Kurita Masakazu, Hirano Koichi, Ebihara Satoshi, Takushima Akihiko, Harii Kiyonori, Fujino Takashi, Fujioka Yasunori
Department of Plastic, Reconstructive, Aesthetic, and Head and Neck Surgery, Kyorin University School of Medicine, Mitaka-City, Tokyo, Japan.
Int J Clin Oncol. 2007 Dec;12(6):448-54. doi: 10.1007/s10147-007-0711-9. Epub 2007 Dec 21.
We report a case of mesopharyngeal squamous cell carcinoma with spontaneous regression of lymph node metastasis. Spontaneous regression of lymph node metastasis of head and neck carcinoma has not been reported previously. Possible causes of the regression of lymph node metastasis include regression of lymphocytic division transiently inflated by an immunological stimulus, and en-bloc tumor necrosis due to degradation of vascularity, such as thromboembolism and intranodal hemorrhage. However, the patient's history and repeated imaging analyses suggested that these factors were not responsible for the regression. To clarify the etiology of this rare phenomenon, we investigated the cause of spontaneous regression with analyses of paraffin-embedded sections.
The frequency of cystic lesions, en-bloc necrotic lesions, and apoptosis of carcinoma were investigated with immunohistochemical analysis, and these features were compared with those in specimens from five other patients with head and neck squamous cell carcinoma.
The present case revealed no tendency towards microscopically confirmed cystic formation or necrosis, but the frequency of apoptosis was significantly higher than that in the other five cases. The apoptotic tendency was not restricted to the lymph node in which spontaneous regression was confirmed clinically, but was also consistently observed in other lymph nodes and in the primary lesion that was detected and radically ablated 2 months after complete neck regional dissection had been done.
Our case may be the first case of squamous cell carcinoma undergoing spontaneous regression in which enhanced apoptosis was demonstrated quantitatively. The findings were considered to contribute to evidence of spontaneous regression in squamous cell carcinoma of the head and neck resulting from enhanced apoptosis.
我们报告一例中咽鳞状细胞癌伴淋巴结转移自发消退的病例。头颈部癌淋巴结转移的自发消退此前未见报道。淋巴结转移消退的可能原因包括因免疫刺激而短暂增生的淋巴细胞分裂消退，以及由于血管退化（如血栓栓塞和结内出血）导致的肿瘤整块坏死。然而，患者的病史和反复的影像学分析表明这些因素并非消退的原因。为阐明这一罕见现象的病因，我们通过对石蜡包埋切片的分析来研究自发消退的原因。
采用免疫组织化学分析研究癌组织中囊性病变、整块坏死病变及凋亡的频率，并将这些特征与其他5例头颈部鳞状细胞癌患者的标本进行比较。
本病例在显微镜下未显示出形成囊肿或坏死的倾向，但凋亡频率明显高于其他5例。凋亡倾向不仅限于临床上证实有自发消退的淋巴结，在完全颈部区域清扫术后2个月检测到并根治性切除的其他淋巴结及原发灶中也始终观察到。
我们的病例可能是首例经定量证实凋亡增强的鳞状细胞癌自发消退病例。这些发现被认为有助于为头颈部鳞状细胞癌因凋亡增强而自发消退提供证据。
