Nuclear DNA contents and ploidy patterns of DNA histograms were measured using flow cytometry (FCM) for specimens of squamous cell carcinomas (SCC) obtained from the oral cavity, in order to investigate the relationship between DNA ploidy pattern and T classification, the mode of metastasis to cervical lymph nodes, and the histological differentiation of the tumors. The materials consisted of 27 cases of oral SCCs in which radical neck dissection was performed. DNA aneuploidy and DNA index (DI) were measured in the fresh specimens of primary lesions and those of formalin fixed paraffin embedded cervical lymph nodes. The cervical lymph nodes were examined in regard to lymph node metastasis routine hematoxylin-eosin staining. DNA aneuploidy was found in 7 cases (25.9%), and DNA index ranged from 1.35 to 1.72. DNA index was over 1.5 in 6 from these 7 cases. Although all DNA aneuploidy cases showed cervical lymph node metastasis, 9 cases in the DNA diploidy group showed cervical metastasis (45%). The ratio of cervical lymph node metastasis between the DNA aneuploidy group and the DNA diploidy group was significantly different. DNA index tended to increse as tumor differentiation and there was no correration between T classification and DNA aneuploidy. However, the level of cervical lymph node metastasis was more advanced in the DNA diploidy group than in the DNA aneuploidy group. Three of 9 DNA diploidy cases (33.3%) showed advanced level 3 cervical metastasis. However, DNA aneuploidy cases showed only level 1 or 2 cervical metastasis. DNA aneuploidy pattern of cervical lymph nodes was detected in 2 ceses of the DNA diploidy group, and in 3 cases of the DNA aneuploidy group. DNA indexes from the cervical lymph nodes differed from those of the primary legions.
Fusobacterium nucleatum and Streptococcus constellatus are the most common isolates from oral suppurative infections. Reference strains and clinical isolates of F. nucleatum and S. constellatus were studied with regard to their abscess-forming abilities and usefulness as an experimental intra-abdominal abscess model in mice. The abscesses were produced in 80% or more of mice by a simple intraperitoneal injection of F. nucleatum (108 CFU/mouse). Some of the clinical isolates of S. constellatus with a capsule showed very good abscess-forming ability by themselves. Moreover, abscess-forming ability was strikingly enhanced when F. nucleatum and S. constellatus were inoculated concomitantly. Mixed infection led to increased mortality in mice, while infection with F. nucleatum alone did not cause death. These results suggested that F. nucleatum had higher pathogenicity as a causative agent of oral suppurative infections. These findings demonstrated a synergistic effect between F. nucleatum and S. constellatus, and suggested that F. nucleatum might increase the pathogenicity of S. constellatus. It also is easy to induce intra-abdominal abscesses and obtain specimens, making this a quite useful experimental animal model of anaerobic infections.
Recently, -G1cNAcβ1-6Man-(β1-6) branched N-glycosidic oligosaccharides have been reported to play a role in tumor malignancy. In this study, to examine the expression of β1-6 branched oligosaccharides on oral squamous cell carcinoma cells, lectin histochemical staining with phaseolus vulgaris leucoagglutinin (L-PHA), which has a high affinity for β1-6 branched oligosaccharides, was performed on frozen tissue sections prepared from 34 patients with oral squamous cell carcinomas. The β1-6 branched oligosaccharides were localized on the surface of the tumor cells as follows: 1. All of the tumor cells were positive for staining (positive); 2. A population of the tumor cells were positive but the remainder were negative (weakly positive), 3 All of the tumor cells were negative (negative). Statistical analysis revealed that the incidence of metastasis to regional lymph nodes in the cases positive for L-PHA staining on the tumor cells was higher than that in cases negative for the L-PHA staining. These results suggested that the increased expression of β1-6 branched oligosaccharides of oral squamous cell carcinoma may enhance the metastatic potential to regional lymph nodes. On the other hand, previous studies have shown that β1-6 branched oligosaccharides may contribute to the ability of tumor cells to escape recognition by macrophages. Therefore, the number of CD14 positive cells, regarded to be a population of macrophages, which invaded into the stromal tissue adjacent to the tumor was also examined. As a result, smaller numbers of the CD14 positive cells were observed in the stroma adjacent to tumors positive for L-PHA staining compared with the stroma adjacent to tumors which were weakly positive or negative for L-PHA staining. These results suggested a role of β1-6 branched oligosaccharides in the recognition of oral squamous cell carcinoma cells by macrophages.
We have succeeded in transplanting human osteogenic sarcoma of the mandible into nude mice. The transplanted tumor shows the features of calcified chondrosarcoma. This time, focusing our attention on fibronectin which has various biological functions in the body, we studied the relations his between the distribution of fibronectin and chondrogenic differentiation of the transplanted tumor using immunofluorescence technique. Fibronectin was distributed in cells and matrix in the marginal region of the transplanted tumor, and it disappeared in the pre-mineralized and mineralized regions. However, when sections were treated with hyaluronidase, fibronectin also appeared in these regions. These results indicate that the distribution of fibronectin changed during the differentiation of the transplanted tumor cells.
Fixation by adding tannic acid to ordinary aldehyde solution has been reported to be a useful means for the ultramicroscopic visualization of phospholipids. Sialolithiasis is a common disorder of the salivary glands. Although the mechanism of calcifying sialoliths remains to be elucidated, it was reported that biochemically sialoliths contain a lipidenriched matrix. The lipids in this matrix are associated with mineral deposition in sialoliths. Therefore, using an ultramicroscope with a fixative containing tannic acid we examined human sialoliths to ascertain whether the phospholipids contained in the siaoliths are related histologically to the mechanism of mineralization. Multilamellar bodies (MLB) were found in the surface layer of the sialoliths. MLBs were composed of alternating dark and light layers and their cycle length measured about 4-6 nm (approximately 5 nm). Morphological characteristics of MLBs are similar to the lamellar bodies in pulmonary surfactant. These MLBs clearly represented phospholipids and the view that phospholipids are involved in mineralization in sialoliths was supported by these histologic findings.
This paper describes an osteosarcoma arising from the left ramus which invaded the middle cranial fossa. Although this case was initially evaluated to be inoperable, the authors could completely resect the lesion in cooperation with brain surgeons, after high-dose methotrexate therapy. The patient was a 17-year-old male who presented to our clinic with a complaint of trismus. He had an elastic soft swelling in the left preauricular region, trismus and paresthesia of the mental region. Radiograms showed destruction of the mandible ranging from the left lower second motar region to the left entire ramus and the zygomatic arch. CT scans revealed that the tumor destroyed the middle cranial fossa without invading into the brain. A histological diagnosis of the biopsy specimens indicated the lesion to be an osteosarcoma. After high-dose methotrexate therapy, he underwent radical operation radical neck dissection, tumor resection, reconstruction of the soft tissue defect with PMMC, reconstruction of the internal jugular vein with a left great saphenous vein graft). There were no disturbances of the brain after operation. The wound healed uneventfully. The patient has been observed for 30 months without signs of recurrence and metastasis. Although the safety margin at the cranial base was not sufficient, the prognosis was excellent. Therefore, it was concluded that this adjuvant chemotherapy was very effective against osteosarcoma.
A 5-year-old boy presented at our clinic complaining of a firm swelling with mild tenderness in right cheek region. Panoramic X-ray did not reveal any evidence of odontogenous infection, suspected to be the cause of the mandibular osteomyelitis.α-Streptococcus was detected by exploratory punction of the lesion, and the histopathological diagnosis of the biopsy specimen was chronic suppurative osteomyelitis. Saucerization with curretage for the lesion was carried out in order to conserve the cortical bone on the medial side of the mandibular ramus and condyle. The cause of osteomyelitis could likewise not be identified during operation. New bone formation at the mandibular defect was observed by CT scan at 6 months after operation, and the patient's subsegvenr clinical course has been asymptomatic.
Warthin's tumor, also called adenolymphoma, is a relatively rare tumor of salivary gland origin which occurs exclusively in the parotid glands, occasionally bilaterally. The case presented is a 61-year-old male whose chief complaint was painless swelling of the right parotid gland. The swelling, though present for seven years, was untreated until he visited our hospital for the first time. We performed enucleation under general anesthesia. Histopathological study revealed papillary or tubular arrangement of necrotic columnar epithelium in lymphoid tissue with lymph follicules and island-or cord-like squamous metaplasia accompaned by cystic changes in the surrounding fibrous conective tissue. The case proved to be Warthin's tumor equivalent to subtype 4 by Seifert (1980). The patient's postoperative course has shown no evidence of reccurence for four months.
The treatment of tetrapod zygomatic fractures is generally preceded by open reduction and fixation by means of supraorbital eyebrow and infraorbital incisions. However, fixation of the infraorbital rim does not produce adequate stability of the fractured zygoma owing to the thinness of this bone. We used open reduction and fixation via a supraorbital eyebrow incision and an intraoral approach in three cases of zygomatic fracture. The advantage of this intraoral approach is that it allows reduction under direct vision and provides sufficient stability after mini-plate fixation. Consequently, satisfactory results were obtained.
A case of adenoid cystic carcinoma arising from the anterior lingual gland (Blandin-Nuhn gland) is reported. A 65-year-old woman had an elastic, movable swelling (8×8 mm) with pain at the apex of the tongue. The tumor was removed together with the surrounding tissue. Histological examination revealed a typical adenoid cystic carcinoma with a cribriform pattern and mucous and serous glands surrounding the tumor. Recurrence, metastasis and functional handicap of tongue have not occurred as of 4 years and 3 months after surgery.
The overall incidence of tuberculosis in recent years has markedly decreased through the development of excellent chemotherapeutic agents, and the improvement of public health systems and living standards. Consequently, oral tuberculosis is now rarely encountered. However, when oral tuberculosis develops, it is frequently accompanied by ulceration. Differential diagnosis from malignant tumors is therefore often difficult. The patient desclibed here is a 59-year-old man with ulceration in the maxillary gingiva. Histopathological examination, performed due to suspicion of a malignant tumor, indicated a diagnosis of gingival tuberculosis. Additional examinations also revealed active pulmonary tuberculosis and esophageal cancer.
Ameloblastic fibroma is a rare odontogenic tumor. Generally, the tumor occurs intraosseously in children under 20 years of age. Recently, we encountered an ameloblastic fibroma in a four-year-old boy. The tumor was located at the A region, and was extirpated with A. Histopathologically, the tumor consisted of strands and groups of odontogenic epithelial cells in immature fibrous tissue. Immunohistochemical staining using monoclonal antibody against proliferating cell nuclear antigen (PCNA) revealed PCNA-positive cells mainly in mensenchymal tissue.
Amyloidosis is a disease characterized by progressive deposition of amyloid substance in various tissues. We encountered a case of tongue amyloidosis associated with multiple myeloma. The patient was a 54-year-old woman, who had been already diagnosed as having multiple myeloma. After about 6 months, multiple nodules were formed on the tongue. Amyloid deposition was revealed by biopsy and pathological diagnosis. About 2 months later, the tongue presented with marked macroglossia and amyloid was deposited on the cheek mucosa, eyelids, and knees. We carried out chemotherapy, but the effect was poor. The patient died of cerebral hemorrhage.
So-called static bone defects are usually situated in the molar or angular regions of the mandible. A rare case of a so-called static bone defect which existed in the ascending ramus of the mandible of a 25 year-old female is reported. X-ray findings showed a cyst-like radiolucent lesion in the ascending ramus but computed tomography and magentic resonance imaging proved that the lesion was a defect on the lingual ramus with anomaly of the mandible. Histopathological examination revealed the lesion to contain fatty tissue.
A rare case of a cavernous hemangioma in the maxillary sinus of a 48-year-old female is presented. CT scans showed destruction of the anterior and medial bony wall of the maxillary sinus. Histopathological examination revealed no evidence of malignancy, but a hematoma, necrotic tissue and a cavernous hemangioma were noted. Upon suspicion of a malignant tumor in the maxillary sinus, the possibility of a cavernous hemangioma should be kept in mind.
We analyzed 7 myxomas of the mandible clinicopathologically. Age at the initial visit ranged from 23 to 43 years (mean 34.3 years). Only one case was localized in the anterior portion of the mandible. The other cases mainly extended from the premolar to molar region. Three cases involved the ascending ramus. Radiologically, 3 cases showed unilocular radiolucency and 4 cases a honeycomb appearance. Two cases had an ill-defined margin and another 2 had unerupted teeth in the tumor. Histologically, the nyxomas were classified into two types: type I had minimal fibrous components and type II had relatively large amounts of fibrous tissue in the tumor. Three cases were type I and 4 cases type II. With regard to the relationship between histologic type and capsule of the tumor, type II tended to show a distinct capsule, whereas type I showed an unclear capsule. There was no case with odontogenic epithelium in the tumor. For treatment, enucleation followed by curettage was performed in 2 cases, enucleation followed by cryosurgery in 3 cases, marginal resection in 1 case, and segmental resection in 1 case. There is no evidence of recurrence in any case.
This case report describes an erectile hemangioma of the masseter muscle. The patient was a 21-year-old male with a 10-year history of illness who experienced bulging of his right cheek when he chewed. Because a hemangioma of the masseter muscle was suspected on the basis of a MRI study, resection was performed from within the oral cavity. The histopathological diagnosis was a cavernous hemangioma containing 3 phlebolith within the tumor mass. At the present, 3 years postoperatively, there are no signs of recurrence.
We have applied Holmium: YAG laser irradiation for TMJ arthroscopic surgery to treat TMJ internal derangement. Ten cases (eleven joints) were treated for unlocking jaw diagnosed as a nonreducing anteriorly displaced disc. Two cases (two joints) were treated by debridement of degenerative tissue of the TMJ. The average setting of the Holmium: YAG laser was approximately 0.8 J and 10 Hz. In this study, all cases satisfied our criteria for successful treatment. The results obtained by TMJ arthroscopic surgery using a Holmium: YAG laser were superior to those obtained by previous techniques for arthroscopic surgery using mechanical instruments such as a power shaver or an electric cautery. In addition it enabled all patients to be a more rapid recovery period and a faster return to normal daily activities. It is concluded that the Holmium: YAG laser system has the potential for becoming an effective and efficient modality for TMJ arthroscopic surgery.