Tateharu Kawasaki

Evaluation of histopathologic parameters in predicting cervical lymph node metastasis of oral and oropharyngeal carcinomas

A retrospective study of 53 patients with squamous cell carcinomas of the oral cavity and oropharynx was undertaken to evaluate histopathologic parameters in predicting cervical lymph node metastasis. Biopsy and surgical specimens were examined for degree of differentiation, pattern and depth of stromal invasion, lymphatic-vascular invasion, and lymphoplasmacytic response in relation to metastasis. The incidence of lymph node metastasis in tumors showing grade III type diffuse invasion (71.4%) and with stromal invasion of more than 8 mm in depth (83.3%) was significantly higher than that of tumors with well-demarcated boundaries (44.4% to 5.2%) and superficial invasion (35.3% to 8.3%). Lymph node metastasis also increased in the presence of lymphatic-vascular invasion by tumor cells, whereas the degree of differentiation and lymphoplasmacytic response was not related to metastasis. Thus, the pattern and the depth of stromal invasion and the presence of lymphatic-vascular invasion were important indicators in prediction of cervical lymph node metastasis. Prophylactic neck dissection is advocated when grade III type diffuse invasion, invasion exceeding 8 mm in depth, or grade II type invasion accompanied by a 4 mm to 8 mm depth of invasion is observed in a biopsy specimen.

Metastatic tumours of the mouth and jaws: A review of the Japanese literature

A review of the Japanese literature revealed 41 well-documented metastatic tumours of the mouth and jaws. The incidence was 1.5 times higher in females than in males and 76% were in the fourth to seventh decades with a mean of 44 years. Instead of the breast which is the most frequently encountered site of origin of metastatic tumours in Caucasians, the uterus followed by the lung, kidney and stomach was the site of primary carcinoma with the highest incidence. Histologically, carcinomas of glandular origin showed the highest rate of metastasis which was followed by choriocarcinomas. Squamous cell carcinoma and sarcoma were unusual. Metastasis occurred in the gingiva in 23 cases and bony involvement was noted in 16 cases. The most common symptoms were swelling, pain, bleeding, paraesthesia and loosening of teeth. The radiographic appearance was quite variable with no specific diagnostic characteristics. The oral lesions were treated by surgery, irradiation or chemotherapy in 32 cases, while no treatment was carried out in seven cases. Prognosis was very poor with 33 fatal cases due to multiple metastases.

Adenoid cystic carcinoma of the major and minor salivary glands: A clinicopathological study of 17 cases

Local recurrence and distant metastasis were studied in relation to treatment modality and histological findings in 17 patients with adenoid cystic carcinoma of the major and minor salivary glands. Fifteen patients underwent surgical resection with or without postoperative irradiation and the others were treated by irradiation alone. Local recurrence developed in nine patients (52.9%), mostly within two years of the treatment. Incomplete removal was the major reason for the failure to control the primary lesion. Postoperative irradiation was of value in preventing recurrence in patients who demonstrated microscopic residual disease at the surgical margins, whereas it was not effective if gross residual tumour was recognized. Direct surgical intervention on the tumour tissue could have been the possible cause for the distant metastasis that developed in 10 (58.8%) of the 17 patients. Surgical excision with a wider safety margin than the visibly affected area, followed by postoperative irradiation and chemotherapy was essential to obtain a better prognosis.

Chondrosarcoma of the mandible. Report of case and a survey of 23 cases in the Japanese literature.

A huge chondrosarcoma of the mandible (80 X 95 X 100 mm in size) with extension into the infratemporal fossa is described. The tumour was successfully treated by surgical removal and postoperative irradiation. A survey of the Japanese literature revealed 23 cases of chondrosarcoma with involvement of the mandible. The tumours occurred equally in males and females whose mean age was 38 years. The molar region was the site of predilection. The most common symptom was swelling and it was accompanied by pain in 7 cases and paraesthesia in 5 cases. Radiographically, the lesions were quite variable and with the exception of 3 cases in which information was not available, they consisted of a combination of irregular radiopacity and radiolucency in 9 cases, whereas the predominant feature was radiopacity in 6 cases and radiolucency in 4 cases. There was no radiographical abnormality in 2 cases. Root resorption of adjacent teeth was noted in 3 of 6 cases where information existed. Computed tomography was thought to be quite valuable in determining the nature and extent of the tumour. Although an elevation of serum alkaline phosphatase was observed in our case, results of laboratory tests were mostly of no diagnostic significance. Surgical removal was employed in 22 cases alone or in conjunction with irradiation and/or chemotherapy. Of 14 cases on whom information was available, local recurrence occurred in 6 cases in which radiotherapy was not given and distant metastasis in 2 of 10 cases on whom information was available. Of 20 patients on whom information was available on the postoperative course, 7 patients died 5 months to 6 years after the primary treatment.

Extensive Osteolysis of the Mandible Following Devitalization of a Tooth by Arsenic Trioxide

A case of progressive osteolysis of the mandible that consisted of extensive fibrosis and granulation tissue and contained the occluded inferior alveolar artery and the inferior alveolar nerve is described. Arsenic trioxide was suspected as the possible precipitating cause of the lesion, which started with an abrupt onset of paresthesia of the lower lip following its application to the mandibular second molar for devitalization.

Metastatic thyroid carcinoma of the mandible

Abstract Two cases of thyroid carcinoma with metastatic involvement of the mandible are described. The importance of considering occult carcinoma of the thyroid when metastatic lesions are found in the mandible is emphasized.

Recurrence of carcinomaof the oral cavity, oropharynx and maxillary sinus after radical neck dissection

Summary Cervical recurrence was studied in 63 patients who had undergone radical neck dissection for the treatment of carcinoma of the oral cavity, oropharynx and maxillary sinus. Over the whole series, recurrence occurred in 17 patients (27 %). The rate of recurrence did not decrease in patients who remained free of carcinoma at the primary site, but was significantly lower in patients in whom elective neck dissection was performed than in those who were treated by therapeutic or secondary neck dissection. With the exception of two patients, cervical recurrence was associated with the presence of metastatic lymph nodes. Although the rate of recurrence was not affected by the number of metastatic lymph nodes, it was very high (80 %) in patients having metastatic lymph nodes with histological evidence of extra-nodal spread. The results indicate that elective treatment by irradiation or surgery may be needed to reduce cervical recurrence because of a high tendency of carcinoma of the oral cavity and adjacent regions to metastasize.

Central carcinoma of the jaw: A survey of 28 cases in the Japanese literature

A survey of the Japanese literature revealed 28 well-documented cases of central carcinoma of the jaws. There was no sex predominance and the mandible was the site of involvement in 26 cases. The most common initial symptom was local swelling, which was followed in order of frequency by spontaneous pain, paraesthesia of the lower lip, discomfort, loosening of teeth and trismus. On clinical examination, local swelling which was often accompanied by variable symptoms was an almost constant finding. Radiographic appearance varied from unilocular to worm-eaten type radiolucencies which were often surrounded by indistinct margins on close examination. Radical surgery, combined with irradiation and/or chemotherapy was the principal treatment in most cases, but there were 4 cases in which the lesions were simply excised under a tentative diagnosis of cyst; local recurrence was noted in 5 cases. Regional lymph node metastasis and lung metastasis were observed in 8 and 2 cases, respectively. No definite conclusion was drawn with regard to the prognosis because of the short follow-up period. Histologically, epidermoid carcinoma was most frequently seen, but odontogenic cyst was confirmed to be the site of origin in 3 cases only.

Cytologic study of salivary gland tumors

Cytologic examination was performed on 22 known oral tumors of glandular origin. Cytologically, the cells of benign pleomorphic adenomas and an adenolymphoma could easily be identified as of benign tumor origin, but cytologic determination of malignancy was difficult in 11 of 14 malignant tumors due to lack of malignant features. A precise and comparative study of the morphologic details of the tumor cells with the histologic findings, however, seemed to suggest a possibility of determining the histologic type even in smear preparations.

A Cytologic Study of Oral Tumors of Glandular Origin

Cytologic examinations were performed on 13 known oral tumors of glandular origin. These consisted of 5 benign pleomorphic adenomas, 3 adenoid cystic carcinomas, 2 adenocarcinomas of solid type, 1 carcinoma of small cell type, 1 mucoepidermoid carcinoma and 1 metastatic adenocarcinoma.Only 2 cases, both of adenocarcinoma of solid type, out of the 8 malignant tumors, were clearly diagnosed as malignancy from their cytologic smears. But in other 6 cases cytologic diagnosis was very difficult due to lack of cytologic malignant characteristics.Therefore, the morphologic details helpful to diagnosis of malignant tumors of glandular origin have been described.