The prognosis factors of early tongue squamous cell carcinoma were studied. Depth of invasion is an important prognostic factor of delayed neck lymph node metastasis. However, depth of invasion is based on the result of histology after surgery, and is difficult to predict preoperatively. In this study, we focused on the prognostic factors of early tongue squamous cell carcinoma, especially the depth of invasion, aiming to clarify the relationship between image findings and prognosis. 　Between April 2000 and March 2016, 213 patients were treated for early tongue squamous cell carcinoma and underwent surgery in our department. The subjects were 114 males and 99 females, mean age 60.4. There were 129 Stage Ⅰ and 84 Stage Ⅱ patients. Median follow-up period was 66.2 months. Mean depth of histological invasion was 3.3mm. Mean tumor budding was 2.9. The threshold of depth of invasion and tumor budding were set at 5mm as a result of Receiver Operating Characteristic curve analysis. 　The 5-year overall survival, disease-free survival, local control rate and neck control rate were 93.8％, 79.7％, 91.5％ and 86.4％, respectively. By univariate analysis, stage, muscle invasion, depth of invasion, and tumor budding were correlated with neck control rate. In addition, by multivariate analysis, depth of invasion and tumor budding were correlated. 　As to image evaluation, the detectability was 10.7％ on CT, 51.3％ on MR, and 97.5％ on US images. The depth of invasion measured with MR as well as US was significantly correlated with histology. 　As a result, depth of invasion and tumor budding are useful as prognostic factors, and US is the most useful modality for early tongue squamous cell carcinoma.

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According to statistical data of the Supreme Court, the number of cases of medical litigation settlement in the District Court as a whole was 1,120 cases in 2006. However, the number decreased significantly to 753 cases in 2017. In contrast, the number of dental cases was 74, 91, and 88 in 2006, 2016, and 2017, respectively, which means that the risk of dental medical conflict including dental medical litigation is increasing, and so dentists must be made even more aware of risk management. 　This paper examines the following: （1） the current state of medical disputes, （2） the concept of “negligence” of medical institutions in the event of a medical accident, （3） “recording” and “explanation” required in daily practice to prevent medical conflict, and （4） “appropriate response” after the occurrence of medical accidents for avoiding conflict, based on court cases and my experience.

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Simultaneous production of granulocyte-colony stimulating factor （G-CSF） and parathyroid hormone-related protein （PTHrP） is rare in oral tumors. We report a case of tongue carcinoma, wherein the production of G-CSF and PTHrP was suspected after recurrence. A 72-year-old male with a tumor on the right side of the tongue was referred to our department. He was diagnosed with tongue squamous cell carcinoma with right neck lymph node metastasis （T3N1M0, StageⅢ）. Tumor resection and neck dissection were performed and neoadjuvant chemotherapy was initiated. However, recurrence of the oral carcinoma on the floor of the mouth and left mandibular region was recognized 2 months after surgery. Chemoradiotherapy was planned considering his general condition. During treatment, laboratory findings showed leukocytosis without infection. Soon afterward, hyperkalemia without bone invasion was also observed. The levels of G-CSF and PTHrP in serum were high. Finally, the effects of treatment proved to be limited. The patient’s condition grew worse and he died 8 months after initial treatment. We examined tissue specimens taken at the primary and recurrent carcinoma by immunohistochemical staining with monoclonal anti-G-CSF antibody. All tissue reacted positively. These results suggested that this was a case of tongue carcinoma producing both G-CSF and PTHrP.

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