Hitoshi Yoshimura

Treatment modalities for oral verrucous carcinomas and their outcomes: contribution of radiotherapy and chemotherapy

AbstractBackground. This clinical study focused, firstly, on the results of treatment and, secondly, on the anaplastic transformation, of oral verrucous carcinomas (OVCs) diagnosed and treated from 1981 to 1997 at the Department of Oral and Maxillofacial Surgery at Shimane Medical University Hospital. Methods. We analyzed the treatment modalities and outcomes for 15 patients with OVC. Results. Excluding the results for 4 palliatively treated patients, the disease-free survival rates of the patients after the initial treatments, were 82% at 5 years and 66% at 10 years; for all 15 patients, these rates were 57% and 46%, respectively. Surgery alone and surgery combined with other treatments (such as radiotherapy and chemotherapy) appeared to yield disease-free survival rates to those achieved superior with other treatments whether single or combined; (78% vs 33% for 5-year disease-free survival; 52% vs 33% for 10-year disease-free survival); however, the difference was not significant (P = 0.47). Well differentiated squamous cell carcinomas (W-SCCs) (n = 5) as well as spindle cell carcinoma (n = 1) were found in subsequent operative or biopsy specimens. Conclusion. Surgery was the most reliable treatment method for OVC; however, radiotherapy combined with chemotherapy was the next most preferable treatment when surgery was not undertaken. We also found that highly malignant transformation (anaplastic transformation) occasionally occurred during treatments for OVC.

Clinical characteristics of oral adenosquamous carcinoma: report of a case and an analysis of the reported Japanese cases.

We present a case of adenosquamous carcinoma (ASC) which developed in the floor of the mouth of a 72-year-old Japanese man, and review 19 reported ASC cases in Japan from between 1986 and 2001, including the subject case herein. These ASCs occurred at an average age of 63 years, with 74% of the ASCs occurring in the floor of the mouth (8) and the tongue (6); the other sites of occurrence were the palate (3) and mandibular alveolus (2). Chief complaints were painless mass formation (28%), pain and/or sensational abnormality (28%), painful ulcer or swelling (22%), simple ulcer (11%), and miscellaneous others (11%). The clinical presentations of ASC were tumor with ulceration (58%), tumorous mass (26%), and ulcer (16%). Tumor size at first examination varied from bean-size to approximately 65 x 40 mm. In the pretreatment period, 31.3% were known to have cervical lymph node involvement, and descriptions on distant metastasis were not noted in any of the 19 cases. Some of the ASCs were initially diagnosed as other types of lesions, such as squamous cell carcinoma (SCC; 41%), adenocarcinoma (Ad.C; 12%) mucoepidermoid carcinoma (MEC; 6%), and MEC or SCC (6%). After initial treatments, neck and distant metastases were ascertained in 47.1 and 17.6% of the cases, respectively. Generally, a surgical procedure was performed as one of the most critical methods of treatment. The overall 5-year survival rate was 57.0%, with that of patients who underwent active treatment at 60.6%. Our study demonstrates the extent of the varied nature of ASC.

The Incidence of Neurosensory Disturbance after Sagittal Split RamusOsteotomy Depending on the Path of the Inferior Alveolar NeurovascularBundle

Both sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) are common surgical treatments for the mandible in patients with jaw deformities. Although SSRO has a wider indication than IVRO, SSRO has several disadvantages, including neurosensory disturbance (NSD) of the inferior alveolar nerve (IAN) [1,2]. While the incidence of NSD of the IAN after IVRO is 0 to 35% [1,3], that after SSRO is 9 to 85% [1,3,4]. In addition, several reports showed that the incidence of NSD of IAN was 99 to 100% immediately after SSRO [3,5,6], and 1 to 66% of the disturbances persisted permanently [5,7]. This permanent NSD not only irritates patients but also decreases patients’ quality of life (QOL) [8].

Interval Presentation of Non-cancerous Lesions Following Neck Surgery for Oral Squamous Cell Carcinoma

Objective: Lumps developing in the neck after neck surgery for oral squamous cell carcinoma usually indicate recurrent disease but, on occasion, a non-cancerous lesion may be present. A study was performed to evaluate the clinical and histological features of newly formed non-cancerous lesions in the neck area previously treated for regional lymph node metastasis. Patients and Methods: Twenty three patients presenting with newly developed lumps in the neck area following neck surgery for oral squamous cell carcinoma were investigated. Results: Eleven patients had metastatic disease, while 12 had benign tumours. Fifteen specimens obtained from the 12 patients with benign tumours were histopathologically examined. The 12 patients revealed usual clinical features and were treated similarly to other patients with oral squamous cell carcinoma. The noncancerous lesions occurred in the submandibular and upper neck regions, revealing the following range of histological features: abscesses or granulomatous tissues (6); lymph nodes with reactive inflammation or no particular changes (6); simple subcutaneous tissues containing muscle and nerve (2), and amputation neuroma (1). Conclusion: There is a need for precise biopsy from a suitable part of the neck using an excisional procedure for accurate diagnosis.

Oral Squamous Cell Carcinoma in Patients with Pulmonary Metastasis but no Locoregional Recurrences

Abstract Objective : This retrospective study aimed to clarify the clinicopathologicalfeatures of patients with oral squamous cell carcinoma that revealed pulmonary metastasis alone on first recognition of relapse and who died as a result of this pulmonary metastasis. Patients and Methods : This study comprised 6 patients with pulmonary and/or distant metastasis, but with no locoregional recurrences throughout their lives. These patients were selected from a base population of 104 oral squamous cell carcinoma patients. Results : Among the oral squamous cell carcinoma patients studied, 5.8% of patients (6/104) had previously experienced both primary and neck diseases. Histopathologically, the primary lesions were all well-differentiated squamous cell carcinomas. Pulmonary metastasis was most commonly observed in tongue cancer patients (67%; 4/6). Biopsy of the pulmonary metastatic lesion in 1 patient revealed moderately differentiated squamous cell carcinoma. Radical neck dissection with preservation of the internal jugular vein was done on 4 of the 6 patients. While no patient underwent radical salvage surgeries for pulmonary metastasis, all patients underwent palliative treatments, such as chemotherapy and radiotherapy, either alone or in combination. The study findings show that complete radical neck dissection was more effective than functional neck dissection. Conclusion : Six oral squamous cell carcinoma patients with pulmonary metastasis, but no locoregional recurrences, were analysed from the clinicopathological perspective, and a possible cause for the metastasis related to neck lymphatic and blood systems was identified.

A case of adenoid cystic carcinoma which occurred in the orbit and progressed to the mouth

初回手術から24年後に多形性腺腫から悪性転化した腺様嚢胞癌のまれな1例を報告した。患者は60歳, 男性, 上顎右側歯肉腫瘍の加療を目的とし当科に紹介された。患者は右側涙腺腫瘍にて過去に2回手術を受けていた。初回手術では, Krnlein法にて腫瘍摘出術が行われ, その手術材料の病理組織診断は多形性腺腫であった。24年後, 右眼球突出を訴えて眼科を受診した際のCT・MRIにて, 腫瘍は右側眼窩上外側部を占拠し, また, 頭蓋内にも進展発育していたことが明らかとなった。この第2回目の手術により摘出された手術標本は腺様嚢胞癌と病理組織学的に診断された。約10か月後には腫瘍は上顎洞, さらには口腔内にも進展した。この著しく進展発育した腫瘍に対して放射線療法, および超選択的動注化学療法が施行され, 一時的には腫瘍は著しい縮小を示したが, 再び徐々に増大, 死の転帰をとった。多形性腺腫は, 特に不完全なたび重なる摘出術後に悪性化をおこすことがまれにあるとされており, ここにそのまれな症例を報告した。