下顎歯肉癌の外科病理 : 下顎骨浸潤様式 Surgical pathology of squamous cell carcinoma in the mandibular gingiva : Mode of mandibular invasion

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下顎歯肉扁平上皮癌102症例について臨床病理学的な検索を行った。下顎歯肉癌は, 下顎骨への浸潤様式によって病理組織学的に2種類の癌Expansive type (80%) とInvasive type (20%) に分類することができる。すなわち, Expansive typeとは癌と骨組織の境界線が平滑かつ連続的なもの, Invasive typeとは境界線が不整かつ不連続で, 癌が骨梁間へ浸潤性の広がりを示すものである。<BR>両型の下顎歯肉癌を比較検索すると, この下顎骨浸潤様式は, X線的下顎骨吸収像と強い相関が認められ, Expansive type症例の骨吸収像はpressure type70%, moth-eaten type30%であり, Invasive type症例はすべてmoth-eaten typeであった。組織学的には, Expansive type症例では, 癌の浸潤よりも骨吸収が先行するのに対し, Invasive typeでは癌浸潤が骨吸収よりも先行するかあるいは同時に進行していた。前者では骨再形成期のHowship窩が比較的多くみられるのに対し, 後者では骨吸収期のHowship窩が目立つ。両型の組織学的検索から, 骨吸収像を伴わない癌の下顎管内進展は, Invasive type症例にのみ見られる浸潤像であった。両型の全症例における5年生存率は, Expansive typeが75%, Invasive typeが32%であった。<BR>これらの検索結果から, 下顎歯肉癌の病理組織学的分類であるExpansive type, Invasive typeは, 口腔癌を扱う我々にとって有用な分類と考えられる。

One hundred and two cases, diagnosed as squamous cell carcinoma of the mandibular gingiva, were clinicopathologically examined. According to the mode of mandibular invasion, all cases were histologically classified two groups : 1) expansive type (80%) and 2) invasive type (20%) . The expansive type carcinomas were found to have a well-defined smooth borderline, while the invasive type had a diffuse irregular margin with infiltrative growth pattern.<BR>These two histopathological types of mandibular gingival carcinoma were compared. The histopathological types were closely associated with radiographical types of mandibular resorption, pressure and moth-eaten types. The cases of expansive type showed radiologically pressure type (70%) and moth-eaten type (30%), and all cases of invasive type showed moth-eaten type. Histologically, the bone resorption was occurred befor carcinoma invasion in the expansive type. On the other hand, in the invasive type the bone resorption was occurred after carcinoma invasion or synchronously. In the expansive type Howship's lacunae in the reformation phase were relatively marked, while a large number of Howship's lacunae in the resorption phase were observed in the invasive type. Especially, histological examination showed that the intra-mandibular canal inf iltrasion without bone resorption was revealed in cases of invasive type, only. The 5-year survival rate of total cases was 75% in the expansive type and 32% in the invasive type.<BR>These results suggested that the histopathological types of mandibular carcinoma, expansive and invasive types, were useful classification for oral oncologists.

収録刊行物

  • 日本口腔腫瘍学会誌

    日本口腔腫瘍学会誌 13(4), 223-228, 2001-12-15

    Japanese Society of Oral Oncology

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各種コード

  • NII論文ID(NAID)
    10012338029
  • NII書誌ID(NCID)
    AN10170059
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    09155988
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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