Kohmura Y, Hosoda S, Kawabe Y, Isojima G
Gan To Kagaku Ryoho. 1983 May;10(5):1320-7.
Nine cases of squamous cell carcinoma of the tongue were treated by either intramuscular or local injections of total 60 to 200 mg of Bleomycin (BLM), and 7 cases by total doses of 1,200 to 5,320 rads of irradiation, followed by surgical removal of primary neoplasm. The histologic examination of the biopsied and surgical specimens from each case was done focussing on the antitumor effect of both treatments. In the cases with keratinizing component more than 25% in the biopsy specimens, the earliest change due to BLM was vacuolar degeneration of proliferating cells either at the base of superficial cancer epithelia or at the periphery of invading cancer foci. When the proliferating cancer cells disappeared, an appearance of invading cancer foci resembled to that of ectopic islands of normal squamous epithelium. These foci of differentiated squamous cell carcinoma gradually underwent morphological change into the so-called cancer pearls. Finally, the cancer pearls degenerated, leaving foreign bodies consisting of concreted keratin. The stromal reaction was characterized by the formation of granulation tissues accompanying significant numbers of foreign body giant cells. In the cases of lingual carcinoma with poor squamous differentiation, these processes were indistinct. Instead, the proliferating anaplastic cancer cells were markedly reduced and the remaining cancer cells transformed into large bizarre cells, probably at degenerative stage. On the histologic level, irradiation showed essentially similar antitumor effect to BLM, except for the rapid formation of concreted keratin bodies accompanying more abundant foreign body giant cells and the presence of irregular granulation tissues at different stages. We concluded that both BLM and irradiation had a powerful antitumor action on squamous cell carcinoma of the tongue. It is necessary, however, to establish an appropriate treatment modality through the more detailed histologic evaluation of a number of lingual cancer patients in consideration of the natural history of this neoplasm.
9例舌鳞状细胞癌患者接受了肌肉注射或局部注射博来霉素（BLM）治疗，总量为60至200毫克，7例患者接受了总量为1200至5320拉德的放射治疗，随后手术切除原发肿瘤。对每例患者活检和手术标本进行组织学检查，重点关注两种治疗方法的抗肿瘤效果。活检标本中角化成分超过25%的病例，BLM引起的最早变化是浅表癌上皮底部或浸润癌灶周边增殖细胞的空泡变性。当增殖的癌细胞消失后，浸润癌灶的外观类似于正常鳞状上皮的异位岛。这些分化型鳞状细胞癌灶逐渐发生形态变化，形成所谓的癌珠。最后，癌珠退化，留下由凝固角蛋白组成的异物。间质反应的特征是形成伴有大量异物巨细胞的肉芽组织。在鳞状分化差的舌癌病例中，这些过程不明显。相反，增殖的间变癌细胞明显减少，其余癌细胞可能处于退化阶段，转化为大的奇异细胞。在组织学水平上，放射治疗显示出与BLM基本相似的抗肿瘤效果，只是凝固角蛋白体形成更快，伴有更丰富的异物巨细胞，且存在不同阶段的不规则肉芽组织。我们得出结论，BLM和放射治疗对舌鳞状细胞癌都有强大的抗肿瘤作用。然而，有必要通过对大量舌癌患者进行更详细的组织学评估，并考虑该肿瘤的自然病程，来建立合适的治疗模式。
