野口 忠秀

CD14はマクロファージのLPS (lipopolysacharide) のレセプターの1つとして知られている。口腔扁平苔癬の発症と進展に細菌性因子の関与の可能性を検討するため, CD14の病変部上皮内における発現について免疫組織学的に検討した。対象は病理組織学的に扁平苔癬と診断された10症例で, 採取部位はすべて頬粘膜, 臨床型は網状型が5例, ビラン型が4例, 環状型が1例であった。一次抗体としてマウス抗ヒトCD14, マウス抗ヒトMac-1を使用し, 蛍光抗体法にて観察した。<BR>その結果, 10症例中7症例において上皮細胞細胞質内にCD14の陽性像が認められた。Mac-1はすべて陰性であった。さらに5例についてウェスタンブロッティング法を用いて検討すると55kDaのCD14のバンドが検出された。<BR>以上の結果より, 口腔扁平苔癬の発症と進展に可溶型CD14の関与が示唆された。

A case of acute myelocytic leukemia with unusual oral manifestation characterized by nodular lesion of the tip of the tongue is reported. The patient was a 31-year-old woman who had been admitted for treatment of recurrent leukemia. Pathologically, the lesion was diagnosed as leukemic cell infiltration. The possible reasons for this localized specific leukemic cell infiltration are discussed.

ICAM-1は, 上皮細胞と活性化T細胞の接着過程において重要な役割を果たす接着分子の一つである。<BR>今回われわれは, 口腔粘膜と表皮上皮細胞におけるICAM-1の発現状態の違いを解析する目的で, ヒト歯肉ならびに皮膚由来培養上皮細胞を用い, ICAM-1の発現についてIFN-γの影響を観察した。<BR>材料と方法: 検体となる歯肉ならびに皮膚は手術の際に採取し, 1～2週間培養後, 培地にIFN-γを加え5～48時間後に免疫組織化学的ならびにフローサイトメトリーにてICAM-1の発現を観察した。<BR>結果: 免疫組織化学的観察において, 歯肉ではIFN-γ10³U/ml添加24時問後でICAM-1の発現を認めたが, 10²U/mlでは発現は認めなかった。一方, 皮膚では, 10²U/mlで発現を認めた。フローサイトメトリーでの解析では, 10, 10²U/ml添加12, 24, 48時間後と10³U/ml添加12時間後において, 皮膚に比べ歯肉はICAM-1の発現量が統計学的に有意に低い結果であった。<BR>われわれの結果は, 口腔粘膜と皮膚上皮細胞ではICAM-1発現におけるIFN-γの感受性に違いがあることを示唆した。

In order to clarify the molecular mechanism of cell adhesion between oral keratinocytes, expression pattern of adhesion molecules in human normal gingival epithelia and cultured gingival keratinocytes was analized. The expression pattern was examined immunohistochemically by using monoclonal antibodies for human integrins α2, α3, α5, α6, β1, β4, E-cadherin, P-cadherin, desmoglein, ICAM-1, and VCAM-1. The expression of integrins α2, α3, and β1 was observed as a linear pattern corresponding with the cell membrane in the basal and the spinous cell layers, and that of a6 and β4 was observed on basal cell surface of the basal cell layer.<BR>E-cadherin and desmoglein was observed on the cell membrane of the basal cell layer and the spinous cell layer, while that of P-cadherin in the basal cell layer only. Integrins α2, α3, β1, and Ecadherin were also observed on cell membranes in cultured gingival keratinocytes. After treatment with cytochalasin-B, microfilaments were disrupted and the linear expression pattern of integrins α2, α3 and β1 was drastically changed to a dotted pattern. However, there were no such drastic changes in the expression pattern of E-cadherin even after treatment with cytochalasin-B.<BR>These results demonstrated that integrins α2, α3, β1, and E-cadherin are expressed in cultured human gingival keratinocytes, and suggested that distribution of integrins is restricted by microfilaments but that of E-cadherin may not be restricted strongly by these filaments.

口腔扁平苔癬と肝機能障害との関連性を明らかにするため, 病理組織学的に扁平苔癬と診断された68症例について, 肝機能との関連を臨床統計的に検討した。(1) 肝機能異常群 (Group 1) は12例 (17. 6%), 正常群 (Group 2) は56例 (82.4%) であった。(2) 性差は Group 2で男性が多く, 平均年齢は差はなかった。(3) 主訴は Group 2に比べ Group 1でしみるが多かった。(4) 既往歴は Group 1で肝疾患, 次いで糖尿病の順で, Group 2では高血圧, 次いで消化器潰瘍であった。(5) 発症部位は両群とも頬粘膜, 舌, 歯肉の順であったが1人平均病変部位数は Group 1は4.8部位, Group 2は2.8部位と明らかに Group 1の方が多かった。(6) 臨床型は Group 1ではびらん型が60.7%と最も多く, Group 2では網状型が多かった。すなわち肝機能異常群はびらん型が多く, 病変が広範囲であることが明らかになった。以上のことから肝機能異常が扁平苔癬の発症・増悪因子として関与している可能性が示唆された。

Tongue dorsal epithelia exhibit a highly specialized structure. In order to characterize biological features of tongue dorsal epithelia, expression pattern of cytokeratins and adhesion molecules in human normal tongue were analyzed. Positive reaction with monoclonal antibodies for cytokeratins AE 3, AE 5, No.5/6, and 903 was observed in the basal cell layer, the spinous cell layer and the keratinized layer, while CK 1 stained the basal cell layer and the spinous cell layer. Positive reaction with No.4 and No.13 was observed in the spinous cell layer of the interpapillal region, but no reaction was seen in the papillal region. The expression of integrin a2 was observed at the cell membrane of the basal cell layer and the spinous cell layer, and those of as and as were observed at the cell membrane of the basal cell layer in the interpapillal region. However, positive reaction with anti-a5 antibody was also seen in the spinous cell layer as well as basal cell layer in the interpapillal region. The localizations of as and 484 were demonstrated at the basal cell surface of the basal cell layer. The expressions of E-cadherin and desmoglein were observed at the cell membrane of the basal cell layer and the spinous cell layer, while that of P-cadherin in the basal cell layer only. Our results clearly demonstrated that there are significant differences in the expression patterns of cytokeratins and adhesion molecules between the region of papillae and interpapillal epithelia.

A case of verrucous carcinoma of the oral floor which had an excellent response to tegafur alone is reported.<BR>A 76-year-old woman complained of a swelling in the oral floor of 8 months' duration. Oral examination revealed an approximately elliptical tumor that measured 45×20×15mm and extended bilaterally from the oral floor to the alveolar mucosa. Regional lymph nodes were not clinically involved, and no distant metastasis was evident. She was orally administered 600mg per day of tegafur before operation. The tumor was reduced to about half of its primary size 10 days after the start of tegafur treatment. Two months later, no remaining verrucous carcinoma was observed on histologic examination.<BR>There were no noteworthy side effects. There is no evidence of recurrence or metastatic disease as of 28 months after treatment.

W e experienced a case of secondary syphilis in a 31-year-old male with eruption of the oral mucosa. Defined grayish white surfaced erosion with raised margin was observed on the lower lip. Slightly raised grayish white lesion was observed on the apex and bilateral edges of tongue, and a well-defined grayish white lesion with redness on the palate was also observed. The serological tests for syphilis were positive, and Treponema pallidum could be stained by Warthin-Starry method and immunofluorescene technique in the biopsy specimen taken from the lower lip and tongue. After the treatment with AMPC 1.5g/day for 8 weeks, and PCV 1.2 million unit/day for 4 weeks, the oral lesion disappeared in 3 weeks.

Tongue dorsal epithelia exhibit a highly specialized structure. In order to characterize biological features of tongue dorsal epithelia, expression pattern of cytokeratins and adhesion molecules in human normal tongue were analyzed. Positive reaction with monoclonal antibodies for cytokeratins AE 3, AE 5, No.5/6, and 903 was observed in the basal cell layer, the spinous cell layer and the keratinized layer, while CK 1 stained the basal cell layer and the spinous cell layer. Positive reaction with No.4 and No.13 was observed in the spinous cell layer of the interpapillal region, but no reaction was seen in the papillal region. The expression of integrin a2 was observed at the cell membrane of the basal cell layer and the spinous cell layer, and those of as and as were observed at the cell membrane of the basal cell layer in the interpapillal region. However, positive reaction with anti-a5 antibody was also seen in the spinous cell layer as well as basal cell layer in the interpapillal region. The localizations of as and 484 were demonstrated at the basal cell surface of the basal cell layer. The expressions of E-cadherin and desmoglein were observed at the cell membrane of the basal cell layer and the spinous cell layer, while that of P-cadherin in the basal cell layer only. Our results clearly demonstrated that there are significant differences in the expression patterns of cytokeratins and adhesion molecules between the region of papillae and interpapillal epithelia.

A case of verrucous carcinoma of the oral floor which had an excellent response to tegafur alone is reported.<BR>A 76-year-old woman complained of a swelling in the oral floor of 8 months' duration. Oral examination revealed an approximately elliptical tumor that measured 45×20×15mm and extended bilaterally from the oral floor to the alveolar mucosa. Regional lymph nodes were not clinically involved, and no distant metastasis was evident. She was orally administered 600mg per day of tegafur before operation. The tumor was reduced to about half of its primary size 10 days after the start of tegafur treatment. Two months later, no remaining verrucous carcinoma was observed on histologic examination.<BR>There were no noteworthy side effects. There is no evidence of recurrence or metastatic disease as of 28 months after treatment.

W e experienced a case of secondary syphilis in a 31-year-old male with eruption of the oral mucosa. Defined grayish white surfaced erosion with raised margin was observed on the lower lip. Slightly raised grayish white lesion was observed on the apex and bilateral edges of tongue, and a well-defined grayish white lesion with redness on the palate was also observed. The serological tests for syphilis were positive, and Treponema pallidum could be stained by Warthin-Starry method and immunofluorescene technique in the biopsy specimen taken from the lower lip and tongue. After the treatment with AMPC 1.5g/day for 8 weeks, and PCV 1.2 million unit/day for 4 weeks, the oral lesion disappeared in 3 weeks.

Pemphigus vulgaris is accompanied by oral erosions in the overwhelming majority of cases. The authors studied oral findings at the first visit of 12 patients with pemphigus vulgaris.<BR>1. In 9 cases, the chief complaint was pain of the gingiva and/or oral mucosa. In 2 cases, it was erosion of the oral mucosa, and in 1 case it was oral bleeding.<BR>2. In 11 cases, erosion was observed in several regions of the oral cavity.<BR>3. Erosion was frequently observed on the buccal mucosa, gingiva and hard palate. However, erosion of the alveolar mucosa and tongue was rare.<BR>These results suggest that the characteristics of erosion differ depending on the region of the oral cavity which is affected.

Pemphigus vulgaris is accompanied by oral erosions in the overwhelming majority of cases. The authors studied oral findings at the first visit of 12 patients with pemphigus vulgaris.<BR>1. In 9 cases, the chief complaint was pain of the gingiva and/or oral mucosa. In 2 cases, it was erosion of the oral mucosa, and in 1 case it was oral bleeding.<BR>2. In 11 cases, erosion was observed in several regions of the oral cavity.<BR>3. Erosion was frequently observed on the buccal mucosa, gingiva and hard palate. However, erosion of the alveolar mucosa and tongue was rare.<BR>These results suggest that the characteristics of erosion differ depending on the region of the oral cavity which is affected.