To predict indicators of occult neck metastasis, we evaluated clinico-pathological findings in N O cases of squamous cell carcinoma of the tongue by the quantification theory type II. The number of N O cases without local failure from 1974 through 1995 was 88. Biopsy specimens were evaluated pathologically after treatment of the primary lesion alone. Cervical lymph node metastasis subsequently developed in 18 cases. Data analysis, in which occult neck metastasis was considered a dependent variate and clinico-pathological findings as an independent variate, indicated that the invasion pattern was the most significant predictor of cervical lymph node metastasis. The presence or absence of occult cervical lymph node metastasis was correctly predicted in 76.1% of the cases. On analysis by the Anneroth classification, the contribution of morphologic variables to metastasis diminished in the following order: mode of invasion, number of mitoses, degree of keratinization, stage of invasion, lymph-plasmocytic infiltration, and nuclear polymorphism. On analysis of the total score derived from the correlation coefficients, occult neck metastasis was not found in patients with a score of 9 or less. The higher the total score, the higher was the incidence of cervical metastasis.
In present study, the pathogenicity of Streptococcus constellatus, Peptostreptococcus micros, Prevotella intermedia, and Fusobacterium nucleatum, which are implicated in odontogenic infection, was determined using an oral floor abscess model in mice. The potential to kill mice, the ability to form an abscess, and the lesion type were used as indices of pathogenicity. The results showed that F. nucleatum was more pathogenic than the other pathogens. It appeared that P. micros and P. intermedia acted aggressively and destructively when the mice were challenged with a sufficient number of these pathogens. Moreover, it appeared that P. intermedia caused a spreading inflammatory lesion that spread to the surrounding tissue via spaces in the oral floor tissue. The present study suggests that pathogens responsible for odontogenic infection differ with respect to pathogenicity.
The pull-through technique of the inferior alveolar nerve was introduced by Ishikawa in 1977. However, there are no studies of the recovery of sensation after this technique. We applied this technique after mandibulectomy in 5 patients and evaluated the recovery of sensation with a Semmes-Weinstein pressure aesthesiomater. Our findings show that postoperative sensory disturbance improved to between 1.65 to 2.83 (Fmg) in all patients within 10 months after surgery. Thus, this technique appears to be useful in nerve preservation.
A 59-year-old woman noticed swelling of upper eyelids and sublingual region. Dryness of the oral cavity and eyes was not present. Examination of a biopsy specimen of the tumor showed marked polyclonal lymphoproliferation with lymphoid follicles on immunohistological staining. This was a case of so-termed pseudolymphoma. We gave prednisolone at 30 mg initially and gradually decreased the dose. When we stopped treatment with prednisolone, tumor recurrence was noted. Treatment with prednisolone was started again, and symptoms improved while receiving a dose of 10 mg. Since the transformation of pseudolymphoma to malignant lymphoma has been reported, careful follow-up is necessary.
We describe a case of plasma cell gingivitis that occurred in the upper and lower gingivae of a 38-year-old man. As clinical findings in this patient, the peripheral region of the upper and lower gingivae was swollen and painful. The clinical diagnosis was gingival hypertrophy, and primary treatment for gingivitis and gingivectomy were performed. Histologically, many infiltrative plasma cells were observed mainly under the epithelium in the surgical specimen. Moreover, many cells stained positively with monoclonal antibody against anti-immunoglobulin kappa chain and anti-immunoglobulin lambda chain on immunohistological analysis. These finding suggested that the infiltrative plasma cells were polyclonal phenotype, and that the pathological diagnosis was plasma cell gingivitis and not plasmacytoma of the gingiva. Based on our observations, we conclude that immunohistological analysis of the cytological phenotype of plasma cells is very important for the differential diagnosis of plasma cells gingivitis and plasmacytoma.
A rare case of congenital midline fistula of the upper lip with acute infection in a 11 year-old-girl is presented. Only 14 cases have been reported in the Japanese literature. The characteristic clinical features were a very small pit of the midline upper lip and pus discharge from the fistula. The etiology and theories of fistula formation were also discussed.
Oral tuberculous lesions are uncommon and usually develop secondarily to pulmonary tuberculosis (Tb). A case of tuberculous ulcer of the bilateral maxillary molar gingiva is presented here. The patient was a 75-year-old man with a chief complaint of contact pain in the hard palate for 2 weeks. His medical history disclosed pulmonary tuberculosis (Tb) 43 years ago and asthma 2 years ago. Intraoral examination revealed irregularly shaped ulcerative lesions, measuring 14×13mm (left side) and 15×14mm (right side), on the bilateral maxillary molar gingiva. Laboratory examination revealed no noteworthy findings expect for an abnormal erythrocyte sedimentation rate (80mm at 30min, 135mm at 60min, and 160mm at 120min). A tuberculin skin test was tentatively positive. ASLO, CRP, and TPHA were negative. The clinical diagnosis was oral Tb or malignancy, and a biopsy was performed. The pathological diagnosis was a suspicion of Tb. The chest X-ray film showed extensive pulmonary Tb. However, cultures of the sputum revealed no tuberculous bacilli. Therefore, a biopsy was perfomed again, and the material was examined by polymerase chain reaction (PCR) method. Based on the results of the PCR-Tb, a final diagnosis of oral Tb was established. The patient was given anti-Tb drugs (SM, REP, INH, and EB) for 6 months. The ulcer completely healed.
The CREST syndrome is a variant of progressive systemic sclerosis (PSS), characterized by calcinosis (C), Raynaud's phenomenon (R), esophageal dysfunction (E), sclerodactyly (5), and telangiectasia (T). A case of incomplete CREST syndrome associated with Sjögren's syndrome is reported. The patient was a 60-year-old Japanese woman suffering from dry mouth for 3 years and dry eyes for a year. Her initial diagnosis was sicca syndrome, but laboratory data and Raynaud's phenomenon without symptoms indicated a connective tissue disorder. Immunological data demonstrated positive values for rheumatoid factor (372U/ml) and antinuclear antibody (1: 640, centromere type). The 99mTc scintigram showed reduced uptake in both the parotid and submandibular glands. Histological examination of a lip biopsy specimen revealed perivascular and periductal lymphocytic infiltration in the labial salivary glands. For further evaluation, she was referred to the department of internal medicine. The diagnosis was incomplete CREST syndrome (CRES) with intramuscular calcification of the deltoid portion, Raynaud's phenomenon, esophageal dysfunction, and sclerodactyly.
A case of an impacted second deciduous tooth superior to an impacted second premolar is reported.To our knowledge, only three similar cases have been reported in the Japanese literature.All reported cases occurred in the mandible.Our very rare case was the first to arise in the maxilla.This case was thought to be caused by the formation of a follicular cyst around the deciduous tooth crown and an abnormal position of the tooth germ of the second premolar.