J Korean Assoc Oral Maxillofac Surg.  2016 Jun;42(3):133-138. 10.5125/jkaoms.2016.42.3.133.

Muscular invasion by oral squamous cell carcinoma of the posterior mandibular alveolar ridge is associated with cervical lymph node metastasis

• Min SK
• Myoung H
• Lee JH
• Kim MJ

• KMID: 2309254
• DOI: http://doi.org/10.5125/jkaoms.2016.42.3.133

Abstract

OBJECTIVES
To assess the association between muscle invasion by oral squamous cell carcinoma of the posterior mandibular alveolar ridge and cervical lymph node metastasis on the basis of preoperative magnetic resonance imaging (MRI).
MATERIALS AND METHODS
Twenty-six patients with oral squamous cell carcinoma of the posterior mandibular alveolar ridge were evaluated by MRI. The associations between cervical lymph node metastasis and independent factors evaluated by MRI were analyzed. Overall survival was also analyzed in this manner. Representative biopsy specimens were stained with anti-podoplanin and anti-CD34 antibodies.
RESULTS
Mylohyoid muscle invasion was associated with cervical lymph node metastasis. A combinational factor of mylohyoid and/or buccinator muscle invasion was also associated with cervical lymph node metastasis. Cervical lymph node metastasis and masticator space invasion had a negative effect on overall survival. No lymphatic vessels were identified near the tumor invasion front within the mandible. In contrast, lymphatic vessels were identified near the front of tumor invasion in the muscles.
CONCLUSION
This study demonstrates an association between muscular invasion by oral squamous cell carcinoma of the posterior mandibular alveolar ridge and cervical lymph node metastasis.

Keyword

Oral squamous cell carcinoma; Mandibular alveolar ridge; Muscle invasion; Cervical lymph node metastasis

MeSH Terms

Alveolar Process*
Antibodies
Biopsy
Carcinoma, Squamous Cell*
Epithelial Cells*
Humans
Lymph Nodes*
Lymphatic Vessels
Magnetic Resonance Imaging
Mandible
Muscles
Neoplasm Metastasis*
Antibodies

Figure

• 

  Fig. 1 Anatomical factors assessed on preoperative magnetic resonance imaging. Examples of bone marrow invasion (arrow) (A), sublingual space invasion (arrowhead) and buccinator muscle invasion (arrow) (B), masticator space invasion (arrow) (C), and mylohyoid muscle invasion (arrow) (D) are shown.

• 

  Fig. 2 Immunohistochemical stainings of sections from representative specimens are shown. No lymphatic vessels are identified in the tumor front within the marrow space of the mandible (A), while lymphatic vessels (arrows) are present at the submocosa overlying the mandible (B). Both Fig. 2. A and 2. B are different areas of the same section stained with anti-podoplanin antibody (A: ×100, B: ×200). With no evidence of lymphatic vessels near the bone marrow invasive tumor front in the anti-podoplanin-stained section (C) (×100), the capillary structures are variously stained by anti-CD34 antibody in a serial section (D) (×100). In contrast with the bone marrow, muscles attached to the mandible contain numerous lymphatic vessels (arrows) (E), thus when the tumor invades the muscles, they have close access to the lymphatic vessels (F). Fig. 2. E and 2. F stained with anti-podoplanin antibody (E: ×200, F: ×100).

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