術前療法後に外科療法を施行した下顎歯肉扁平上皮癌一次症例57例を対象とした。対象症例の縮小率, 軟組織での組織学的術前療法効果および硬組織中での組織学的術前療法効果の関係について検討し, 以下の結果を得た。1.縮小率が高いほど予後が良好であった。2.縮小率が高い症例は, 大星・下里分類で著効例が多く認められた。3.術前療法による顎骨中の腫瘍の組織学的効果は, 軟組織中の所見とほぼ同様であった。4.X線所見がinvasive typeの症例では, 術前療法後, 骨中に生活癌細胞の残存が認められる傾向にあった。

抄録全体を表示

下顎歯肉扁平上皮癌の予後因子を明らかにする目的で73例の下顎歯肉扁平上皮癌を対象にCoxの比例ハザードモデルを用いて多変量解析を行った。生存率に影響を及ぼす因子として選択されたのは, X線骨吸収様式 (p=0.0055) と組織学的頸部リンパ節転移の有無 (p=0.0277) の2項目であった。X線骨吸収様式別の疾患特異的5年累積生存率は, no change: 93.5%, erosive type: 92.9%でinvasive typeの症例は53.6%であった。X線骨吸収様式は下顎歯肉癌細胞のいろいろな性質が集約した表現型である可能性が示唆された。一方、組織学的頸部リンパ節転移の有無別の疾患特異的5年累積生存率はpN (+) : 54.1%でpN (―) : 91.8%であった。下顎歯肉扁平上皮癌では、骨吸収様式がinvasive typeでpN (+) の症例は著しく予後が不良であることが明らかとなった。

抄録全体を表示

28歳女性．主訴は発熱，下痢で両下肢に有痛性結節性の紅斑を認めた．大腸内視鏡では横行結腸を中心に浅い縦走潰瘍を認めた．生検では陰窩膿瘍を伴う高度の炎症細胞浸潤がみられ，炎症性腸疾患の像であったが，肉芽腫性病変はなくCrohn病の確定診断に至らなかった．一方，足背の皮膚生検では皮下脂肪織に類上皮肉芽腫を認め，Crohn病の診断を支持する所見であった．Crohn病を疑い皮膚症状を伴った場合，早期の皮膚生検が診断に有用である．

抄録全体を表示

Basal cell nevus syndrome (BCNS) is an autosomal dominant hereditary disease with various skin lesions and multiple jaw cysts. An 11-year-old male with BCNS followed up for 14 years was reported. The patient was admitted to our hospital with the complaint of reversed occlusion. Clinical examination revealed basal cell nevus of left cheek, temporal and frontal bossings, ocular hyperterorism, and palmar and planter pits. Radiographs revealed multiple cystic lesions of the mandible. Clinical diagnosis was BCNS with jaw deformities, and the cysts were extirpated. Later, the jaw cysts were extirpated 3 times at the ages of 15, 19 and 24 years. Histopathologically, all operated specimens were diagnosed as odontogenic keratocyst. Immunohistochemically, Ki-67 positivity in the lining epithelia of these cysts was higher than that of control odontogenic keratocysts. Careful follow-up is considered necessary because odontogenic keratocyst associated with BCNS tends to have great proliferating potential.

抄録全体を表示

The purpose of this study was to assess the efficacy of preoperative ultrasonography (US) of cervical lymph node (LN) metastasis in oral squamous cell carcinoma patients. Criteria to detect LN metastasis are proposed and discussed.
In this retrospective study 58 LNs from 29 patients were included. They were evaluated ultrasonographically before surgery and studied histologically after surgery for cervical lymph node metastasis. US findings were compared with histological results in order to ascertain the accuracy of the ultrasonographic examination of cervical lymph nodes. The results of the study showed that US findings of an absent hilum and the shorter diameter of a LN exceeding 10mm have high predictive values for LN metastasis. The criteria of an absent hilum or smaller diameter of a LN over 10mm regardless of the presence of the hilum provided a sensitivity of 92%, a specificity of 82%, and an accuracy of 86%.
The results of this study, verified the efficacy of US assessment for LN metastasis. The presence of LN metastasis could be diagnosed with good accuracy by US examination.

抄録全体を表示

The purpose of this study was to assess changes in prognostic factors related to modification of surgical treatment on the basis of grade of tumor malignancy and to contribute to improved surgical treatment of patients with oral squamous cell carcinoma. Fourhundred three patients with oral squamous cell carcinoma treated by surgery were classified according to treatment period as follows: f irst period, 1976-1986; second period, 1987-1991; and third period, 1992-1997.
Three and 5-year cumulative disease-specific survival rates according to treatment period were as follows: first period (n=187), 78.6, 76.3%; second period (n=113), 76.6, 73.7%; and third period (n=103), 88.9, 87.2%. On univariate analysis of survival according to T, N, stage, growth pattern, and mode of invasion, significant differences (P<0.05) were found for all characteristics in the first and second periods, while in the third period no significant difference was found for growth pattern or mode of invasion.
Cox regression analysis of disease-specific survival identified the following as independent prognostic factors: mode of invasion (1+2, 3, 4C+4D), growth pattern (exophytic, endophytic), and N (0, 1, 2) in the first period, mode of invasion (1-3, 4C+4D) and N (0, 1, 2+3) in the second period, and only N (0, 1, 2) in the third period.
Owing to the improved outcome for highly invasive carcinoma, the prognostic values during the third period differed from those during the first and second periods.

抄録全体を表示

In this study, we investigated the proliferating activity of odontogenic keratocysts in 6 cases of basal-cell nevus syndrome by immunohistochemical studies using the proliferating cell nuclear antigen (PCNA) monoclonal antibody. The results were as follows.
1. PCNA-positive cells were detected on the basal cell layer and suprabasal cell layer in the epithelial linings, rete peg formations, or satellite cysts of odontogenic keratocysts. PCNApositive cells were widely distributed in the epithelial layer, especially in epithelial islands.
2. Odontogenic keratocysts had a significantly higher PCNA labeling index than that of radicular cysts, used as control, especially in epithelial islands.
These results strongly suggest that odontogenic keratocysts in basal-cell nevus syndrome have high proliferating activity.

抄録全体を表示

顎口腔領域悪性腫瘍の臨床病理学的所見の特徴を明らかにすることを目的として, 本研究を行った。
888例の悪性腫瘍症例を対象とした。平均年齢は60.0歳, 男女比は2.3:1で, 大半 (84.7%) は扁平上皮癌であった。紹介医別では70.5%は歯科からの紹介 (直接来院も含む) であった。
口腔扁平上皮癌一次症例481例の主訴は, 腫瘤形成: 58.8%, 疼痛: 22.5%であった。癌浸潤様式4D型では疼痛を主訴とする症例が最も多く, 約半数であった (45.2%)。臨床視診型 (鷲津分類, 1973年) は潰瘍型, 肉芽型が多かった。白斑型, びらん型は, 腫瘍径が40mm以上の症例は少なく, これらは, 口腔扁平上皮癌の非進展例に特徴的な所見であることが示唆された。

抄録全体を表示

舌癌の造影CT画像所見と術前療法効果の関係を知る目的で本研究を行った。1996年から2000年における術前療法後に外科的切除を行った舌扁平上皮癌10例の造影CT像における造影効果と術前療法効果ならびに組織学的所見との比較検討を行った。
造影CT像において術前療法前の造影効果が強いほど組織学的治療効果が高い傾向にあった。これらの症例は組織学的にリンパ球浸潤が強く, 血管数が多い傾向にあった。術前療法による造影効果の減少した症例では線維性間質の増生に伴う血管およびリンパ球浸潤の減少がみられ, 造影効果の増強した症例では血管に富んだ肉芽組織の増生がみられた。これらの結果より造影CT像は間質の組織所見を反映し, 術前療法による造影CT像の変化は組織の治療効果による変化を反映している可能性が示唆された。

抄録全体を表示

口腔扁平上皮癌における核DNA量の予後因子としての意義を検討した。イメージサイトメトリーを用いて, 197例の口腔扁平上皮癌の生検組織のパラフィン包埋切片における腫瘍発育先進部の癌細胞の核DNA量を測定した。得られたDNAヒストグラムの評価として, 超4c率 (4cを越える癌細胞の比率) を用いた。
197例の超4c率は最低値0から最高値51%にわたり, 中央値は9.7%であった。各種臨床病理組織所見との関連をみると, 癌の進展と悪性度との関連がみられた。全症例の5年累積生存率は75%で, 超4c率9.7%未満群: 90%, 超4c率9.7%以上群: 60%であった。癌浸潤様式 (山本・小浜分類) の各モードごとに超4c率と生存率との関係をみると, モード1および2を除き, 超4c率が低値の群で良好な傾向がみられたが, 推計学的に有意差がみられたのはモード3のみであった。そこで, モード3のみを対象に予後因子の多変量解析を行ったところ, 超4c率が最も独立性の高い因子であった。
以上より, 超4c率は有用な口腔癌の予後因子となり得ることが示唆された。

抄録全体を表示

外科療法を行った口腔扁平上皮癌509例を対象に, 悪性度評点 (Malignancy score: MS) の臨床的意義を明らかにする目的で検討を行った。MSは生検の組織学的所見 (分化度, 分裂指数, 細胞異型度, 癌浸潤様式, 単核細胞浸潤) に基づき決定した。病因特異的5年累積生存率は, MS5-9点の低悪性では90%以上, MS10-12点の中悪性では67-78%、MS13-16点の高悪性では40-57%であった。多変量解析にて, T, N, MSは独立した予後因子であった。stage III, IVの85例についてp53と bax の発現を免疫組織化学的に検討した。低悪性および中悪性では予後は比較的良好であったが, p53(+) bax (-)では不良で, 高悪性では, p53の発現に関わらず bax (-)では不良であった。P53, bax などのバイオファンクショナルマーカーを患者個人にみあった治療方針に反映させることを考える場合には, 組織学的悪性度と併せて評価を行うことの必要性が示唆された。

抄録全体を表示

  Keratocystic odontogenic tumor (KCOT) is an aggressive lesion with a well-documented predilection for recurrence. This study aims to investigate the reason for the recurrence tendency of KCOT.
Material and Methods:
  The materials were 80 KCOTs in 58 patients. All 80 KCOTs were reviewed histopathologically, and 45 of them in 23 patients were examined immunohistochemically by means of monoclonal antibodies against proliferating cell nuclear antigen (PCNA) ，Ki-67, interleukin-1 α (IL-1 α ) ，and podoplanin.
Results:
1.　Comparison of sporadic KCOTs with lesions of nevoid basal cell carcinoma syndrome (NBCCS)
(1) Histopathologically, the proportion of lesions showing budding proliferation, islands of odontogenic epithelium and daughter cysts was higher for NBCCS than for sporadic KCOTs.
(2) Immunohistochemically, the ratio of Ki-67-positive cells in NBCCS lesions was higher than in sporadic KCOTs. The intensity of PCNA immunoreactivity was higher in the basal layer of NBCCS lesions than in KCOTs. However, there was no significant difference in the ratio of IL-1 α -positive cells between NBCCS and sporadic KCOTs.
(3) The podoplanin immunoreactivity in NBCCS lesions was more intense than in sporadic KCOTs.
2.　Comparison of recurrent and non-recurrent lesions after enucleation
(1) Histopathologically, the proportion of lesions showing odontogenic epithelial islands was higher in recurrent KCOTs (45.5%) than in non-recurrent (11.6%) KCOTs.
(2) Immunohistochemically, the positivity ratios were higher in recurrent KCOTs than in non-recurrent KC4.4% and 2.8%) and PCNA (55.6% and 44.6%).
(3) In sporadic KCOTs, the podoplanin immunoreactivity in recurrent primary lesions was more intense than in non-recurrent lesions.
3.　Comparison of the primary KCOTs with or without recurrence and the secondary KCOTs after recurrence
(1) Histopathologically, only one lesion of secondary KCOT showed a slight sign of inflammation, in contrast to the high ratio (63.6%) in primary KCOTs.
(2) Immunohistochemically, the ratio of IL-1 α -positive cells in secondary KCOTs that showed almost no inflammation was higher than that in primary KCOTs.
(3) There were no significant differences in podoplanin immunoreactivity between primary KCOTs and secondary KCOTs after recurrence.
Conclusion:
  The experimental results suggest that any residual epithelial tissue left behind after surgery on the KCOT has a potential to cause proliferation and recurrence. Furthermore, this immunohistochemical study of reactivity for podoplanin supports the contention that KCOT is a benign cystic neoplasm but becomes aggressive when associated with NBCCS.

抄録全体を表示

We analyzed clinicopathologically patients with upper gingival carcinoma, especially those with cervical lymph node metastasis. This study included 35 patients who had undergone treatment for upper gingival carcinoma from 1975 to 2001. Clinically suspected node positive (N(+)) cases were appeared in 7 of the cases (20.0%). The TNM classification (UICC) was T4N1 and T4N2 in 3 each patients, with all patients classified as M0. Histopathologically confirmed node positive (pN(+)) cases appeared in 4 of 7 N(+) cases and 4 cases of secondary metastasis, for a total of 8 cases. A high prevalence of pN(+) cases were found among the endophytic, and 4C types. Regarding treatment modality, preoperative chemotherapy was administered to 30 of the cases. Chemotherapy was administered intra-venously in 8 cases and intra-arterially in 13 cases. Among patients treated intra-venously, there were no cases demonstrating neck metastasis ; however, among those treated intra-arterially, there was secondary metastasis in 3 cases. The 5-year cumulative survival rate was 81.3% overall and 62.5% among the pN(+) cases. Uncontrolled sites in pN(+) cases consisted of cervical lymph node metastasis in one case, and distant metastasis in another case.

抄録全体を表示

A total of 44 patients with oral squamous cell carcinoma of stage III or N, treated by neoadjuvant chemotherapy followed by radical surgery were investigated, to elucidate the clinical significance of Bax expression for predicting chemotherapeutic effects. Immunohistochemistry for Bax protein was carried out on serial sections from f ormalin-f ixed, paraffinembedded tissues, which were classified into Bax positive and Bax negative. The effects of neoadjuvant chemotherapy were evaluated according to general rules for clinical and pathological studies on head and neck cancer by the Japan Society for Head and Neck Cancer, the Oboshi-Shimosato grade, and classification of variation of kinetic proliferation based on DNA contents and the mitotic index. Bax expression was associated with favorable effects of neoadjuvant chemotherapy. The five-year cumulative survival rate was 70% for the whole series, 90% for Bax-positive patients, and 52% for Bax-negative. Baxpositive patients had a statistically high survival rate compared with Bax-negative (P=0.01). From these results, it was suggested that Bax expression serves as a predictive indicator for neoadjuvant chemotherapy, and as a prognostic factor for survival.

抄録全体を表示

1976年から1996年に当科で外科療法によって加療した上顎歯肉癌は27例であった。内訳はstage I: 3例, II: 14例, II: 7例, IV: 3例で, 組織学的悪性度ではgrade1: 9例, 2: 9例, 3: 8例, 4: 1例であった。20例に対して術前にブレオマイシン単独またはシスプラチン, メソトレキセートによる複合化学療法を施行した。平均腫瘍縮小率は52%で, 奏効率は75%であった。大星・下里分類によると, 15例がgrade IIb以上の効果良好例であった。原発巣の切除法は歯槽部のみの切除が10例で, 上顎部分切除が17例であった。原発巣切除と同時に頸部郭清を行った症例は6例で, このうち4例は組織学的にリンパ節転移が認められた。全症例の5年累積生存率は88%で, stage別ではI, II: 100%, III IV: 74%であった。

抄録全体を表示