Osamu Teranobu

Heterogeneity of primary malignant melanomas in oral mucosa: An analysis of 43 cases in Japan

&NA; In contrast to Caucasians, Japanese people have a relatively high incidence of malignant melanoma in the oral cavity and volarsubungual skin. The classification of oral melanoma has not been established. We report 7 new cases of oral melanoma, with a review of 36 cases, published in Japan, between 1970 and 1984. Most of the cases reviewed have radial growth phases, and their gross and microscopic features seem to correspond to those of acral lentiginous melanoma of the skin. However, 1 of our cases and 3 previously reported cases of oral nodular melanoma suggest the presence of melanoma heterogeneity in the oral cavity.

Criteria for diagnosing lymph node metastasis from squamous cell carcinoma of the oral cavity: A study of the relationship between computed tomographic and histologic findings and outcome

PURPOSE This retrospective study was conducted to determine the relationship between the computed tomographic findings for cervical lymph nodes (LN), histologic findings, and outcome in patients with squamous cell carcinoma of the oral cavity who underwent radical neck dissection. PATIENTS AND MATERIALS Sixty-six patients were analyzed. Of these 66 operations, 43 were immediate therapeutic dissections in clinically N+ necks, and 23 were subsequent therapeutic dissections in patients whose necks were initially node free but progressed to positive nodes during observation. RESULTS When the size criterion (area of the axial section) of nodal metastasis depicted on the scan of 45 mm2 was selected, almost 78% of LN were diagnosed consistent with the histologic diagnosis. As the size of the LN increased, the frequency of extranodal invasion also became higher, whereas patients with the higher histologic grades of malignancy often showed neck metastases with extranodal invasion in the early stage. Patients having LN smaller than 100 mm2, or without extranodal invasion, showed good outcome, whereas those having LN 100 mm2 or larger, with extranodal invasion, showed extremely poor outcome. CONCLUSIONS These findings indicate that it is possible to delay neck dissection in node-free patients until neck disease is diagnosed with timely CT examination, although great caution is necessary, especially in those with a high histologic grade of malignancy.

Unknown Primary Tumour Presenting as Bilateral Metachronous Cervical Lymph Node Metastasis and Lung Cancer: Immunohistochemical Studies

Abstract A patient with an occult primary cancer presenting as bilateral cervical lymphadenopathy and lung cancer is described. First, the mass in the left side of the neck was found to indicate squamous cell carcinoma. Second, a new mass appeared in the right side of the neck, which revealed adenosquamous carcinoma. Third, an asynchronously-appearing lung mass showed adenocarcinoma. All of these specimens showed positive immunoreactivity with cytokeratin-7 and carcinoembryonic antigen, and negative immunoreactivity with cytokeratin-20, surfactant apoprotein, and MOC-31. It is suggested that the primary tumour originated in the head and/or neck and metastasised to both sides of the neck and the lung. Bilateral neck irradiation may be useful for the treatment of this patient, even if the primary lesion has not been identified. The patient remains alive without local recurrence or distant metastasis, despite the poor prognosis for patients with cervical metastasis of unknown primary.

A clinical study of local recurrence after surgery in patients with squamous cell carcinoma of the oral mucosa.

1990年～1991年の口腔粘膜扁平上皮癌手術症例のうち, 原発巣再発をきたした22例について臨床的に検討し, 以下の結果を得た。1.舌癌22例中原発巣再発は9例に認められた。再発は局所進展例で舌半側切除, 亜全摘, 全摘を施行した症例に多かった。2.下顎歯肉癌の原発巣再発は42例中7例に認められた。再発はT4の局所進展例だけではなくT1・T2で口内法による下顎骨辺縁切除を施行した症例にも生じた。また, X線所見や組織学的悪性度と再発との関連性は認められなかった。3.口底癌の原発巣再発は17例中4例に認められた。再発はT2・T3で下顎骨辺縁切除を施行した症例に生じた。組織学的悪性度と再発との関連性は認められなかった。4.上顎歯肉癌の原発巣再発は22例中2例に認められた。再発はT1～T3の症例にはみられなかった。5.再発例22例のうち予後良好は7例のみで, 5年累積生存率は34.1%であった。

A case of histiocytic medullary reticulosis complicated with x-ray-irradiated oral cancer

We report the case of a patient in whom oral squamous cell carcinoma and a fatal reactive form of histiocytosis were simultaneously manifested. Our conclusions indicate that such a hematophagocytic syndrome may occur in the setting of oral squamous cell carcinoma as previously described in other malignancies.