舌癌症例における口底部の介在リンパ節転移の画像診断学的検討  [in Japanese] Imaging features of in-transit lymph node metastases in patients with tongue carcinoma  [in Japanese]

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Author(s)

    • 星名 由紀子 Hoshina Yukiko
    • 新潟大学大学院医歯学総合研究科顎顔面再建学講座組織再建口腔外科学分野 Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Tissue Regeneration and Reconstruction, Niigata University Graduate School of Medical and Dental Sciences
    • 林 孝文 Hayashi Takafumi
    • 新潟大学大学院医歯学総合研究科顎顔面再建学講座顎顔面放射線学分野 Division of Oral and Maxillofacial Radiology, Department of Tissue Regeneration and Reconstruction, Niigata University Graduate School of Medical and Dental Sciences
    • 新垣 晋 Shingaki Susumu
    • 新潟大学大学院医歯学総合研究科顎顔面再建学講座組織再建口腔外科学分野 Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Tissue Regeneration and Reconstruction, Niigata University Graduate School of Medical and Dental Sciences
    • 齊藤 力 Saito Chikara
    • 新潟大学大学院医歯学総合研究科顎顔面再建学講座組織再建口腔外科学分野 Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Tissue Regeneration and Reconstruction, Niigata University Graduate School of Medical and Dental Sciences

Abstract

目的:舌扁平上皮癌症例における口底部の介在リンパ節への後発転移の画像所見について検討を行う。<br>対象と方法:1997年から2007年までの間に,口底部の介在リンパ節への後発転移と考えられる腫瘤性病変が出現した舌扁平上皮癌5症例を検討対象とした。いずれも1か月に1回の綿密な超音波診断による経過観察で検出されたものであり,CTとMRI検査が引き続き施行された。われわれは,転移巣が舌下隙後方で顎下腺内側に出現した場合に,外側舌リンパ節と同様の介在リンパ節への転移と考え,傍顎下腺リンパ節転移と呼称することとした。<br>結果:術前画像と頸部郭清で得られた病理標本との照合の結果,2例は外側舌リンパ節転移,2例は傍顎下腺リンパ節転移,1例はそれらの両方と推測された。同期間に口底部の介在リンパ節に転移を来たした症例は潜在的転移が認められた2例を含めて7例であり,頸部リンパ節転移が証明された舌扁平上皮癌43例の16.3%に及んだ。<br>結論:傍顎下腺リンパ節は,外側舌リンパ節とともに舌から上内頸静脈リンパ節にいたる経路の介在リンパ節の役割を有すると考えられた。N0舌扁平上皮癌の経過観察において,外側舌リンパ節と傍顎下腺リンパ節への後発転移を画像で検出するには,正確な解剖学的知識と注意深い観察が必要と考えられる。

Purpose: To elucidate the imaging features of subsequent metastases to the in-transit lymph nodes in the floor of the mouth of patients with squamous cell carcinoma (SCC) of the tongue.<br>Materials and methods: From 1997 through 2007, five tongue SCC patients with mass lesions in the floor of the mouth suggesting subsequent metastases to the in-transit lymph nodes were shown on imaging studies, and enrolled in this retrospective study. The lesions were demonstrated initially by conscientious monthly repeated follow-up sonography, followed by post-contrast CT or MRI. We named lymph node metastases observed posterior to the sublingual space and medial to the submandibular gland as the “parasubmandibular node” metastases, and considered the nodes belonging to the in-transit lymph nodes the same as the lateral lingual nodes locating in the sublingual space.<br>Results: With regard to the comparison between preoperative images and histopathological specimens obtained by radical neck dissection on a one-to-one basis, it was speculated that two cases had lateral lingual node metastases, two cases had parasubmandibular node metastases and one case had both. In the same research period, the total numbers of patients having in-transit lymph node metastases in the floor of the mouth were seven, which accounted for 16.3% of 43 tongue SCC patients with histopathologically verified metastases to the cervical lymph nodes.<br>Conclusions: We deemed that the parasubmandibular nodes played a role as in-transit lymph nodes locating on a lymph drainage pathway from the tongue to the internal jugular nodes, the same as the lateral lingual nodes. Accurate anatomical knowledge and careful observation is needed to detect the subsequent metastases to the lateral lingual and/or parasubmandibular nodes on imaging studies during a follow-up period after treatment of the tongue SCC with N0 neck.

Journal

  • Journal of Japanese Society of Oral Oncology

    Journal of Japanese Society of Oral Oncology 22(1), 25-36, 2010

    Japanese Society of Oral Oncology

Codes

  • NII Article ID (NAID)
    130001185435
  • Text Lang
    JPN
  • ISSN
    0915-5988
  • Data Source
    J-STAGE 
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