Hi
My dad got diagnosed with squamous cell mouth cancer in September 2012. Surgery was done leading to extraction of third lower molar and about 2 cm margin and removal of three lymph nodes. Buccal fat pad was used for reconstruction of the retromolar triangle defect post resection. Post surgery the biopsy reports suggested positive posterior margin and rest everything was clear.

Hence radiotherapy was advised and during marker CT for radiotherapy they noticed "an irregularly marginated soft tissue density lesion with necrosis in right molar trigone". Hence a biopsy was performed which said - "chronic granulation tissue with mild to moderate dysplasia in overlying epithelium. Definite evidence of malignancy NOT seen in biopsy received."

Hence radiotherapy was done on face and neck region - 60 gray in 30 seatings. 6 weeks after radiotherapy we had the MRI done yesterday which shows - " ill defined mildly enhancing soft tissue lesion in right retromolar trigone. mass appears to be adherent with pterygoid muscles.Possibility of residual neoplasm can be considered. Correlate histopathologically."

Now, we will meet our radio-oncologist with these reports next week and we expect he will advice a biopsy or FNA.
My questions -
Is it possible to differentiate dysplasia and neoplasia on MRI?
Could this soft density lesion seen pre and post radiotherapy be due to buccal fat pad?
Is it progressing from dysplasia to neoplasia?
What should be the line of treatment in this case?
Original Post
Gosh... you definitely need Vinod on that one!

Firstly, let me offer you and your father my best wishes. Do let us know the outcome.

Basically I think you are managing the issue in the way that best suits you, and is probably the best way for the situation in general. You are taking a very analytic stance, and that helps keep the mind clear; it also helps you to define what questions you want to ask the team. The first thing we all want when we get ill is information; understanding the options and issues is very important.

All the same, even though it's scary, I think you should be careful not to avoid the emotional side altogether, for your father if not for yourself. Couching everything in medical and highly specialised terms can actually cause more confusion and fear; so unless you happen to come from a particularly medical family, turning this technical lexis into normal language may be a good move when talking with him.

Once again, all my best wishes.
Hello Ship


Your questions - and the answers
quote:

Is it possible to differentiate dysplasia and neoplasia on MRI? no
Could this soft density lesion seen pre and post radiotherapy be due to buccal fat pad? could be
Is it progressing from dysplasia to neoplasia? a biopsy is a snapshot in time. The progression can't be seen, only suspected. The biopsy (another snapshot) then confirms the suspicion, or not
What should be the line of treatment in this case? a step at a time, your oncologist will advise


Let us know how things go.

Best wishes
Vinod Coffee

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