To detect lymph nodes metastasis, clinical palpation, ultrasoundsonography (US) and 99mTc rhenium colloid lymphoscintigraphy (LSG) were carried out in forty-one cases of oral squamous cell carcinoma, and the results obtained from these examinations were compared to histopathological findings of the resected lymph nodes. All patients were classified according to TNNI system, and only 56.9% of the lymph nodes diagnosed as metastasised by clinical palpation were confirmed histopathologically. As to the US findings, the involved lymph nodes showed heterogeneous or cyst-like hypoechogenisity. In LSG, the abnormal images detected by static imaging procedure were as follows; 1) absence, 2) enlargement, 3) blurred appearance and 4) asymmetry of lymph node RI counts at the lymph node showing enlargement and absence with LSG were high and low, respectively. In relation to the histopathological findings, more than two thirdsof the lymph nodes were occupied by tumor cells in the absent image, approximately half in theblurred image and less than one third with follicular hyperplasia in the enlarged image. The lymphatic flow, detected by dynamic imaging procedure, was disturbed and delayed on the tumor-bearing cervical side in most instances. The present results revealed that 85.7% of the involved lymph nodes were accurately estimated by using both US and LSG. So far as lymph node metastasis, US and LSG offered the different informations so that a combination of US and LSG is thoughtto be useful for the detection of cervical lymph node metastasis in oral malignant tumors.
Twenty-two cases of primordial cysts and odontogenic keratocysts in the Department of Oral Surgery II, Okayama University Hospital, from 1982 to 1990 were clinically, histopathologically and immunohistochemically analysed. For immunostaining, four monoclonal antibodies to cytokeratins and polyclonal antibody to involucrin were used. Primordial cysts and Odontogenic keratocysts were classified into four groups histopathologically and immunohistochemically. Clinical, histological and immunohistochemical findings suggested that the cysts classified into I, II, and III types had the nature of stratified keratinized epithelia and that Type IV cyst might be a primordial cyst with non-keratinized characteristics. The histological characteristics were somewhat related to the radiographical findings and clinical behaviors. Present classification is useful to evaluate the behaviors of these cysts.
The growth characteristics of primary ameloblastoma were examined in 30 resected mandibles. In all cases, whole tissue sections were prepared and microscopic examinations were conducted on 122 marginal regions of the tumors. Statistical analyses were employed to determine the factors which are related to the growth characteristics. 1. The growth characteristics of the tumor were histologically classified into two major patterns: expansive and invasive. Based on the parenchymal morphology of the margin, the former was further divided into flat and saw-tooth types, and the latter into cord-like, sporadic, and diffuse types. Most ameloblastomas examined displayed multiple types of growth simultaneously. 2. The outer layer cells of the tumors were classified into 3 types: cuboidal, columnar, and basal cells. The cuboidal cell type had a tendency of being expansive, the basal cell type was apt to be invasive, and the columnar cell type showed both characteristics. 3. The relationship between the host site and the growth patterns has revealed that the tumors in the alveolar region invaded the cancellous bone, while the tumors in other regions had a tendency of being expansive, especially in the mandibular ramus. This finding suggests that differences in the inner architecture of the mandible can affect the tumor growth. 4. In order to predict the growth pattern of the tumor prior to surgery, the quantification theory Type II of Hayashi was employed with the following parameters: 1) the histological type of the outer layer cells, 2) the host site, 3) radiographical features, and 4) macroscopic appearances i.e. cystic or solid. Then the result was evaluated in comparison with the histological figures of the marginal regions of the tumors. It was found that the estimation was as accurate as 78.7%. We concluded treatment should be carried out after careful consideration of the growth pattern at various anatomical sites of the mandible.
We studied 74 cases of squamous cell carcinoma in the oral cavity, clinico-pathologically and immunohistochemically. Of the 74 cases, primary cervical lymph node metastasis was observed in 19 cases and secondary cervical lymph node metastasis in 8 cases. The materials were obtained before the treatment, fixed in 10% formalin or 2% PLP and embedded in paraffin. Immunostaining of carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA) was performed by the avidin-biotin peroxidase complex (ABC) method with monoclonal mouse anti-human CEA antibody and anti-human EMA antibody respectively. CEA-and EMA-positive stainings were graded as “slight”, less than 25%, “moderate”: 25-75%, “marked”: more than 75%, judging by stained area in the 100X field. The results showed that the grade of CEA and EMA staining correlated with the degree of epithelial differentiation of the tumor, although EMA was more sensitive marker than CEA. In addition, high frequency of “marked” CEA and EMA expression in no cervical lymph node metastatic cases was observed significantly. However, there was no significant relation between the grade of CEA and EMA stainings and the presence of cervical lymph node metastasis as whole. Thus, by examining these factors, we were unable to satisfactorily predict the presence of cervical lymph node metastasis.
Langerhans cells (LC) have been known to play a central role in initiation of immunological defense in oral mucosa. As similar functions may be involved in the immune response to malignant oral tumors, thirty-four cases of oral squamous cell carcinoma were examined immunohistochemically to investigate the change of LC and the expression of HLA-DR antigen. The number of LC decreased in lesions of squamous cell carcinoma. However, the specific relationship between the number of LC and the differentiation of the tumor, T-cell infiltrate, or invasion to surrounding tissue could not be observed. There was also no difference in the number of LC, whether the patients had metastasis of cervical lymph nodes or not. The expression of HLA-DR antigen on LC increased according to the differentiation of the tumor and T-cell infiltrate. In patients who had metastasis of cervical lymph nodes or deep invasion to surrounding tissue, the expression of HLA-DR on LC decreased. These results suggest that the number of LC may decreased with tumor occurrence, and that the expression of HLA-DR on LC seems to decrease in accordance with tumor malignancy. It is postulated that not only the number of LC, but also the expression of HLA-DR on LC may play important roles in the immune response against oral squamous cell carcinoma.
Blood eosinophils, eosinophils infiltration around the tumor and lymph node reaction were investigated relatively to cervical lymph node metastasis in 17 patients of oral squamous cell carcinoma treated by tumorectomy with neck dissection. The eosinophils infiltrated around the tumor in the biopsy specimen and peripheral blood eosinophil was counted. Lymph node reaction which included germinal center hyperplasia (GCH) and sinus histiocytosis (SH), was evaluated in the surgical specimen of the neck. The following results were obtained: 1. The cases with high grade eosinophil infiltration (>50 cells in high power field) showed significantly higher incidences of cervical lymph node metastasis than those with low grade.(P<0.05). 2. There was no correlation between the levels of blood eosinophil and eosinophil infiltration around the tumor. 3. No distinct relationship was observed between blood eosinophil level and cervical lymph node metastasis. 4. Cervical lymph node metastasis was observed in 4 out of 5 patients with low grade SH. Incidence of GCH has no significant correlation to the lymph node metastasis.
The authors have been making a series of experimental studies in the rat on healing after fracture of the condylar process as well as after removal of the articular disc. However, it was impossible to observe changes in the identical rat with the passage of time. Accordingly, we could only speculate the course of healing with passage of time on the basis of general evaluation of macroscopic and histological findings on the excised mandible. There are many kinds of X-ray apparatus available for standard radiographic observation of experimental animals. However, most of these employ projection from the vertex, which is inappropriate for the observation of the condylar process.: Moreover, detailed lateral observation of a process is impossible because the two opposing processes would overlap. In order to solve this problem, we developed a rat-fixing apparatus and improved a soft X-ray apparatus (Hitex HA-80R) for lateral projection. Employing these apparatus, we could observe the bilateral condylar processes without overlap. Moreover, we were able to obtain images of high standard and reproduciblity. Thus, it has become possible to make precise morphological observation of the condylar process with the passage of time in the same rat.
We described the histopathological and morphometrical findings of oromaxillary region of two autopsy cases of siblings with DiGeorge syndrome (DGS). At the time of the autopsy, case 1 (11-month-old male) showed aplasia of the thymus and hypoplasia of the parathyroid gland, while case 2 (2-year-9-month-old female) showed hypoplasia of both the thymus and the parathyroid gland. In both cases, mucocutaneous lesions due to varicella, hyperterolism, low-set malformed ear, ill-developed jaws and delayed dentition were observed. Histopathologically, these cases revealed reduction of bone formation and absorption (remodeling activity) in the mandible and slight hypoplasia of enamel and dentin of the teeth with dental caries. The tongue revealed hypoplasia of papillae especially marked at the base. Inflammatory infiltration was rather slight in the many areas of oral mucosa ulceration. From the above-mentioned findings, hypoparathyroidism and immunological deficiency superimposed in developmental abnormalities were considered to characterize the pathological features of the hard and soft tissues of the oromaxillary region.
Sixty one patients with oral squamous cell carcinoma received radical tumor excision. Of these, 30 patients were treated with polysaccharide Sizofiran (SPG) for postoperative adjuvant immunotherapy. SPG was intramuscularly given at a dose of 40mg once every 2 weeks. The 3-year survival rate of the 30 patients treated with SPG was 95.2%. It was significantly higher than 78.4% of the 31 untreated patients (P<O.05). Moreover, the study on immunological parameters, including counts of lymphocytes, OKT3 and OKT4 subsets, and activity of IL-2 produced by the lymphocytes, suggested that SPG promoted the recovery of cellular immunity which was reduced in the patients who had received radio-and/or chemotherapy.