Kiyomi Kawashima

Interpretation of scintigraphy of papillary cystadenoma lymphomatosum (Warthin's tumor) on the basis of histopathologic findings

OBJECTIVES The accumulation of 99mTc-pertechnetate in Warthins tumor was estimated scintigraphically and histopathologically to determine the role of the epithelial component in scintigraphy. STUDY DESIGN Six cases underwent histopathologic examination and scintigraphic evaluation with 99mTc-pertechnetate. Histopathologically the tumors were classified into types according to the epithelial component and cystic space and compared with scintigraphic results evaluated by dynamic radioactive index and wash-out image. RESULTS Histopathologic and scintigraphic observations showed an adequate correlation. Cases with a large epithelial component and poor cystic space showed a large radioactive index of dynamic scintigraphy and hot accumulation of wash-out image. CONCLUSION The scintigraphic results were chiefly due to the epithelial component, but the influence of the cystic space could not be disregarded.

Merkel Cell Carcinoma of the Mental Region

Abstract Merkel cell carcinoma, first described by Toker in 1972, is a rare malignant tumour that predominantly occurs in the head and neck region of older patients. This report is of an 86-year-old woman who presented with a mass in the mental region diagnosed as Merkel cell carcinoma. The clinical, histological, and immunohistochemical features of this tumour are described, together with a brief review of the literature.

Scintigraphic Detection of Oral Cancer with Early Bone Scintigraphic Image

In 117 patients with oral cancer who were examined scintigraphically and histopathologically, the tumor blood flow was estimated scintigraphically immediately after administration of99mTc-Hydroxymethylene-diphosphate (99mTc-HMDP). The radioactivity was measured in the venous phase (30 to 40 seconds after administration) and in the blood pool phase (1 to 3 minutes), and the radioactivity ratios of the tumor to the control region in both phases, (venous ratio, VR and blood pool ratio, BPR, respectively) were calculated. The early image with99mTc-HMDP (early image) was obtained 5 minutes after administration, and the image with67Ga-citrate (Ga-image) was obtained 3 days after administration. Among the tumor classified histopathologically as showing rich, intermediate and poor vascularity, those with poor vascularity showed small VR (M±SD=0.97±0.08) and BPR (1.02±0.04), whereas those with rich vascularity showed large VR (1.39±0.01) and BPR (1.31±0.16). Early image demonstrating tumor was frequent among tumors with large VR (78%) and with large BPR (100%). Of tumors under 3 cm in diameter, 65% showed intermediate or rich vascularity and positive early image for tumor blood flow. These results suggest that the detection of small soft tissue tumors can be improved by combining the early image with the Ga-image.

Pemphigus vulgaris. Report of a case with electron microscopic observations of the lesion.

Pemphigus vulgaris is a chronic autoimmune bullous disease with a severe prognosis which involves the epidermis and mucous membranes.A 24-year-old woman was referred to our clinic for diagnosis and treatment of bullae and erosion of oral mucosa.Intraoral examination revealed numerous extensive erytheraatous erosion on the palate, tongue, buccal mucosa, and labial mucosa.Specimen for biopsy was obtained from lower lip mucosa.Histopathological features showed suprabasal intraepithelial bulla formation with acantholysis typical of pemphigus vulgaris.Direct immunofluorescent staining demonstrated intercellular substance deposition of IgG.Ultrastructural investigation in oral pemphigus vulgaris showed loss of desmosomes, widened intercellular spaces and the tonofilaments accumulated around the nucleus.The diagnosis of pemphigus vulgaris was established, and treatment with 40mg prednisone daily was instituted. With progressive improvement the dosage was tapered.The skin and oral lesions remitted and a maintenance dose of 5mg of prednisone every other day and 25mg of gold sodium thiomalate once a week was instituted.