can also be used as palliative modality in advance cases. The role of chemotherapy is investigational; however, criteria have been defined for its use concurrent with radiation in adjuvant postoperative settings in high-risk patients. Cure rates are as high as 85% in early stages and as low as 0%–20% in advance stages. Follow-up strategy is aimed at detection of locoregional failure initially and prevention and management of second cancers