PMC3892990_01
Fig. 1A is a three dimensional iCAT image of the buccal aspect of the patient's left body of the mandible. Readily apparent is the marked bone destruction associated with his second and first mandibular molars-which corresponds to the placement site for the smokeless tobacco quid. Fig. 1B is a panoramic view of the patient's iCAT image which reveals pronounced inter-radicular bone loss (arrows) which is restricted to the smokeless tobacco placement site. Fig. 1C is a clinical photograph of the patient's OSCC tumor. The surface is micronodular and focally ulcerated as indicated by areas of fibrin deposition. The erythematous color corresponds to both the highly angiogenic nature and the presence of numerous host chronic inflammatory cells. The OSCC tumor histopathology (4x image scale) is depicted in Fig. 1D. Tumor cells arise from an overlying hyperkeratotic dysplastic surface epithelium (arrow). An intense host chronic inflammatory cell infiltrate (small blue cell infiltrate) is noted in association with the dysplastic epithelium and OSCC tumor nests.
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F1
The tobacco placement site (left posterior mandible) matched the site of a lesion in his mandibular vestibule (See Fig. 1A.). Intraorally, an exophytic, focally ulcerated 3.5 by 3.0 cm tumor was observed that extended from the buccal gingiva of the second mandibular premolar to the distal aspect of the second mandibular molar and also involved the associated buccal vestibule (Fig. 1A) and corresponded to the site where smokeless tobacco was placed. The mandibular second molar was extremely mobile. 3D Cone Beam imaging (iCAT) demonstrated complete erosion of the buccal plate associated with the left second mandibular molar with partial erosion of the distal aspect of the buccal plate of the mandibular first molar (Fig. 1B). Also apparent from these imaging studies was the extensive inter-radicular bone loss that was restricted to these two teeth (Fig. 1C). The carcinoma demonstrated an infiltrative growth pattern, cellular and nuclear pleomorphism, a high mitotic index, and production of abundant keratin (Fig. 1D).