[Purpose] Lung metastases in patients with tongue cancer are resistant to various therapies, resulting in poor outcomes. In the present study, we examined whether such lung metastases are controllable by adjuvant chemotherapy targeting micrometastases in the lung. We used a micrometastasis model using a rat tongue carcinoma cell line (RSC3) tagged with the green fluorescent protein gene (RSC3LM-GFP) in nude mice.[Methods] Lung metastases were formed after intravenous (i. v.) injection of 1 (3)×10⁵ tumor cells in a low (high) metastasis model. TS-1 (5-fluorouracil derivative)(20mg/kg) was orally administered from day 1 Postinjection (early administration) and from day 7 post-injection (late administration) 5 times per week for 3 weeks. Mice bearing lung metastases underwent autopsy 4 weeks after injection, and the lungs were removed. The numbers of lung metastases were determined by GFP fluorescence.[Results] Lung metastasis including micrometastasis could be clearly visualized under illumination with blue light. In the low metastasis model, GFP-positive metastatic nodules in the lung were more strongly reduced by early TS-1 oral administration than by late administration (p<0.003). Survival was also much longer in mice with early TS-1 treatment than in those with late treatment in the low metastasis model (p<0.02), but not in the high metastasis model.[Conclusion] These results indicate that the sensitivity of lung metastases of tongue carcinoma to TS-1 depends on the timing of drug administration and the number of metastases. Small numbers of micrometastases in the lung at an early stage are most susceptible and can be effectively eliminated by chemotherapy targeting micrometastasis, leading to longer survival of mice.

抄録全体を表示

Postoperative dysphagia is often improved by postural compensatory techniques in patients with head and neck cancer. This study was done to evaluate the effects of postural technique on postoperative dysphagia in patients with tongue cancer. We compared improved cases with unimproved cases on head tilting toward the stronger side.
Fifteen patients with dysphagia were subjects. All subjects swallowed 5ml of the contrast medium in both an upright position and with the head tilted toward the stronger side during videofluorographic (VF) examination. Eight patients (improved cases) showed aspiration in the upright position and no aspiration during head tilting. Seven patients (unimproved cases) showed aspiration in both the upright position and on head tilting.
Tilting magnitude, vallecular angle, and epiglottic angle were measured on video prints. Pharyngeal delay time, pharyngeal passing time, and pharyngo-esophageal (PE) segment opening time were measured using a video motion analyzer. Retention amounts (intraoral, valleculae, and pyriform sinuses) were qualitatively evaluated on video prints.
The results were as follows:
1) Vallecular angle in the tilting posture was greater than that in the upright posture in 6 of the 8 improved cases.
2) Vallecular angle in the tilting posture was smaller than that in the upright posture in 6 of the 7 unimproved cases.
3) As compared with the upright position, pharyngeal delay time and pharyngeal passing time in the tilting posture were shorter in both the improved and the unimproved cases. The time difference between pharyngeal passing time and pharyngeal delay time in the tilting posture was a positive value in all improved case.
4) PE segment opening time in the tilting posture was longer than that in the upright position in 5 of the 8 improved cases.
5) PE segment opening time in the tilting posture was shorter than that in the upright position in 6 of the 7 unimproved cases.
6) Intraoral retention amount after barium swallow during the tilting posture was mild in 7 of the 8 improved cases and in 6 of the 7 unimproved cases.
7) Retention amounts in the valleculae and pyriform sinuses after barium swallow during the tilting posture were less in the improved cases than in the unimproved cases.

抄録全体を表示

We report a case of van der Woude syndrome associated with Hirschsprung disease. The patient was delivered vaginally. Our department was consulted because of cleft lip and palate (CLCP). After cheiloplasty, the department of pediatric surgery was consulted because of continuous vomiting. Hirschsprung disease was diagnosed.
Hirschsprung disease occurs in 1/5, 000 live births and is caused by defective development of embryonic neural crest cells at the vagal level, leading to intestinal obstruction. The patients show severe vomiting and constipation, but owing to improved surgical techniques, the number of curable patients is increasing. Our patient received radical treatment and has no difficulty in eating or excretion at present.
Several reports have described patients with CLCP and Hirschsprung disease, and all have had mental retardation. Moreover, there are several syndromes associated with both CLCP and Hirschsprung disease, such as Goldberg-Shprintzen syndrome, Waardenburg syndrome, and Smith-Lemli-Opitz syndrome. Each syndrome has their own differential diagnosis, but our patient did not meet the diagnostic criteria. We gave our patient a diagnosis of van der Woude syndrome combined with Hirschsprung disease for the present.
However, mental retardation cannot be ruled our in this patient, and he might have other congenital malformations that have not been identified. If so, he may have a subtype of a syndromic disease.

抄録全体を表示

Palisaded encapsulated neuroma (PEN), defined by Reed et al. in 1972, is a benign nerve sheath tumor with characteristic clinical and histological features. Clinically, the lesion is a solitary, firm, asymptomatic nodule; histopathologically, it is a well-circumscribed, partially or completely encapsulated tumor. The tumor cells are composed of interlacing fascicles of spindle cells. Nuclear palisading is found on occasion, but Verocay bodies are unremarkable. Axons are also found in the fascicles. In European countries there have been many reports of PEN by dermatologists, but PEN arising in the oral mucosa is rare. In Japan there has been no reported case of PEN arising in the oral mucosa, although several cases involving the skin have been described by dermatologists. In this article, we present a case of PEN arising in the lower lip mucosa. A 36-year-old man visited our clinic because of a mass of the lower lip. We suspected a mucous cyst the basis of the clinical course and other findings, and the mass was removed under local anesthesia. The pathological diagnosis of the specimen was PEN. There was no sign of recurrence 8 months after surgery.

抄録全体を表示

Granular cell tumor (GCT) is a rare benign tumor first reported by Abrikossoff in 1926. GCT is of neural crest cell origin, and consists of a single, well-circumscribed nodule, usually arising in the tongue. We report a case of GCT arising in the tip of the tongue of a 33-year-old woman. The tumor was resected along with the peripheral soft tissue under local anesthesia. Immunohistochemical studies showed reactivity for and-S100 antibody and anti-NSE antibody. At present, the postoperative course is good, with no recurrence of the tumor.

抄録全体を表示

We report a case of cartilaginous choristoma of the tongue with a review of the literature. A 76-year old woman had been aware of a soft tumor present at the midline of the inferior surface of the tongue for several years. At presentation, the tumor was approximately 8mm in diameter and situated in the middle of the inferior surface of the tongue. The tumor was excised under local anesthesia. Histological examination revealed that the tumor had cartilaginous characteristics. The histological diagnosis was cartilaginous choristoma of the tongue. To our knowledge, this tumor has not yet been reported previously in this region. The etiology of this tumor remains unclear. The most plausible theory is that the tumor originates from traces of ectopic embryonic tissue or mesenchymal metaplasia.

抄録全体を表示

It has been reported that multiple primary cancers including oral cancer have recently increased. However, to our knowledge synchronous multiple cancers including oral cancer and intrahepatic cholangiocarcinoma (ICC) have not been described. We report a case of triple cancers arising synchronously in the lower gingiva, intrahepatic bile duct, and stomach. The triple cancers were all excised. Segmental resection of the mandible with dissection of the right side of supraomohyoid neck was performed. Five months after the operation at our department, segmental hepatectomy and distal gastrectomy were done. The histological diagnoses were squamous cell carcinoma, adenocarcinoma, and tubular adenocarcinoma. There has been no sign of recurrence or metastasis as of 1 year after the operation at our department.

抄録全体を表示

We describe a case of malignant lymphoma located in the oral floor of a 72-year-old man. The patient noticed a painless mass in the oral floor, which enlarged slowly over the course of several weeks. He was referred to our department. An elastic, painless, hard tumor, 28×12mm, was located in the right side of the oral floor. Magnetic resonance imaging (T1) showed enhancement of a mass. Gallium scintigraphy showed positive results in the oral floor, but negative results for the other region. A biopsy was performed, and the pathological diagnosis was a suspected MALT lymphoma with a lymphoepithelial lesion in the oral floor.
Tumor resection, including both sublingual glands and the upper layer of the mylohyoid muscle, was performed under general anesthesia.
Histopathological examination revealed diffuse, nodular proliferation of large atypical lymphoid cells with round or indented nuclei and distinct nucleoli. In addition to foci of diffuse proliferations of medium-sized lymphoid cells, lymphoepithelial lesions were present. Immunohistochemical examinations revealed that the atypical cells were positive for CD20, 79a, CD45RO, and Bcl-2, but were negative for CD 10 and Helicobacter pylori. This case was finally diagnosed as a diffuse large B cell lymphoma arising from MALT lymphoma.

抄録全体を表示