[A prospective study of introducing self-determined treatment policy for the patients with hypopharyngeal cancer].

A total of 57 patients with hypopharyngeal cancer were given an opportunity to select their treatment options after a thorough explanation of the tumor stage, treatment modalities, complications due to treatment, and prognosis. As a result, many patients selected chemoradiotherapy as the initial treatment. Two patients requested treatment at other institutes and were immediately transferred. A 91-year-old patient with T4N3M0 tumor declined treatment. The duration from the initial visit to the start of treatment course was prolonged because of the informed consent process. Patient rejection of salvage surgery following the failure of chemoradiotherapy increased. However, both the physician-patient relationship and physician-patient's family relationship in the uncured group did not deteriorate. No change in the 3-year crude survival rate by introducing self-determined treatment was observed at this time. It is ideal that the patient choice of treatment options is the one physician recommend. Meanwhile, physicians should consider ideal treatment options, which are most desirable for the patient. In conclusion, thorough informed consent provides positive clinical impact even with ominous hypopharyngeal cancer.

[Clinical and histopathological studies of granular cell tumor of the tongue].

We studied the clinical and histopathological characteristics of granular cell tumor (GCT) of the tongue in 5 cases (2 males and 3 females) over a period of 25 years. The patients ranged in age from 8 to 44 years old. In 4 cases, the site of origin in the tongue was the anterior two thirds of the lateral border (UICC). In the remaining case, the tumor originated on the dorsal surface of the tongue (UICC). The tumor was 3-10 mm long and had an average diameter of 6mm. The lesions were painless. The cellular granules in all the tumors reacted positively to PAS regent and S-100 protein using immunohistological methods. Other immunohistological staining using anti-actin antibody showed cellular granules beneath the epithelium. In one case, these findings were especially marked in the portion that exhibited pseudo-epitheliomatous hyperplasia. There was a mixture of both positive and negative cells in the deep layer of the epithelium. Not all tumor cells stained with anti-desmin antibody, however, there appeared to be a direct transitions from stained striated muscle fibers to the tumor cells. Staining with anti-vimentin antibody was positive at the boundaries between cells and the positive granules in cells appeared in the dots. Two of the five, tumors were unencapsulated, and the other 3 were partially encapsulated. The constituent fibers of the capsule consisted of collagen fibers alone. Thus, the former 2 cases should be regarded as proliferative in nature, and the latter 3 as benign. These tumor cells were potentially very active beneath the epithelium. From the results of our immunohistological stainings, we concluded that myoepithelial cells might also be the source of GCT cells, although GCT cells have generally been reported to originate from muscle and nerve cells. We maintain that care must be taken when removing GCTs because there may be proliferative growth along the epithelium.

[Histological study of intractable recurrent ulcer of the oral cavity and pharynx].

Intractable recurrent ulcer of the oral cavity and pharynx was defined as irregular ulcerative lesions occurring only in the oral cavity and pharynx, showing no specific findings on clinicohematological examinations, which recurred easily and were resistant to various treatments for at least one month. Twenty-two cases with intractable recurrent ulcer were studied histologically. The following results were obtained: 1. Five histological types (LP type, LPE type, NL type, NLE type and NLP type) were identified, according to the invasive cells present, using H.E staining. 2. Subclasses of the invasive lymphocytes were classified using UCHL1 and L26. As a result, both LP type cases showed dominant T lymphocyte invasion. 3. Appearances of the activated T lymphocytes and Langerhans cells were studied using anti-Human HLA-DR and epithelial and endothelial expression of HLA-DR were observed. As a result, the characteristic findings of each histological type were demonstrated. These results suggest that cellular immunity may participate in the occurrence and progression of intractable recurrent ulcer. However, its role in the causes and effects of ulcer cannot be confirmed at this point.

[Clinical study of intractable recurrent ulcer of the oral cavity and pharynx].

The etiology and clinical definition of intractable recurrent ulcer of the oral cavity and pharynx were long unknown. Then, intractable recurrent ulcer of the oral cavity and pharynx was defined as irregular ulcerative lesions occurring only in the oral cavity and pharynx, showing no specific findings in clinicohematological examinations, which recurred easily and were resistant to various treatments for at least one month. Twenty-five cases of intractable recurrent ulcer of the oral cavity and pharynx were treated in our hospital. Patient age, sex, chief complaint, past history, duration of illness, the locations and clinical findings of the ulcers, clinico-hematological examinations, the pathology of the ulcers, therapy and prognosis were analysed. Disease specificity was found in age, sex, past history, locations and clinical findings of the ulcers, and prognosis. Our results suggest that intractable recurrent ulcer of the oral cavity and pharynx is a characteristic disease. The possibility that HLA-linked genetic factors play a role in the development of intractable recurrent which ulcers, which in addition to other factors, induce local immunoreaction which then prolongs the course of this disease, was suggested.

[Study of pyogenic granuloma of the oral cavity].

Pyogenic granuloma is one of the diseases sometimes seen in otorhinolaryngology clinics. The clinical features of this disease are understood to be that the lesion is located in the oral cavity in the majority of cases that its causative agent is usually discovered and that it most likely grows as a malignant tumor. However, the entity of pathological diagnosis has not been established. Thirty-one cases of oral pyogenic granuloma, including 16 males and 15 females, are reported in this paper. The granuloma was located most frequently at the tongue, followed, in order, by the gingiva, buccal mucosa, hard palate, lip and oral floor. The period between the patient's first visit to our clinic and the onset of his/her complaint was variable. It was relatively shorter in those cases with the lesion at the gingiva or tongue as compared to other locations. The size of the lesion was smaller than 10 x 10 mm. We classified the pathological features into three patterns; granuloma type, hemangioma type, and intermediate type. Many cases of lesions located at the back of the tongue, buccal mucosa, or hard palate were of the hemangioma type, while many cases of lesions located at the top of the tongue, gingiva, or oral floor were of the granuloma type. We have the impression that pyogenic granuloma could be one of the purulent changes associated with benign oral tumors.