Malignant transformation of oral squamous cell papilloma
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• This case report contributes to the growing pool of reports concerning human papillomavirus (HPV) associated oral cancers.

• There is a paucity of information in the literature regarding the malignant transformation of oral squamous cell papilloma (SCP).

• The authors present a unique case of virus-associated cancer highlighting its progress and implications.

• Immunocompromised patients and the elderly are at higher risk of malignancy and require closer observation.

A 61 years old female patient, with a chief complaint of an intraoral white lesion covering the mucosa of the right cheek that appeared 2 years ago. The patient was a non-smoker and non-drinker and suffered from end-stage renal disease (ESRD). The undertaken biopsy from the right buccal mucosa and histopathological examination revealed an oral squamous papilloma. A year later, a second biopsy performed, and the pathological diagnosis of an oral squamous papilloma persisted.

The patient presented 6 months later, complaining of the enlargement and change in the consistency of the lesion causing discomfort and dysfunction. Clinical examination revealed that the lesion extended to involve the floor of the mouth and the extraoral skin of the right cheek. Bilateral suspicious lymph nodes were also noted. MRI and CT scan with contrast revealed a well-defined soft tissue mass measuring 6.2×2.5x3.5 cm along its maximum dimensions. The lesion was opposite the mandibular body (likely deep to buccinators muscle) with no evidence of bone erosion. It displayed a hypointense signal in T1WIs and hyperintense signal in STIR images with faint homogenous post-contrast enhancement. The largest of which was at the right submandibular group measuring 17x10 mm.

The multidisciplinary team included surgical oncologists, oral and maxillofacial surgeons, surgical pathologists, and maxillofacial prosthetists. The treatment plan was dictated by the severity of the condition. Neck dissection, hemimandibulectomy, and the placement of a reconstruction plate to bridge the mandibular defect were performed. The combination of Pectoralis major flap for intraoral reconstruction and deltopectoral flap for extraoral coverage were used. The two flaps raised at the same time without compromising the vascularity of each other as described by McGregor, I.A. The postoperative pathological diagnosis was squamous cell carcinoma (SCC) grade II. The histopathological analysis of the dissected lymph nodes showed no metastatic involvement. The duration of postoperative follow-up was short since the patient died of complications of acute renal failure 1 month postoperative.