In Pakistan, oral cancer ranks as the most common malignancy in males and the second most common malignancy in females. Cyclooxygenase-2 has been explored as an agent of carcinogenesis in oral and other neoplasms. This study aimed to observe the expression of cyclooxygenase-2 in oral squamous cell carcinoma, and to correlate the expression with patients’ clinical features and overall and disease-free survival.

Immunohistochemistry for cyclooxygenase-2 was performed on a total of 100 oral squamous cell carcinoma formalin-fixed, paraffin-embedded blocks. Expression was correlated with patients’ clinicopathological variables and overall and disease-free survival.

Cyclooxygenase-2 was overexpressed in 55 per cent of oral squamous cell carcinoma patients. Overexpression was correlated with overall survival (p = 0.013) and disease-free survival (p = 0.001) on univariate analysis. However, on multivariate analysis, cyclooxygenase-2 was associated with only disease-free survival (p = 0.044) and not overall survival (p = 0.208).

Expression of cyclooxygenase-2 is associated with poorer overall survival and higher rates of recurrence in oral squamous cell carcinoma patients.

To investigate the clinicopathological and prognostic significance of the expression of cathepsin L and its inhibitor headpin, in oral squamous cell carcinoma.

Immunohistochemical studies were performed on 56 oral squamous cell carcinoma samples. We evaluated the relationship between cathepsin L and headpin expression versus patients' clinicopathological factors and survival.

The group that was positive for cathepsin L expression tended to have positive metastatic neck lymph nodes and a poorer prognosis. Headpin expression was not related to metastasis or prognosis. Well differentiated squamous cell carcinoma had higher levels of headpin expression compared with poorly differentiated squamous cell carcinoma.

Cathepsin L expression is related to the invasive and metastatic potential of oral squamous cell carcinoma.

Traditionally, a 1-cm surgical resection margin is used for early oral tongue tumours.

All tumour stage one (n = 65) and stage two (n = 13) oral tongue cancers treated between January 1999 and January 2009 were followed for a median of 38 months (minimum 12 months). The sites of close and involved margins were histologically reviewed.

Involved and close margins occurred in 14 and 55 per cent of cases, respectively. The number of involved vs clear or close margins was equivalent in tumour stage one (90 vs 82 per cent), node-negative (100 vs 84 per cent) and perineural or lymphovascular invasion (20 vs 21 per cent) cases. Close or involved margins were similarly likely to be posterior (59 per cent) as anterior (41 per cent, p = 0.22), lateral (57 per cent) as medial (43 per cent, p = 0.34), and mucosal (59 per cent) as deep (41 per cent, p = 0.22). Local recurrence occurred in 28 per cent of cases at a median of 12 months, and was more likely in cases with involved (50 per cent) than clear or close margins (25 per cent, p = 0.10). Disease-free survival was worse in involved margins cases (p = 0.002).

Involved margins are common in early tongue tumours, and are associated with increased local recurrence and worse survival. Close or involved margins occur in all directions and all tumour types. A wider margin may be justified.

Most human immunodeficiency virus positive patients now have a longer life expectancy, with the advent of highly active antiretroviral therapy. However, they are now at increased risk of developing a malignancy during their lives.

To investigate the age at which oral squamous cell carcinoma presents in patients infected with human immunodeficiency virus.

Prospective, clinicohistopathological audit of patients infected with human immunodeficiency virus.

Of 200 human immunodeficiency virus positive patients, 16 (8 per cent) presented with oral squamous cell carcinoma (nine women and seven men; age range 18–43 years, mean age 31.7 years). The majority of patients (62.5 per cent) had stage III and IV disease (tumour-node-metastasis staging). There was a predilection for poorly differentiated oral squamous cell carcinoma (using Broder's histopathological classification).

Oral squamous cell carcinoma associated with human immunodeficiency virus infection appears to present at a relatively young age.

We present an extremely rare case of isolated angiokeratoma of the tongue.

Case report and review of related literature.

An 18-year-old, male adolescent presented with a fleshy, intermittently bleeding mass in the posterior third and base of the tongue. The lesion was initially suspected to be a lingual thyroid or haemangioma, but histopathological features were consistent with angiokeratoma. Magnetic resonance imaging revealed that the lesion extended up to the vallecula and involved the lamina propria and superficial tongue musculature. No similar lesions were found elsewhere in the body. No metabolic derangements were identified in the patient or his family. The 2.6 × 1.5 × 0.5 cm mass was excised under general anaesthesia.

We present the 1st case of isolated lingual angiokeratoma in a male, the 4th such case overally, the largest ever documented. The lesion was situated in the posterior third and base of the tongue, a position not previously described.

We present a novel, previously undescribed technique of obtaining a biopsy from an inaccessible parapharyngeal space mass.

A modified endo-cavitary ultrasound probe was utilised to obtain an intra-oral, image-guided core biopsy of a parapharyngeal tumour. The parapharyngeal mass was not accessible to percutaneous ultrasound-guided biopsy due to its anatomical location.

To our knowledge, this is the first such modification of the conventional endo-cavitary probe technique described in the literature. The technique permits accurate, well controlled biopsy of lesions located high in the parapharyngeal space, under general anaesthesia.

Different strategies are available for the management of patients with early (i.e. tumour stage one or two) oral or oropharyngeal carcinoma and a clinically negative neck.

In 2006, a questionnaire was sent to the eight head and neck cancer centres of the Dutch Head and Neck Oncology Cooperative Group. This questionnaire covered: the factors influencing the decision to perform an elective neck dissection; the neck staging procedure; and the types of neck dissection undertaken.

All eight questionnaires were returned completed. Respondents indicated that the site (n = 6), size (n = 7) and thickness (n = 6) of the primary tumour were important in decisions regarding elective neck dissection. Ultrasound-guided fine needle aspiration cytology was the most frequently used diagnostic technique (n = 7). Depending on the site and stage of the primary tumour presented, in the different cases 3–7 of the centres would perform an elective neck dissection. Selective neck dissections (i.e. levels I to III/IV) were more frequently performed than modified radical neck dissections.

There was no uniformity regarding management of the clinically negative neck in patients with early stage oral and oropharyngeal carcinoma, within The Netherlands.

Oral submucous fibrosis is a chronic disease characterised by progressive inability to open the mouth. Various treatment modalities are available for its management, but these have largely been ineffective.

Nine cases of oral submucous fibrosis underwent a release procedure using a KTP-532 laser, from March 2005 to January 2006, within the ENT – head and neck surgery department of a tertiary centre.

Pre- and post-operative mouth-opening was compared using the Wilcoxon signed rank test, and a significant difference observed (Z = −2.690, p = 0.007). Follow up over an average period of 12 months showed encouraging results.

This preliminary study indicated that adequate release of oral submucous fibrosis can be achieved by using a KTP-532 laser release procedure, with minimal morbidity and satisfactory results. These promising results should encourage more widespread use of this technique in the management of this condition.

We present the case of a 59-year-old Chinese patient with an unusual presentation of mucosal plasmacytosis involving the oropharynx, related to the use of toothpaste.

Case presentation and review of English medical literature involving mucosal plasmacytosis.

Mucosal plasmacytosis is an uncommon disease process and has been associated with hypersensitivity reactions. Most cases involve the gingival mucosa, although there have been reports of cases involving other oral mucosal sites and the upper aerodigestive tract. Our case provides an example of oropharyngeal plasmacytosis related to toothpaste. A resolution of signs and symptoms followed withdrawal of the suspected allergens.

Mucosal plasmacytosis is a benign inflammatory process that may appear to be more sinister on clinical examination. Skin patch testing is a useful adjunct in confirming the diagnosis.