title: Squamous cell carcinoma presenting as an endodontic-periodontic lesion.
abstract: BACKGROUND
  Regardless of advances in diagnosis and treatment during the past 40 years, the overall 5-year survival rates for oral and oropharyngeal squamous cancers have only slightly improved and remain around 50%. Thus, the early diagnosis and treatment of carcinoma by health care providers are essential in achieving a good prognosis. We report a case of invasive squamous cell carcinoma that presented as a benign endodontic-periodontic lesion with a 7-mm periodontal pocket on tooth #15 in a 40-year-old, non-smoking woman. The subsequent management of the case is also discussed. The study was conducted in accordance with the Helsinki Declaration of 1975, as revised in 2000.
  
  
  METHODS
  Our patient was seen for a comprehensive periodontal examination including a periodontal charting, occlusal analysis, study casts, electronic pulp test for tooth #15, and complete mouth periapical radiographs. As there was a periapical radiolucency, an endodontic consultation was obtained. A periodontal flap surgical procedure was performed on teeth #13 to #15, and as there was bone erosion into the maxillary sinus, a biopsy of the soft tissue was submitted to the local hospital for histological analysis.
  
  
  RESULTS
  The biopsied lesion was diagnosed as invasive, moderately differentiated squamous cell carcinoma with focal spindle and clear cell differentiation (grade II to III of IV). Bone invasion was also identified. The treatment of the carcinoma involved a hemimaxillectomy with the removal of the maxillary left posterior teeth. The patient remained free of tumor for 5 years after the initial presentation.
  
  
  CONCLUSIONS
  Patient education and periodic oral cancer examinations by dental professionals are necessary to reduce diagnostic delay and improve prognosis. This case report emphasizes the important role of dental professionals, especially periodontists and endodontists, of being aware that squamous cell carcinoma may manifest itself clinically and/or radiographically as a common periodontal or endodontic lesion.
authors.affiliation: Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA 02111, USA. levishuman@aol.com
authors.forename: Paul A
authors.initials: PA
authors.lastname: Levi
authors.forename: David M
authors.initials: DM
authors.lastname: Kim
authors.forename: Scott L
authors.initials: SL
authors.lastname: Harsfield
authors.forename: Erica R
authors.initials: ER
authors.lastname: Jacobson
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D005887:Gingival Neoplasms / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008441:Maxillary Neoplasms / Q000473:pathology* / Q000601:surgery; D008444:Maxillary Sinus Neoplasms / Q000473:pathology; D009361:Neoplasm Invasiveness / Q000473:pathology; D010509:Periodontal Cyst / Q000175:diagnosis*