舌癌病理形态与潜在淋巴结转移的研究

舌癌是头颈部常见的恶性肿瘤之一,其5年生存率仅为50％～60％,在头颈部肿瘤中偏低。对于T_1、T_2病变,潜在性颈部淋巴结转移是影响预后的主要因素。本文对临床病理学因素与舌癌潜在性颈部淋巴结转移之间的关系进行了研究。结果发现:核异型度、核分裂像、浸润方式和组织恶性度与潜在性颈部淋巴结转移密切相关,其中浸润方式和组织恶性度作为有意义的指标可以用于潜在性颈部淋巴结转移的预测。     

Cell kinetic markers in cutaneous squamous and basal cell carcinoma of the head and neck

IntroductionProliferation markers play a significant role in the biologic behavior of tumors. Geminin is a known inhibitor of the cell cycle and DNA replication and has not been previously reported in cutaneous basal and squamous cell carcinomas of the head and neck.ObjectivesWe aimed to investigate proliferation markers ki67, MCM2, and geminin in head and neck cutaneous basal and squamous cell carcinomas.MethodsForty cases of each tumor were immuostained with ki67, MCM2, and geminin followed by assessment of labeling indices (LIs). MCM2/ki67- and geminin/ki67-ratios were also determined; t-test was used for statistical analysis (p < 0.05).ResultsThere was no significant difference in ki67 (p = 0.06) and MCM2 (p = 0.46) between cutaneous basal and squamous cell carcinomas; however, geminin LI was significantly higher in squamous cell carcinomas compared to cutaneous basal cell carcinomas (p < 0.001). Only geminin/ki67 showed a significant difference between the two tumors with the ratio showing significantly higher numbers in squamous cell carcinomas (p = 0.015).ConclusionsGeminin could be regarded as an effective factor in the pathogenesis of head and neck cutaneous cutaneous basal cell carcinomas and squamous cell carcinomas and may be one of the responsible elements in the difference between the biologic behavior of these tumors.     

KRAS mutations in tongue squamous cell carcinoma

Background: p16^INK4a (p16) expression in tongue cancer (TC) is reportedly not associated with human papilloma virus (HPV). Mutations of KRAS in cancer cells are most frequently observed within codon 12. However, few reports have investigated the association between KRAS mutations and p16 status in TC.

Objectives: This study aimed to evaluate the influence of KRAS mutations on TC.

Methods: Clinical records and surgically resected specimens of 85?TC patients were analyzed. Tumor samples were analyzed for mutations of KRAS located within codons 12 and 13. p16 staining was performed and considered positive in cases with moderate to strong nuclear and cytoplasmic staining.

Results: Positive p16 staining was observed in 10 cases (11.8%). A KRAS mutation was detected in one case (1.2%). The case with KRAS mutation showed negative p16 staining. Despite being at an early stage, the patient died of lung metastasis at 43 months from initial treatment.

Conclusions and Significance: KRAS mutations are not associated with p16 expression in TC and may predict poor prognosis in TC patients. Further analysis of mutations in regions other than codons 12 and 13 of KRAS will be necessary to determine the relationship between KRAS mutations and prognosis of this disease.     

舌鳞状细胞癌颈部淋巴结转移的治疗

目的 分析舌鳞状细胞癌颈部淋巴结转移性的分布规律,探讨舌鳞状细胞癌cN0患者的颈部处理。方法 回顾性分析1975年1月-2000年12月初次在我院诊治的329例舌鳞状细胞癌患者的临床资料。cN0 179例,cN1 131例,cN2＋3 19例（2例出现双侧颈淋巴结转移）。在cN0患者中,肩胛舌骨肌上清扫或单纯颔下清扫20例,根治性颈清扫93例,扩大的肩胛舌骨上（包括Ⅳ区）清扫8例。在cN1患者中,30例接受颈部单纯放疗;肩胛舌骨肌上清扫6例,根治性颈清扫94例,扩大的肩胛舌骨上清扫1例。所有cN2＋3患者均行根治性颈清扫。结果 舌鳞状细胞癌颈部淋巴结隐性转移率为8．3％（10／121）,其中T1为1．3％（1／76）,T2为4．3％（4／93）,T3为44．4％（4／9）,T4 100％（1／1）。实际颈部淋巴结转移率为71．7％（81／113）。91例患者组织学检查发现颈清扫标本中淋巴结转移阳性,Ⅰ区淋巴结转移占39．6％（36／91）、Ⅱ区71．4％（65／91）、Ⅲ区19．8％（18／91）和Ⅳ区8．8％（8／91）。有2例患者发生对侧Ⅰ、Ⅱ和Ⅳ区的淋巴结转移。在cN0患者中,颈部单纯放疗的同侧颈部复发率为7．5％（3／40）,综合治疗为7．5％（6／80）,单纯手术为2．4％（1／41）,等待观察为16．7％（3／18）;颈部单纯放疗的5年生存率分别为42.0％,综合治疗为55．6％,单纯手术为79．6％,等待观察为48．6％。结论 Ⅱ区是舌鳞状细胞癌最易转移的部位,不主张对所有cN0患者实施择区性颈清扫,对T3和T4患者可考虑扩大的肩胛舌骨肌上清扫（Ⅰ～Ⅳ）。     

Adenoid cystic carcinoma of the base of tongue: A population-based study

Background

The objective was to assess demographic and survival patterns in patients with adenoid cystic carcinoma of the base of tongue.

Sympathetic innervation of the tongue in rats

We employed a glyoxylic catecholaminergic histofluorescence method to study the sympathetic innervation present in the rat tongue. One percent neutral red was used as a counterstain. Many noradrenergic fibers were demonstrated around the blood vessels, muscles, glands and submucosa of the tongue, but not in the epithelium or papilla. In a group of rats following neurectomy, the superior cervical ganglia (SCG) were removed unilaterally or bilaterally. Changes in sympathetic innervation of the tongue were examined 14 days after SCG ganglionectomy. In those animals after unilateral SCG ganglionectomy, we found no noradrenergic histofluorescence in the ipsilateral anterior 2/3 of the tongue, although some scant fluorescence was found in the ipsilateral posterior 1/3 of the tongue. However, no noradrenergic histofluorescence could be observed in animal's bilateral SCG ganglionectomies. Our results indicate that sympathetic innervation of the tongue in rats originates in the SCG, with some cross-innervation of the sympathetic fibers occurring in the posterior 1/3 of the tongue.     

Adenoid cystic carcinoma of the tongue

Malignant tumours of the salivary glands in children are extremely rare. We present here a 12-year-old girl initially diagnosed as pleomorphic adenoma on fine needle aspiration biopsy, and adenoid cystic carcinoma (ACC) after the lesion was excised and examined by histopathology. A wide resection of the lesion and bilateral supraomyohyoid neck dissection was performed. To our knowledge this is one of the youngest patients with ACC of the minor salivary glands. Due to its benign histological appearance, the biological agressiveness of ACC is usually underestimated. Although fine needle aspiration cytology (FNAC) is very valuable in diagnosis, cytological variations of pleomorphic adenoma must be considered. ACC of the tongue in a young age group should be treated with wide resection and selective neck dissection if the tumour is localized in places where the risk of metastasis is increased and if there is a clinically palpable lymph node. In such cases the clinician should not avoid radical operations even in a young patient.     

Oral tongue carcinoma and its treatment in Finland

Management of oral tongue squamous cell cancer (OTSCC) remains a challenge. This nationwide study reports the used treatment approach and the outcome of OTSCC in Finland. Retrospective study of OTSCC patients in 1995–1999 with a 5-year follow-up. The corresponding data from 1980 to 1989 is also included. About 235 patients (125 M, 110 F; mean age 61.6 years; range 24–90 years) were included, 77% had SCC of lateral border of the tongue and 25% were N+. Treatment with curative intent was given to 224 (95%) patients. Surgery of the primary tumour was performed in 218 (97%) patients and with a reconstruction in 69 (31%) patients. A neck dissection was performed ipsilaterally in 114 (51%) and bilaterally in 9 (4%) cases. Irradiation was given to 131 (58%) patients. The rate for locoregional recurrence was 28%. The 3- and 5-year overall survival (OS) rates were 66 and 47%, respectively. The corresponding disease specific survival (DSS) rates were 74 and 64%, respectively. The mean DSS for patients younger than 40 years and older than 40 years was 111 and 88 months, respectively (P < 0.02). The 3- and 5-year DSS rates were: Stage I, 88 and 74%; Stage II, 74 and 62%; Stage III, 79 and 71% and Stage IV, 36 and 33%, respectively. In the present study the surgical treatment approach seems effective in controlling early stage OTSCC but the modest survival, in spite of combination of radiotherapy and surgery, points out the need to consider new strategies in the management of advanced stage disease.     

Mucoepidermoid carcinoma of the tongue in a child

Tongue base tumors are not common, they are mostly malignant and although the rarity of mucoepidermoid carcinoma of tongue base, it constitutes more than 50% of malignant lesions of salivary glands in this region. In this report, we present a 15-year old girl with mucoepidermoid carcinoma of tongue base with discussion of histopathological types of the tumor and its management.     

舌根癌的手术治疗

目的：探讨4种手术方式治疗舌根癌的疗效。方法：回顾性分析1985—1999年间49例舌根癌，采用4种手术方式治疗，即切除下颌骨升支和/或部分体部的经咽侧入路；保留下颌骨经咽侧入路；切开下颌骨入路；保留下颌骨缘的改良下颌骨部分切除入路。38例舌根缺损采用6种不同的皮瓣或肌皮瓣一期修复。结果：49例舌根癌病人3，5年生存率分别为53．1％，32．7％。手术入路各组间生存率无统计学意义(P＞0．05)；6种皮瓣或肌皮瓣修复以薄皮瓣及舌瓣术后功能恢复好；有颈淋巴结转移组较无转移组5年生存率明显下降(P＜0.05)。结论:为了提高病人的生存质量，在彻底切除肿瘤的前提下，应尽可能保持下颌骨的连续性，舌根缺损宜用较薄肌皮瓣组织修复；对N0舌根癌病人施行颈廓清术是十分必要的。     

Histological study on aging changes in the human tongue

Dryness of the mouth, taste disturbance or misswallowing may appear due to physiological changes of tongue especially in old aged person. The purpose of this study is to investigate histological changes related to aging in the human tongue, qualitatively and quantitatively. The samples were collected from 100 autopsy-cases without any pathological changes consisting of 50 males and 50 females aged between 5 and 82. Five specimens (I-V) were obtained from each tongue by frontal section. Specimen I (anterior part of tongue), III (central part), V (posterior part) were studied. Each specimen with thickness of 4 microns were stained with Hematoxylin-Eosin and Alucian-Blue. Tongue mucosa, glands such as Blandin-Nuhn gland, von Ebner gland and those glands distributed in the root of tongue, and M. longitudinalis superior were observed histologically. The study was done quantitatively by I-BAS one picture analyzer manufactured by Zeiss Co. The results of this study are as following: 1) The epithelium of lingual mucosa The thickness of epithelium decreased with aging, rather prominent on dorsal part than the lateral. 2) lingual glands Acinar atrophy increased with aging, especially quickly in females. The atrophy of the acinus started from 40 years old in Blandin-nuhn gland and 30 in von Ebner gland. However, tongue root glandular atrophy was milder in comparison with the other two glands. 3) Lingual muscles Decrease in muscle fiber diameter with aging is also observed.     

微波组织凝固在舌鳞癌综合治疗中的病例对照研究

目的：通过两组病例对照研究,以证实微波组织凝固治疗是否可作为治疗舌鳞癌原发灶的一种治疗方法,非比较其与传统手术方法的优缺点。方法：80例舌鳞状细胞癌患者,依临床分期、性别、年龄相应随机分组。实验组病例原发灶进行微波组织凝固治疗,颈部行颈淋巴结清扫术,同时行颈外动脉或舌动脉结扎术。对照组病例Ⅰ、Ⅱ期患者采用颈淋巴结清扫术加半舌切除术,Ⅲ、Ⅳ期患者采用舌癌联合根治术。结果：通过比较治疗后2年的原发灶复发、颈淋巴结转移、远处转移情况及2年生存率,两组无显著性差异（P=0．675,0．747,1．0和0．713）。比较口腔功能及外形的满意程度,实验组优于对照组（P=0．00125,P＜0．0001）。术后创面出血及呼吸困难是微波组织凝固治疗舌鳞癌主要并发症。结论：在行综合治疗同时微波组织凝固治疗的近期疗效与传统方法相同,具有保全口腔功能和外形的优点,它可以作为治疗舌鳞癌原发病灶的手段之一。     

Rhinosporidiosis associated with squamous cell carcinoma in the tongue

The peritumoural region of a squamous cell carcinoma of the tongue when examined with light and electron microscope showed nodular bodies in the submucosa with all the distinctive features of 'sporangium and 'spores' of rhinosporidiosis. The occurrence of rhinosporidiosis in the tongue along with malignancy has not been reported hitherto. Some interesting observations and causal relationships are discussed.     

青年舌鳞状细胞癌

目的 探讨青年舌鳞状细胞癌（简称舌癌）的临床病理特征、预后及影响因素.方法 对30例45岁以下青年舌癌患者（青年组）与同期71例45岁及以上（中老年组）进行对照研究,分析其临床病理特征、结果 及影响预后的因素.结果 青年组和中老年组舌癌浸润性生长的比例分别为40.0％和16.9％（P＜0.05）,临床分期(Ⅲ～Ⅳ期)的...