Immunopathological analysis was made of phenotypic change in a recurrent parotid gland adenocarcinoma occurring in a patient with a long clinical course of 30 years or more. At the first and second operations, in 1959 and 1978, the resected parotid gland tumors were diagnosed histopathologically as acinic cell carcinoma. However, 11 years after the second operation, in 1989, the resected recurrent tumor showed a microscopically phenotypic change towards adenocarcinoma with typical tubular arrangement. At the last operation in 1991, histopathological examination of the tumor revealed adenocarcinoma with diffuse oncocytic change in association with cervical lymph node metastasis. These findings suggest that phenotypic change may occur in vivo among human neoplasms during a long period, which may be related to the cytodifferentiation in the salivary gland tumor.
Our aim was to evaluate the clinical efficacy of computed tomography and coronectomy for preventing postoperative inferior alveolar nerve injury after impacted mandibular third molar surgery. Among the patients who visited Kawasaki Medical School Hospital between January 2009 and December 2010, 12 patients with high-risk signs of inferior alveolar nerve injury on panoramic imaging were examined for the extraction of impacted mandibular third molar by computed tomography (CT). CT examinations were performed in order to examine the relationship between the root apex of impacted mandibular third molar and inferior alveolar canal for 16 teeth. Based on the imaging findings,the patients were informed about treatment methods and their consent was obtained. We compared the CT and panoramic findings and discussed the relationship between the impacted third molar and the inferior alveolar nerve. Medical records were also examined for the presence of abnormal postoperative complications. 1) Interruption of the cortical white line of the inferior alveolar canal was identified in 13 panoramic radiographs, and bending of the inferior alveolar canal was observed in 2 panoramic 4) Pogrel MA, Lee JS, Muff DF:Coronectomy: a technique to protect the inferior alveolar nerve. J Oral Maxillofac Surg 62: 1447-1452, 2004 5) Renton T, Hankins M, Sproate C, McGurk M: A randomized controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars. Br J Oral Maxillofac Surg 43: 7-12, 2005 6) Hatano Y, Kurita K, Kuroiwa Y, Yuasa H, Ariji E: Clinical evaluations of coronectomy (intentional partial odontectomy) for mandibular third molars using dental computed tomography: a case-control study. J Oral Maxillofac Surg 67:1806-1814, 2009 7) 後藤新吾,栗田賢一,波多野裕子,黒岩裕一朗, 泉雅浩,有地榮一郎,久保勝俊,前田初彦:下顎 第三大臼歯歯冠部切除術後に歯根摘出に至った症 例の検討.日本口腔外科学会雑誌57:459-465, 2011 8) http://www.jsoms.or.jp/sns/uploads/fckeditor/file/IC/ IC01.doc(2011.10.18) 9) Ay S, Agar U, Bicakci AA, Kosger HH: Changes in mandibular third molar angle and position after unilateral mandibular first molar extraction. Am J Orthod Dentofacial Orthop 129: 36-41, 2006 10) Sencimen M, Ortakoglu K, Aydin C, Aydintug YS, Ozyigit A, Ozen T, Gunaydin Y: Is endodontic treatment necessary during coronectomy procedure? J Oral Maxillofac Surg 68: 2385-2390, 2010
The incidence of pulmonary thromboembolism (PTE) has been increasing, although it remains lower in Japan than in Western countries. We report a case of PTE after free flap reconstruction in a patient with left tongue cancer (T2N2bM0) treated in May 2004.We performed tracheostomy, hemiglossectomy, and neck dissection. The tongue defect was repaired with a free radial forearm flap using a microsurgical vascular anastomosis. Although antithrombolytic therapy with prostaglandin El was started during microsurgery, circulatory disorders of the free flap occurred 2 days after operation. Therefore, we tried removing the intravenous thrombus and performed re-anastomosis, followed by anticoagulant and thrombolytic therapy. However, total necrosis of the flap occurred 5 days after re-operation. We therefore discontinued the anticoagulant and thrombolytic therapy. The following day PTE developed, but we saved the patient's life by immediate treatment, administered by cardiologists and other specialists.Our experience indicates that preventative treatment such as low-dose unfractionated heparin and using elastic stockings or intermittent pneumatic compression until the patient can walk after surgery may be necessary when there is a high risk of PTE.
An 84-year-old woman was referred to the hospital complaining of a large movable and massive mass located on her lower lip, which was first noticed approximately five years previously. On examination, the mass was well-defined, elastic soft and measured 45 × 45 × 28 mm in size. The clinical diagnosis was a lipoma, and a complete excision was performed under general anesthesia. The histopathological diagnosis was a fibrolipoma. (Accepted on December 7, 2009)
Using an immunohistochemical study and an immunoblot analysis, the expression of cellular oncogenes of the human salivary glands such as c-myc, ras p21, and p53 tumor-suppressor gene in pleomorphic adenomas and its malignant form, carcinoma in pleomorphic adenomas was examined to evaluate a differential biological significance, in comparison with that in normal salivary gland tissues. Immunohistochemically, the c-myc product was detected in 42% of the pleomorphic adenomas and in 56% of the carcinomas in pleomorphic adenoma. The ras p21 expression was observed in 24% of pleomorphic adenomas, and in 50% of carcinomas in pleomorphic adenoma. The p53 protein was detected in 18% of the pleomorphic adenomas and in 67% of the carcinomas in pleomorphic adenoma. Although there was no significant difference between the benign and malignant forms for the expression of c-myc, a statistical significance in ras p21 and p53 expression was found between the pleomorphic adenoma and its malignant form (P < 0.05) and P < 0.001, respectively). An immunoblotting assay clearly demonstrated the expression of c-myc and p53 gene products in both the benign and malignant forms of the pleomorphic adenoma, and that of ras p21 in the malignant form. These results indicate that activation of c-myc and ras p21 proto-oncogenes and the involvement of p53 mutation may play important roles in the malignant transformation of salivary gland pleomorphic adenoma.
The immunoreactivity of anti-neuron-specific enolase (NSE) and anti-Leu-7 on formalin-fixed sections of human salivary gland neoplasms was determined by the avidin-biotin-peroxidase complex method. In addition, neuropeptides, such as vasoactive intestinal polypeptide, somatostatin, and substance P, in human salivary gland neoplasms were expressed, whereas other polypeptides, including glucagon, cholecystokinin, leuenkephalin and calcitonin, were absent. When 182 paraffin-embedded examples of human salivary gland tumors, including 112 benign and 70 malignant neoplasms, were examined immunohistochemically, positive immunoreactivity was observed in: 51 cases with NSE (59%) and 46 cases with Leu-7 (54%) of 86 pleomorphic adenomas; 11 cases with Leu-7 (61 %) of 18 Warthin's tumors; 7 cases with Leu-7 (58%) of 12 acinic cell carcinomas; 5 cases with NSE (31 %) of 16 adenoid cystic carcinomas; 5 cases with NSE (42%) and 4 cases with Leu-7 (33%) of 12 adenocarcinomas; 4 cases with NSE (25%) and 6 cases with Leu-7 (38%) of 16 undifferentiated carcinomas. The other tumors, such as oxyphilic adenomas, basal cell adenomas, epidermoid carcinomas, and mucoepidermoid carcinomas, were nonreactive. Neuropeptides were observed in the neoplastic epithelial cells of certain tumors such as Warthin's tumors, acinic cell carcinomas, adenocarcinomas and undifferentiated carcinomas. These findings suggest the possibility that cells of neuroendocrine origin, present in certain neoplastic salivary gland epithelia may play a significant role in the histogenesis of human salivary gland neoplasms.
