A Diagnostic Challenge: Gingival Lesions in a Postirradiated Nasopharyngeal Carcinoma Patient

Case Report

Austin Head Neck Oncol. 2021; 4(1): 1010.

A Diagnostic Challenge: Gingival Lesions in a Postirradiated Nasopharyngeal Carcinoma Patient

Sng JHT*, Lum JL, Loy CHR and Yeo JF

Discipline of Oral and Maxillofacial Surgery, National University Centre for Oral Health, Singapore

*Corresponding author: Timothy SJH, Discipline of Oral and Maxillofacial surgery, National University Centre for Oral Health, National University of Singapore, 9 Lower Kent Ridge Road, 119085, Singapore

Received: January 04, 2021; Accepted: February 24, 2021; Published: March 03, 2021


This paper shares a diagnostically challenging case of radiation-induced sarcoma that first presented as gingival ulcerations and pain in a postradiated nasopharyngeal carcinoma patient. Insufficient information from the clinical presentation and non-specific findings from initial imaging results hindered early diagnosis. Nonetheless, correlation with medical history, prompt histopathological analysis and PET-CT imaging eventually led to a definitive diagnosis. This case report aims to increase the awareness of this uncommonly known but deadly long-term complication of head and neck radiotherapy. Clinicians ought to include radiation-induced sarcoma in their list of differential diagnosis when a patient, with a history of head and neck radiotherapy, presents with persistent gingival or oral mucosa lesions, alveolar bony exposure or other suspicious dental-related symptoms.

Keywords: Radiation-induced sarcoma; Post-irradiation; Nasopharyngeal carcinoma; Gingiva; Oral cavity


NPC: Nasopharyngeal Carcinoma; ANUP: Acute Necrotizing Ulcerative Periodontitis; ORN: Osteoradionecrosis of the Jaw; OSCC: Oral Squamous Cell Carcinoma; RIS: Radiation-induced Sarcoma; MRI: Magnetic Resonance Imaging; PET-CT: Positron Emission Tomography-computed tomography; FDG: Fluorodeoxyglucose

Case Presentation

A 65 year old Chinese man presented to an oral & maxillofacial surgeon for management of persistent & severe pain over his upper and lower left posterior gingiva. The pain started 2 weeks ago. Previously diagnosed with Nasopharyngeal Carcinoma (NPC), he underwent radiotherapy 30 years ago. He has been in clinical remission since then. An ex-smoker for 44 years, the patient quit smoking 2 years ago. No abnormalities were detected on extraoral examination. Intraoral examination revealed poor oral hygiene, heavily restored dentition and rampant caries. Multiple sinus tracts, likely associated with necrotic teeth, were also seen. Regions of white punched-out ulcers were present along the gingival margins of his upper and lower left posterior teeth (Figure 1). The ulcers were extremely tender to palpation. Periapical radiographs of the involved region revealed severe bone loss and periapical radiolucencies associated with root resorption (Figure 2).