Sixty-eight cases of benign papillary squamous tumors of the mouth were reviewed to elucidate further their histopathologic variations, as well as to clarify the premalignant nature of these tumors. The cases were calssified into five varieties: idiopathic pseudoepitheliomatous hyperplasia (2 cases), papilloma (55 cases), oral florid papilloma (7 cases), inverted papilloma (3 cases) and recurring oral papillomatosis (1 case). The series included very rare cases, to our knowledge, undescribed in the literature. Though a microscopic differentiation between the benign papillary squamous tumors, verrucous carcinoma and well differentiated squamous cell carcinoma is quite difficult, clinical and pathologic recognition of these tumors is imperative, because of the differences in their clinical course and therapeutic requirement. A definite diagnosis should be made after the clinical and microscopic findings have been carefully correlated. Malignant change occurred in the oral florid papilloma and recurring oral papillomatosis.
Sixteen autopsy cases of the primary sarcomas of the mouth and jaws were reviewed, which included 1 chondrosarcoma, 3 osteosarcomas, 1 leiomyosarcoma, 7 rhabdomyosarcomas and 4 histiocytic lymphoma (reticulum cell sarcoma). Although the case materials studied were too small, the pattern of the spread of the sarcomas of the mouth and jaws was likely to be divided into two groups, localized and generalized. The former is comprised of chondrosarcoma, osteosarcoma, leiomyosarcoma and pleomorphic rhabdomyosarcoma. The latter is comprised of alveolar rhabdomyosarcoma and histiocytic lymphoma. Embryonal rhabdomyosarcoma belongs to either group depending on the case. The former, being resistant to local therapy, tended to recur with a contiguous spread but was slow to metastasize. Metastases were limited to the lung and pleura through the hematogenous route. The primary sarcomas of the latter group were not so extended in local spread and occasionally cured with therapy. However, metastases, both hematogenous and lymphogenous, were generalized.
Two autopsy cases are presented of spindle-cell carcinoma of the oral cavity, which were transformations from the pre-existing well differentiated squamous cell carcinoma in Case I and verrucous carcinoma in Case 2, after large doses of irradiation. In Case 2, the conventional squamous cell carcinoma existed at the time of biopsy. Our case study suggests that the spindle-cell carcinoma may develop from the verrucous carcinoma by dedifferentiation through the intermediate stage of conventional squamous cell carcinoma.
Nine cases of fibromatosis occurring in or near the oral cavity are presented here. They are classified as nodular fasciitis (5 cases), aggressive infantile fibromatosis (2 cases), fibrosing myositis (l case) and fibromatosis (1 case). Of the 5 cases of nodular fasciitis, 3 occurred from the fascia of the masticatory muscle and 2 from the submucous fascia of the palate and tongue. The aggressive infantile fibromatosis showed a prominent infiltrating growth and an alarming histologic appearance. One of the 2 cases showed a recurrence, but the postoperative course of both cases was uneventful for 13 years and 10 years, respectively. The fibrosing myositis is an unusual fibromatosis of the muscle, which arose within the tongue muscle. The lesion was benign and can be cured by conservative surgery.
Acute sodium fluoride toxicity was studied histologically and histochemically in the rat kidney. The doses given subcutaneously by a single injection were 10, 12.5 and 15 mg/100 gm of body weight and the duration after the administration were 30 minutes, and one, 3, 5 and 7 days. Histologically, coagulation necrosis of the proximal tubules was found at I day and the injury was most striking at 3 days. Regeneration was almost complete at 7 days. Among the enzymes studied, e.g., alkaline phosphatase, acid phosphatase, 5'-nucleotidase, adenosine triphosphatase and succinic dehydrogenase, the acid phosphatase of the tubular epithelium was the most severely impaired.
In order to study the role and metabolism of high density lipoprotein (HDL) subfractions, the serum HDL2-cholesterol (HDL2-C) and HDL3-cholesterol (HDL3-C) were measured by the new method using high performance liquid chromatography in the normal subjects and patients with various diseases.
It was highly characteristic that the serum HDL3-C levels of the patients with liver cirrhosis (LC) were remarkably lower than those of the normal subjects. The result suggests that HDL3 may be produced in the liver.
Both the serum HDL2-C and HDL3-C levels were significantly lower in the patients with coronary heart disease (CHD) or cerebral thrombosis (CT) than in the normal subjects (P<0.001).
In the normal subjects, the changes in the serum HDL-cholesterol (HDL-C) levels were mainly due to those in the serum HDL2-C levels. On the other hand, in the patients with atherosclerotic diseases (CHD, or CT) the changes in the serum HDL-C levels were attributed to those of both the serum HDL2-C and HDL3-C levels. So it is suggested that in the atherosclerotic diseases, in which the HCL-C is usually lower, the HDL3-C also may play an important role in the regulation of the total HDL-C and its anti-atherogenetic effect.
Focal lymphocytic infiltration of the submandibular gland was investigated on the autopsy cases. The materials examined were 340 cases without the collagen diseases and 28 cases with collagen diseases. Of the 28 cases with collagen diseases, 20 were systemic lupus erythematosus, 2 with the coexistence of systemic lupus erythematosus and Sjögren’s syndrome, 4 with rheumatoid arthritis and 2 with progressive systemic sclerosis. Among the cases without the collagen diseases, the focal lymphocytic infiltration was seen in 154 cases (74%) of 209 males and in 94 cases (71%) of 131 females. All 28 cases with collagen diseases had a focal lymphocytic infiltration. The incidence of grade 3 or severe infiltration was 4% in the males and 14% in the females in the cases without the collagen diseases, 65% in the 20 cases with systemic lupus erythematosus, 50% in the 4 cases with rheumatoid arthritis and 50% in the 2 cases with progressive systemic sclerosis. No cases of very severe infiltration were found, which were seen in the classical Sjögren’s syndrome, in both cases with and without the collagen diseases. Hyperplastic change in the ductal cells, which can be called an epimyoepithelial island, was found in 23% of the cases with collagen diseases. These observations suggest that the focal lymphocytic infiltration is a focal sign of the immunologic disorder of the submandibular gland in the collagen disease.
To study the gastrointestinal hormones in hyperthyroidism and the interrelations with the thyroid hormones, the preprandial serum gastrin and motilin were measured by radioimmunoassay in 104 patients before and after the treatments. The following results were obtained:
1) Serum gastrin concentration in hyperthyroidism was significantly higher than that of the control, and when the patients reached euthyroidism or hypothyroidism after the treatments, the gastrin concentrations in the serum decreased to the normal level. There was a positive correlation between the thyroid hormones and the serum gastrin.
2) Serum motilin concentration in hyperthyroidism was slightly lower than that of the control. As the patients reached the euthyroid or hypothyroid state after the treatments, an increasing tendency of motilin was observed, though the change was not significant. There was a slightly negative correlation in gastrin versus motilin and also in T4 versus motilin.