Eugenol as a potential adjuvant therapy for gingival squamous cell carcinoma

Adoption of plant-derived compounds for the management of oral cancer is encouraged by the scientific community due to emerging chemoresistance and conventional treatments adverse effects. Considering that very few studies investigated eugenol clinical relevance for gingival carcinoma, we ought to explore its selectivity and performance according to aggressiveness level. For this purpose, non-oncogenic human oral epithelial cells (GMSM-K) were used together with the Tongue (SCC-9) and Gingival (Ca9-22) squamous cell carcinoma lines to assess key tumorigenesis processes. Overall, eugenol inhibited cell proliferation and colony formation while inducing cytotoxicity in cancer cells as compared to normal counterparts. The recorded effect was greater in gingival carcinoma and appears to be mediated through apoptosis induction and promotion of p21/p27/cyclin D1 modulation and subsequent Ca9-22 cell cycle arrest at the G0/G1 phase, in a p53-independent manner. At these levels, distinct genetic profiles were uncovered for both cell lines by QPCR array. Moreover, it seems that our active component limited Ca9-22 and SCC-9 cell migration respectively through MMP1/3 downregulation and stimulation of inactive MMPs complex formation. Finally, Ca9-22 behaviour appears to be mainly modulated by the P38/STAT5/NFkB pathways. In summary, we can disclose that eugenol is cancer selective and that its mediated anti-cancer mechanisms vary according to the cell line with gingival squamous cell carcinoma being more sensitive to this phytotherapy agent.

Aspirin Inhibition of Group VI Phospholipase A2 Induces Synthetic Lethality in AAM Pathway Down-Regulated Gingivobuccal Squamous Carcinoma

Background: To elucidate the role of iPLA2/PLA2G6 in gingivobuccal squamous cell carcinoma (GB-SCC) and to ascertain the synthetic lethality-based chemoprevention role of aspirin in arachidonic acid metabolism (AAM) pathway down-regulated GB-SCC. Methods: The in vitro efficacy of aspirin on GB-SCC cells (ITOC-03 and ITOC-04) was assessed by cell proliferation, colony formation, apoptosis, cell migration, cell cycle assay and RNA-seq, while inhibition of PLA2G6 and AAM pathway components was affirmed by qPCR, Western blot and immunofluorescence staining. The in vivo effect of aspirin was evaluated using NOD-SCID mice xenografts and immunohistochemical analysis. Results: We found that aspirin, which has been reported to act through the COX pathway, is inhibiting PLA2G6, and thereby the COX and LOX components of the AAM pathway. The findings were validated using PLA2G6 siRNA and immunohistochemical marker panel. Moreover, a pronounced effect in ITOC-04 cells and xenografts implied aspirin-induced synthetic lethality in the AAM pathway down-regulated GB-SCC. Conclusions: This study reveals that aspirin induces the anti-tumor effect by a previously unrecognized mechanism of PLA2G6 inhibition. In addition, the effect of aspirin is influenced by the baseline AAM pathway status and could guide precision prevention clinical trials of AAM pathway inhibitors.

[Failure to Remove Long-Term Indwelling Central Venous Catheters in Two Patients]

The use ofa central venous(CV)port system has become common for the treatment of patients with tumors. We report on the failure to remove CV catheters in 2 patients. The first patient was a 50 years woman with acute myeloid leukemia. She underwent CV port implantation via the left brachial approach 11 years previously. The second patient was an 80 years man with a lower gingival carcinoma. He underwent CV port implantation via the left brachial approach 6 years previously. CV catheter removal was attempted in both patients, but was unsuccessful because of strong adhesion to the vessel wall. Based on our experience, if catheter removal is impossible, its retention is more suitable.

Methanolic extracts of Solieria robusta inhibits proliferation of oral cancer Ca9-22 cells via apoptosis and oxidative stress

Many red algae-derived natural products are known to have anticancer effects. The biological functions of the red alga Solieria robusta from the Karachi coast (Pakistan) remain unclear. Here, we prepared a methanolic extracts of S. robusta (MESR) to examine its possible anti-oral cancer effects and the corresponding mechanism of action. Cell viability of MESR-incubated oral cancer Ca9-22 cells was dose-responsively decreased (p<0.001). According to a propidium iodide (PI)-based assay the cell cycle distribution was dramatically changed, especially for subG1 accumulation. Annexin V/PI assay of apoptosis using flow cytometry also showed that MESR-incubated Ca9-22 cells were dose-responsively increased (p<0.001). For evaluation of oxidative stress in MESR-incubated Ca9-22 cells, we found that reactive oxygen species (ROS) were overexpressed dose- and time-responsively and mitochondrial depolarization was also increased (p<0.001). Taken together, MESR showed inhibitory effects on oral cancer proliferation coupled with apoptosis and oxidative stress.

A Case of Bullous Pemphigoid Arising in Juvenile Hyaline Fibromatosis with Oral Squamous Cell Carcinoma

We experienced a case of bullous pemphigoid (BP) arising in juvenile hyaline fibromatosis (JHF) associated with oral squamous cell carcinoma (SCC). JHF is a very rare disease inherited in an autosomal recessive fashion. Skin-colored, elastic hard nodules up to 10 cm in size were scattered mainly on the trunk and scalp. Gingival hypertrophy and an ill-defined mass with an irregular surface on the hard palate were noticed. A skin biopsy and a gingival biopsy confirmed the diagnosis of JFH and oral SCC, respectively. The patient was receiving anti-cancer drugs for the treatment of oral SCC and the treatment was successful. In the meantime, bean to nail sized bullas were noticed on the hands and feet. Histological examination, immunofluorescence method and ELISA confirmed the diagnosis of BP. The pathophysiological mechanisms are discussed in the present case.

Primary gingival diffuse large B-cell lymphoma: a case report and a review of the literature

The patient was a 73-year-old male who came to our hospital with a chief complaint of pain and swelling of the left side of his jaw. Computed tomography revealed a mass in his left gingiva but no bone destruction. No lesions were observed at any other sites, and an incisional biopsy was performed on the gingival mass on the left side. Histologically, the mass was a diffuse large B-cell lymphoma (DLBCL), and it was CD20-positive, and CD5-negative, CD10-negative, surface immunoglobulin-negative, and Epstein-Barr virus-encoded RNA (EBER)-negative. A serum Human immunodeficiency virus (HIV)-antibody test was negative. A complete remission was achieved after 6 courses of systemic combination chemotherapy, and the complete remission has been maintained for approximately 3 years. According to the literature, primary gingival DLBCL have a high Ki-67-positive rate and many of the cases are stage I and international prognostic index low-risk. However, HIV patients have a high EBER-positive rate and a high risk of developing a CD20-negative, CD138-positive plasmablastic lymphoma, and they have a poor prognosis. By contrast, limited-stage primary gingival lymphomas whose data can be used have been rare in human immunodeficiency virus-negative patients, and only 12 cases, including our own, have ever been reported. Many of the patients have been around 65 years of age, and all of the cases have been CD20-positive, CD138-negative DLBCLs, and the CD5-negative, Epstein-Barr virus-positive rate has been low, with most cases having been non-germinal-center B-cell-like. The prognosis for relapse-free survival has been favorable.

A case report: metastatic choriocarcinoma to the gum

Choriocarcinoma is a rare neoplasia with a tendency of distant metastasis although highly sensitive to chemotherapy renders a good prognosis and outcome. Lungs, liver and cerebral metastasis are commonly implicated with maxillofacial region rarely involved. We illustrate a case of overwhelming metastatic choriocarcinoma to lungs, liver, brain and to the extreme of gum metastasis. Decompressive craniectomy for intracranial bleeding, multiple transfusions to correct anaemia and coagulopathy were done before high-risk-regime chemotherapy. Despite this, due to fulminant multi-organs involvement she finally succumbed to death. In conclusion, gum bleeding in choriocarcinoma may suggest metastasis and poor prognosis.

[A case of advanced upper gingival carcinoma responding completely to concurrent chemoradiotherapy with S-1]

We report a case of advanced upper gingival carcinoma with a contralateral metastatic lymph node invading the maxillary sinus (T4aN2cM0). An 83-year-old man was treated concurrently with chemoradiotherapy and S-1. S-1 (80 mg/body/day) was administered for 2 weeks followed by a 1-week rest period as one course. Radiation therapy involved a total of 60 Gy (2 Gy/day; 5 days/week). There were side effects of mild leucopenia and a grade 2 stomatitis. After the completion of 2 courses and radiation therapy, the primary tumor disappeared, and the patient achieved a pathologically complete response. The metastatic lymph node also completely disappeared. S-1 was then administered in the same regimen for 1 year. Neither local recurrence nor distant metastasis has been detected 2 years after the completion of the concurrent chemoradiotherapy with S-1.

[Combination chemotherapy of S-1, docetaxel and CDDP produces a remarkable response in a patient with metastases of supraclavicular lymph nodes and gingival carcinoma of the mandible]

We report a 53-year-old female patient with an unresectable metastasis to the supraclavicular lymph node from a primary gingival carcinoma of the mandible. The patient had a history of tongue carcinoma and had undergone a radical neck dissection for the treatment of gingival carcinoma. She underwent combined chemotherapy consisting of S-1 (80 mg on days 1-14, followed by a 7-day rest), docetaxel (35mg/m2 by intravenous infusion on days 1 and 8), and CDDP (10mg/m2 by intravenous infusion on days 1 and 8) every 3 weeks. After three courses of the above chemotherapy regimen, a computerized tomography examination revealed a complete response. The patient did not experience any severe side effects during the course of chemotherapy. Combined S-1, docetaxel, and CDDP chemotherapy can thus be effective for unresectable recurrences of oral cancer in lymph nodes.

[Severe advanced lower gingival carcinoma effectively reduced by chemoradiation with S-1--report of a case]

Severe advanced head and neck carcinoma which can not be removed via surgical procedure combined with a large lymph node metastasis has a poor prognosis. We administered concurrent chemoradiotherapy with S-1 for a lower gingival carcinoma. As a direct result, we discovered that the treatment greatly reduced the size of tumor, and we consider that this treatment prolonged the patient.s life. The treatment results suggest that the so-called dormancy state of the tumor was continued. In this case study, radiotherapy with S-1 showed a highly effective response from the viewpoint of QOL improvement.

Doxorubicin delivery by polyamidoamine dendrimer conjugation and photochemical internalization for cancer therapy

Coupling anticancer drugs to synthetic polymers is a promising approach to improve the efficacy and reduce the side effects of these drugs. The pH-activated polymer has been demonstrated to be a successful drug delivery vehicle system, whereas the photochemical internalization (PCI) was invented for site-specific delivery of membrane impermeable macromolecules from endocytic vesicles into the cytosol. In this study, doxorubicin (DOX) was conjugated to polyamidoamine (PAMAM) dendrimers via pH-sensitive and -insensitive linkers and was combined with different PCI strategies to evaluate the cytotoxic effects. Our results showed that both PCI strategies significantly improved the cytotoxicity of free DOX on Ca9-22 cells at higher concentrations. The 'light after' PCI treatment was efficient in releasing DOX from the PAMAM-hyd-DOX conjugates, resulted in more nuclear accumulation of DOX and more cell death through synergistic effects. On the other hand, antagonism was observed when 'light before' PCI combined with PAMAM-hyd-DOX conjugate. The distribution of PAMAM-amide-DOX was mainly cytosolic with or without PCI treatments. Both PCI strategies failed to improve the cytotoxicity of PAMAM-amide-DOX conjugates. Our results provide invaluable information in the future design of drug-polymer complexes for multi-modality cancer treatments.

[A successful case of lower gingival cancer with pulmonary metastases by adjuvant chemotherapy including paclitaxel, cisplatin and 5-fluorouracil following a surgical procedure]

We report a successful case with pulmonary metastases from lower gingival cancer by a surgical procedure and four cycles of adjuvant chemotherapy including paclitaxel (PTX), cisplatin (CDDP) and 5-fluorouracil (5-FU). A 47-year-old woman underwent chemotherapy with CDDP and 5-FU after an operation for lower gingival squamous cell carcinoma and its neck lymph node metastases. At 4 months from the initial treatment, pulmonary metastatic lesion was resected by video-assisted thoracoscopic surgery (VATS). Fourteen months later, pulmonary metastatic lesion was found and dissected again using VATS. Furthermore, the patient was treated by adjuvant chemotherapy with PTX 135 mg/m(2) over 3 hours on day 1, CDDP 75 mg/m(2)on day 2 and 5-FU 350 mg/m(2)/day by continuous intravenous infusion on day 2 through 5. After that, there is no evidence of pulmonary recurrence for more than six years.

Local delivery system of cytotoxic agents to tumors by focused sonoporation

Recently, ultrasound-targeting microbubble destruction has been employed in molecular gene therapy, and a new potent nonviral gene transfer method known as 'sonoporation' has been developed. We investigated the efficiency of sonoporation toward growth inhibition of human gingival squamous carcinoma cell line, Ca9-22, in vitro and in vivo. The cytotoxicity of bleomycin (BLM) was investigated using flow-cytometric analysis and Hoechst's staining in vitro assay systems. We found that the delivery of BLM by sonoporation induced cytotoxic effect toward Ca9-22 cells in vitro. Our in vivo results showed that tumors nearly disappeared in Ca9-22 cell-implanted nude KSN/slc mice treated with a low dose of BLM followed by sonoporation during the 4-week experimental period. Histological analysis revealed that the cytotoxic effect was mainly apoptosis. We previously reported that the cytolethal distending toxin B (cdtB) from Actinobacillus actinomycetemcomitans, a periodontopathic bacterium, is responsible for cell cycle arrest and apoptosis in vitro. Thus, we used sonoporation to transfect a cdtB-expressing plasmid into Ca9-22 cells and examined cell viability in vitro and in vivo. We found that an administration of cdtB-expressing plasmid followed by sonoporation-induced marked growth inhibition of Ca9-22 cells and apoptotic cells were also observed in vitro and in vivo. These findings suggest that local administration of cytotoxic agents with sonoporation is a useful method for molecular cancer therapy.

p53 mutation and cyclin D1 amplification correlate with cisplatin sensitivity in xenografted human squamous cell carcinomas from head and neck

To investigate the response of tumour growth to cisplatin treatment, in relation to p53 mutation and cyclin D1 dysregulation on DNA and protein level, biopsies from seven xenografted human squamous cell carcinomas from the head and neck were analysed with immunohistochemistry for p53 expression and cyclin D1 expression. Polymerase chain reaction-singlestranded conformation polymorphism was used to determine p53 mutations. Fluorescence in situ hybridization was performed to analyse cyclin D1 amplification. The mice were injected i.p. with NaCl (controls) or cisplatin. After injection the tumour volume were measured. The inhibition of tumour growth by cisplatin was defined as the area under the growth curves, and compared with the growth curves of the tumours in the control group. Xenografts with p53 mutation showed significantly higher resistance to cisplatin (p < 0.001) and also tumours with cyclin D1 amplification showed significantly higher resistance (p < 0.001).

Chondrosarcoma involving the periodontum: clinicopathological and immunohistochemical features of a case study

Chondrosarcoma is a rare flat bone neoplasm. Herein, we present the clinicopathological and immunohistochemical findings of a case affecting the periodontum. A 16-year-old girl presented a painless reddish mass in the lower anterior gingiva. Radiographs showed bone affected by vertical and horizontal loss and enlargement of periodontal space. The histopathological features showed atypical cartilage arranged in lobules compatible with chondrosarcoma. Immunohistochemistry showed that tumor cells were immunoreactive for the anti-vimentin and S-100 antibodies. Moreover, no tumor cells had been immunostained by anti-p53. Treatment consisted of chemotherapy, followed by radical surgery and postsurgery treatment with an association of radio and chemotherapy. After one year, no signs of recurrence have been observed.

Gingival Involvement in a Case Series of Patients With Acquired Immunodeficiency Syndrome-Related Kaposi Sarcoma

BACKGROUND

This case series presents the polymorphic clinical characteristics of gingival acquired immunodeficieny syndrome (AIDS)-related Kaposi sarcoma (KS), a malignancy that is gradually becoming uncommon in developed nations. An up-to-date overview of the related epidemiology, etiopathogenesis, histopathology, and treatment is provided, along with a pictorial guide to ease clinical diagnosis.

METHODS

The oral/maxillofacial pathology records at Aristotle University and the University of Geneva were retrospectively reviewed. Thirty-two cases diagnosed with oral AIDS-related KS were retrieved between 1991 and 2004. KS diagnosis was established histologically by incisional biopsies from intraoral lesions. All charts contained clinical oral examination data, radiological images, and detailed photographic records.

RESULTS

Thirteen patients (12 males and one female) presented with KS gingival involvement (40.6%). Eleven of the male patients were homosexual/bisexual men. The mean age of the patients at the time of intraoral KS diagnosis was 42.1 years, and the mean CD4 cell count was 103 (0 to 481). Gingival epidemic KS presented with various degrees of pigmentation and a wide range of clinical patterns, from relatively flat macules (early stage) to tumors with variable nodular morphology (advanced disease). Solitary or multiple gingival involvement may appear concomitantly with palatal and/or cutaneous lesions.

CONCLUSIONS

Even though the incidence of intraoral KS had fallen precipitously in developed countries after the mid-1990s, gingival KS should be considered in the differential diagnosis of every pigmented gingival lesion. Periodontists are in a unique position to identify gingival involvement of intraoral KS and facilitate early diagnosis.

Expression of caveolin-1 and its correlation with cisplatin sensitivity in oral squamous cell carcinoma

PURPOSE

Cisplatin (CDDP) is widely used for chemotherapy of oral squamous cell carcinoma (OSCC). However, the mechanism of resistance to CDDP is unclear. Recently, caveolin-1 was identified as being associated with both metastasis and multidrug resistance. In the present study, we showed that caveolin-1 expression is significantly related to chemosensitivity in OSCC.

METHODS

We established a CDDP-resistant cell line, H-1R, from the parental OSCC cell line, H-1. Caveolin-1 expression was determined by reverse transcriptase-polymerase chain reaction (RT-PCR) in both cell lines. We analyzed expression of caveolin-1 in 30 OSCC biopsy specimens and investigated the relationship between expression of caveolin-1 and patients' clinicopathological parameters and chemotherapeutic responses.

RESULTS

The 3-(3,4-dimethyl-thiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay indicated that H-1R has a ten-times greater resistance to CDDP than H-1 has. The level of caveolin-1 expression in H-1R was significantly decreased in comparison with that in H-1 by real-time RT-PCR analysis. Positive caveolin-1 immunostaining correlated positively with a complete response (16/20, 80.0%). However, negative immunostaining was found in 6/7 (85.7%) cases with no response. Positive immunohistochemical staining of caveolin-1 correlated positively with chemosensitivity to CDDP-based combination chemotherapy (P=0.02).

CONCLUSIONS

These results suggest that overexpression of the caveolin-1 gene may provide novel diagnostic markers associated with CDDP sensitivity in OSCC.

[Gingival Burkitt lymphoma in a hepatitis C-positive renal transplant patient]

Malignant tumors are a frequent complication in the late phase after organ transplantation. Malignant lymphomas are the second most common tumor, exceeded only by cutaneous carcinomas. Compared to the general population, the organ transplant patients have a 30-60 fold increased risk of developing non-Hodgkin's lymphoma. A 55-year-old, hepatitis C-positive man developed an Epstein-Barr virus (EBV)- negative Burkitt lymphoma (BL) first appearing on the gingiva under immunosuppressive therapy nine years after allogenic renal transplantation. He died 37 days after the onset of polychemotherapy. Immediately before his death, meningeal involvement by the BL was diagnosed. BL after organ transplantation is often found at extranodal sites; it involves the central nervous system more frequently than it does in immunocompetent patients. In 70% of BL occurring after organ transplantation, genes or gene products related to EBV can be demonstrated within the tumor cells. The EBV status of the tumor is of important prognostic significance: EBV-positive BL occurring in organ transplant patients usually responds well to reduction or cessation of immunosuppressive therapy; in some cases permanent complete remissions can be achieved even without chemotherapy. In contrast, patients with EBV-negative BL have a very poor prognosis and hardly respond, even to aggressive chemotherapy protocols.

Brain Metastasis Responding to Gefitinib Alone

A woman with stage IIIb non-small cell lung cancer (NSCLC) developed disease progression with brain metastases during chemotherapy. Due to unusual circumstances, the patient received gefitinib alone, without the use of corticosteroid treatment or radiotherapy. There was a dramatic clinical improvement within 1 week. Follow-up magnetic resonance imaging of the brain 1 month later showed decreases in both the size and number of brain metastases. The patient remains well 9 months after initiation of gefitinib. It is proposed that gefitinib may have a role in treatment of brain metastases from NSCLC.

Oral mucosal melanoma: a series of case reports

INTRODUCTION

Due to the rarity of oral malignant melanomas case reports are a necessary source of information. Ten new cases are reported with a minimum follow-up of 3 years.

PATIENTS AND METHODS

Patients were treated during a period of 10 years. Clinical, demographic and pathologic findings were examined.

RESULTS

In 6 males (60%) and 4 females with a mean age of 64.3 years the tumour locations were: hard palate-maxillary gingiva (3 cases), maxillary gingiva (2), lower gingiva (2), tongue (2), hard/soft palate-buccal mucosa (1). Pre-existing melanotic pigmentation had been present in 4 patients. Four patients were in stage I, 5 in stage II, and 1 in stage III. Surgical excision was the primary treatment in 9 cases. Five patients underwent simultaneous neck dissections. All patients received radiation and multimode adjuvant therapies. After a 3-year follow-up 3 patients are still alive (50% (2/4) of those presenting in stage I and 20% (1/5) in stage II).

CONCLUSIONS

Due to the rarity of oral melanoma, individual experience is limited. The poor prognosis and the different treatments reflect this situation.

[A case report--a patient with gingiva carcinoma showing complete remission after combination chemotherapy with nedaplatin and 5-fluorouracil]

We report a patient showing a complete remission after combination chemotherapy with nedaplatin and 5-fluorouracil (5-FU). A 63-year-old man was admitted to our hospital for advanced carcinoma of gingiva. 5-FU was administered at a dose of 1,000 mg/body (700 mg/m2) by continuous infusion for 120 hours on days 1 to 5. Nedaplatin was administered at a dose of 140 mg/body (90 mg/m2) by drip infusion for 120 minutes on day 5. This combination chemotherapy resulted in a complete remission of the tumor after 2 weeks. There has been no sign of recurrence for 6 months after the chemotherapy.

Granulocytic sarcoma of gingiva: an unusual case with aleukemic presentation

BACKGROUND

Granulocytic sarcoma (GS) is an uncommon extramedullary tumor composed of dense aggregates of immature myeloid precursor cells, which is usually associated with acute or chronic myeloid leukemia. The tumor may also be a predecessor to acute myeloid leukemia (AML). It may be found in any location throughout the body; however, intraoral occurrence is extremely rare. This report describes a case of gingival granulocytic sarcoma that developed prior to AML in a 12-year-old female.

METHODS AND RESULTS

The patient, who had a 3-month history of gingival enlargement, was diagnosed as having granulocytic sarcoma based on clinical, radiological, and histological findings. Although the tumor regressed significantly after two induction chemotherapy courses, the patient subsequently died due to pneumococcal sepsis and pleurisy.

CONCLUSION

This case report affirms the importance of granulocytic sarcoma in the differential diagnosis of gingival enlargements, since the tumor may occur before bone marrow involvement by leukemic cells.

[A case of mandibular gingival cancer (T4) responding to concurrent chemoradiotherapy with TS-1]

We report here a patient with advanced oral cancer in which concurrent chemoradiotherapy with TS-1 was performed. The patient was an 82-year-old male who had a 41 x 22 mm tumor mass around the left lower gingiva, whose X-ray showed a bone resorption image reaching the mandibular canal. We carried out concurrent chemoradiotherapy with TS-1. After 4 weeks, severe side effects, i.e., stomatitis and diarrhea, force us to discontinue the treatment. However, the tumor had begun to shrink from the 2nd week of treatment, and had clinically disappeared by the 8th week. The histopathological examination also indicated a complete response (CR). Thus, this treatment was very effective and may be useful for advanced cases.

Choroidal metastasis of a gingival squamous cell carcinoma

PURPOSE

To report a case of choroidal metastasis of a gingival squamous cell carcinoma.

DESIGN

Interventional case report.

METHODS

Review of the clinical history and pathologic findings.

RESULTS

A 59-year-old woman with a history of right gingival squamous cell carcinoma presented with sudden dimness of vision in the left eye of 4 weeks duration. Fundus examination of the left eye revealed a yellowish elevated subretinal lesion involving the optic disk and macula. Fine-needle aspiration biopsy of the choroidal lesion, left eye, revealed metastatic squamous carcinoma cells. The patient was referred to a radiation oncologist for further management.

CONCLUSION

Choroidal metastasis from gingival squamous cell carcinoma is rare, and it may develop from hematogeneous spread.

Granulocytic sarcoma occurring in the maxillary gingiva demonstrated by magnetic resonance imaging

We report the case of a 43-year-old woman presenting with a painless swelling that had developed over 8 months in the maxillary labial vestibule. An oral examination revealed an exophytic, firm, black-pigmented lesion measuring 3.5 x 1.5 cm that bled on palpation. Periapical radiographs showed a slightly enlarged periodontal ligament space of the left central incisor and bone resorption in the region of the missing lateral incisor. Panoramic and other conventional radiographs showed no obvious lytic area, and a magnetic resonance imaging examination demonstrated a low signal intensity lesion on both the T1-weighted and the T2-weighted images. Therefore, granulocytic sarcoma was suspected. Granulocytic sarcoma of the oral cavity is a rare condition, and its diagnosis is usually difficult. Increased awareness of this entity may minimize misinterpretation of radiographic and clinical findings and can assist suitable treatment planning that is essential to this pathosis.

[A case of mandibular gingival cancer T4N0M0 which markedly responded to a combined therapy of nedaplatin with 5-fluorouracil]

We recently experienced a case of mandibular gingival cancer T4N0M0 which markedly responded to a combination therapy of nedaplatin (254-S) with 5-fluorouracil (5-FU). The patient was a 68-year-old male who visited our department with the main complaint of ulceration in the left mandibular gingiva. Biopsy revealed a moderately differentiated squamous cell carcinoma which extended to the mandible, mandibular gingiva, buccal mucosa, half tongue and oral floor on the left side of the face. As a neoadjuvant chemotherapy (NAC), 254-S at a dose of 100 mg/m2 was intravenously administered on day 1, while 5-FU at a dose of 700 mg/m2/day was intravenously administered from day 1 to 5 in succession. Hydration (2,000 ml/day) was performed from day 1 to 3. Adverse reactions observed included thrombocytopenia, anorexia, nausea, vomiting, stomatitis and SIADH, but no sign of renal dysfunction was observed. The clinical outcome was evaluated as CR. Surgery was performed later. Pathological examination of the extracted tissues showed tumor cells in the tongue only, indicating an excellent effect of this combination therapy of 254-S and 5-FU.

Correlation between EGF receptor expression and peplomycin cytotoxicity in squamous cell carcinoma cell lines

The relationship between sensitivity to anti-cancer agents and EGF receptor expression on squamous cell carcinoma (SCC) cells was investigated. The cytotoxicity of peplomycin (PEP) was correlated with the number of the EGF receptors expressed on the cancer cells, but no correlations were found between the cytotoxicity of adriamycin and cisplatin and EGF receptors. Addition of TNFalpha increased the number of EGF receptors in the SCC cell lines 1.5- to 2-fold. The cytotoxic effect of combined administration of PEP and TNFalpha was correlated with the number of EGF receptors, and produced a 2- to 5-fold increase in IC50 compared with administration of PEP alone. These observations suggest that EGF receptor expression is closely associated with the cytotoxic effect of PEP on SCC cells.

Topical application of vitamin A to oral leukoplakia: A clinical case series

BACKGROUND

Due to the possibility of malignant transformation of oral leukoplakia, these lesions must be assessed and managed closely and, if not resolved, must be reassessed on a regular basis.

METHODS

This study evaluated the use of topical 0.05% vitamin A (tretinoin) acid gel for the treatment of oral leukoplakia. Tretinoin was applied topically 4 times a day for the management of nonmalignant oral white lesions in 26 patients. The clinical response was evaluated in all patients and posttreatment biopsies were performed in ten patients.

RESULTS

The mean age of the patients at the time of diagnosis was 62 years. Of the 26 patients, 50% were tobacco users. Patients were followed for a mean of 23 months. Approximately 27% of the patients had a complete clinical remission. Recurrence of leukoplakia was observed in approximately 40% of patients in whom complete clinical remission occurred if topical applications were discontinued. A 50% reduction in the clinical grade of leukoplakia from a mean of 2.8 to 1.4 on a scale ranging from 0 (no leukoplakia) to 4 (speckled leukoplakia) was observed. When the pretreatment and posttreatment biopsies from 10 patients were evaluated, no change in the mean histologic grade (between mild and moderate dysplasia) was noted; however, some reduction in the histologic grade was noted in 3 of these patients (30%).

CONCLUSIONS

The use of topical vitamin A acid showed a limited effect in controlling oral leukoplakia. Further studies are needed to establish the appropriate indication, efficacy, and best choice for chemoprevention agents. Close follow-up of all patients with oral leukoplakia is required.

Gastric and gingival localization of mucosa-associated lymphoid tissue (MALT) lymphoma. An immunohistochemical, virological and clinical case report

Non-Hodgkin's lymphomas (NHL) of the mucosa-associated lymphoid tissue (MALT) are characterized by their mucosal and glandular tissue localization. The case described here falls into the European-American classification of a low-grade B-cell lymphoma of the MALT type, with a gingival lesion 2 years after a gastric lesion. The pathogenetic mechanisms of NHL in oral MALT and the diagnosis and treatment are discussed.

Apoptosis and growth inhibition of head and neck tumor cell line induced by epidermal growth factor receptor tyrosine kinase inhibitor

Overexpression of the epidermal growth factor (EGF) receptor, a hallmark of aerodigestive squamous cell carcinoma of the head and neck (SCCHN), correlates with aggressive tumor behavior. There is evidence that SCCHN cells auto-activate their EGF receptors. The receptor has therefore attracted interest as a potential therapeutic target. We tested the in vitro therapeutic efficacy of PD153035--a potent, specific inhibitor of the tyrosine kinase intrinsic to the EGF receptor--by employing a well-characterized cell line derived from human gingival SCCHN. DNA-synthesis and cell number were assayed for growth-inhibitory effects, phosphorylation of the EGF receptor was quantitated by immunoblot, and cell apoptosis was detected by terminal deoxytransferase (TdT)-mediated deoxyuridine triphosphate (dUTP)-biotin nick end labeling (TUNEL) in situ assay. PD153035, at nanomolar concentrations, inhibited autophosphorylation of the EGF receptor induced by EGF stimulation and the inhibition occurred in a dose-dependent manner. Under the same conditions, PD153035 inhibited cell growth, and induced apoptosis of SCCHN cells in vitro. We conclude that selective inhibition of the EGF receptor tyrosine kinase completely abolishes EGF receptor phosphorylation resulting from receptor stimulation, and results in growth inhibition and apoptosis of SCCHN cells in vitro. By inducing cytostasis and apoptosis, this new class of inhibitors may be of therapeutic value against SCCHN.

Inhibition of Na+,K+-ATPase by cisplatin and its recovery by 2-mercaptoethanol in human squamous cell carcinoma cells

Na+,K+-ATPase (EC 3.6.1.37) is assumed to be involved in the transport of cisplatin [cis-diamminedichloroplatinum(II)] into cells and to act as a modulator of 5-fluorouracil (5-FU) in combination therapy of cisplatin and 5-FU. Whereas inhibition of Na+,K+-ATPase activity by cisplatin is expected to have effects on both anti-cancer therapy and nephrotoxicity, the inhibition mechanism remains to be elucidated. We studied the inhibition of Na+,K+-ATPase activity by cisplatin using an enzyme partially purified from Ca9-22 cells derived from a human squamous cell carcinoma of the gingiva. Cisplatin inhibited the Na+,K+-dependent ATP hydrolysis activity, and this inhibition depended on both the concentration of cisplatin and the preincubation time with cisplatin. The time-dependent inhibition was thought to be caused by a slow change of cisplatin from the inactive to the active form. We further tested the effect of cisplatin on the partial reactions of the enzyme, Na+-dependent ATP hydrolysis and K+-dependent pnitrophenylphosphate hydrolysis activities to determine which step in the reaction sequence of Na+,K+-ATPase was inhibited. Cisplatin inhibited both activities depending on its concentration and the preincubation time, whereas the Na+-dependent ATP hydrolysis activity was inhibited even at lower concentrations. Formation of a phosphointermediate of Na+,K+-ATPase was also inhibited by cisplatin depending on the concentration and preincubation time. Cisplatin (500 microM) and 8-fold higher concentration of 2-mercaptoethanol (2-ME; 4 mM) prevented inactivation of the enzyme by cisplatin, and the Na+,K+-ATPase activity inhibited by pretreatment with cisplatin was also recovered almost completely by 2-ME. These results suggest that the active form of cisplatin inhibits the Na+,K+-ATPase activity by inhibiting the formation of a phosphointermediate of the enzyme and that the inhibition by cisplatin is arrested by an addition of thiol group.

Proliferative potential of canine oral epulides and malignant neoplasms assessed by bromodeoxyuridine labeling

The proliferative potential of canine oral lesions, including epulides, squamous cell carcinomas, a malignant melanoma, and a fibrosarcoma, was examined using a monoclonal antibody to bromodeoxyuridine (BrdU). Twenty-three dogs with oral masses were administered BrdU intravenously at a dose of 8 mg/kg 1 hour before surgery, and the BrdU labeling index (LI) of each lesion was determined immunohistochemically. The average BrdU LIs for the main proliferating elements in the fibromatous epulis (4 cases), ossifying epulis (2 cases), and acanthomatous epulis (10 cases) were 4.9, 3.0, and 8.8%, respectively. The squamous cell carcinomas (5 cases) had an average LI of 15.9%, and the LIs of the malignant melanoma and fibrosarcoma were 7.5 and 10.3%, respectively. All cases of acanthomatous epulides and squamous cell carcinoma treated with simple marginal surgical resection recurred within a short time. The higher LIs in the acanthomatous epulides, squamous cell carcinomas, and fibrosarcoma correlate well with their poor prognoses, reflected by rapid growth and frequent recurrence. Acanthomatous epulis is clearly distinguished from other epulides by its aggressive clinical behavior and high proliferative potential, which is equivalent to that of malignant tumors, despite a lack of cell atypia. The BrdU LI is a useful marker for evaluating the proliferative potential and prognosis of canine oral tumors.

The effect of intralesional bleomycin on canine acanthomatous epulis

Four dogs with recurrent acanthomatous epulis (AE) were injected with bleomycin (5 mg) intralesionally once a week. In three cases, tumors were clinically indistinguishable within three-to-eight weeks. In the fourth case, the tumor disappeared after 10 weekly injections. Through the administration period of bleomycin, no adverse reactions were recognized in any case. Electron microscopic examination together with a decrease in the percentage of mitotic cells implied that bleomycin might inhibit deoxyribonucleic acid (DNA) synthesis of tumor cells.

Histomorphometric analysis of osteoclastic resorption in bone directly invaded by gingival squamous cell carcinoma

Whole frontal sections of the mandibular bone from 18 patients with gingival squamous cell carcinoma showing direct bone invasion were prepared for histometrical analysis by a non-decalcified grinding method. The osteoclast cytoplasmic area in tumor sites was larger and its relative frequency distribution was broader than that of osteoclasts in non-tumor sites. The index of bone resorption was significantly increased, while that of bone formation was decreased, in the tumor sites compared to the non-tumor sites (P < 0.01). In the tumor sites, the indices of bone resorption and formation in the group showing greatest chemotherapy and radiation therapy effects (CRE) were significantly different from those in the group with low CRE (P < 0.01). A history of irradiation therapy was associated with significantly decreased bone resorption (P < 0.05).

Intralesional vinblastine injections for the treatment of oral Kaposi's sarcoma: report of 10 patients with 2-year follow-up

PURPOSE

This study evaluated the use of intralesional vinblastine injections for the treatment of the intraoral lesions of Kaposi's sarcoma.

PATIENTS AND METHODS

Eighteen patients were treated with up to three intralesional injections of 0.1 mg/cc vinblastine.

RESULTS

All lesions responded to the local injections; 40% required one injection; 31%, two injections; and 29%, three injections. Large, exophytic lesions usually required the multiple injections. No complications were encountered, and the patients tolerated the protocol well. Ten patients were followed for 24 months. Eight died of their general disease during this period. Four patients developed new intraoral lesions, which were treated with, and responded favorably to, the three-injection protocol.

CONCLUSION

Intralesional vinblastine injections are an effective and useful treatment alternative for human immunodeficiency virus (HIV)-associated intraoral Kaposi's sarcoma.

Results of combined external irradiation and chemotherapy of bleomycin or peplomycin for squamous cell carcinomas of the lower gingiva

PURPOSE

In Japan, the role of radiotherapy for gingival carcinomas has not been considered as a radical treatment, but only a pre and/or postoperative treatment. This study was aimed to discuss a possibility of radiotherapy for a radical treatment. In this study, radiotherapy was given as an initial treatment for squamous cell carcinomas of the lower gingiva in simultaneous combination with chemotherapy of bleomycin or peplomycin (Tokyo, Japan).

METHODS AND MATERIALS

When complete regression of the tumor was obtained, subsequent surgery was postponed with or without a booster of radiotherapy of about 30 Gy until a recurrent lesion was confirmed.

RESULTS

Sixty-seven percent of 100 patients with T1 or T2 had complete regression, while only 22 (35.5%) of 62 patients with T3 or T4 had complete regression. The 5-year local control rate by T classification, including the results of secondary treatments (surgery and/or radiotherapy and/or chemotherapy) for recurrent lesions, was 91% for T1, 89% for T2, 76% for T3 and 61% for T4. The 5-year local control rate according to treatment methods was 95% in the group without surgery and 86% in the group with surgery for T1 and T2 patients. The rates were 54% and 71%, respectively for T3 and T4 patients. The cause specific 5-year survival rate by stage was 75% for Stage I, 87% for Stage II, 71% for Stage III, 51% for Stage IV and 70% overall.

CONCLUSION

The combination of radiotherapy and chemotherapy could be a conservative radical treatment for T1 and T2 patients with lower gingival carcinoma.

[A study of intra-arterial infusion with carboplatin (CBDCA) for 2 patients with maxillary gingival cancer]

In 2 cases of squamous cell carcinoma of maxillary gingiva, carboplatin (CBDCA) was administered by continuous infusion for 5 days, and the clinical outcome and platinum concentrations in the peripheral blood, urine and tissue were investigated. Clinical effects were PR in one of the 2 cases and CR in the other. Platinum concentrations were as high as 3.17 and 13.90 micrograms/g in the tissue, but low in peripheral blood, not exceeding 0.61 and 0.62 micrograms/ml, respectively. These findings suggested that the present method secures the transport of the agent to a local site, with possible reduction of side effects.

Gingival Kaposi's sarcoma and periodontitis. A case report and suggested treatment approach to the combined lesions

Kaposi's sarcoma is frequently observed in patients with the acquired immunodeficiency syndrome, and the mouth is a common site for these lesions. Gingival Kaposi's sarcoma lesions can often be exacerbated by coexisting periodontal disease. To obtain the best treatment results, it is important to recognize and treat the gingival Kaposi's sarcoma lesion and the associated periodontitis concomitantly. In this report we describe a case of oral Kaposi's sarcoma in which gingival debridement, root planning and scaling, and monitored oral hygiene were used in conjunction with intralesional and systemic chemotherapy. These combined therapies significantly reduced the size of the lesions and dramatically improved the symptoms.

HIV infection: clinical features and treatment of thirty-three homosexual men with Kaposi's sarcoma

The clinical findings of patients with oral Kaposi's sarcoma are reviewed. These oral findings commonly included candidiasis, hairy leukoplakia, gingivitis associated with human immunodeficiency virus (HIV), periodontitis, and other symptoms, including xerostomia. The other common symptoms of HIV disease that may be of importance in leading to a diagnosis are reviewed in this patient group. Treatment by local radiotherapy or by intralesional vinblastine of these oral Kaposi's sarcomas resulted in successful palliation, with more than 50% regression of the lesions in 80% of the patients treated.

[Relapse of gingival tumor during hematological remission in acute promyelocytic leukemia]

A 56-year-old man was admitted to the hospital in April, 1986, with the chief complaint of fatigue. The diagnosis of acute promyelocytic leukemia (APL) was made based on the proliferation of atypical promyelocytes in the bone marrow. No gingival swelling was found on admission. A complete remission was achieved by the BHAC-DMP therapy and maintained by the consolidation therapy and the intensification therapy. In July, 1987, he noticed a solitary gingival tumor around the left lower second molar. The biopsy showed the massive infiltration of leukemic cells, despite the hematological remission. Combination chemotherapy was not effective but the tumor disappeared by irradiation. A hematological relapse occurred in November, 1987, but the second complete remission was achieved by the AB-triple V therapy. He died because of the second hematological relapse in July, 1988. Along with the wide use of intensive chemotherapy for acute leukemia, tumor forming leukemia during the hematological remission, as seen in this case, would be increasing. Thus, we should not overlook any newly formed tumor in the treatment of leukemia.

[Radio- and radio-chemosensitivity of human head and neck cancer cell line detected by human tumor clonogenic assay]

The radiosensitivity and radio-chemosensitivity of 3 series of human cancer cell lines were evaluated by human tumor clonogenic assay. The sources of cell lines were gingiva carcinoma (Ca9-22), uterus carcinoma (Hela) and gastric carcinoma (MKN-45). BLM and CDDP were used, and chemosensitivity of gingiva carcinoma tended to be higher than other cell lines. Radiosensitivity was same as MKN-45. Isobologram were employed for quantitation of the interaction between the irradiation and anti-cancer agents. In Ca9-22, the interaction of between gamma-rays, BLM and CDDP was supra-additive. Hela was also supra-additive, but in MKN-45, the interaction of between gamma-rays and BLM was sub-additive.

[MTX-BLM therapy for squamous cell carcinoma of the oral cavity]

Effects of Methotrexate (MTX) alone and sequential combination chemotherapy of MTX and Bleomycin (BLM) were evaluated in 29 primary cases of squamous cell carcinoma of the oral cavity. MTX 50mg or 500 mg was administered intravenously once a week for a total dose of 100 to 200 mg in 10 cases and 1000 mg in 19 cases. In the cases of MTX 500 mg, CF (Leucovorin) rescue was given subsequently. BLM 15 mg was also administered intravenously twice a week for a total dose of 45-90 mg in 25 cases, so that 4 patients received MTX alone, 6 were transferred from BLM to MTX treatment and 19 were transferred from MTX to BLM. Objective response rate to MTX in cases of single and prior administration was 12/23 (52.2%). Treatment was found to be effective clinically in cases of exophytic growth type and histologically in cases of well differentiated types of tumor cells and well defined types of tumor-host borderline. Objective response rate to MTX treatment followed by BLM was 12/19 (57.9%) while that of BLM switched to MTX was 3/6 (50.0%). Side-effects, such as myelosuppression and anorexia, were observed in 12/29 cases given MTX, while, in only one case given BLM, skin reaction was observed. With respect to side-effects and the general preoperative condition of patients, the MTX to BLM course seemed to be better than that in which BLM was switched to MTX. Moderate-dose MTX: CF rescue + small-dose BLM therapy for oral cancer was, therefore, concluded to be useful as a preoperative adjuvant chemotherapy.