Clinical study on histopathological findings and prognosis in oral squamous cell carcinoma
With immunohistochemical study
1990 Volume 36 Issue 2 Pages 343-357
Details
1990 Volume 36 Issue 2 Pages 343-357
Forty-eight patients with oral squamous cell carcinoma (SCC) were investigated to compare the clinical type, grade of differentiation, mode of invasion, stromal reaction and immunohistochemical findings with their prognosis. The following results were obtained:
1) According to Kaplan-Meier's method, the 3-year and 5-year survival rates of 48 patiens were 62.5% and 52.1% respectively, with females surviving longer than males.
2) 43 SCC's were well differentiated, while 3 cases were moderate, and 2 cases were poor. The moderate and poor differentiated SCC's appeared erosive and ulcerative type clinically. Using Yamamoto & Kohama's classification of invasion, 12 cases were mode 2, 24 cases were mode 3 and 12 cases were mode 4 (6 cases were mode 4 C, 6 cases were mode 4D). Most cases of mode 4 demonstrated the erosive and ulcerative type or the tumor mass type clinically. The 5-year survival rates of cases categorized modes 2, 3 and 4 were 58.3%, 66.7% and 41.7% respectively.
3) The stromal reaction showed a weak lymphocytic infiltration in 12 cases, moderate in 25 cases and strong in 11 cases. Collagen fiber formation was small in 11 cases, moderate in 27 cases and abundant in 10 cases. Strong lymphocytic infiltration improved SCC prognosis. Cases with little collagen fiber formation showed a tendency to be poorly differentiated SCC and mode 4 invasion (mostly mode 4 D).
4) Carcinoembryonic antigen (CEA) and n-CEA (nonspecific cross-reacting antigen-free CEA) were detected on tumor cells of cancer pearls. n-CEA demonstrated a higher specificity than CEA.
5) The cells of cancer pearls were positively stained with keratin.
6) Cases of mode 2 and 3 were positive for CEA, n-CEA and keratin, while some cases of mode 4 were negative for these tests and showed a worse prognosis.
7) Fibrinogen was detected in the stroma bordering the tumors. Plasminogen and Antithrombin III were generally demonstrated in both the nests of the tumors and the stroma. Furthermore, α2-Macroglobulin, C 3 and C 4 were shown within the tumor nests, the bordering stroma and on granulocytes.
8) Cases categorized poorly differentiated SCC and mode 4 were mainly of the erosive and ulcerative or tumor mass type clinically. These SCC were usually negative for CEA, n-CEA and keratin. It is suggested that immunohistochemistry should be combined with routine pathology in treatment planning and determining prognosis.
