Case report

Incidental detection of an occult oral malignancy with autofluorescence imaging: a case report

Nadarajah Vigneswaran¹ , Sheila Koh² and Ann Gillenwater³

¹  Department of Diagnostic Sciences, The University of Texas Dental Branch at Houston, Houston, Texas 77030, USA

²  Department of Restorative Dentistry and Biomaterials, The University of Texas Dental Branch at Houston, Houston, Texas 77030, USA

³  Department of Head and Neck Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA

author email corresponding author email

Head & Neck Oncology 2009, 1:37doi:10.1186/1758-3284-1-37

Published:	28 October 2009

Abstract

Background

Autofluorescence imaging is used widely for diagnostic evaluation of various epithelial malignancies. Cancerous lesions display loss of autofluorescence due to malignant changes in epithelium and subepithelial stroma. Carcinoma of unknown primary site presents with lymph node or distant metastasis, for which the site of primary tumour is not detectable. We describe here the use of autofluorescence imaging for detecting a clinically innocuous appearing occult malignancy of the palate which upon pathological examination was consistent with a metastatic squamous cell carcinoma.

Case Description

A submucosal nodule was noted on the right posterior hard palate of a 59-year-old white female during clinical examination. Examination of this lesion using a multispectral oral cancer screening device revealed loss of autofluorescence at 405 nm illumination. An excisional biopsy of this nodule, confirmed the presence of a metastatic squamous cell carcinoma. Four years ago, this patient was diagnosed with metastatic squamous cell carcinoma of the right mid-jugular lymph node of unknown primary. She was treated with external beam irradiation and remained disease free until current presentation.

Conclusion

This case illustrates the important role played by autofluorescence tissue imaging in diagnosing a metastatic palatal tumour that appeared clinically innocuous and otherwise would not have been biopsied.