原発巣切除後, 局所再発なく後発転移をきたした非進展舌癌の検討. -とくに腫瘍の浸潤様式との関連について

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Characteristics of cervical metastasis after excision of only primary lesion in cancer of the tongue were investigated from clinical and histological findings. Metastasis after treatment was found in 5 out of 16 cases which showed no local recurrence more than one year after excision of only primary lesion. Four of these five cases were clinically small in size (T1:4, T2:1) and endophytic in growth pattern. On the other hand, they were histologically of a tendency of low grade differentiation and high grade nuclear-atypia. The most interesting finding was that these cases all showed diffuse invasion in the tumor-host borderline. These cases were classified into three of grade 4 C and two of grade 4 D in the mode of tumor invasion by modified Jacobsson's criteria (Yamamoto & Kohama, 1982). Duration from the time of primary tumor excision to that of palpation of cervical metastasis was 6-20 months. Size of metastatic tumor ranged from 20 to 80 mm in diameter. Number of metastatic nodes was 1 in three cases, 3 and 7 in one case each. Location of nodes were level 1 and 2 in level of involvement proposed by the UICC. The control of these metastases was not so easy and resulted in bad survival rate (tumor-free survival: 2/5, 40%). Therefore for these cases strict follow up at least for one year and in some situations, prophylactic neck dissection would be recommended.
社団法人日本口腔外科学会の論文