Determination of the distribution of cytokeratin (CK) is prerequisite to using CK monoclonal antibodies (MAB) as a salivary gland tumor marker. The availability of monospecific antibodies to all CKs of simple epithelia provides an opportunity to analyze the CK profiles of salivary ductal, acinar and myoepithelial cells. In the present study, a battery of MABs to CK were produced and their reactivities to human salivary gland were examined immunohistochemically. Cytokeratin was extracted and purified from bovine hoof according to Achtstaetter's method. Mice were immunized with a cytokeratin preparation containing seven polypeptides in the 50-68 kDa range. Out of 226 hybridomas, 21, resulting from fusion with SP 2/0 cells, produced antibodies that were positive by ELISA. Fifteen of them strongly stained the human salivary gland with diverse reactivities which were classified in to 6 types. I) MABs reacting with all epithelia (KH-21) II) MABs reacting with all epithelia except myoepithelial cells (MECs)(KH-1, KH-2, KH-3, KH-7, KH-8, KH-14) III) MABs recognizing all epithelia except acinar cells (KH-4, KH-20) IV) MAB recognizing MECs and basal cells (KH-5) V) MAB recognizing only basal cells (KH-6) VI) MABs staining acinar cells and intercalated ducts (KH-11, KH-12, KH-13, KH-16) Immunoblotting demonstrated that a common epitope of the MECs and basal cells recognized by KH-5 was located in the 60 kDa polypeptide, and that many CK MABs produced by us share a common antigenic determinant existing in multiple CKs. The usefulness of the KH-series was demonstrated immunohistochemically.
The cationic lipophilic compound, rhodamine 123, has a unique cytotoxic mechanism of action which is dependent on mitochondria-specific affinity of this fluorescent dye. The author investigated the anticancer activity of rhodamine 123 against a VX2 tongue cancer in rabbits. The following results were obtained: 1) In normal rabbits injected with rhodamine 123 in doses equal to or lower than 10 mg/kg (i.v.), marked systemic toxic effects on body weight, peripheral blood findings, blood chemical examinations, and histopathological findings were not noted. 2) In regard to the anticancer activity of rhodamine 123, groups of rabbits treated with rhodamine 123 showed significant inhibition of VX2 cancer growth conpared with a control group. 3) The anticancer activity of rhodamine 123 against VX2 cancer was markedly enhanced by conbined use with 2-deoxyglucose. 4) Histopathologically, necrosis and disappearance of VX2 cancer cells, atrophy ofmuscle fibers and fibrosis were observed in groups locally injected with rhodamine 123. 5) Ultrastructurally, mitochondrial swelling, dissolution, and disappearance of cristae were particularly remarkable in groups treated with rhodamine 123. The results of these investigations demonstrated the anticancer activity of rhodamine 123 against a VX2 tongue cancer in rabbits, and suggested the possibility of clinically using rhodamine 123 for the treatment of oral cancer.
Immunocytochemical localization of the transferrin receptor (TfR) using a monoclonal antibody in HeLa cells was investigated by microscopy and electron microscopy. In addition, changes in transferrin receptor localization evoked by cisplatinum diammine dichloride (CDDP) were examined. The results were as follows: 1. In proliferating cells, TfR was found in the cell membrane and electron microscopic investigations revealed that TfR was localized in a scattered fashion in the cell membrane, microvillus-like projections and intercellular vesicles. 2. After CDDP treatment, microvillus-like projections and intercellular vesicles were not as prominent as in the control group and the quantity of TfR decreased. 3. In some relatively highly degenerated cells by CDDP, many TfRs were demonstrated, suggesting that the mechanism of TfR expression, which reflects the proliferative ability of cancer cells, should be investigated.
The authors designed a regimen of TPP intra-arterial chemotherapy (THP-ADM, CDDP and PEP) for the treatment of oral squamous cell carcinomas. Twenty-one patients were treated, and markedly effective results were obtained. The regimen of TPP intra-arterial chemotherapy was 20 mg/m2 of THP-ADM on day 1 (one shot), 50 mg/m2 of CDDP continuous infusion on day 2, and 5 mg/m2 of PEP from days 3 to 7. After 2 weeks of no treatment, the above regimen was repeated every three weeks. As a rule, 2 cycles were performed. One cycle was received by 3 cases, and 2 cycles were received by 18 cases. The median age of the patients was 57. 1 years old (15 males, 6 females). Primary lesions involved the tongue in 8 cases, maxillary sinus and mandibular gingiva in 3 cases each, buccal mucosa and oral floor in 2 cases each, and the palate, oropharynx and mandibular central carcinoma in 1 case each. TNM classification was Tis in 1 case, T2 in 7 cases, T3 in 1 case, and T4 in 12 cases. All cases were MO. The clinical response was CR in 6 cases (28. 6%), PR in 14 cases (66. 7 %), and MR in 1 case. The response rate was 95. 2%. Among the 8 cases of tongue carcinoma, 4 were CR (50%) and 4 were PR for a response rate of 100%. The response to this chemotherapy of metastatic regions in 11 cases involving the submandibular and cervical lymph nodes was CR in 1 case and PR in 10 cases. The response rate of metastatic lymph nodes was therefore 100%. The main side effects were hair loss on the treated side in 20 cases (95. 2%), anorexia in 18 cases (85. 7%), stomatitis in 17 cases (80. 9%), nausea and vomiting in 11 cases (52. 4 %), facial flush in 10 cases (47. 6%), and fever in 7 cases (33. 3%). Leukopenia (57. 1%) and thrombocythemia (23. 8%) were noted as laboratory abnormalities, but there were no severe cases.
The two cases presented are of particular interest because of the unusual pathologic features of the metastatic tumor, its rapid growth, and the concealed nature of the primary tumor. Case 1 was a 56-year-old man consulting us for gingival swelling. At the time of reviewing the patients disease history, the patient told us that he underwent a gastrectomy for a gastric ulcer 3 years ago. In fact, however, the patient and his wife were not informed of the presence of gastric cancer by his physician. The tumor mass showed remarkable proliferation. Pathologically, biopsy specimens showed characteristics of rhabdomyosarcoma, malignant melanoma, or metastatic tumor from another organ. Gastric cancer and liver metastasis were diagnosed by endoscopy and gallium scintigraphy, performed to investigate the cause of massive bleeding from the digestive tract. The patient rapidly became febrile and cachectic and died of multiple metastases. Case 2 was a 53-year-old man who was referred to our hospital for a recent increase in gingival swelling of the right frontal maxilla. The pathologic diagnosis was a suspected rhabdomyosarcoma. Abdominal echography revealed large tumor at the tail of pancreas. Metastases to lung and brain were also by CT and X-ray. The patient became febrile, deteriorated rapidly, and died at an affiliated hospital. The histopathologic diversity of metastatic tumors arising from primary tumors is discussed in this paper. It is important to bear in mind the possibility of oral metastases arising from distant tumors. The oral cavity should therefore be carefully examined to discover metastatic lesions, which may show various histopathologic characteristics differing from the primary lesion.
Rhabdomyosarcoma is one of the most common malignances of the mesenchymal tissue in the head and neck region. Rhabdomyosarcomas have been classified into 3 histologic categories: embryonal, alveolar and pleomorphic types. This paper presents a 2-yearold female with a rhabdomyosarcoma of the tongue. The most common symptom of rhabdomyosarcomas is a progressively or rapidly growing painless mass. However, the case we report did not show appreciable growth after biopsy. The tumor cells expressed desmin, vimentin and actin. We performed a partial excision of the tongue and administered chemotherapy with cyclophosphamide, etoposide, adriamycin and cisplatin.
In view of the effects of impacted upper third molars upon occlusion and disarrangement of the dental arch, there recently has been an increasing tendency to remove these teeth. The author classified the surgical technique for the extraction of impacted third molars into buccal gum incision and palatal incision. This paper discusses the palatal technique, which is performed as follows: 1) An incision of 2-2. 5 cm is made parallel to the upper molars on the palatal side 5 mm away from their dental cervix, and another 1-1. 5 cm incision is made distal to the retromolar gum of 17 or 27. 2) The mucoperiosteal flap is peeled off and raised from the palatal side, while the surgeon notes the site of the foramen palatinum majus and its blood vessel bundles. 3) The bone surrounding the impacted tooth is cut off, and the tooth is removed. 4) The wound is sutured, with minimal drainage. Advantages of this technique are 1) easy access to the operative field with a good and broad view, 2) minimal bleeding, 3) minimal damage of the gingiva attachment and consequertly a short operation time. Its disadvantages are the risk of injuring a large palatal blood vessel and the inability to remove a buccally displaced impacted tooth.
A malignant melanoma of the oral cavity which was not so responsive to DAV therapy and Liniac radiotherapy but succesfully responded to local injection of interferon-β is reported. A 67-year-old male came to our department complaining of a painful tumor on the palate on November 1, 1989. Initial examination showed a diffuse melanoma on the upper alveolar gum, hard palate, and soft palate which infiltrated to the cheek and upper lip mucosa. Signs of metastasis to the regional lymph nodes were not evident. Although he was treated with chemotherapy (DTIC, ACNU and VCR) and highdose intermittent radiotherapy, the tumor did not disappear. We therefore tried local injection of interferon-β(100-300×104 IU/day, 3-5 times/week). The tumor disappeared completely after 6 months. However, a metastatic lymph node (30 mm) of the submandibular region was detected and neck dissection was carried out. Three years after his first visit, neither local recurrence nor distant metastasis have been clinically detected.
In 1966, Johnson and Helwig called attention to a solitary cutaneous lesion thatthey termed “cutaneous focal micinosis”. These lesions occurred on the skin of the face, trunk, or extremities as nodules or dome-shaped elevations. They were characterized histologically by a mucinous accumulation interspersed with spindle-shaped fibroblasts Similar lesions occurring in oral soft tissue were designanted as oral focal mucinosis by Tomich in 1974. Oral focal mucinosis and myxoma of the oral soft tissue were differentiated by the presence of reticulin fibers and a distinct border with the surrounding connective tissue. A 70-year-old man visited our clinic after noticing swelling of his buccal mucosa. The lesion was the same color as the surrounding mucosa. The resected lesion measured 15×15×10mm, and its sectioned surface Was smooth and grayish-white in color. Routine histochemical observation of paraffin-embedded tissue sections led to a diagnosis of oral focal mucinosis.
A 41-year-old woman visited our hospital. X-ray findings suggested a redicular cyst in the 123 region. However, the palatinal alveolar bone was absorbed and granulation tissue adhered to the palatinal mucosa and teeth. The cyst was extirpated with teeth extraction. The histopathological diagnosis was a odontogenic fibroma.
We report a case of basal cell adenoma of the parotid gland, which is a comparatively rare salivary gland tumor. A 68-year-old woman visited our department complaining of swelling in the right parotid region. The tumor was excised under the diagnosis of a parotid gland tumor. The tumor was located in the superficial lobe of the parotid gland and was surrounded by a fibrous capsule. Histopathologically, the tumor was mainly composed of isomorphic basaloid cells forming solid irregular trabecular structures with occasional ductal or cystic formations. Generally, the stroma was poor and contained no chondroid or mucoid components similar to pleomorphic adenomas.
A 13-year-old boy was referred to our clinic on December 10, 1988, with diffuse swelling of the left mandible which extended to the left cheek and bleeding from the gums of the left lower molar region. Radiographs showed a multilocular radiolucency extending from the left lower first premolar region to the left mandibular foramen, bony expansion around the area, and dilation of the left mandibular canal. Arteriograms confirmed the presence of an arteriovenous malformation (AVM) of the left mandible. The feeding vessels appeared to be branches of the internal maxillary and facial arteries, while the main draining vessel was the left inferior alveolar vein. A nidus was recognized around the left mental foramen. After embolization of the feeders, the left facial and inferior alveolar vessels ligated and lesion of the mandible was packed with oxidized cellulose and bone wax. A panorex study revealed regeneration of bone in the area of the lesion and no evidence of AVM after 3 years and 6 months of postoperative follow-up.
In Sjögren's syndrome, swelling of the parotid glands or submandibular glands isoften found but unilateral enlargement of the lingual glands is rare. A case of Sjögren's syndrome with swelling of right lingual gland is reported. The patient was a 57-year-old woman. She complained of swelling of the right lingual gland that was suspected to be a neoplasm. However, histological findings of the lesion suggested Sjögren's syndrome. Sialography, tear flow rate and laboratory findings supported the diagnosis of Sjögren's syndrome.
A calcifying odontogenic cyst associated with a complex odontoma which appeared in the mandible of a 21-year-old woman is reported. Radiographically, this lesion showed a single radiolucent area with an odontoma-like radiopaque mass. Histopathologic examination revealed the presence of ghost cells, calcified tissues and structures characteristic of a complex odontoma in the lumen of the cyst. After surgical removal of the cyst, the patient has remained free of symptoms.