Clinico-pathological Evaluation of Cervical Lymph Node Metastasis of Tongue Squamous Cell Carcinoma Keywords :

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1 Clinico-pathological Evaluation of Cervical Lymph Node Metastasis of Tongue Squamous Cell Carcinoma Yasuhiko Tsuyama, Takashi Nakatsuka, Yoshiyuki Mori, Tsuyoshi Takato (Department of Plastic and Reconstruction Surgery, Saitama Medical School, Moroyama, Iruma-gun, Saitama , Japan, Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, University of Tokyo ) We retrospectively evaluated the relationship between clinico-pathological factors and cervical lymph nodes metastases in 50 patients with primary tongue squamous cell carcinoma, who were treated by curative resection from April 1991 to March Clinically, we evaluated the tumor size according to the TNM classification of UICC(1992). Histopathologically, we evaluated the tumor differentiation, pattern of invasion, stage of invasion and lymphoplasmacytic infiltration. Primary and secondary metastases to the cervical lymph nodes after initial therapy were found in 13 patients (26%) and 6 patients(12%), respectively. As the statistical analysis, the Mann-Whitney test was used to compare the occurrence of primary metastases with the frequency of no metastases, and the occurrence of secondary metastases with the frequency of no metastases. There was a significant correlation between the stage of invasion and the occurrence of cervical lymph nodes metastases(p 0.05). A primary tumor was found associated with cervical lymph nodes metastases in the cases with a total histological malignancy score(total score of pattern of invasion, stage of invasion and lymphoplasmacytic infiltration.) of 8 or more(). Thus, the stage of invasion and histological grading of malignancy are considered to be the most important risk factors of cervical lymph nodes metastases of tongue squamous cell carcinoma. Keywords : tongue, squamous cell carcinoma, cervical lymph node metastasis J Saitama Med School 2002;29: (Received January 8, 2002) 1-5) 1986Anneroth 3) ,8,9)

2 1 :13 :6 : UICC TNM 6) WHO 7) Anneroth 3) Table 1:Point 1~4 AnnerothPoint 34 Point 3 Point 4 Mann-Whitney Fisher s exact probability method 5 1. T Table 2 1 P Table 3 P Table Table 5 1 Table 1. Histologic grading of malignancy regarding tumor-host relationship Point Morphologic Parameter Pattern of Pushing, well delineated Infi ltrating, solid cords, Small groups or cords Marked and wide- Invasion infi ltrating borders bands and/or strands of infi ltrating cells spread cellular dissoci- (n 15). ation in small groups of cells(n 15) and/or in single cells Stage of Carcinoma in situ and/ Distinct invasion, but Invasion below lamina Extensive and deep Invasion or questionable invasion involving lamina pro- propria adjacent to invasion replacing Pria only muscles, salivary gland most of the stromal tissues and periosteum tissue and infi ltrating jaw bone Lympho- Marked Moderate Slight None plasmacytic infi ltration Histologic malignancy grading system of oral squamous cell carcinoma proposed by Anneroth et al. (1987)

3 5. (Table 6) 1 P 0.61 P Table 7 Point 8 P 0.05 Point 9 T1 T2 Table 4. Relationship between pattern of invasion and the Pattern of Primary Secondary No Total invasion metastasis metastasis metastasis Point Point Point Point Table 2. Relationship between T * factors and the frequency of cervical lymph nodes metastases Table 5. Relationship between stage of invasion and the T category Primary Secondary No Total metastasis metastasis metastasis Stage of Primary Secondary No Total invasion metastasis metastasis metastasis T T T T Point Point Point Point P 0.98 T * category of TNM classifi cation according to UICC, Table 3. Relationship between dif ferentiation and the Table 6. Relationship between lymphoplasmacytic infi ltration and the Lymphoplasmacytic Primary Secondary No Total Degree of Primary Secondary No Total Differentiationmetastasis metastasis metastasis Grade Grade Grade infi ltration metastasis metastasis metastasis Point Point Point Point P 0.10 P 0.61 P 0.18

4 Table 7. Relationship between total histological malignancy score and the total histological malignancy score 10,11) 12,13) T1 T2 T1 T2 Point 9, 14) 2,5,15) Point4 4,5,8) 9) 4~5 mm 5,8) ) 1 1-3,8,10,11,20-23) 21) Point 8 23)

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