Fas is a cell surface molecule belonging to the tumor necrosis factor (TNF) receptor family. It acts as a receptor molecule responsible for intracellular transmission of apoptosis-inducing signals. Fas ligand (FasL) is a protein homologous with the TNF family. FasL binding to membrane-type Fas has been reported to induce apoptosis. To develop an effective treatment for oral cancer, we immunohistologically examined the localization of Fas and FasL in morphologically normal oral mucosal epithelium, epithelial dysplasia, and oral squamous cell carcinoma. We also examined the expression of these molecules in cultured cell lines derived from squamous cell carcinoma of the head and neck (HSC-2, 3, 4, KB, Ca 9-22) by immunocytochemical procedures, Western blotting, and reverse transcriptase-polymerase chain reaction (RT-PCR). We studied 42 primary invasive oral squamous cell carcinomas, 36 epithelial dysplasias, and 13 samples of normal oral mucosal epithelium. Tissuc specimens were fixed in buffered formalin and embedded in paraffin wax. Fas expression was observed in the spinous and parakeratotic layers of normal oral mucosal epithelium. In contrast, FasL expression was observed in the basal layers of normal oral mucosal epithelium. Fas and FasL expression was not consistently edvident in epithelial dysplasias. Primary invasive oral squamous cell carcinoma showed decreased expression of Fas and enhanced expression of FasL. Coexpression of Fas and FasL in cancer nests was also observed in some areas. In squamous carcinoma cell lines from head and neck cancers, immunocytochemical analysis revealed expression of both Fas and FasL in all specimens examined, whereas weak reactions were observed in some cell lines, such as HSC-4 and KB. Fas expression (45kDa) was detected in HSC-2, 3, and 4 and Ca 9-22 by Western blotting. A high-molecular-weight reaction product was found in the extract from KB. FasL expression was detected in HSC-2, 3, and 4. Expression of both Fas and FasL was detected in all cell lines by RT-PCR. In HSC-2, 3, and 4, a shorter PCR product (87bp) was obtained with the 150-bp PCR product from normal Fas, suggesting the presence of soluble Fas (sFas). These findings clearly indicate that up-regulation of FasL frequently occurs in oral squamous cell carcinomas and suggest that downregulation of Fas expression may be a mechanism by which oral squamous carcinoma cells escape from attack by the host's immune system. sFas antagonizes cell surface Fas function, and sFas expression may increase the resistance of cells against apoptosis.
Recent studies have revealed that glucose transporter 1 (GLUT 1) expression can be detected in basal layer cells of skin. Expression levels of GLUT 1 are thought to be regulated by glucose transport activity within cells. Glucose metabolism in the epithelial layers may affect keratinocyte differentiation. We studied the localization of GLUT 1 expression in the epithelial layers of oral mucosa equivalents, grown in a defined serum-free culture medium without a feeder layer. The oral mucosa produced in this system is minimally exposed to potential foreign contaminants and is thus more acceptable for use in humans. Samples of native human gingiva and oral mucosa equivalents on days 4, 11, and 18 were fixed in 4% paraformaldehyde, embedded in paraffin, and cut into 5-micrometer-thick sections. For immunohistochemical studies, sections were stained by the ABC method using polyclonal antibodies to rabbit GLUT-1. Well-stratified, differentiated epithelial layers in day 18 oral mucosa equivalents had a similar keratinization pattern to that of native tissue. GLUT 1 was expressed in both the basal cell layer and suprabasal cell layer of oral mucosa epithelium, but not in the superficial layer. Immunoreactivity for GLUT-1 was detected in all epithelial layers of oral mucosa equivalents, except for the superficial layer of day 18 equivalents. In conclusion, keratinocytes of all layers of oral mucosa equivalents were in a highly active metabolic state and showed increased glycolysis, suggesting active proliferative and a less differentiated state as comnared with the basal and na.ra.ba.sa.1 cell lavers of native tissue.
Squamous cell carcinoma of the buccal mucosa was diagnosed on biopsy. The preoperative laboratory data revealed a platelet count of 3.8 × 104/mm3. These investigations suggested the presence of idiopathic thrombocytopenic purpura (ITP). For surgical therapy, it is important to maintain normal platelet counts and to control hemostasis. A preoperative high-dose of γ-globulin therapy (400mg/kg/day for 5 days) allowed operation to be performed successfully. After the surgery and without tranfusion, abnormal bleeding did not occur. The postoperative course was uneventful, and no tumor recurrence was observed. High-dose γ-globulin therapy appears to be reasonably safe and useful in the preoperative management of surgical patients with ITP.
A case of basal cell adenocarcinoma arising in the submandibular region of a 76-year-old woman is reported. Basal cell adenocarcinoma was added to the World Health Organization classification of salivary gland tumors in 1991. Most cases develop in the parotid gland, and primary lesions of the submandibular gland are rare. Clinical features and pathological examinations based on hematoxylin-eosin staining and immunohistochemical staining were important in the diagnosis of this case.
A 65-year-old man presented with a tumor measuring 22×24×14mm at the border of the tongue. He had a history of renal cell carcinoma and had undergone a right radical nephrectomy. He also had multiple metastatic lesions to the lungs. A biopsy of the tongue was done. The biopsy specimen showed a renal cell carcinoma that had metastasized from the kidney. Metastasized tumors generally have a very poor prognosis. Therefore, it is very important to consider the patient's quality of life when choosing the procedure for metastatic tumors. The patient was admitted to the hospital. The tumor of the tongue was resected with a KTP laser under local anesthesia. The resected specimen showed that renal cell carcinoma had invaded the muscle layer of the tongue. Forty-eight days after the operation, re-epithelialization of the wound was completed with no evidence of infection. There was no postoperative dysfunction. We conclude that tumors metastasizing to the oral cavity should be aggreassively treated.
We report a rare case of myofibroma arising in the mandibular gingiva in an adult. Myofibroma is a solitary fibroblastic proliferative neoplasm occurring primarily in infants and children. The patient was a healthy 28-year-old woman with a painless mass in the right lower premolar region. Radiographic examination showed radiolucency with an ill-defined border. The tumor was resected with a margin of adjacent tissue and teeth. There was no sign of recurrence at 18 months' follow-up. Microscopic examination revealed irregular proliferation of spindle-shaped cells. A pericytoma-like pattern was found in the center of the tumor. Immunohistochemically, tumor cells were positive for vimentin and HHF-35. On the basis of these findings, the tumor was diagnosed as a myofibroma.
Although necrotizing sialometaplasia occurs mostly in the palate, we recently treated a case in which this condition had developed in the distomolar glands of the lower jaw. Only one other similar case has been reported. The present case was apparently caused by chronic, mechanical stimulation by a maxillary molar and denture. Because necrotizing sialometaplasia resolves spontaneously, no special treatment is necessary. However, to diagnose the present case, we totally resected the lesion. The patient was cured, and there have been no signs of recurrence.
We often find well circumscribed, hemispherical benign or malignant tumors of salivary gland origin on the palate. Minor salivary gland hyperplasia is an uncommon clinicopathological entity, which is a non-neoplastic, non-inflammatory enlargement of the minor mucous salivary glands. This lesion presents clinically as an asymptomatic tumor-like nodule characterized microscopically by a proliferation of minor salivary gland tissue. We encountered a 52-year-old man who had a mass on the palate and report this case.
We report a rare case of a congenital anomaly with unilateral soft palate aplasia. A 10-monthold girl presented with nasal discharge. We recognized a right velar defect. No other abnormalities were noted. In her family, there was no history of cleft lip, cleft palate, or other congenital abnormalities. We examined velopharyngeal closure function by means of cineradiography. The soft palate on the normal side moved upward on swallowing, although nasal escape was recognized. She was operated on with modified push-back procedures at 2 years of age. On operation, the right side of the levator veli palatini and the palatoglossus muscle were absent, while the tensor veli palatini and palatopharyngeus muscle were present. The right side of the palatine tonsils was also absent. After operation, nasal discharge and nasal speech resolved.
EEC syndrome is characterized by ectrodactyly, ectodermal dysplasia, and cleft lip or palate (or both). We encountered a case of EEC syndrome and report this case with a discussion of the literature. The patient was a 1-month-old boy with bilateral split hands and feet. Symptoms of ectodermal dysplasia included light skin color, scanty hair, enamel hypoplasia, and nasolacrimai duct occlusion. He also had bilateral cleft lip and palate. The patient underwent cheiloplasty at the ages of 5 months and 11 months and palatoplasty at the age of 1 year 4 months.
A case of candidosis of the maxillary sinus is reported in a 65-year-old woman with a history of rectal cancer. The patient presented with chronic pressure-like discomfort over the maxillary sinus and drainage from an oroantral fistula. A specific fungal culture from the right maxillary sinus was positive, and Candida albicans was isolated. A computed tomographic scan showed soft tissue density with partial opacity in both maxillary sinuses. Radical bilateral sinusotomies of the maxillary sinus were performed to remove a fungal ball and diseased soft tissue. Histopathological examination showed the caseous material to be fungal hyphae. The patient was treated with amphotericin B to prevent postoperative dissemination. Ten months after surgery, no recurrence of infection had occured.
An 85-year-old man came to our hospital 2 days after the onset of left maxillofacial pain and vesicle formation on the face. Herpes zoster of the 2nd branch of the trigeminal nerve was diagnosed. The patient was treated with an intravenous infusion of acyclovir for 8 days, followed by oral acyclovir for 7 days. He also received linear polarized light irradiation applied by a SUPER LIZER around the stellate ganglion starting on his 2nd day for 23 days. The duration of irradiation was 7 minutes, with a cycle of 1 second on and 4 seconds off. On the 23rd day, most left facial and oral lesions had disappeared, and pain had significantly improved. Herpetic pain was evaluated before and after the treatment according to a visual analogue scale (VAS). The VAS score decreased from 6 to 1. Postherpetic neuralgia has not developed 6 months after the onset of disease. The combination of linear polarized light irradiation near the stellate ganglion and the intravenous infusion of acyclovir is an effective, noninvasive method for the treatment of elderly patients with trigeminal herpes zoster.