The purpose of this study was to create a model of recurrent tongue cancer after cryosurgery for cancer experimentally induced by 4NQO in rats, to investigate the proliferative activity of residual cancer cells, and to evaluate the antitumor effect of peplomycin. The proliferative activity of residual cancer cells the and vascular architecture of recurrent tumor were examined in rats given peplomycin and in those not given peplomycin. Recurrent tumor was macroscopically detected 8 weeks after cryosurgery. Residual cancer cells were observed in the submucosa in all cases. These findings suggested that radical cure cannot be achieved by cryosurgery according to lesion size. A high mitotic index was seen from 4 weeks after cryosurgery, and a high labeling index was noted after 8 weeks, suggesting that re-proliferation of cancer cells that have high proliferative activity is promoted by the formation of new blood vessels and the recovery of blood flow. Re-proliferated cancer cells invaded existing blood vessels, suggesting that they had a high grade of malignancy. Administration of peplomycin immediately after cryosurgery suppressed tumor cell proliferation after 4 weeks but not after 8 weeks. Residual cancer cells were found in both deep and peripheral regions, although the proliferation of these cells wsa suppressed. Destruction of blood vessels was not detected in rate given peplomycin after 4 weeks indicating that peplomycin inhibited the destruction of blood vessels by cancer cells. The architecture of regenerated blood vessels in rats given peplomycin differed from that in rats not given peplomycin. The results suggested that the effect of chemotherapy against by residual cancer cells is reinforced by newly formed vessels and increased vascular permeability.
Pleomorphic adenoma most commonly occurs in salivary gland tumors. Its morphological features are diverse, and in typical cases myxomatous, cartilaginous, and even osseous tissue are seen in the stroma. It has been reported that the cartilaginous tissue is derived from the myxomatous tissue. Furthermore, the stromal cells are thought to derive from neoplastic myoepithelial cells. However, the histogenesis and morphological features of the cartilaginous tissue have not been fully clarified. We studied the histogenesis of the cartilaginous tissue and histological differences from hyaline cartilage by assessing the localization of Type I, II, and X collagens. Seven cases of pleomorphic adenoma with the cartilaginous tissue in their stroma were examined both histopathologically and immunohistochemically. Histopathological examination revealed that the cartilaginous tissue consisted of both myxomatous and cartilaginous regions and that the cell lineage in the cartilaginous tissue was basically similar to that of hyaline cartilage: small round-shaped chondrocytic cells were found in the peripheral portion of the cartilaginous region, and swollen cells with condensed nuclei similar to hypertrophic chondrocytes were present mainly in the central portion. However, alizarin red staining was occasionally positive in the cartilaginous tissue, suggesting that calcification might be rather sparse in the cartilaginous tissue of pleomorphic adenoma. Type I collagen was mainly localized in spindle-shaped cells in the myxomatous region surrounding the cartilaginous region. It was also weakly expressed in chondrocytic cells. Conversely, type II collagen was strongly expressed in chondrocytic cells, while it was weakly expressed in spindle-shaped cells in the myxomatous region. Type X collagen was weakly expressed in chondrocytic cells that showed evidence of hypertrophy. The distribution of each collagen was sparse in the extracellular matrix. These results suggest that cell differentiation in the cartilaginous tissue of pleomorphic adenoma is fundamentally similar to that of hyaline cartilage except for low expression of these collagen species in the extracellular matrix. It may explain the low calcification in the cartilaginous tissue of pleomorphic adenoma.
Outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) show signs of resolving owing to strict infection control at hospitals recently. Nevertheless, some MRSA carriers and infected patients are detected. There are several reports about infants with MRSA infection at neonatal intensive care units, but very few about infants who are MRSA carriers. We have examined the MRSA carrier status of all patients before admission since September 1991. There were 5 infants who were MRSA carriers among 55 patients with cleft lip or palate, or both, who were examined before primary surgery. All cases involved complete cleft lip and palate. Hotz type palatal plates were inserted in 4 patients, and 4 patients had previously visited or been admitted to other hospitals, but we could not determine the route of infection. After application of povidone iodine to the oro-nasal cavity and to the palatal plates, we did not detect MRSA in any patient. Although MRSA had disappeared from the oro-nasal area, it was redetected in some cases. We conclude that: 1) Before admission, some infants are MRSA carriers. 2) Examinations for MRSA are necessary to protect infants against nosocomial infections. 3) Povidone iodine is effective for MRSA carriers. 4) A Hotz type palatal plate is useful for the povidone iodine treatment of patients with cleft lip and palate. 5) To control hospital-acquired infections, MRSA carriers should be managed in a single room, even if MRSA is not detected.
This report describes a case of adenoid cystic carcinoma (ACC) originating in the anterior portion of the tongue. The patient was a 73-year-old woman who complained of swelling of her tongue and gustatory disturbance. A neoplasm was located in right side of the tongue. A partial glossectomy, right-sided functional neck dissection, and immediate reconstruction using a SMMC flap were performed after diagnosis of ACC of the tongue. Histological examination revealed solid cancer nests intermingled with cribriform areas. It appeared that ACC in this patient originated in the minor salivary gland, perhaps the anterior lingual gland. There has been no evidence of local recurrence or distant metastasis as of 6 years after surgery.
A malignant myoepithelioma arising in the soft palate of a 63-year-old woman is reported. On light microscopy, the tumor was found to be composed of myoepithelial cells with clear cytoplasm and appeared to be malignant. These cells were partially encapsulated, but focally invaded the capsule and adjacent salivary gland tissue. Immunohistochemical studies showed positive staining for S-100 protein and vimentin and negative staining for cytokeratin, GFAP, amylase, and α-smooth muscle actin in the tumor cells. A review of this case and existing reports indicates that malignant myoepitheliomas exhibit a wide range of histological characteristics.
Congenital lipomas are very rare in the oral cavity. A 6-month-old girl was referred with a history of multiple lingual lesions that had been noted initially in the early neonatal period. The patient's general condition and family history were non-contributory. On oral examination, two lesions were recognized on the lateral border and ventral surface of the tongue, respectively. Both lesions had clearly demarcated borders, a soft tenderness, and a milky white color. Follow-up examinations were done under the clinical diagnosis of a benign tumor. There was no evidence of growth. At the age of 14 months, the two lesions were removed with the patient under general anesthesia. Pathological examination revealed multilobular growth of adipose tissue, composed mainly of mature adipocytes in the submucosal connective tissue and muscular layer. The histopathological diagnoses were fibrolipomas. There has been no recurrence as of 3 years after operation.
This paper describes Papillon-Lefèvre syndrome (PLS) in a father and son. The son came to our hospital on May 27, 1995 because of loose front teeth in the upper and lower jaws with dental separation. The patient had coronations on his palms and soles, first noticed at 2 months of age, and palmoplantar keratoderma was diagnosed when he was 3 years old. General physical examination showed coronations on the palms and soles as well as dental mobility with separation, gingival flare, and swelling in the oral cavity. His father also showed cornification on the palms and soles and had edentulous jaws. X-ray examination showed horizontal bone resorption in both patients. These results led to a diagnosis of PLS. As PLS is a genetic disease, chromosomal and immunological examinations were performed. Immunological examination showed the following abnormalities in the son: CD11b+CD8+, CD11b+CD8-, and CD11b+CD8++.
Pycnodysostosis is a rare, normal chromosomal recessive disease named in 1962 by Maroteaux and Lamy. We reconstructed the mandible in a 41-year-old man with pycnodysostosis who had complications of osteomyelitis and a pathologic fracture of the mandible. Treatment involved hyperbaric oxygen therapy, sequestrum removal, resection of the mandibular region, and the placement of titanium plates. The findings in this patient, who subsequently had repeated recurrence of osteomyelitis, are described.
Cervical cellulitis is most commonly odontogenic in origin. The incidence of cervical cellulitis has decreased since the development of antibiotic therapy. However, there are still some severe cases with serious complications, such as lethal mediastinitis. Two patients with mediastinitis secondary to odontogenic cervical cellulitis were treated at our departments. In case 1, a 78-year-old woman with diabetes mellitus, cervical cellulitis was caused by pericoronitis of the right mandibular third molar. In case 2, a 51-year-old man with alcoholic liver disfunction, cervical cellulitis was caused by pericoronitis of the left mandibular third molar. Both cases were treated successfully by early debridement and surgical drainage from both the neck and the mediastinum (transcervical mediastinal drainage in case 1 and transthoracic mediastinal drainage in case 2). Early recognition of complications and aggressive surgical and medical treatment are essential to reduce mortality.
Squamous odontogenic tumor-like proliferation (SOTP) is considered a benign legion associated with odontogenic cysts. Histologically, SOTP associated with hyperplasia of odontogenic squamous epithelial cells must be differentiated from squamous odontogenic tumor, which is a true odontogenic neoplasm. Here we report a case of SOTP associated with radicular cyst occurring in the upper incisor region of a 49-year-old man. The legions were removed by conventional enucleation, and the postoperative course was uneventful.
Recently, the prevalence of mycosis of the maxillary sinus has increased. However maxillary sinus mucormycosis is relatively rare. We encountered a case of maxillary sinus mucormycosis in a 45-year-old man whose chief complaint was pain in the left infraorbital region and the upper molar region. This patient had foul-smelling rhinorroea, and a radiograph showed diffuse radioopacity in the left maxillary sinus. The clinical diagnosis was odontogenic maxillary sinusitis. Lavage of sinus was performed, and antibiotics were given, but there was no response. Therefore, radical surgery of the maxillary sinus was performed, and fungal masses were noted in the maxillary sinus. Although bacteriological studies were not performed in this case, histological examination verified that the fungus belonged to the order Mucorales. The postoperative course was uneventful, and there have been no signs of recurrence as of 1 and a half years after operation.