Objective histopathological judgment is very important to determine the treatment and prognosis of oral squamous cell carcinoma. However, there are many problems in clinical practice, such as the chronic shortage of pathologists and disagreements among evaluators. Therefore, there are great expectations for the development of algorithms to support pathological diagnosis using machine learning.
Intercellular bridges, a histological feature of normal oral squamous epithelium, are known to disappear at poor differentiation in oral squamous cell carcinoma. However, the structures are extremely narrow and difficult for pathologists to distinguish and evaluate from the entire pathological tissue.
We evaluated the clinicopathology of intercellular bridges in oral squamous cell carcinoma. In addition, to provide an objective measure for this evaluation, we attempted automated segmentation of intercellular bridges using machine learning. As an area of interest, intercellular bridges in the infiltration depth region were selected using whole slide imaging of HE specimens of primary oral squamous cell carcinoma cases.
In the classification and evaluation of intercellular bridges, we found a close association between loss of intercellular bridges and poor prognosis. We were also able to develop an automated segmentation of those intercellular bridges. However, there are still many unstable aspects of automatic segmentation using machine learning, and there is still room for improvement for clinical application.

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We report the cases of two super-elderly patients with mandibular gingival carcinoma who underwent surgery and were retrospectively evaluated using a patient evaluation tool. Patient 1 was a 93-year-old man with mandibular gingival carcinoma （cT4aN0M0） who underwent tracheostomy, neck dissection, and segmental mandibulectomy. Postoperatively, he developed pleural effusion and pneumonia but was discharged 31 days after surgery. Five years post-surgery, he maintains the same activities of daily living （ADL） as before surgery, with no recurrence of the carcinoma.
Patient 2 was a 93-year-old man with mandibular gingival carcinoma （cT4aN1M0） who underwent tracheostomy, neck dissection, segmental mandibulectomy, and reconstruction using a pectoralis major musculocutaneous flap. He experienced postoperative pleural effusion and pneumonia, which improved; however, he suffered a severe hemorrhage six weeks postoperatively and severe arrhythmia nine weeks postoperatively. He was transferred to another hospital twelve weeks after surgery and died of recurrent pneumonia four weeks later.
The patient evaluation tools included life expectancy, American Society of Anesthesiologists classification, Performance Status, Charlson Comorbidity Index, Prognostic Nutritional Index, Mini Nutritional Assessment, Geriatric-8, Vulnerable Elders Survey-13, Flemish Version of the Triage Risk Screening Tool, Japan Clinical Oncology Group classification for the elderly, Clinical Frailty Scale, Frailty-Index, basic checklist, Functional Oral Intake Scale, Food Intake Level Scale, and Estimation of Physiologic Ability and Surgical Stress. These results suggest that even in very elderly patients with oral cancer, surgery may be considered based on their general condition and that it may be important to reduce the invasiveness of surgery. As useful tools for patient evaluation and prognostic factors are not yet available, it is necessary to study more cases in the future.

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Methotrexate （MTX） is an antitumor drug classified as a folate metabolic antagonist and because of its immuno­suppressive effect, is regarded as an “anchor drug” in the treatment of rheumatoid arthritis （RA）. Recently, methotrexate-associated lymphoproliferative disease （MTX-LPD） has been classified as a critical complication in the RA guidelines. In this study, we examined five cases of MTX-LPD. Symptoms were mainly ulceration, mass formation and lymphadenopathy. All patient symptoms resolved after MTX withdrawal. Because two patients were treated with bone resorption inhibitors, it was necessary to differentiate medication-related osteonecrosis of the jaw （MRONJ）. In this study, the patients had good outcomes with only drug withdrawal, however, some reports describe cases needing treatment with chemotherapy based on malignant lymphoma. We suggest the importance of careful follow-up.

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