cr0277 metastatic melanoma detected through symptoms of temporomandibular joint disorder

ORAL MEDICINE OOOO

e386 Abstracts May 2014

such habits. We report the first case of TUGSE affecting thetongue secondary to khat chewing as a result of the combinationof local mechanical and chemical irritation.

CR0313 OROFACIAL PAIN CAUSED BY BRAIN TU-MORS: 3 CASES Yeon-Hee Lee, Ji-Woon Park, Hee-KyungPark, Jin-Woo Chung, Hong-Seop Kho, Department of OralMedicine and Oral Diagnosis, School of Dentistry, SeoulNational University, Seoul, South Korea

Background: Orofacial pain may be caused by variousdiseases and conditions, providing an ongoing diagnostic challengefor clinicians. In rare cases, patients with orofacial pain may haveintracranial tumors as the underlying cause. Therefore, it isimportant for dental clinicians to understand and recognize warningsigns of intracranial tumors associated with orofacial pain.

Summary: We report on 3 patients with orofacial pain andneurologic deficits due to brain tumors. In case 1, a 58-year-oldwoman presented with a 5-month history of right TMJ pain, righthemifacial dysesthesia, paresthesia, and dysgeusia, which hadgradually become aggravated. In case 2, a 64-year-old womanreported a 5-year history of electric-like sensations on her leftfacial area. The symptoms gradually worsened and expanded,while accompanying tinnitus and hearing loss of her left ear. Incase 3, a 70-year-old woman presented with a 2-year history ofparesthesia in her right perioral area, foreign body sensation andparoxysmal pain of her right middle and lower face, and bitter tastesensation. Because all 3 patients had neurologic symptoms, theywere referred to the department of neurology for further evaluationincluding brain imaging. Brain MR imaging found lesions in thecerebellopontine angle (CPA) area. Their specific diagnoses wereacoustic schwannoma (case 1) and meningioma (cases 2 and 3)located on the ipsilateral side of the pain. In cases 1 and 2, therewas no delay to the final diagnosis, but there was a 6-month delayin case 3.

Conclusions: The warning signs for brain tumors includedisabling neurologic symptoms such as worsening paresthesia,dysesthesia, neuralgia, facial weakness, and neurologic deficits.Understanding these warning signs help practitioners reduce risksof neglecting subtle neurologic deficits and the possibility ofmisdiagnosing such life-threatening conditions.

CR0277 METASTATIC MELANOMA DETECTEDTHROUGH SYMPTOMS OF TEMPOROMANDIBULARJOINT DISORDER Louis Formica, Samir Singh, BhavikDesai, Virginia Commonwealth University School ofDentistry, Richmond, VA, USA

Background: Head and neck malignancies have been re-ported with initial presenting symptoms of facial pain andparesthesia.

Summary: A 75-year-old woman with a history of right-sided facial pain of 18 months’ duration was referred to theVirginia Commonwealth University Oral Medicine clinic. Painwas described as a constant dull ache in the right masseterregion with progressively increasing paresthesia, not respon-sive to conservative therapy. Her medical history was signif-icant for migraines and previous surgical removal of a basalcell carcinoma of the right arm. Extraoral findings were withinnormal limits, and cranial nerve examination elucidated mildhypoesthesia of the right-sided V3 trigeminal nerve. TMJexamination found normal range of motion with bilateral joint

crepitation. Myofascial examination was significant for mild tomoderate tenderness of the right-side masseter and temporalis.A panoramic radiograph recently taken by the patient’s dentalprovider was positive for degenerative changes in both con-dyles, consistent with a diagnosis of TMJ osteoarthritis andmyofascial pain to the muscles of mastication along withatypical facial paresthesia of the V3 nerve distribution. Amagnetic resonance imaging scan of the midface and neck wasprescribed to determine the source of paresthesia. Throughimaging, focal lesions were identified in the right side of thepatient in the vallecula, temporal lobe, and frontal lobe. Asubsequent positron emission tomography (PET) scan foundmultiple hypermetabolic lesions, notably a large abdominalsoft tissue mass, multiple smaller hepatic lesions, multiplelung lesions, and several subcutaneous lesions. A biopsy ofthe brain lesions was consistent with metastatic malignantmelanoma subsequently determined to have originated from asubcutaneous abdominal source. The patient was lost tofollow-up, electing to pursue therapy at a different medicalcenter.

Conclusions: This case documents metastatic melanoma tothe head and neck detected through symptoms of atypical facialpain and temporomandibular joint dysfunction.

CR0316 INTRAORAL MANIFESTATION OF MYCOSISFUNGOIDES: A REPORT OF 2 CASES Chizobam Idahosa,Eric Stoopler, Thomas Sollecito, Faizan Alawi, Universityof Pennsylvania School of Dental Medicine, Philadelphia,PA, USA

Background: Mycosis fungoides (MF) is the most commonform of cutaneous T-cell lymphoma. MF is usually a slowlyprogressive disease with evolution of cutaneous lesions frompatches, papules, and plaques to tumors with or without extrac-utaneous involvement. We describe 2 patients who presented withintraoral manifestations.

Summary: Patient 1 was a 52-year-old white man referredfor evaluation of a tongue mass of 6 weeks’ duration. The patientwas previously diagnosed with folliculotropic MF, and over a5-year period, his skin lesions continued to evolve despite mul-tiple treatments with total skin electron beam therapy, photo-therapy, and various chemotherapeutic agents, without evidenceof extracutaneous disease. Intraoral examination found an exo-phytic, nonindurated verrucous mass with shallow ulcers and ahemorrhagic appearance covering the entire dorsal surface of thetongue. Patient 2 was a 76-year-old white man with a 3-yearhistory of treatment-refractory MF. He presented with complaintsof dry, burning lips with generalized mouth soreness. Linear ul-ceration of the anterior labial mucosa and diffuse erythema of thebuccal mucosa were evident on intraoral examination consistentwith a Candida infection. He presented 6 weeks later withwidespread painful oral swellings. Histologic analysis of affectedtongue tissue from patient 1 and affected buccal mucosa frompatient 2 both found a diffuse infiltrate of atypical, CD3+ Tlymphocytes with marked epidermotropism. After the diagnosesof oral T-cell lymphoma, both patients were classified with stageIV MF, with subsequent modification of their therapeutic regi-mens. Brentuximab was initiated for the first patient, with sig-nificant improvement of his tongue and skin lesions. The secondpatient was started on gemcitabine, but after multiple complica-tions, the CHOP chemotherapy regimen (cyclophosphamide/