Is it time to incorporate 'depth of infiltration' in the T staging of oral tongue and floor of mouth cancer?

PURPOSE OF REVIEW: To summarize recent acquisitions in three-dimensional tongue and floor of mouth anatomy that can help in better evaluation of the pathways of cancer progression within these oral subsites, thus giving some hints for refining of the current TNM staging system. RECENT FINDINGS: The Visual Human Project is an initiative aimed at establishing a three-dimensional dataset of anatomy of two cadavers made available free to the scientific community. Visual human data have been analyzed by specific software thus improving our three-dimensional understanding of the tongue myostructure. It is already known that there is limited prognostic utility in using the two-dimensional surface diameter alone as criterion for T1-T3 definition. Recently, also the T4a categorization for the infiltration of 'deep' or extrinsic tongue muscles has been criticized. This is largely because the descriptor 'deep' does not take into account the fact that considerable portions of these muscles lie in a very superficial plane. Different prognosticators have been proposed for inclusion into the TNM staging system of oral cancer but 'depth of tumor infiltration' seems to be the most robust, universally recognized, and reproducible in the preoperative, intraoperative, and postoperative settings. SUMMARY: Oral tongue and floor of mouth cancer needs to be classified according to a revised TNM staging system in which 'depth of infiltration' should be taken into account. An 'ideal cut off' for distinguishing 'low' (T1-T2) from 'high-risk' (T3-T4) categories has been proposed based on the literature review, but needs retrospective as well as large prospective trials before its validation.

Tumefaçöes do soalho bucal relacionadas às glândulas sublinguais em desdentados parciais e totais: estudos clínico e microscópico / Mouth floor enlargement related to the sublingual gland in edentulous and partially edentulous: clinical and microscopical studies

A tumefaçäo do soalho bucal relacionada à glândula sublingual é uma entidade que tem sido pouco enfatizada na literatura e foi descrita inicialmente por Campos, em 1996, como uma hiperplasia da glândula sublingual. Ocorre em pacientes com perda de dentes posteriores inferiores e pode causar problemas na adaptaçäo de próteses totais ou parciais inferiores. O objetivo deste trabalho foi definir as principais alteraçöes microscópicas e a epidemiologia das tumefaçöes do soalho bucal. Foram removidas 24 glândulas sublinguais de 19 pacientes, 15 do gênero feminino e quatro do masculino, com idade variando de 48 a 74 anos e média de 57 anos. A indicaçäo para cirurgia foi o traumatismo sobre a regiäo no soalho bucal ou para possibilitar a adaptaçäo de próteses. O material obtido foi corado com H.E., Tricrômico de Mallory e P.A.S. Das 24 glândulas sublinguais removidas, seis foram consideradas microscopicamente normais, apesar do aspecto clínico alterado. Nas 18 glândulas alteradas, observamos as seguintes alteraçöes: 1) Atrofia acinar e aumento no número de ductos e formaçöes ductiformes. 2) Fibrose intersticial e retençäo de muco intraductal em 17 casos. 3) Discreto infiltrado mononuclear e diminuiçäo do tecido linfóide em 16 casos. 4) Infiltraçäo de tecido adiposo em 15 casos. 5) Oncocitose em cinco glândulas. Ocorrem principalmente em mulheres após a quarta década de vida, sempre associadas com ausência de dentes posteriores inferiores. Sugerimos que as tumefaçöes do soalho bucal em desdentados parciais ou totais sejam consideradas entidade nosológica

[The assessment of basement membrane in cancer of the floor of the mouth and larynx]. / Ocena blon podstawowych w raku dna jamy ustnej oraz raku krtani.

An immunohistochemical method using a monoclonal antibody to collagen type IV was employed to assess the basement membrane (BM) deposition in 36 cases of cancer of the floor of the mouth and in 32 cases of cancer of the larynx. The BM deposition was scored as extensive or limited, and compared to degree of histologic differentiation of tumor and to 3-year survival rate for patient and regional metastasis. There were 42 cases with extensive and 26 with limited BM deposition between cancer of the floor of the mouth and cancer of the larynx were found. Statistical analysis did not show a relationship between BM deposition of either cancer and the survival of patients or with regional metastasis, however a little better results was obtained for patients with extensive BM deposition. Poorly differentiated carcinoma of the floor of the mouth had a tendency to limited BM deposition.

The sublingua and tongue of Tupaia (Scandentia, Mammalia): a scanning electron microscope study.

The surface morphology of the tongue and the sublingua in Tupaia belangeri was examined both under the dissection microscope and with the scanning electron microscope. Shape and structural differentiation of the sublingua and the anterior ventral part of the tongue are described. Special types of papillae were found on the lingual segment of the keel, along the serrated edges of the sublingua, and at the apex linguae. The findings are discussed with respect to the special conformation of the oral cavity of Tupaia and in relation to the evolutionary and functional significance of the tongue and the sublingua in this species.

[Endoral sonography in comparison with transcutaneous sonography, computerized tomography and magnetic resonance tomography]. / Die enorale Sonographie im Vergleich zur transkutanen Sonographie, Computertomographie und Magnetresonanztomographie.

Endoral ultrasound was introduced for imaging of T1 and T2 tumors of the anterior third of the tongue and the floor of the mouth in 1988. Using this method, 100 patients with diseases of the oral cavity and the oropharynx were examined, and the findings were compared with those of transcutaneous ultrasound, CT and MRI. Endoral ultrasound provided valuable additional information in tumors of the tongue base and the middle and dorsal third of the tongue. Tumors of the tonsil were demonstrated very well. MRI proved to be superior for imaging of large lesions. CT was of less value in diagnostic imaging of the oral cavity and the oropharynx due to low soft tissue contrast.

Ultrastructural study of calcinosis universalis with dermatomyositis.

Calcinosis universalis associated with dermatomyositis occurred in a 58-year-old woman. Tissues removed from the sublingual region in the patient were studied by ordinary microscopy, electron microscopy, and an electron-microanalytic method. The calcified materials were distributed on collagen fibers and seemed to have a relationship with foci of fibrinoid degeneration. Moreover, globular and/or membranous structures, considered to originate from the degenerate cells of the stroma, were observed in these calcified zones. Some of them contained electron-dense materials. Therefore, the globular and/or membranous structures were thought to be concerned with initial calcification in this case. Furthermore, irregular bone tissue was formed adjacent to the calcified masses. In addition, the calcified materials were identified by X-ray diffraction examination and electron microscopy as hydroxyapatite.

Scanning electron microscopic study of surface of human oral mucosa.

The surface ultrastructure of the healthy oral mucosa of humans was studied using SEM as follows: dorsum of the tongue (10 specimens), buccal mucosa (5), floor of the mouth (3), hard palate (5), and gingiva (10). One part of each formalin-fixed sample was processed routinely using the system of critical point drying for scanning electron microscopy. The other part of the specimen was embedded in paraffin blocks and stained with hematoxylin-eosin for light microscopy. With SEM at low magnification, the surface structure of the oral mucosa at different areas of the oral cavity was smooth with some desquamating cells. Only the tongue mucosa with its papillae formed a specialized mucosa. The hairs of the filiform papillae were covered by microorganisms, whereas on the oral mucosa there usually was little or no colonization by microorganisms. At high magnification, the surface structure of the superficial epithelial cells was pitted or microplicated. On keratinized epithelium the surface structure was pitted, whereas on non-keratinized epithelium it was microplicated. On cell boundaries some variation could also be seen; in keratinized epithelium these boundaries were overlapping and in non-keratinized epithelium they were tight.

A scanning and transmission electron microscope study of the premetamorphic papillae: possible chemoreceptive organs in the oral cavity of an anuran tadpole (Rana japonica).

Premetamorphic papillae of an anuran tadpole (Rana japonica) were studied by scanning and transmission electron microscopy. Premetamorphic papillae of several shapes are seen in and around the oral cavities of tadpoles during late larval and early metamorphic stages. These papillae are composed of three parts: the apical cellular part, the underlying connective tissue core and the epithelial covering. In the apical cellular part, two populations of cells are observed: apical and basal cells. The apical cell has a slender cytoplasmic process whose apical surface is exposed in the oral cavity. The basal cell is located at the basal portion of the apical cellular part of the papilla without researching the oral cavity. A long solitary microvillus and a bunch of short microvilli are seen on the apical surface of each apical cell. The apical cells contain dense-cored vesicles of 100 nm diameter and make synaptic contacts at their basal membranes with terminals of nerve fibers. Possible chemoreceptive function of the premetamorphic papilla is discussed.

Scanning electron microscopy of oral epithelial cells. Part I. Normal and malignant tissue.

The surface features of cells removed by scraping from normal human oral mucous membrane and from squamous cell carcinomas of the oral mucosa were examined by scanning electron microscopy. It was concluded that in normal oral mucosa the cell surface morphology is dependent on the state of keratinisation of the tissue. Malignant cells were observed to display modified surface characteristics which have been tabulated. It is suggested that these characteristics may be of value in the diagnosis of malignancy.

Epithelium--connective tissue interface of oral mucous membranes.

The interface between the epithelium and connective tissue of mucous membranes and skin represents a tissue site that is affected by a host of diseases which alter its normal morphologic features. Many differences exist in the normal morphologic pattern of this interface between various anatomic sites. It is essential, therefore, to have a thorough understanding of these differences before a meaningful study and assessment of pathologic changes affecting the interface can be made. This study was undertaken to establish a set of morphologic standards which can be used as a basis for interpreting pathologic changes which occur at the epithelium--connective tissue interface of oral mucous membranes.

Architecture and density of the connective tissue papillae of the human oral mucosa.

The papillary body of the human oral mucosa was studied at six different sites. Biopsy and autopsy material from 57 individuals, 11-81 years of age, was split chemically along the basal lamina and the epithelium-connective tissue interface examined by light and scanning electron microscopy. Morphometric techniques were employed in order to determine: epithelial thickness, height and density of connective tissue papillae and the percentage of basal epithelial surfaces occupied by them. In the majority of sites, connective tissue plateaux or ridges carrying a variable number of single or grouped papillae were found to be the basic structural units of the papillary body. Three regions with diferent characteristics of the epithelium-connective tissue interface could be identified: (1) floor of the mouth, (2) lip and cheek, (3) gingiva and hard palate. The floor of the mouth showed the lowest connective tissue papillae density, the smallest papillae, and connective tissue plateaux separated by narrow grooves. Lip and cheek mucosae revealed an intermediate density, the papillae were frequently bifurcated and angulated. Gingiva and hard palate were characterized by the highest papillary density and by papillae which were cylindrical, slender and erect. The alveolar mucosa exhibited intermediate features between those of the floor of the mouth and those of the cheek mucosa.

Analytical ultrastructural studies on implanted dental amalgam in guinea-pigs.

Implantation of amalgam induced a cellular reaction, and a rapid loss of copper and zinc and a more gradual loss of tin and mercury occurred. The silver remaining was generally associated with sulphur and was present either as a diffuse fuzz around remaining masses or in a finely particulate form.