A case of carcinoma of the buccal mucosa with the development of therapy-related myelodysplastic syndrome

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  • Yoshizawa Yasumasa
    Department of Oral and Maxillofacial Surgery, Kochi Medical School, Kochi University
  • Kitamura Naoya
    Department of Oral and Maxillofacial Surgery, Kochi Medical School, Kochi University
  • Yamamoto Tetsuya
    Department of Oral and Maxillofacial Surgery, Kochi Medical School, Kochi University

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  • 治療関連骨髄異形成症候群を発症した頰粘膜癌の1例

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Therapy-related myelodysplastic syndrome （t-MDS） is a pathological condition with quantitative and qualitative dysplasia of erythrocytes, leucocytes, and platelets after chemotherapy and/or radiotherapy for malignant tumors. Here, we report a case of carcinoma of the buccal mucosa with the development of t-MDS.<br>The patient was a 57-year-old male. He had noticed painful swelling and ulceration on the left buccal mucosa and visited our department. General examination revealed gastric carcinoma, which was treated with endoscopic submucosal dissection, and hypopharyngeal carcinoma. Histopathological diagnosis of a biopsied buccal mucosal material was moderately differentiated squamous cell carcinoma. Clinical diagnosis was buccal mucosal carcinoma （T4aN2bM0, Stage Ⅳa）. Functional total neck dissection, buccal mucosal tumor resection, and reconstruction by a forearm flap were performed after administration of S-1 for 2 weeks. Pathological examination revealed four regional lymph node metastases, but the surgical margin was negative. Then, combined chemotherapy （CDDP, DTX, and S-1） and chemoradiotherapy with S-1 and X-rays were performed as adjuvant therapy for buccal mucosal carcinoma and chemoradiotherapy for hypopharyngeal carcinoma. Four years after the adjuvant chemoradiotherapy, continued fever and pancytopenia were observed, and the number of myeloblasts and WT1 mRNA copies in peripheral blood increased. Bone marrow examination revealed CD13-, CD33-, and CD34-positive cells. The patient was diagnosed as t-MDS. Eleven courses of azacitidine were administered. Though the patient remitted temporarily, he died of pancytopenia.

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