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Calcified lesions of the temporomandibular joint discs obtained from 135 human cadavers were studied. Calcifications were observed in 92 of 250 discs by soft x-ray radiography. Studies by light and electron microscopy and x-ray diffraction revealed that there were two different types of calcification in the discs: apatite crystal deposition with or without ossification, and calcium pyrophosphate dehydrate (CPPD) crystal deposition. Calcifications were recognized more frequently posteriorly than anteriorly, and were related to disc perforation. The results of this investigation suggest that disc degeneration, which may occur as a result of aging or mechanical stress, causes calcifications.

This report describes a case of localized Langerhans' cell histiocytosis which occurred in the maxilla of a 23-year-old male. The lesion was treated by an injection of corticosteroids. Corticosteroid treatment for Langerhans' cell histiocytosis of the maxilla is considered to be beneficial because no sequelae remain following the treatment.

Keratocystic odontogenic tumor commonly occurs in the posterior body and ramus of the mandible. Rarely, however, it develops in the attached gingiva or alveolar mucosa and exhibits the same histopathologic features. The lesion clinically resembles a gingival cyst in adults. Differential diagnosis is therefore difficult. We encountered a case of keratocystic odontogenic tumor arising in the mandibular gingiva and report it as a peripheral keratocystic odontogenic tumor.A 53-year-old man was referred to our department because of an asymptomatic swelling measuring 6 mm in diameter at the gingiva attached to the labia near teeth 2 3. The swelling was covered with normally appearing mucosa and had a whitish hue. The lesion was fluctuant on palpation and had neither spontaneous pain nor tenderness. The teeth adjacent to the lesion were noncarious, and confirmed pulp vitality by electrical stimulation. The lesion was totally excised with a 1-mm margin of normal gingiva under local anesthesia. The alveolar bone adjacent to the lesion had undergone pressure resorption. Exposure of the root surface of 2 3 was noted intraoperatively. Histopathologically, a cystic space was located within the gingival soft tissue. It was lined by parakeratotic stratified squamous epithelium composed of several cell layers and lacking rete pegs. No recurrence was noted for 6 years.

Primary intraosseous squamous cell carcinoma was reported in a 76-year-old Japanese woman. The patient exhibited bone expansion of the premolar-molar region of the left mandible with unilocular radiolucency surrounded by indistinct margins. Biopsy revealed a cystic cavity lined by non-carcinomatous squamous epithelium focally exhibiting epithelial dysplasia and distinct basal cell palisading. However, the overlying oral mucosa was normal in appearance. Under the provisional diagnosis of carcinoma arising in odontogenic cyst, segmental resection of the mandible and supraomohyoid neck dissection was performed. The resected mandible had a unicystic lumen lined by papillary or verrucous proliferation characteristic of welldifferentiated squamous cell carcinoma. However, invasion of the malignant cells along the displaced inferior alveolar nerve was not seen. There was no trace of unicystic ameloblastoma. No lymph node metastasis was confirmed. From these clinical, radiographic and histological findings, the present carcinoma was strongly suspected to be derived from a pre-existing keratocystic odontogenic tumor.

Glandular odontogenic cyst (GOC), first described in 1988 by Gardner et. al, is a comparatively rare jawbone cyst of odontogenic origin, which shares some features with both botryroid odontogenic cysts and mucous-producing salivary gland tumors. Although GOC has a high rate of recurrence, cases of recurrence have not been reported in the Japanese literature.This paper describes a case of GOC arising in the mandible of a 58-year-old man. The cyst recurred 12 years after primary treatment. Diagnosis and treatment of the lesion are discussed.

Myoepithelioma is a rare salivary gland tumor that appears mainly in the parotid gland and palate. We report a case of myoepithelioma originating from the buccal gland. A 19-year-old woman presented with a painless elastic hard mass beneath the left buccal mucosa. The mass was well defined and showed no ulcer. The mass was surgically removed under the clinical diagnosis of a benign minor salivary gland tumor. Macroscopically, the tumor was solid and nodular, surrounded by a thin fibrous capsule. Histopathologically, the tumor consisted of spindle-shaped and/or stellate cells with scanty cytoplasm. These tumor cells formed a trabecular structure and small nests in some regions; however a tubular structure was not seen. Immunohistochemistry showed positive staining for cytokeratin, S-100 protein, actin, and GFAP.The tumor was diagnosed as a myoepithelioma arising from the buccal gland.

口腔癌の病理組織学的予後因子としての脈管侵襲 (VI) と神経周囲浸潤 (PNI) の意義を評価するために, 一次治療で切除術を施行した48例51病変における舌扁平上皮癌の全割標本を検索した。脈管腔を正確に同定し, アーティファクトによる偽陽性を除くため, VIの検索については脈管内皮細胞を検知できる第皿因子関連抗原とCD31に対する抗体を用いた免疫組織化学を行った。加えて, 血管への腫瘍塞栓同定のために弾性線維染色も行った。VIとPNIはそれぞれ9病変 (17.6%) , 7病変 (13.6%) に認めた。VIを認めた9病変の内訳は, 4病変にリンパ管侵襲 (ly) を, 9病変すべてに静脈侵襲 (v) を認めた。すべてのT1病変と深達度4mm以下の病変ではVIもPNIも認めなかった。しかし深達度10mm以上の病変では, それ以下の病変よりVIの頻度が有意に高かった (p

Fifty-two patients with squamous cell carcinomas of the oral cavity, oropharynx, and maxillary sinus who underwent neck dissection were clinico-pathologically reviewed. Maxillary sinus and tongue carcinomas showed high incidences of lymph node metastases. In contrast, carcinomas of the lower gum and oropharynx had low incidences of lymph node metastases. Of the 36 cases with histologically positive nodes, level 2 was the most frequent site of metastases followed by level 3, level 1, and level 4 at the affected side. Metastasis contralateral to level 2 was not infrequently observed. Non-contiguous nodal sites were observed in 2 patients with bilateral metastases. The largest number of metastatic nodes was 18, but the largest proportion of cases in this series had only one positive node. There was some correlation between the number of involved nodes and the level of metastasis. In relation to T category, many of the T 1 cases had only one affected node, but the numbers of involved nodes varied considerably in T2, T3 and T4 cases. The cumulative 5-year survival rate was 86.7% in pN (+) cases, versus 62.4% in pN (-) cases, and this difference was significant (P

A case of acinic cell tumor of accessory parotid gland associated with “crystalloid” is presented. The patient was a 69-year-old female who was aware of a small mass of right buccal mucosa for 12 years. She consulted our clinic complaining of repeated swelling of the right parotid region. Oral examination revealed a submucosal elastic hard nodule beneath the right papilla parotidea. The lesion exhibited scattered radiopacity on roentgenogram. Under the clinical diagnosis of infected sialolithiasis in Stensen's duct, curettage was performed intra-orally. After two weeks, the submucosal nodule remained unchanged, then the lesion was excised along with the papilla parotidea under local anesthesia. Stensen's duct involved with the capsulated spheroid tumor was sacrificed and the proximal stump of the duct was sutured to the buccal mucosa. The patient recovered well after surgery.The excised tumor was 15 mm in diameter, and histologically composed of eosinophilic cuboidal cells organizing tubular or acinar structure with poor fibrous stroma. Capsular structure with thin fibrous connective tissue was evident. Characteristic “crystalloid”, which is occasionally found confined in the parotid gland and the origin of which is not known, as well as psammorna body were scattered throughout tumor, and some of the crystalloids had cores consisting of psammoma body. But, there was no sialolith in the specimen. Histopathological diagnosis was acinic cell tumor.The origin of the tumor in tins case was speculated to be accessory parotid gland rather than buccal minor salivary gland upon consideration of findings such as the anatomical relationship between the tumor and Stensen's duct, and identified crystalloid in the tumor. This is the first case reporting the existence of crystalloid in acinic cell tumor.

Multiple granular cell tumors of the oral cavity are very rare. We reported clinical and pathological finding of two granular cell tumors on the left lateral border of the tongue in an 18-year-old female.

Muscle is thought to be highly resistant both to involvement by primary and metastatic carcinoma, and it is apparently vulnerable mainly to invasion of malignant tumors from the adjacent tissues. Metastatic tumors to muscle are distinctly uncommon,1-3 although intramuscle metastases have been reported in skeletal muscle,1 the diaphragm,4 the extraocular muscles,5 and the tongue.6,7 Tumors metastatic to the masseter muscle have not been reported in the literature. This report is the first to describe a case of metastatic tumor of the masseter muscle that originated in the rectum.

A case of primary amyloidosis diagnosed by morphological and immunological examination was reported. The patient was a 71 year-old woman who had tumorous masses at the retromolar pad, the left buccal mucosa and the tongue. The specimens taken from the lesions displayed green birefriegence after Congo red staining on polarization microscopy, and proliferation of plasma cell around the amyloid substance was obsereved. Also, positive reaction of λ type antisera with those cells, as well as the amyloid substance were shown by immunohistochemical method. Besides, the quantitative analysis of immunogloblin and immunoelectrophoresis of the patient's serum wre examined; increased IgGλ type monoclonal protein was revealed. However, there were no findings associatedwith multiple myeloma by several systemic examinations, e. g., X-ray and Tc-scintigram. From those findings described above, this case was finally diagnosed as “primary amyloidosis with plasma cell dyscrasia”.

A case of large mucous cyst occurred under the buccal mucosa of a 47year-old male was reported.Minor salivary gland cysts are usually small, 1cm or less indiameter. This cyst extended from the posterior lip to the, retromolar region, 5cm in diameter. From surgical findings, this cyst originated in the glan dula, labiales.Histological examination revealed a well defined mucous cyst, no epithelial lining. Histopathological diagnosis was an extravasation.

Thirteen cases of actinomycosis in oral and maxillofacial regions were reported. They were histologically diagnosed by detecting sulfur granules in pus and granulomatous tissue. Clinical, bacteriological and histological studies of these cases revealed the following:1. Clinically, five types were recognized: non-abscess indurative type, subcutaneous abscess type, deep abscess type, mandibular ostitis type and secondary infection of cyst type. Subcutaneous abscess type showed the most typical clinical symptoms of actinomycosis.2. Histologically, sulfur granules were detected in all the cases, and typical sulfur granules with club formation were seen in 4 cases. In other cases, club formations were not so clear, and their central mass of granules were variable, i. e., a loosely-tangled mass of filaments, a compact mass of filaments or a mixture of them.3. Bacteriologically, Actinomyces were detected in 4 cases, and Bacteroides and Streptococcus were dominant in isolated strains from pus.4. Treatments of these cases consisted of administration of antibiotics combined with incision, drainage and elimination of predisposing pathologic condition. Penicillins and cephems were mainly administered in duration of 3 days to 3 months. In the non-abscess induration type, the longest term of treatment was needed, although the treatment proved effective eventually.

Two cases of verruciform xanthoma are reported with the review of 39 cases in domestic literature. Case 1, a 48-year-old female had a slightly elevated yellowish lesion on lingual aspect of mandibular left premolar-molar gingiva. Case 2, a 40-year-old female had a crescent shaped yellowish area on the gingiva buccal to the mandibular left first molar. Both were uneventful after simple surgical excision. Histologically, pebbly surface was covered by parakeratotic squamous epithelium. Characteristic accumulation of lipid laden foam cells were identified in connective tissue papillae between equally elongated rate pegs to a uniform depth. Especially in case 1, examination with the serial sections revealed gradual transformation to papillary architecture of the squamous epithelium in peripheral portion.The cause of verruciform xanthoma is still uncertain, but mild chronic inflammatory irritation may play the important role of its genesis.

The granular cell tumor is a rare lesion with a predilection for the subcutaneous region and the tongue, it's histogenesis is still controversial. A 59 year-old female presented with a granular cell tumor in the left floor of the mouth.The tumor was excised together with a part of the sublingual gland, but invasion of the Wharton's duct was not observed. In the excised specimen, there was no encapsulation and the tumor had partially invaded the sublingual gland. Beneath the overlying stratified squamous epithelium associated with pseudo-epitheliomatous hyperplasia, the tumor cells had proliferated diffusely and/or were arranged in small nests especially around the peripheral nerve bundles. Scattered axon like dark brown fibrils were seen in the tumor nests after Bodian silver staining. The intracytoplasmic granules of the tumor cell showed either a weak or sometimes a strong PAS positive reaction which was diastase resistant. The tumor cells and Schwann cells were positive when tested by the immunohistochemical method using anti S-100 protein antiserum. Electron microscopical observation revealed granules of various sizes and shapes bounded by a membrane in the cytoplasm of the tumor cell. The tumor nest, which was bounded by a basement membrane, consisted of tightly packed spindle shaped cells with long pseudopodial-like processes. Isolated tumor cells were also found within the basement membrane of peripheral unmyelinated nerve fibers adjacent to Schwann cells and axons.These findings suggest that histogenesis in this case is from Schwann cells of the peripheral unmyelinated nerve fibers.

It is pointed out that minor salivary gland calculi are more common than previously supposed in the English language literature. But in Japan, reports of them are still rare and as far as we know only sixteen cases have been reported.This report contributes three additional cases of sialolithiasis in the minor salivary gland located in the upper lip of elderly persons. They were solitary, firm, freely movable, small masses. Histopathologically, all the calculi revealed similar findings that contained homogenous non mineralized organic matrix. Chronically inflamated granulation tissue surrounded the calculus in 2 cases and the dilated duct surrounded the calculus in 1 case. Chronic lobular inflamation and diffuse lobular fibrosis were common findings.The authors suggested that clinicians and pathologists tend to fail to diagnose the calculi of minor salivary gland if the calculus was small and nonmineralized, and soft tissue inflamation was prominent.

Malignant fibrous histiocytoma of the oral region is rare. Clinical course, histopathological observations and biochemical analysis of malignant fibrous histiocytoma of the mandible in an 18-year-old male is reported.The clinical findings revealed rapid enlargement of two nodular tumors 5 cm and 3cm diameter, in the molar region of the right mandible and tender regional lymph nodes. Radiographically, separation of the wisdom tooth and the second molar tooth and an irregular radiolucent area reaching to the mandibular canal were shown. Segmentary resection of the mandible and radical neck dissection were carried out. Postoperative course of the patient was uneventful and no recurrence or metastasis was found after 2 years.Histopathologically, most of the tumor consisted of a highly myxoid tissue. In the myxoid area widely spaced spindle cells, pleomorphic cells and giant cells were arranged in a matrix.In electron microscopic examination, fibroblast-like cells, histiocyte-like cells and polynuclear giant cells were observed.By the biochemical methods, type I, III and V collagen were detected by the SDS-PAGE method. Dihydroxylysinonorleucine was found to be the major reducible cross-link in this collagen and its ratio to hydroxylysinonorleucine is 2.4. This suggested that the collagen is similar to the hard tissue collagen or at the young and growing stage. Pyridinoline and histidinoalanine were found to be the noreducible cross-link in this collagen.

Carcinoma arising from the remnant of branchial epithelium or branchial cleft cyst is known as branchiogenic carcinoma. It is very rare, and its existence is a matter of controversy. We report a case of cystic carcinoma of the upper neck that fully met Martin's criteria for branchiogenic carcinoma. A 53-year-old male visited Tsurumi University Dental Hospital with a swelling on the left side of the neck. Three tumors were excised from the neck, and histopathology revealed squamous cell carcinoma in a cystic lesion. As metastatic carcinoma of the cervical lymph nodes was suspected, the appropriate clinical tests and imaging were performed to determine the possible presence of a primary tumor. However, no primary carcinoma was found. These findings suggest that this was a case of branchiogenic carcinoma. The patient was treated with radiotherapy and followed up over an 8-year period. No evidence of recurrence was found.

A series of 522 patients with a diagnosis of squamous cell carcinoma or carcinoma in situ of the tongue were reviewed and followed. Leukoplakia was found in 88 of these patients before and after the diagnosis of tongue carcinoma. A high incidence of multiple carcinomas in the oral cavity and pharynx (116 times greater than expected) was encountered in tongue carcinoma patients. The observed incidence of multiple oral carcinomas in the group with tongue carcinoma with leukoplakia was five times greater than that of the subjects without leukoplakia. The incidence of secondary esophageal carcinomas was also high, 12 times greater than the statistical expection. However, there was no increased occurrence of secondary esophageal carcinomas in the patients with leukoplakia.