Hiroshi Yusa

Peroxiredoxin I expression in oral cancer: a potential new tumor marker

This study investigates the applicability of the novel antioxidant protein, peroxiredoxin (Prx) I as a marker for tumor status in oral squamous cell carcinoma (SCC). Samples from 53 patients with SCC in the oral cavity were examined by immunohistochemistry. Correlations between the expression level of Prx I and proliferating cell nuclear antigen (PCNA), the clinical features of tumors, and their histopathological classifications were statistically analyzed. Cases exhibiting low Prx I expression level included significantly more with larger tumor mass cases (T-category, P=0.004), positive lymph node metastasis (N-category, P=0.015), advanced stage (P=0.002), and poorly differentiated cells (P=0.020). There was no significant difference between Prx I expression and the other indices.

Factors associated with diagnostic delay of oral squamous cell carcinoma

Shortening the diagnostic delay from the onset of symptoms to the final diagnosis leads to early cancer detection and a reduced incidence of advanced cases. To analyze factors contributing to delays in the diagnosis of oral cancer, information was collected from the medical charts of 152 consecutive patients with oral squamous cell carcinoma, and factors associated with diagnostic delay were examined retrospectively. No characteristic was significantly associated with delay caused by patients. Referral by a non-initial professional, initial visit to a dentist, T1 cancer, and the presence of an ulcerative lesion were significantly associated with delay caused by the initial professionals. Patients with N0 were significantly associated with diagnostic delay caused by the final professional. These results re-emphasize the important role of the initial professional, particularly the dentist, and the diagnostic difficulty posed by ulcerative lesions and small-sized or early-stage oral cancer.

Heme oxygenase-1 expression predicts cervical lymph node metastasis of tongue squamous cell carcinomas

Heme oxygenase-1 (HO-1) is known as a stress-inducible protein. The present study was designed to investigate the relationship between HO-1 expression levels and clinical features of tongue cancer by using HO-1 responsiveness to stress as a clinical indicator. One-hundred and twelve biopsy samples from tongue squamous cell carcinomas were analyzed semiquantitatively by immunohistochemistry. Correlations between the expression level of HO-1 and the clinical features of tumors were statistically analyzed. Fifty-four cases with surgical confirmation of lymph node metastasis were examined for the association between cervical lymph node metastasis (pN) and other clinical features, including the HO-1 expression level, using logistic regression. The low HO-1 expression group contained significantly more undifferentiated samples (P=0.04) and pN positive cases (P=0.01) by univariate analysis. The low HO-1 expression group (odds ratio=8.49; 95% confidence interval=1.64-44.09, P=0.01) and an endophytic shape (odds ratio=16.79; 95% confidence interval=1.77-159.53, P=0.01) were significantly associated with an increased risk of developing lymph node metastasis by multivariate analysis. Low HO-1 expression was associated with lymph node metastasis. The expression profile suggests HO-1 could be used clinically as a marker for tumors possessing the potential for lymph node metastasis. This method could prove useful as an adjuvant method to detect lymph node metastasis and may help reduce the number of surgeries by indicating when surgery is unnecessary.

Use of doppler color flow imaging for differential diagnosis of vascular malformations: A preliminary report

PURPOSE To ascertain whether Doppler color flow imaging can demonstrate the characteristics of blood flow within vascular lesions. MATERIALS AND METHODS Two cases with vascular malformation in the soft tissues of the maxillofacial region were examined. One was an arteriovenous, high-flow type malformation involving the tongue, the floor of the mouth, and the mandible. The other was a venous, low-flow type malformation of the whole tongue. The technique used was the same as that for the extraoral approach in conventional ultrasound imaging. RESULTS Doppler color flow imaging provided valuable information on the hemodynamic characteristics of the vascular malformations when comparing with other diagnostic forms of imaging, and clearly differentiated between high- and low-flow vascular lesions. CONCLUSION Doppler color flow imaging was suggested to be another method in our armamentarium for differential diagnosis of vascular malformations.

Ultrasonographic Criteria for Diagnosis of Cervical Lymph Node Metastasis of Squamous Cell Carcinoma in the Oral and Maxillofacial Region

PURPOSE This retrospective study was done to establish an objective criterion for sonographic diagnosis of cervical lymph node metastasis of squamous cell carcinoma in the oral and maxillofacial region. PATIENTS AND METHODS A quantitative criterion for differentiating metastatic from nonmetastatic nodes was statistically calculated using logistic regression analysis of 106 cervical lymph nodes in 41 patients. A prospective study was then conducted to ascertain the reliability of the criterion for 82 nodes in another 23 patients. RESULTS The following equation was obtained from the retrospective study: Y = 1/(1+e(-lambda) (lambda = -7.5709 + 4.2423 X1 + 1.9354 X2 + 0.5507 X3) Y represents the predicted value; lambda, also representing a predicted value, was defined as negative for nonmetastatic and positive for metastatic nodes; X1, signifying the existence of an echogenic hilus, was defined as 0 for presence and 1 for absence; X2, signifying the internal echo pattern, was defined as 0 for homogeneous and 1 for heterogeneous; X3, signifying the minimal diameter, was the actual measured value (mm). This equation showed a sensitivity of 82%, a specificity of 91%, and an accuracy of 88% in the prospective study. CONCLUSION The equation calculated by logistic regression analysis was a reliable criterion for diagnosing cervical lymph node metastasis.

Analysis of fluorescence in oral squamous cell carcinoma

This study was carried out to examine the spectral properties of the red fluorescence emitted from oral squamous cell carcinoma (SCC). Fluorescent samples obtained from oral cancers induced in hamsters, human oral SCCs, and the medium from cultured oral cancer cell lines were analyzed with a spectrofluorometer with excitation at 404 nm. The spectral profile of the experimentally induced cancers changed with increasing malignancy: peaks at 634 and 672 nm increased and peaks at 520 and 582 nm decreased. A reduction in fluorescence intensity at 582 nm and a rise of intensity at 634 nm were commonly observed in the experimental, clinical, and cell line samples, and the ratio of the fluorescence intensity at 582 nm over that at 634 nm was consistent in all samples. These results suggested that the red fluorescence was emitted by porphyrin, which we believe to be produced by oral SCCs and to accumulate inside or on the surface of cancer tissues in greater amounts with progressing malignancy.

ULTRASONOGRAPHIC EVALUATION OF SMALL CERVICAL LYMPH NODES IN HEAD AND NECK CANCER

To establish sonographic criteria for differentiating metastasis and nonmetastasis in small cervical lymph nodes, correlations between sonographic parameters and histological diagnosis were statistically examined in 117 lymph nodes with maximal diameter of up to 10 mm in the sonographic findings, consisting of 26 metastatic and 91 nonmetastatic nodes. The equations obtained with logistic regression analysis showed lambda predictive values of -1.5 and 0.5 as effective cutoff-point criteria, and were considered to be a reliable indicator for differentiating small nodes with predictive values outside of -1.5 < lambda < 0.5. The sensitivity, specificity and accuracy with predictive values outside of -1.5 < lambda < 0.5 were 83%, 97% and 95%, respectively.

Ultrasonographic assessment for response to radiochemotherapy of metastatic cervical lymph nodes in head and neck cancer: usefulness of grey-scale and color doppler sonography.

To predict the response of lymph node metastasis to preoperative radiochemotherapy sonographically, the correlation between ultrasonographs and histologic features was retrospectively examined in 43 metastatic cervical lymph nodes from 24 patients with squamous cell carcinoma in the oral and maxillofacial region. Ultrasonographs were compared among poor-, good-, and complete-response lymph nodes. Before radiochemotherapy, hypoechoic internal echo and intranodal blood perfusion demonstrated many complete-response nodes; in contrast, most poor-response nodes showed peripheral blood perfusion and an avascular pattern, but did not have specific internal echo intensity. Complete-response nodes showed a significant reduction in their maximum and minimum diameters after radiochemotherapy. These results indicate that ultrasonography is useful for predicting the response of cervical lymph node metastasis to radiochemotherapy.

Phosphoglyceride crystal deposition disease

An extremely rare phosphoglyceride deposition disease is reported. A healthy 62‐year‐old Japanese woman suffered from tumors that repeatedly appeared in injured soft tissues for more than 20 years. No immunologic disorders or abnormal laboratory data were found. Histology showed foreign body granulomas consisting of macrophages surrounding yellowish‐white crystals. The crystals were weakly positive by von Kossas method, were dissolved in 30% acetic acid with gas, and were easily dissolved in 0.1 N NaOH or potassium hydroxide, losing their crystal structure. Using a scanning electron microscopy X‐ray microanalyzer, phosphorus and calcium peaks were detected. Phosphoglycerides were detected by microscopic infrared spectrophotometry and microsampling mass spectrometry. The gold hydroxamic acid method for detecting phosphoglyceride showed strong positive staining in the crystals. Based on the above analyses, the deposited crystals were regarded as phosphoglyceride, which bound calcium as a counter ion. The crystals tended to be deposited at sites of injury, where macrophages had accumulated. The patient had received many injections of a medicine made from alcohol extract from bovine liver. We suspect that this medicine was related to the cause of the deposition as the deposition repeatedly appeared at the site of the injections.

c-Abl expression in oral squamous cell carcinomas

c-Abl is proto-oncogene product. c-Abl has roles in signal transduction, cell cycle regulation, and inhibition of apoptosis. There are many reports about c-Abl function in hematopoietic cells, but few are concerned with solid tumors. In the present study, biopsy specimens from 44 patients with oral squamous cell carcinomas were subjected to immunohistochemistry, and the expression levels of c-Abl were correlated with clinicopathological features. Statistical analyses revealed that c-Abl expression was significantly associated with T-category (p = 0.011), sex (p = 0.014), and differentiation (p = 0.007), but no significant difference was observed with N-category, age, primary tumor region, or the other histological gradings. The low c-Abl expression group included more T4, male, and poorly differentiated cases. There was a trend towards longer tendency survival in the high expression group, but the difference was not significant. We conclude that c-Abl is a good candidate for a tumor-expansion marker.