Robert D. Harwick

The association of the IgA levels of serum and whole saliva with the progression of oral cancer

Elevated IgA concentrations in the serum and whole saliva of patients with neoplastic disease have been reported. However, there does not seem to be any information available on the correlation of the secretory immunoglobulins of these patients with the progress of their disease. The whole saliva and sera of 102 cases of squamous carcinoma of the oral mucosa were studied. Patients were subclassified into age‐matched groups of primary untreated cancer (21), recurrent cancer (18), and “cured” patients who had been free of disease for at least 9 months (16). A separate group of laryngeal (14) patients was included. Sixteen (16) patients treated by radiation therapy alone were also included to test the effects of radiation on whole saliva IgA. An age‐matched group of patients (17) with moderate to severe periodontal disease served as controls. Unstimulated whole saliva was collected for 15 minutes and stored at 0°C. IgA was quantitated by radial immunodiffusion on Hyland and Meloy Laboratory low level plates with 7S and 11S standards. Serum IgA was measured on Hyland plates with serum standards. Protein content of saliva was assayed by the Lowry method. Flow rate was quantitated for the 15‐minute collection period. Primary oral and laryngeal cancer patients had a two‐fold increase of serum and salivary IgA compared to controls. Recurrent cancer patients had even greater elevation of salivary IgA. Cured patients showed a persistent elevation of serum but a return to normal of salivary IgA. Radiation therapy did not markedly influence the level of salivary IgA. A followup study of 26 patients confirmed this pattern of a drop in whole salivary IgA with cure and a spike with recurrence. It would appear that IgA levels of whole saliva and serum are elevated in oral cancer patients, and that salivary IgA levels may prove useful in distinguishing patients with possible recurrent disease.

Oral granular-cell tumors: Report of twenty-five cases with electron microscopy

Twenty-five cases of granular-cell tumor of the oral cavity are reported. The clinical findings are similar to previously published data. Of five cases studied by electron microscopy, three were processed directly from fresh surgical specimens and two cases were processed following initial formalin fixation. The granules for the most part are morphologically compatible with lysosomes except for a single variety containing viruslike particles. There is increasing evidence in support of a neural origin, but the indications are that more than one cell type may be the progenitor of granular cells of the granular cell tumor.

Carcinoma of the pyriform sinus

Ninety-one consecutive patients with carcinoma of the pyriform sinus were treated surgically during a ten year period from 1964 to 1973. Two of the ninety-one patients died postoperatively. The absolute five year survival was fifteen to fifty-nine patients or 25.4 per cent. One of the survivors had bilateral cervical metastases at the time of initial operation.

Oral manifestations of cutaneous T-cell lymphoma: A report of eight cases

Cutaneous T-cell lymphoma rarely involves the oral cavity. Only 14 detailed cases of oral cutaneous T-cell lymphoma have been described in the English-language literature; this report describes eight additional cases observed among 824 patients evaluated at our cutaneous T-cell lymphoma center since 1968. Oral involvement occurs late in the course of cutaneous T-cell lymphoma and usually is associated with poor prognosis; most patients die of disease complications within 3 years of the diagnosis of oral involvement.

Jugular venous reconstruction: a technique to minimize morbidity of bilateral radical neck dissection.

Disfiguring facial edema and elevated intracranial pressure often accompany ligation and excision of the internal jugular veins (IJV) during simultaneous or staged bilateral radical neck dissection. To minimize this morbidity, unilateral reconstruction of the IJV was undertaken at the time of second-side neck dissection in 11 patients. Five patients underwent reconstruction with the spiraled saphenous vein (SVG) and in six patients 10 mm externally supported polytetrafluoroethylene (e-PTFE) was used. Prebypass jugular venous stump pressures (JVPs) were measured and ranged from 28/17 to 75/54 mm Hg with mean pressures of 17 to 62 mm Hg. Two patients had simultaneous neck dissections and nine had staged dissections. The staged interval ranged from 0.3 to 33 months. Six of nine staged reconstructions were right-sided and three of nine were left-sided. Low molecular weight dextran was started intraoperatively, regional heparinization was used in all but two cases, and platelet inhibitors were continued postoperatively in all patients. Additional time in the operating room was 45 minutes (mean). All patients have been followed up 2 to 18 months postoperatively. B-mode ultrasonography, Doppler spectrum analysis, CT scan with contrast, and magnetic resonance imaging were used to assess patency. Four of five SVGs and three of six e-PTFE grafts have remained functional, which resulted in an overall patency rate of 64%. Four grafts (one SVG, three e-PTFE) failed in the immediate postoperative period. All grafts in patients who had a mean JVP greater than 30 mm Hg remained patent, whereas those in patients with lower stump pressures thrombosed.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrastructure of oral squamous-cell carcinoma.

Fresh surgical specimens of sixteen cases of oral squamous-cell carcinoma were processed for electron microscopic study. All cases were histologically graded as moderately differentiated carcinoma. As compared to normal oral stratified squamous epithelium, some unusual ultrastructural features were present in carcinoma. These features were spherical or ovoid nuclear bodies composed of concentrically arranged filaments and granules, clustered ribosomes, many lysosomal bodies, cell residues in other cells, absence and multilayering of basal lamina, pseudopodal cytoplasmic projections, microfilaments in peripheral cytoplasm, clusters of swirled tonofilaments, intracytoplasmic desmosomes, and a small amount of glycogen. These features are interpreted as being related to hyperactivity, phagocytosis, locomotion, and differentiation of cancer cells.

Estrogen receptor assay in polymorphous low-grade adenocarcinoma and adenoid cystic carcinoma of salivary gland origin. An immunohistochemical study.

An apparent relationship between breast cancer and salivary gland cancer has been observed, and there is one report in the literature that describes estrogen receptors in normal salivary gland and salivary gland cancers. With the use of a monoclonal antibody against estrogen receptor protein and the avidin-biotin immunoperoxidase procedure, we were unable to demonstrate estrogen receptors in formalin-fixed paraffin-embedded sections of either polymorphous low-grade adenocarcinoma or adenoid cystic carcinoma of salivary gland origin.

Malignant lymphomas of the pharynx

Fifty‐five patients with malignant lymphoma of the pharynx were studied, and the pathologic material was analyzed. It is concluded that reticulum cell sarcoma with no involvement of the cervical lymph nodes is a highly curable tumor by radiotherapy (7 out of 9 survived 5 years or more). On the other hand, almost all the patients with involvement of the cervical lymph nodes had early recurrences or metastases that failed to respond to various therapeutic measures. Well‐differentiated lymphocytic lymphoma (lymphosarcoma) showed more tendency to disseminate, but recurrences were relatively easier to control by radiotherapy or chemotherapy and compatible with long survival. As expected, all 3 patients with nodular lymphoma (giant follicular lymphoma) are living 5 years or more and only one with disseminated disease. Hodgkins disease is rare in the pharynx. Careful histologic classification and irradiation to eradicate the tumor are extremely useful measures in controlling these neoplasms.

Rhabdomyosarcoma of the oral cavity: Report of four cases

Clinical and pathologic findings of four cases of rhabdomyosarcoma of the oral soft tissues are described that include findings from immunohistochemistry and electron microscopy. Three cases occurred in children under 16 years of age and one in a 22-year-old. Included is a brief discussion on reported gene abnormalities that may contribute to neoplastic development.

Osteogenic sarcoma of the tongue

A 45-year-old woman had a mass in the left side of the tongue. Histologic examination of the tumor revealed it to be an extraskeletal osteogenic sarcoma. Pulmonary metastases were seen on admission. The patient had a rapid downhill course and died. Extraskeletal osteogenic sarcomas are well-recognized albeit rare neoplasms. In a search of the literature we were unable to find a single case arising in the tongue. The electron microscopic findings are also presented.