The Kitakanto Medical Journal

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Background & Aims : Some oral mucosal diseases display clear predispositions toward certain sites of occurrence. Oral lichen planus is one such disease, and is thought to have some relationships with cell-mediated immunity leading to a tendency to develop on the buccal mucosa. The aim of this study was to investigate the distribution of Langerhans cells in various sites of oral mucosa. Methods : Immunohistochemical examination using an anti-S100 antibody was performed for 47 samples of healthy oral mucosa and skin. Results : S100-positive cells were more frequent in lining mucosa than in masticatory mucosa. Significantly more S100-positive cells were found in buccal mucosa than in other sites. Conclusions : Langerhans cells are positive for S100 and are thought to represent antigen-presenting cells. These cells were most frequent in buccal mucosa, a result that is in accordance with the predisposition of oral lichen planus.

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A CT scan was performed because the patient complained of an oppressing feeling in the upper abdomen and back and upper abdominal pain and his anemia had progressed while he had been treated by his family doctor for both an irregular pulse and high blood pressure.
The CT scan showed a tumor measuring 6.4×6.4×4.3cm in diameter which had invaded the surrounding internal organs and which had no clear border. A gastrointestinal scope study showed mucosal redness and thickness and local deformation in the posterior wall of the cardiac part of the stomach. We therefore suspected a malignant stromal tumor.
Surgical treatment was thereafter performed. The tumor was resected with a proximal gastrectomy, left kidney extraction, left adrenal gland extraction, a transverse colon resection, a partial duodenectomy and a spleen resection.
There have been no signs of recurrence during the 2-year postoperative follow-up.

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Tegafur/uracil (UFT) is an oral anticancer drug composed of tegafur which is a derivative of fluorouracil (5-FU) and uracil in a molar ratio of 1 : 4. UFT is effective as adjuvant chemotherapy for breast cancer², colorectal cancer³, non-small cell lung carcinoma⁴, head and neck cancer⁵ and other tumors. We report a 41-year-old man who orally ingested a large dose of UFT (tegafur : 40000 mg/uracil 9960mg) in an effort to commit suicide, and suffered from sub-acute toxicosis (main symptoms were bone-marrow suppression, and hair loss) of UFT. His life was saved by empiric antibiotic chemical treatment (meropenem, isapamicin, and micafungin), and granulocyte colony-stimulating factor (G-CSF). In the case of toxicosis of UFT, strong antibacterial empiric chemotherapy and G-CSF are necessary for rescue. If G-CSF is not work, biopsy of bone marrow woud be necessary, and the case of no stem cells, bone marrow transfusion should be thought.

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