Odontogenic keratocyst is considered to be a synonym for epidermoid cyst of the jaw in Europe and the United States. In Japan, Eda et al. first described odontogenic keratocyst in 1972. They claimed that previously reported cases of epidermoid cysts of the jaw could be included in this category. However, these two diseases are often treated as separate entities. The authors conducted a detailed clinical and histological study of 16 patients (15 with odontogenic keratocysts and one diagnosed as having epidermoid cysts of the jaw in 1971) to investigate the presence of epidermoid cysts of the jaw. The results of this study were compared with those in 48 patients with 54 cysts who were reported to have had epidermoid cysts of the jaw during the 60 years from 1931 to 1990 in Japan to retrospectively study cases previously reported in the literature. Fifteen patients who were diagnosed as having odontogenic keratocysts during the 14 years from 1979 to 1992 and one patient who was diagnosed as having epidermoid cysts of the jaw in 1971, all of whom were diagnosed in our department, were analyzed in regard to compatibility with the histopathological criteria for odontogenic keratocysts described by Pindborg et al. in 1963. All cysts were compatible with the criteria. An analysis of the 48 patients with a total of 54 epidermoid cysts of the jaw that were previously reported in Japan showed that these cysts were similar histopathologically to the odontogenic keratocysts described by Pindborg et al. Clinically, the former cysts did not apparently differ from the latter cysts. It was difficult to distinguish the majority of previously reported cases of epidermoid cysts from odontogenic keratocysts.
In order to reduce the inherent risk of serum-supplemented media in cancer patients treated with LAK cells and induce high cytotoxic activity, we have developed a serum-free medium designated as RD5F. RD5F medium consists of transferrin, 2-aminoethanol, 2-mercaptoethanol, sodium selenite and interleukin-2 in addition to nutrient mixture. The cytotoxic activity of LAK cells generated in RD5F is higher than that in medium containing 10% human AB serum against Raji, K562 cells, and oral cancer cells. We have also found that insulin and insulin-like growth factor-1 (IGF-1), which is considered to be the most important hormone of serum-free media for animal cells, inhibited the induction of cytotoxic activity of LAK cells derived from PBL and RLNL, and that transferrin was an essential component of serum-free media for induction of LAK cells. The results obtained by two-color FACS analysis suggested that insulin stimulated differentiation of PBL to CD4+ cells in serum-free culture. Tumor infiltrating lymphocytes (TIL) generated in RD5F medium exhibited CD3 + HLA-DR + phenotype and much higher cytotoxicity against autologous tumor cells than that against allogenic cells. These results strongly suggest the possibility that insulin and IGF-1 act as immunosuppresive factors. In addition, RD5F medium was suggested to be useful in the adoptive immunotherapy of cancer.
In this study, we examined the expression of fibroblast growth factor-1 (FGF 1) and FGF-2 in oral squamous cell carcinomas (SCC) by immunohistochemical technique using specific monoclonal antibodies. In vitro growing oral SCC cells expressed both FGF-1 and FGF-2 in their cytoplasms and nuclei, but no staining was observed when the cells were confluent. In vivo, the expression of FGF-1 and FGF-2 in 13 oral SCC cases was examined. Compared to normal oral epithelium, SCC showed a high frequency and intense staining of both FGF-1 and FGF-2. These results indicate that SCC cells express high levels of endogenous FGFs and suggest that these growth factors may contribute to cancer cell growth as part of an autocrine mechanism.
It has been recently suggested that active oxygen species such as superoxide (SO) have carcinogenic and anticancer effects. Anticancer agents such as peplomycin (PEP), which are widely used in the treatment of oral cancer, produce pulmonary fibrosis and other side effects which might be caused by SO. Superoxide dismutase (SOD) inactivates SO and protects against physical SO injury. In order to investigate the effects of intravenous PEP and SOD, given singly or in combination, on VX2 carcinoma implanted in the tongue and pulmonary tissue of domestic rabbits, light and electron microscopic studies were performed. The preventive effect of these drugs on lymph node metastasis was determined by histopathological investigation of the positive rate of metastasis (PRM). In addition, the collagen content in the pulmonary tissues and the oxygen partial pressure of arterial blood (PaO2) in the left ventricle were measured. The following results were obtained: 1. Anticancer effects on VX2 carcinoma implanted in the tongue were recognized in the PEP and PEP-SOD groups. The values of PRM in the cervical lymph nodes and lung in the PEP and PEPSOD groups were significantly lower than those of the SOD and control groups. 2. Electron microscopic examination of VX2 carcinoma cells of the tongue in the PEP and PEPSOD groups showed pycnosis, karyorrhexis, vacuolization and indistinct cell borders. Electron microscopic examination of the pulmonary tissue in the PEP groups showed increased fibroblasts and collagen fibers in the alveolar walls. In the PEP-SOD groups, there were far less inflammatory changes and significantly milder pulmonary fibrosis. 3. The collagen content in the PEP-SOD groups was lower than that in the PEP groups. 4. The PaO2 of the left ventricle in the PEP-SOD groups was higher than that in the PEP groups. These findings indicated that the use of SOD concurrently with PEP in the chemotherapy of oral cancer, inhibited the induction of pulmonary fibrosis associated with PEP withoutaffecting the anticancer effect of this agent.
In the present study, expression of the adhesion molecule CD44 in oral squamous cell carcinoma (SCC) cells was investigated by immunoperoxidase staining of 35 surgically removed SCC lesions. In addition, the relationship between metastasis of SCC to regional lymph nodes and the mode of expression of CD44 in SCC was evaluated. Likewise, the relationships between the mode of expression of CD44 and the T classification, degree of differentiation, and mode of invasion were also assessed. Most SCC lesions were positive for CD44 staining. Among the 35 lesions, 17 were strongly positive for CD44 staining, 16 were moderately positive and 2 were negative. Comparative analysis between the 14 patients with metastasis and 21 patients without metastasis revealed that the strongly positive cases had a significantly higher rate of metastasis (12 of 17 cases, 70.6%) than that of moderately positive or negative (2 of 18 cases, 11.1%). Moreover, it was also suggested that strongly positive cases tended to form multiple metastasis. There was no significant correlation between the mode of expression of CD44 and the T classification, degree of differentiation, and mode of invasion. This study demonstrates the following two points: 1. CD44 may play an important role in the metastasis of SCC to regional lymph nodes. 2. The examination of CD44 yields useful information about the metastatic potential of SCC.
Local and systemic effects of 103 titanium miniplates implanted for jaw reduction were studied. Fifty patients who had undergone jaw reduction using titanium miniplates were studied. No patient experienced an allergic reaction related to a plate during the period of implantation. At the time of their removal, almost no fibrous connective tissue existed between bone and the plates. Scanning electron microscopy revealed both corrosion pits and superficial stress fractures on the surface of some plates. Atomic absorption spectrophotometry did not detect the elution of any Ti from the plate into surrounding connective tissue. The present findings suggest that jaw reduction using titanium miniplate produces minimal local and systemic reactions when the plate is removed after its intended purpose has been achieved. However, further studies are needed to recommend the use of the titanium miniplate as a permanent fixing device for jaw reduction as surface corrosion of the plates remains an unsolved problem.
The diagnostic value of magnetic resonance imaging (MRI) for lesions situated in the major salivary glands was clinically discussed in this study. A total of 46 patients with salivary gland disorders treated in our department over the past five years were assessed by mean of MRI, and in 11 patients the findings were compared with the histopathological features of lesions sectioned at the same level postoperatively. In addition, preliminary investigations to introduce a new qualitative diagnostic procedure for estimation of salivary gland function in geriatric patients were attempted. In this investigation, T1 and T2 values, and signal intensity ratios of the submandibular gland were measured in elderly patients complaining of dry mouth and in healthy controls. Likewise, salivary gland function was examined by taste stimulation induced by applying citric acid to the tongue surface just before starting MRI. The results of these trials were as follows: 1 MRI clearly demonstrated lesions in the salivary glands. 2. The histopathological diagnosis could not be accurately predicted by signal intensity. However, benign tumors showed higher intensity signals than did malignant tumors in T2-weighted images. 3. Cystic lesions could be differentiated from tumors by signal intensity. 4 Histopathological features of salivary gland tumors corresponded to the MRI signal intensity. 5. Relaxation times of T1 and T2, values and signal intensity in each major salivary gland were diminished in elderly patients in a resting condition. 6. Only T1 values in healthy subjectives remarkably responded to taste stimulation. These results suggest that MRI is useful and beneficial not only in the qualitative diagnosis of tumors arising from salivary glands but also in the estimation of salivary gland function. MRI should therefore be included in routine diagnostic examinations for salivary gland disorders.
Cleidocranial dysplasia is a congenital systemic bone disorder characterized by delayed ossification of skull, aplastic or hypoplastic clavicle, delayed deciduous dentition, and hereditary characteristics. A 14-year old girl came to our clinic because of many unerupted permanent teeth. She was diagnosed to he cleidocranial dysplasia based on the above characteristics. Further examinations concerning bone metabolism revealed low serum calcitonin level, high levels of bone metabolic markers for absorption, and low lumbar spinal bone mineral density. These findings suggested abnormal bone metabolism in this patient.
A rare case of pycnodysostosis in a 58 year-old man that was complicated by chronic mandibular osteomyelitis is reported. The patient underwent mandibulectomy and immediate reconstruction with an A-O plate, since a pathologic fracture was caused during treatment by sequestrectomy and curettage of pathologic tissue. However, the A-O plate was exposed in the oral surface a few years after the first operation, and it was removed surgically. This case suggests the difficulty of treating severe osteomyelitis in the jaw which has a risk of occurring in patients with pycnodysostosis, and the treatment appropriate for these patients is discussed.
Due to progress in implant material and operative procedures, we started surgery for the Branemark implant system from October 1989. We have installed 202 implants in 32 patients during 4 years. This implant system was applied in 2 patients with fixed dentures in an iliac bone transplant following resection of an adamantinoma. The course of treatment, surgical technique and indications are discussed by means of abbreviated case reports of two patients.
Autoimmune bullous dermatosis is classified into 6 distinct entities based on clinical symptoms and findings obtained from recent advances in immunoelectron microscopic techniques. The 6 entities are: 1) the pemphigus group, 2) dermatitis herpetiformis, 3) linear IgA bullous dermatosis, 4) the pemphigoid group, 5) epidermolysis bullosa acquisita, and 6) herpes gestationis. We report a specific pemphigus vulgaris patient with clinical pathohistological features of bullous dermatosis who showed immunohistological characteristics of pemphigus vulgaris and bullous pemphigoid.
The ilium is the most common donor site for autogenous cancellous bone grafts to the facial skeleton and numerous surgical techniques have been devised to harvest iliac bone. In many of these procedures, posterior approaches to the ilium yield more cancellous bone than anterior approaches. We have treated several patients by secondary bone grafting to the alveolar clefts using autogenous particulate cancellous bone harvested from the posterior iliac crest. This bone harvesting method was considerd to a very useful procedure for patients with wide alveolar bony defects requiring a large amount of cancellous hone to be tansplanted.
The patient was a 20-year-old female who visited the Department of Dentistry and Oral Surgery of Hakodate Goryokaku Hospital complaining of slight pain in the bilateral upper molar regions. Radiographic examination showed radiopaque shadows at the bottom of the bilateral maxillary sinuses. The sinuses were surgically enucleated under a clinical diagnosis of osteoma. The lesions had the consistency and appearance of bone. Microscopic examination revealed lamellar bone with fatty marrow containing a slight infiltration of inflammatory cells. There were few osteoblasts or osteoclasts in this lesion. Near the cut surface, cystic formation characterized by an antral mucous membrane and mucus in the cystic cavity was observed. Due to a previous history of nasal bone fracture. these findings suggested that hone fragments formed an exostosis for reactive bone proliferation.
Most giant cell tumors occur at the ends of long bones. There is little information about giant cell tumors of the jaw hone. A giant cell tumor of the jaw bone of a 19 years old female is described. The tumor presented as an aggresive lesion. The clinical and pathological features and the treatments are discussed.
Weathers and Callihan, in 1974, referred to fibromas or fibrous lesions of the oral mucosa as “giant cell fibromas.” These lesions exhibit numerous large stellate cells and multinucleated giant cells histologically, discriminating them from usual fibromas. Giant cell fibromas have several interesting clinical and histopathological features, however, only a few of these lesions have been reported. This paper describes a case of giant cell fibroma that appeared on the lingual gingive of the lower jaw in a 3 year old male.
We report a case of odontogenic fibroma in the mandible. The patient, a three year-old boy, was referred to us for swelling in the right mandible. Oral examination revealed bony expansion of the right lower deciduous molar region. Panoramic radiography showed a well demarcated radiolucent lesion including E and extending from the D to 6 region.A 5 tooth germ was not found. The lesion was enucleated under a tentative diagnosis of odontogenic tumor. The material was 30 × 20 × 20 mm in size and elatsitc soft in consistency, and the cut surface was solid. The roots of E adhered to the tumor. Histologically, the tumor was fibrous tissues consisting of cells with fusiform and ovoid nuclei resembling dental papillae. There was no evidence of cellular atypia or calcifying materials in the tumor. Odontogenic epithelial cells of various types, ranging from tall columnar with polarization of the nuclei to flattened structures, surrounded the tumor tissue but did not exist in the tumor.
We report a relatively rare case of an aneurysmal bone cyst in the mandible. A 22-year-old female complained of a painless swelling on the left side of the mandible. Radiographs revealed a multilocular radiolucent area in the region. The suspected diagnosis was an ameloblastoma. Biopsy was attempted, and the lesion had some cystic spaces but did not have a typical cyst wall. Pathological examination of the biopsy specimen did not produce a definitive diagnosis. Under local anesthesia, the cystic tissue was extirpated and the lesion was curetted. Pathologically, the lesion consisted of bloodfilled cavities and immature fibrous connective tissue without an epithelial lining. Based on these findings, a final diagnosis of an aneurysmal bone cyst was made. There was no excessive bleeding during the biopsy and surgery.