Toshio Yokobayashi

Marsupialization as a possible diagnostic aid in cystic ameloblastoma. Case report.

Two cases of cystic ameloblastoma are described in which the diagnosis was established after marsupialization. Although the clinical and radiographic findings strongly suggested the diagnosis of ameloblastoma, the initial incisional biopsy specimens consisted of cystic walls lined with squamous epithelium which showed in both cases no evidence of ameloblastic proliferation. Marsupialization could be a diagnostic aid in these cases since relief of intracystic pressure may trigger regeneration of a solid mass of tumour in a monocystic ameloblastoma with cells possessing potentiality for spontaneous proliferation.

Chemotherapy in the treatment of osteogenic sarcoma of the maxilla (case report).

A case of osteogenic sarcoma of the maxilla is described. The tumor was excised by a hemimaxillectomy but recurred in 3 months. The patient died 8 months after the initial onset of symptoms. Chemotherapy and radiation were ineffective with the exception of bleomycin, which caused necrosis of the tumour, with no apparent increase in growth, and a decrease of the serum alkaline phosphatase level to less than half of the maximum value. There was a close correlation between the fluctuating pattern of the serum alkaline phosphatase level and the growth and remission of the tumour during the entire course of treatment.

Pepleomycin-induced pneumonitis resulting in death

Two cases of fatal pneumonitis induced by pepleomycin, a new antitumour antibiotic analogous to bleomycin, are described. In the first case, the patient received radiation in combination with intra-arterial administration of pepleomycin to a total dose of 100 mg. for the treatment of an epidermoid carcinoma of the maxilla. The pulmonary changes were noted two weeks after cessation of the chemotherapy and the patient died of pulmonary insufficiency despite intensive therapy with antibiotics and a steroid. The other case with an epidermoid carcinoma of the cheek and oropharynx was treated by radiation and pepleomycin given to a total dose of 205 mg. Pepleomycin was replaced by predonin soon after bilateral shadows were noticed on a chest radiograph, but the patient died of pneumonitis 10 months later. Various factors which may affect the development of pulmonary toxicity by pepleomycin are discussed.