Biological studies on the extracellular matrix (ECM) and related cell receptors in cancer tissue have demonstrated that fibronectin (FN), which is one type of ECM, is involved in adhesion, cell activation and migration. However, the origin and the biological roles of FN which exists in cancer tissue and whether or not FN inhibits tumor proliferation are largely unclear. To elucidate the origin and the biological roles of FN in cancer tissue, the expression of FN was investigated by immunohistochemical staining and in situ hybridization technigues using an image analysis system for 80 well-differentiated oral squamous cell carcinomas (S. C. C) obtained by biopsy. The immunohistochemical distribution and the gene expression of FN were compared and evaluated in 80 cases of cancer tissue, and FN localization was discussed in regard to T classification, metastasis to regional lymph nodes (UICC 1987), and prognosis. 1) FN distribution in well-differentiated S.C.0 was classified into 4types: negative, type N; FN positive in cancer parenchyma, type T; FN distributed in membrane-like fashion in cancer parenchyma, type M; diffuse distribution of FN in the cancer stroma, type D. 2) Cases with numerous cells expressing FN m RNA in the stroma showed higher frequencies of weak and strong positive FN immunostaining than negative staining (p<0.001). There was no correlation between FN and FN m RNA expression in cancer parenchyma. 3) Cases with numerous cells expressing FN m RNA in cancer parenchyma were significantly more frequent among type T and M than among type D (p<0.001). D-type tumors showed a higher frequency of cells expressing FN m RNA (p<0.001). 4) T3 and T4 well-differentiated oral S. C. 0 were characterized by large numbers of cells expressing FN m RNA in cancer parenchyma and small numbers of cells expressing FN m RNA in stroma (p<0.001, p<0.05). 5) Well-differentiated oral S. C. C. with regional lymph node metastasis frequently exhibited expression for FN m RNA in large numbers of cells in cancer parenchyma (p<0.001). 6) Oral S. C. C. with good prognoses showed higher numbers of cells expressing FN m RNA in stroma and type D (p<0.05, p<0.025).
An 18-year-old girl was referred to our hospital for a painless swelling of the left mandibular angle. Radiographic examinaion revealed a unilocular radiolucent area at the left mandibular angle. Partial resection of mandibule was done under general anesthesia. Histopathologically, some areas of the specimen resembled an aneurysmal bone cyst and a giant cell reparative granuloma, while the major portion was compatible with fibrous dysplasia. The aneurysmal bone cyst and giant cell reparative granuloma in this case were regarded to be secondary phenomena to the primary bone lesion of fibrous dysplasia.
Five cases of osteoradionecrosis (ORN) of the mandible were treated by hyperbaric oxygen therapy (HBO). In four cases, sequestrectomy in combination with HBO was performed. Furthermore, one of these cases underwent iliac bone grafting and HBO to correct mandibular discontinuity. One case underwent HBO after insertion of an implant into the irradiated mandible. Primary sites, with the histological diagnosis of the tumor and irradiation dose were: tonsil-squamous cell carcinoma (SCC), Linac X-ray 60 Gy; hard palatemalignant pleomorphic adenoma, Tele 60 Co 50 Gy; floor of the mouth-SCC, Tele 60 Co 38 Gy and 198Au grain 98 Gy; tonsil-SCC, Tele 60 Co 60 Gy; tongue-SCC, Linac X-ray 40 Gy. ORN appeared in these five cases 3 years, 24 years, 8 months, 1.5 years and 10 years after irradiation, respectively. HBO was performed under the condition of 2.8 ATA for 60 minutes and the patients were given pure oxygen (51/min) using a reservoir mask. All five cases were successfully treated. Otitis, one of the side effects of HBO, occurred in one case. It was managed by puncture of the tympanic membrane. As ORN is caused by hypoxia of the bone and surrounding tissues, HBO is considered to be one of the basic treatment methods for this condition.
High-volume homologous blood transfusion are often used in oral and maxillofacial surgery. However, homologous blood transfusion involves risks such as aquired immunodeficiency syndrom (AIDS) and graft versus host disease (GVHD). Autologous blood transfusion eliminates these risks. However, large volmnes of autologous blood transfusion can cause severe anemia before surgery. Recombinant human erythropoietin (EPOCH) has been shown to enhance erythropoiesis. We therefore decided to take 400ml of blood for autologous transfusion once weekly for 3 weeks while administering EPOCH. 1) Seventeen patients with jaw deformities (male: 5, female: 12) received EPOCH while donating blood for autologous transfusion. 2) The mean total volume of blood collected amounted to 1, 082.4 ± 168.9ml. 3) 6000 units of EPOCH were given three times weekly for 3 weeks prior to surgery. 4) RBC, hemoglobin and serum Fe increased rapidly to nomal levels. 5) No adverse effects were observed. There were no abnomal fluctuations in liver function. We consider this method to be safe and effective.
Ultra-high-strength poly-L-lactide (PLLA) rods were fabricated using a drawing technique. This osteosynthesis system consisted of a bioabsorbable PLLA miniplate and screws that were developed and used clinically in our department over the past five years. Forty-six patients were treated using this PLLA osteosynthesis system. Postoperative infection developed in two patients, but both were controlled by oral antibiotic administration or plate removal. There were no other complications. Bone healing in all cases was satisfactory, without delay of bone union or obvious displacement after surgery. The results of this clinical study suggests that this PLLA bone miniplate and screw system may be used for internal fixation in oral and maxillofacial surgery.
This paper reports a case of dermatitis which was caused by zinc deficiency during total parenteral nutrition (TPN). A 61-year-old male with hemiplegia and dyslalia induced by cerebral hemorrhage developed carcinoma of the maxillary sinus. In spite of intensive cancer therapy, the tumor continued to grow and gradually destroy the tissue of the orofacial area. Since he had dysphagia due to the orofacial tissue defect in addition to hemiplegia and his nutritional state deteriorated, We started TPN. Although TPN improved his poor nutritional state, skin rash and erosion appeared on the face, extremities and perineum about 42 days after starting TPN. The patient's clinical symptoms and the low concentrations of trace elements in blood led us to suspect dermatitis due to trace element deficiency. We started to administer a preparation containing the essential trace-elements intravenously. Consequently, the dermatitis disappeared rapidly and the concentrations of trace elements, particularly zinc, entered the normal range. Therefore, in this case zinc deficiency during TPN most likely caused dermatitis which was cured by the administration of a preparation containing essential trace elements including zinc.
Aneurysmal bone cysts of the jaw are rare. Those of the mandibular symphysis are extremely rare. Recently, we diagnosed an aneurysmal bone cyst in the midline of the mandible in a 29-year-old man in whom an asymptomatic cystic lesion was noted accidentally during routine X-ray examination. Radiographic examination revealed an ill-defined ovoid radiolucent area in the midline of the mandible. The lesion was enucleated and curetted under local anesthesia. Histopathologically, the lesion consisted of fibrous connective tissue stroma containing numerous capillaries, and eosinophilic calcified particles were scattered in some regions.
We report an epidermoid cyst of the tongue which contained a wood chip in the cystic cavity. The patient, a 46-year-old man, had a history of a stab wound of the tongue about 40 years ago. From several years after the injury, he had noticed an asymptomatic induration under the dorsal mucosa of the tongue. On examination the patient presented with a circumscribed round and cartilagelike hard mass of about 20mm in diameter was palpable under the dorsal mucosa of the tongue, and no signs of inflammation were observed. Enucleation of the mass was performed under general anesthesia. The surgically removed specimen was a cystic lesion containing a grayish brown mass in the cystic cavity. Histopathologically, the lesion was diagnosed to be an epidermoid cyst containing a wood chip in the cystic cavity. The case reported here strongly supports the hypothesis that epidermoid cysts may be caused by heteropic epithelial cells.
Congenital lipoma in the oral cavity is very rare. A fibrolipama in the oral cavity of a 40-day-old female infant is reported. A pedunculated tumor measuring 25×15mm was noted at the region from the anterior palate to upper alveolar ridge. Nasal asymmetry due to left deviation of the columella base was present. The patient was admitted and the tumor was resected. A partial bone defect of the midline of the upper alveolar ridge and hard palate were recognized. Pathological examination revealed that the tumor was composed of fat cells and fibrous tissue, and sebaceous glands were present in the submucosal tissue. The pathological diagnosis was a fibrolipoma and histogenetically the tumor seemed to be a hamartoma. A literature-based review of 17 cases of congenital lipoma in the oral cavity is presented. Eleven of these cases were simple lipoma, five fibrolipoma and one was angiolipoma. Two cases of congenital lipoma located in the midline of the upper alveolar ridge, including of our case, had nasal deformity. There may be some relationship between tumor location and nasal deformity.
Angiomyolipoma is a rare tumor in the oral region. This paper describes an angiomyolipoma arising in the palate of a 66-year-old male. Only three oral angiomyolipomas have been reported in Japan. Distinctions between angiomyolipomas and angiomyomas were discussed.
Plasma cell granuloma is a pseudotumor characterized by aggregation of plasma cells. It rarely occurs in the oral cavity. A case of plasma cell granuloma of the buccal mucosa in a 42-year-old woman is reported. She suffered from repeated bite wounds of the right buccal mucosa from 18 months previously, and a granulomatous lesion of this region, initially measuring 15×15mm, developed 15 months previously. The lesion came in contact with metal crowns. Inflammatory cell infiltration chiefly by plasma cells was recognized in the biopsy specimen of lesion. Polyclonality of plasma cells was revealed by immunohistochemical staining of kappa and lambda chains. The histopathological diagnosis was plasma cell granuloma. She had a history of metal allergy and a patch test for dental metal was positive. The stimulation index in the lymphocyte stimulation test by palladium was high. Dental metal allergy was thus suggested to be the main cause of this lesion. The metal crowns in contact with the lesion were removed. The lesion gradually disappeared. Since other region of the oral mucosa that were in contact with the metal crown appeared normal, this lesion was suggeted to be caused by local trauma, as well as metal allergy.
A 45-yesr-old woman who complained of a swelling and induration of the right submandibular region visited our hospital on August 12, 1990. Although symptoms were present for 10 years, she had not previously sought medical attention. X-ray examination revealed a calculus in the right submandibular salivary gland duct. The calculus was removed under local anesthesia on her first visit. The postoperative course was uneventful for about 10 months. She noted a recurrence of submandibular swelling in the middle of June 1991. The swelling persisted and its size did not change. It was a nontender, fluctuant mass. Although X-ray examination did not show any signs of a calculus, an echogram revealed a cyst in the submandibular region. Surgical exploration revealed a thin-walled cystic mass adhering to the posterior portion of the atrophic submandibular gland. The dimensions of the mass and the cyst were 68×55×40mm and 45×40×38mm, respectively. The cyst contained mucous liquid with histiocytes, erythrocytes and lymphocytes. Microscopic findings: The cyst was surrounded by fibrous and hemorrhagic granulation tissue with many foamy macrophages. A large duct communicating with the cyst was present.
Spindle cell carcinoma is a rare neoplasm of the oral cavity. It difficult consists mainly of spindle cells but main various contain other types of tumor cells. Diagnosis is often. In this paper, a spindle cell carcinoma arising in the gingiva of the left impacted third molar in a 64 year-old man is reported. After chemotherapy, radiotherapy and curative resection of the primary tumor, a second tumor developed at the same site of the contralateral gingiva. Based on immunohistochemical and electron microscopic findings, these tumors were diagnosed as spindle cell carcinomas.
Diagnosis and treatment of multiple primary malignancies are difficult. Recently, a 61-year-old man presented at our department with double synchronous cancers located at the 37, 38 and 41, 42 gingiva, respectively. Highly differentiated squamous cell carcinoma was diagnosed in both lesions after preoperative chemotherapy with tetrahydropyranyl adriamycin, cisplatin and peplomycin. The tumors showed a complete response clinically. Postoperatively, histopathological examination showed residual necrotic cancer tissue at the 37, 38 lesion and no residual tumor at 41, 42. There has been no evidence of recurrence as of one year after operation.
A 1-year-old boy with an ameloblastic fibro-odontoma in the anterior mandible is presented. Ameloblastic fibro-odontoma is a rare odontogenic tumor composed of epithelial cells and mesenchymal stroma derived from tooth germ cells. The patient visited our clinic for swelling on the right incisal region of the mandible. Hard swelling of the alveolar bone was found. Radiographic examination demonstrated a cystic radiolucent area with radiopaque mass-like teeth. On December 12, 1991, the mandibular tumor was extirpated under general anesthesia. Microscopically, the tumor was composed of primitive connective tissue resembling dental pulp and odontogenic epithelium as well as enamel, dentin, and tooth germ. This lesion was histologically diagnosed as ameloblastic fibro-odontoma. This case has been followed-up for 2 years 6 months and there has been no evidence of reccurence.
Complex odontoma is a histologically differentiated tumorous lesion consisting mainly of dentine and enamel. Its histological structure is complex and diverse. Recently, we encountered a complex odontoma which showed an extremely rare histological structure. The tumor consisted mainly of cementum and was hollow and did not contain hard tissue. We performed histological studies by microradiography and report the results here. The patient was a 29-year-old male. He presented with an abnormality of the right mandibular ramus on radiographic examination. The abnormality was diagnosed to be a benign tumor. The tumor was removed under general anesthesia. The tumor was calcified, had a lamellar structure, was hollow. Dentine and enamel were observed interspersed with cementum, which was the main component of the tumor.