口腔扁平上皮癌および周辺部における免疫組織化学的研究

Abstract

Various stages of dysplasia are seen pathologically in the surrounding oral mucosal epithelium of oral squamous cell carcinoma. It is feared that carcinoma from residual cancer cells develops into the surrounding mucosa after macroscopic resection alone of the lesion. In recent years, cancer-related antigens for malignant tumors have been developed and immunohistochemical studies using them have been active. These antigens have been evaluated positively as clinical indicators for diagnosis, clinical progress, prognosis, and others. Fifty cases with squamous cell carcinoma in oral cavity were investigated pathologically and immunohistochemically. Immunohistochemical studies examined localization of carcinoembryonic antigen (CEA), keratin and epithelial membrane antigen (EMA) on carcinoma and epithelium of the surrounding site. The results were as followed : 1) With the histological grading of squamous cell carcinoma cells, 33 cases were well differetiated type, 10 cases were the moderate differentiated type, and 7 cases were poor differentiated type. With the epithelium of the surrounding site, 15 cases were the mild or none epithelial dysplasia (Class I), 19 cases were the moderate epithelial dysplasia (Class II), and 11 cases were the severe epithelial dysplasia (Class III). There were no correlations between the grading and the epithelial dysplasia of the surrounding site. 2) CEA, keratin and EMA were closely correlated with dyskeratosis of keratinized area and epithelial pearls. Also, the reactions rose with the rise in the grading, and the reactions of CEA and keratin also rose with it in the cellular stratum like spinous cell adjacent to the keratinized area. 3) EMA was detected in the poor differantiated type where CEA and keratin were negative, it was useful as the epithelial marker. 4) The surface of the keratinized epithelium of the surrounding site of the carcinoma was parakeratinized or hyperkeratinized epithelium, in the majority of the case, and the case of hyperplastic stratum spinosum also was found. 5) The reactions of CEA, keratin and EMA tended to increase with Class II and III than with Class I in the parakeratinized epithelium. CEA showed few cases in the stratum spinosum, but it showed positive reactions in the upper hyperplastic stratum spinosum. Keratin showed strongly positive with Class II and III. In the stratum basale, CEA was negative, and keratin showed the cases of strongly positive, moderately positive with Class II and III. 6) On the basis of the foregoing findings, CEA, keratin and EMA demonstrated biological quality with rise in keratinization of oral squamous cell carcinoma. It is useful for judgement of the grading and the parameter of canceration to the surrounding tissue. These findings provide indications in planning the surgical safety margin for surgical resection of squamous cell carcinoma.