To study malignant neoplasms of the tongue in Japan, we statistically analyzed autopsy cases of malignant neoplasms of the tongue reported in the Annals of Pathological Autopsy Cases in Japan during a 5 -year period (1987-1991). The following results were obtained. 1. A total number of 473 cases (337 males, 136 females) of malignant neoplasms of the tongue were reported. 2. Among patients who died of malignant neoplasms of the tongue, the autopsy rate was 14.5%. 3. Malignant neoplasms of the tongue were found most frequently in the seventh decade (29.6%), followed by the eighth decade (24.7%) and sixth decade (20.9%). 4. Histologically 96.6% of malignant neoplasms of the tongue were squamous cell carcinoma. 5. Squamous cell carcinoma most frequently arose in the lateral border of the tongue (53. 5%), followed by the root of the tongue (28.9%). 6. With respect to organ metastasis, the lung was the most common site, followed by the liver, bone, skin and thyroid. With regard to the lymph nodes, the cervical nodes were the most frequently invaded, followed by the pulmonary hilar, laryngeal, paraesophageal and paratracheal nodes. 7. Multiple primary cancers, affecting both the tongue and other organs, were found in 123 cases (96 males, 27 females). 8. The most common cause of death not associated with malignant neoplasms of the tongue was pulmonary infection.
To determine what conditions should be considered in the diagnosis of palatal tumors which were indolent, well circumscribed, and hemispherical, 83 cases of palatal tumors were clinically studied. The pathological diagnosis was pleomorphic adenoma in 73 cases, carcinoma in pleomorphic adenoma in 2 cases, schwannoma in 2 cases, and adenoid cystic carcinoma, neurofibroma, chronic sialoadenitis, hyperplasia of the salivary gland, myxofibroma and granular cell tumor, in one case each. Thus, approximately 10% of the cases had other pathological conditions, among which one-third had malignant salivary gland tumors. As to sex, age, tumor location, size, and duration of symptoms, there were no obvious differences between pleomorphic adenoma and other conditions, including malignant salivary gland tumor. The tumor consistency was elastic hard in about half of the pleomorphic adenomas, and most of the other lesions were soft or elastic soft.
Hydroxyapatite (HAP) is considered one of the best bioactive ceramics because of its high osteoconductivity. Although it has several characteristics of an ideal bone substitute, it does not possess osteoinductive activity. On the other hand, bone morphogenetic protein (BMP), which can induce the differentiation of mesenchymal cells into cartilage and bone, can be extracted from bone matrix. We used true bone ceramics (TBC) particles, instead of artificial HAP, together with atelocollagen (AC) and BMP as a bone substitute. The bone-inducing and bone-regenerating potency of TBC-AC-BMP composite was evaluated to determine its value as a bone-inductive biomaterial. TBC-AC composite and TBC-AC-BMP composite were implanted into rat skull defects. The animals were sacrificed every 2 weeks after implantation and examined by radiographical and histological methods. The calcium content of the newly formed bone in the implant sites was determined spectrophotometrically using o-cresolphthalein complexone (OCPC) method. In this animal experiment, TBC-AC-BMP composite produced new bone more rapidly than TBC-AC composite, and it produced larger quantities of new bone formation from an early stage. From the results of this study, TBC-AC-BMP composite has excellent bone-inducing ability and has the possibility to become an ideal bone substitute.
This study attempted to determine the reduction rate of jaw cysts after marsupialization. The patients ranged from 10 to 60 years of age; the volume of the cyst cavity ranged from 2.5 to 17 ml. The cyst volume was measured by filling the cavity with water from a graduated syringe every one or two months up to 19 months after marsupialization. Twelve cases of cysts were divided into two groups according to volume: larger than 10 ml or smaller than 10ml. Two other groups were classified according to the patient's age: over 20 years of age and under 20 years of age. The results were as follows. Even larger cysts over 10 ml in volume showed a rapid reduction in size similar to the smaller cysts. Cysts in patients who were over 20 years old showed a lower reduction rate than those in patients under 20 years of age. The mean volume of the 12 cyst cavities fell to 25.8±10.1% 3 months after treatment and to 11.4±8.4% in the next 5 months. Based on the reduction curve of the cyst cavity, the process of cyst diminution was classified into 3 stages. Stage 1, in which the cyst rapidly decreased in volume, was an initial three-month period after marsupialization. After that, the cysts showed gradual diminution and finally disappeared during the second stage, from 3 to 8 months after marsupialization. In the third stage, from 8 months onward, there was long-term persistence of any remaining cysts. Therefore, it is most important to keep the fenestration open for at least 8 months after marsupialization.
Since the establishment of our department in April 1979, 190 patients with newly diagnosed oral squamous cell carcinomas were treated and observed for over one year as of March 1994. Survival rate during this 15-year period was as follows. All cases: 5 years-66.7%, 10 years-64.8%. Upper gingiva: 5 and 10 years-74.9%. Tongue: 5 years-73.1%, 10 years-69.1%. Oral floor: 5 and 10 years-67.3%. Buccal mucosa: 5 and 10 years-62.2%. Lower gingiva: 5 and 10 years-50.3%. T 1 cases: 5 and 10 years-87.6%. T 2 cases: 5 and 10 years-73.5%. T 3 cases: 5 years-54.8%, 10 years-47.0%. T 4 cases: 5 and 10 years-35.8%. N 0 cases: 5 and 10 years-79.6%. N 1 cases: 5 years-41.7%, 10 years-27.8%. N 2 a cases: 5 and 10 years-50.0%. N 2 b cases: 5 and 10 years-36.4%. N 2 c cases: 5 and 10 years-28.6%. N 3 case (only one case): 0%. Stage I cases: 5 and 10 years-86.1%. Stage II cases: 5 and 10 years-83.6%. Stage III cases: 5 years-57.1%, 10 years-50.0%. Stage IV cases: 5 and 10 years-37.8%.
Thirty patients with sqamous cell carcinoma of the mouth floor, who were treated between 1976 and 1993 at Metropolitan Komagome Hospital, were studied to evaluate the possibilities and limitations of radiotherapy, surgery, and palliative treatment. The patients who received primary treatment were divided into three groups: those who received radiation (11 patients), those who received mainly surgery with radical resection (10 patients) and those who received palliative therapy with radiation (8 patients). The 5-year cumlative survival rate in each group was 90% for radiation, 60% for surgery, and 11% palliative treatment.
Adenoid squamous cell carcinoma is an uncommon variant of squamous cell carcinoma (SCC) that is characterized by a mixture of squamous components with adenocarcinomatous elements in the tumor. A rare case of this tumor occurring in the maxillary sinus is reported. A 53-year-old man in whom a poorly-differentiated SCC of the right maxillary sinus (T 4 N 0 M 0) was initially diagnosed by biopsy was admitted to the Hyogo College of Medicine Hospital. The serum levels of SCC-related antigen (SCC-Ag) and carcinoembryonic antigen (CEA) in the serum of the patient before treatment were high, being 52.0ng/ml and 25.0ng/ml, respectively. A reduction in tumor volume by radiotherapy, intra-arterial 5-FU infusion and necrotomy resulted in a marked decrease in serum levels of SCC-Ag and CEA. However, both tumor markers increased with tumor regrowth. Furthermore, tumor specimens, obtained by necrotomy and tumor reduction operation, were histologically diagnosed as adenoid squamous cell carcinoma, suggesting modification by cancer therapy. Immunohistochemical study using the ABC method revealed weak staining of SCC-Ag in the cytoplasm and strong staining of CEA in the plasma membrane of tumor cells. The patient died of intracranial invasion 2 years after combined therapy.
An 84-year-old Japanese woman was referred to our hospital for a polypoid mass on the floor of the oral cavity. She had received chemotherapy and external radiation therapy for gingival carcinoma of the lower gingiva 5 years earlier. Histopathological examination revealed spindle cell carcinoma. The tumor tissue consisted primarily of spindle-shaped cells associated with carcinomatous components and transitional structures. With immunohistochemical staining, the spindle-shaped cells and transitional structures from spindle-shaped cells to squamous cell carcinoma were positive only for vimentin, and squamous cell carcinomatous components were positive for cytokeratin.
Although metastasis to the lateral retropharyngeal node (Rouviere node) is often found in nasopharyngeal cancer, it is rare in oral cancer. One 67-year-old man and one 69-year-old man with metastasis to this node from oral cancer are reported. Both patients had squamous cell carcinoma of the upper gingiva (case 1, T 3 N 2 b M 0 case 2, T 1 N 0 M 0). Metastasis to the Rouviere node was detected along with other cervical lymph node metastases by CT scan after preoperative radiotherapy (case 1) or radiotherapy and surgical excision of the primary lesion (case 2). Further radiotherapy to treat cervical lymph node metastases, including the Rouviere node, combined with CDDP or CBDCA was ineffective, and both patients died of metastases after about six months.
A case of verrucous carcinoma of the oral floor which had an excellent response to tegafur alone is reported. A 76-year-old woman complained of a swelling in the oral floor of 8 months' duration. Oral examination revealed an approximately elliptical tumor that measured 45×20×15mm and extended bilaterally from the oral floor to the alveolar mucosa. Regional lymph nodes were not clinically involved, and no distant metastasis was evident. She was orally administered 600mg per day of tegafur before operation. The tumor was reduced to about half of its primary size 10 days after the start of tegafur treatment. Two months later, no remaining verrucous carcinoma was observed on histologic examination. There were no noteworthy side effects. There is no evidence of recurrence or metastatic disease as of 28 months after treatment.
We report a case of lipoma arising in the parotid gland. A 62-year-old man presented with a swelling in the left preauricular region, which had persisted for two months. The tumor was soft and the size of a hen's egg, with no tenderness. Sialography revealed a so called ball-in-hand appearance, which suggested a benign tumor. CT scan demonstrated a clear-cut low density area showing -104.3 Hounsfield units. The tumor was extirpated easily. The diagnosis of lipoma was made histologically.
We report a case of aspergillosis of the maxillary sinus that was suspected to be a malignant tumor. A 51-year-old woman was referred to our hospital for swelling and pain in the left cheek. Trismus was observed. Radiographs and CT scans showed opacification of the left maxillary sinus and destruction of the posterolateral bony wall. The clinical diagnosis was a malignant tumor of the left maxillary sinus. A biopsy was performed. Histopathological examination and fungal culture revealed aspergillosis. Caldwell-Luc operation was performed. After operation, amphotericin B was administered orally for three weeks. Presently, about three years after operation, this patient is well and there are no signs of recurrence.
Basal cell nevus syndrome (BNS syndrome) is considered to be an autosomal dominant hereditary disease, associated with pits of the palm, multiple jaw cysts, calcification of the falx cerebri, and skeletal anomalies. We treated two sisters with BNS syndrome associated with multiple jaw cysts. In their grandmother and other brother and sister, multiple jaw cysts were recognized. It was suggested that genetic factors might play a role in the development of multiple jaw cysts. Moreover, two of six children of the family also had ocular hypertelorism and pits of the palm.
We report a case of a heterotopic lymph node arising at the dorsal surface of the tongue, which has not been previously documented. A 48-year-old woman complained of a mass in the tongue, which became increasingly noticeable during the past 3 month. Clinical examination revealed a mobile nodular, nontender mass, measuring 20×15mm, which was covered by reddish but normal mucosa. Under general anesthesia, the lesion was shelled out easily and totally from the surrounding tissue. Histologically, a heterotopic lymph node was diagnosed. The relevant literature is reviewed on the mechanism of occurrence.