Squamous cell carcinoma occurring with aspergillosis in the maxillary sinus: a case report and histological study

변준호,이정희,노규진,박봉욱,Byun, June-Ho,Lee, Jeong-Hee,Rho, Gyu-Jin,Park, Bong-Wook The Korean Association of Oral and Maxillofacial S 2010 대한구강악안면외과학회지 Vol.36 No.2

The coexistence of aspergillosis and squamous cell carcinoma (SCC) in the maxillary sinus was very rare. To our knowledge, this is the second report of coexistent SCC and aspergillosis in the maxillary sinus. A 58-year-old man underwent surgery for unilateral maxillary sinus infection with oroantral fistula. In the surgical specimen, SCC and aspergillosis were co-detected with routine and immunohistochemical stainings. Moreover, human papillomavirus 18 (HPV-18) was detected by polymerase chain reaction in the sinus specimen. The patient was re-operated with subtotal maxillectomy and has been followed up for two years without any evidence of recurrence or metastasis. Although it is not understood how aspergillosis could induce carcinoma formation, the chronic inflammation caused by prolonged fungal infection might be carcinogenic. Moreover, HPV-16 and -18 were another causative pathogens of SCC in the head and neck region. We recommend careful examination, including preoperative cytology, in patients with maxillary sinus fungal infections because of the potential for cancer development.

설암의 술전 조직표본에서 악성도와 혈관내피세포성장인자 발현과의 상관관계

변준호,박봉욱,정인교,김종렬,김욱규,박봉수,김규천,Byun, June-Ho,Park, Bong-Wook,Chung, In-Kyo,Kim, Jong-Ryoul,Kim, Uk-Kyu,Park, Bong-Soo,Kim, Gyoo-Cheon 대한악안면성형재건외과학회 2005 Maxillofacial Plastic Reconstructive Surgery Vol.27 No.6

Angiogenesis is important for the growth and metastasis of solid tumors. Some growth factors, inflammatory cytokines, and angiogenin are known to promote tumor angiogenesis. Among them, Vascular endothelial growth factor (VEGF) is the most intriguing factor in regard to tumor angiogenesis. Inhibition of VEGF activity by neutralizing antibodies or by the introduction of dominant negative VEGF receptors into endothelial cells of tumor-associated blood vessels resulted in the inhibition of tumor growth and in tumor regression, indicating that VEGF is a major initiator of tumor angiogenesis. VEGF promotes angiogenesis through their receptors, Flt-1 and Flk-1/KDR. on vascular endothelial cells. These two receptors were usually believed to be expressed specifically on vascular endothelial cell. Several reports have now shown that VEGF is not only significantly associated with microvessel density but also has prognostic value in both node-negative and node-positive oral squamous cell carcinoma. For many years several histologic features of the neoplasms are being considered when assessing the influence of malignancy grading on recurrence and prognosis. Among the characteristics investigated, degree of keratinization, nuclear pleomorphism, mode of invasion, microscopic depth of invasion, intravascular invasion, lymphocyte infiltration, and number of mitoses have been considered as important prognostic factors. So, this study was conducted to evaluate the correlation of vascular endothelial growth factor expression with malignancy in paraffin-embedded biopsy specimens from 11 patients with tongue cancers. Our results showed that high immunoreactivity specimens of VEGF expression were significantly lower keratinization degree and more pronounced nuclear pleomorphism than in low immunoreactivity specimens. Thus, VEGF expression could be used as a prognostic marker in tongue cancer.

성견에서 하악골 신장술 후 하악과두 연골의 조직학적 변화와 Matrix Metalloproteinase-2 (MMP-2)와 Tissue Inhibitor of Matrix Metalloproteinase-2 (TIMP-2)의 발현

변준호,박봉욱,조영철,성일용,손재희,김종렬,Byun, June-Ho,Park, Bong-Wook,Cho, Yeong-Cheol,Sung, Iel-Yong,Son, Jae-Hee,Kim, Jong-Ryoul 대한악안면성형재건외과학회 2006 Maxillofacial Plastic Reconstructive Surgery Vol.28 No.5

Purpose : This study was to clarify the changes in mandibular condyle after unilateral mandibular distraction osteogenesis throughout histological changes and expression of matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of matrix metalloproteinase-2 (TIMP-2). Materials & Methods : Intraoral distractors were placed via submandibular incision in 8 dogs. Two unoperated animals served as controls. Distraction was performed five days after osteotomy as a rate of 0.5 mm twice per day for 10 days. Two animals were sacrificed on 7, 14, 28, and 56 days after completion of distraction, respectively. Ipsilateral condyles were harvested and processed for histological and immunohistochemical examinations. Results : The condyle cartilage is separated into four layers: fibrous layer, proliferative layer, hypertrophic layer, and calcified layer. At 7 days and 14 days after distraction, the condylar cartilage showed the decreased thickness of the articular cartilage and reduced cellularity. At 28 days after distraction, there was an increase in cellularity of fibrous, proliferative, and hypertrophic layer. However, it demonstrated reduced cellularity compared to the control. At 56 days of after distraction, the articular cartilage was an almost normal histologic structure. Positive Safranin-O staining, indicative of sulfated proteoglycans, was examined in the condylar cartilge of nonloaded control. At 7 days and 14 days after distraction, the sulfated proteoglycans is almost completely depleted from the noncalcified part of the condylar cartilage. At 28 days after distraction, there was an increase in Safranin-O staining intensity. However, the staining intensity of the experimental condyle was weaker than that of the control. At 56 days of after distraction, the condylar cartilage showed almost normal Safranin-O staining pattern. In control condyle, MMP-2 immunostaining was seen in fibrous, proliferative, and hypertrophic layer of condylar cartilage, however, it demonstrated lack of staining in fibrous and proliferative layer. At 7 days and 14 days after distraction, strong MMP-2 immunoreactivity was seen in the fibrous, proliferative and hypertrophic layer of the condylar cartilage. At 28 days after distraction, MMP-2 immunostaining was seen in the fibrous and hypertrophic layer of condylar cartilage, however, their immunoactivity was reduced. At 56 days after distraction, MMP-2 immunoreactivity showed almost normal immunostaining pattern. In control condyle, TIMP-2 immunostaining was primarily seen in fibrous and hypertrophic layer of condylar cartilage, however, it demonstrated lack of staining in proliferative layer. At 7 days after distraction, very weak TIMP-2 immunoreactivity appeared in fibrous, proliferative and hypertrophic layer of the condylar cartilage. At 14 days after distraction, weak TIMP-2 immunoreactivity was seen in the fibrous, proliferative and hypertrophic layer of the condylar cartilage. At 28 days after distraction, TIMP-2 immunoreactivity was increased in the fibrous and hypertrophic layer of condylar cartilage. At 56 days after completion of distraction, TIMP-2 immunoreactivity showed almost normal immunostaining pattern. Conclusions : The results show that short-term outcome of physiologic distraction osteogenesis may lead to degenerative changes in the condylar cartilage. These alterations in the condylar cartilage may be considered as a pressure-related degeneration of the cartilage tissue. However, the long-term results suggest that the condylar cartilage display repair activity after mandibular distraction osteogenesis.

양성 및 악성 타액선 근상피종: 증례보고 및 면역조직화학적 연구

변준호,이종실,김종렬,박봉욱,Byun, June-Ho,Lee, Jong-Sil,Kim, Jong-Ryoul,Park, Bong-Wook 대한악안면성형재건외과학회 2009 Maxillofacial Plastic Reconstructive Surgery Vol.31 No.1

Benign myoepithelioma (BME) and malignant myoepithelioma (MME) of the salivary gland are very rare and its biologic behavior has not been clarified fully. Although, cases reports for BME and MME were increased in recent, their diagnostic criteria were not completely established. We describe herein a case of BME of the parotid gland and a case of MME of the palatal minor gland, respectively. Histologically, multinodular growth pattern, infiltration to adjacent tissues, and hyalinized and myxoid matrix were observed in MME, that were different histologic features compared with BME. Strong immunoreactivities for the S-100 protein and vimentin were detected in the tumor cells of BME and MME. In specimen of MME, moderately expressed p53 and strongly expressed p63 were detected. However, in specimen of BME, p53 was negatively and p63 was weakly expressed, respectively. In conclusion, the expression patterns of p53 and p63 as well as histologic aggressiveness might be used to diagnose the MME.

심하게 흡수된 상악골에서 자가 장골 이식술과 동시에 시행한 임프란트 치료의 안정성에 대한 연구

변준호,박봉욱,정희찬,김종렬,Byun, June-Ho,Park, Bong-Wook,Jeong, Hee-Chan,Kim, Jong-Ryoul 대한악안면성형재건외과학회 2006 Maxillofacial Plastic Reconstructive Surgery Vol.28 No.6

A severely atrophic maxilla may disturb the proper implant placement. The various bone graft techniques are required for simultaneous or delayed implantation in the cases of atrophic alveolar ridges. We present 11 consecutive patients treated with simultaneous implantation using the autogenous inlay and/or onlay bone grafts from iliac crest to the floor of the maxillary sinus and the alveolar crest. In the cases of atrophic maxilla, a total 69 implants were simultaneously placed with autogenous iliac bone graft. 40 fixtures were inserted in the sinus floor simultaneously with subantral block bone graft, the other 29 fixtures were placed in the anterior or premolar areas with block or particulate bone graft. The vertical alveolar bone height was measured with Dental CT at the preoperation and 6 months postoperation. Moreover, the implant stability quotients (ISQ) were measured by $Osstell^{TM}$ during second implant surgery at 6 months later of first implantation. All implants were obtained successful osseointegration with the grafted bone. The mean vertical increases were 3.9mm in the anterior ridges and 12.8mm in the posterior ridges. During the second implant surgery, mean ISQ were 62.95 in the anterior ridge and 61.32 in the posterior ridge. We concluded that the simultaneous implantation with autogenous iliac bone graft were stable and available methods for severely atrophic maxilla.

미니돼지에서 자가 피부유래 전구세포와 탈회골 및 피브린 스케폴드를 이용한 하악골 골결손부의 골재생에 대한 연구

변준호,최문정,최영진,심경목,김욱규,김종렬,박봉욱,Byun, June-Ho,Choi, Mun-Jeong,Choi, Young-Jin,Shim, Kyoung-Mok,Kim, Uk-Kyu,Kim, Jong-Ryoul,Park, Bong-Wook 대한악안면성형재건외과학회 2009 Maxillofacial Plastic Reconstructive Surgery Vol.31 No.3

Purpose: The aims of this study were to assess the in vitro co-culturing pattern of isolated skin-derived precursor cells (SKPs) with a mixed demineralized bone (DMB) and fibrin glue scaffold and to evaluate in vivo osteogenesis after transplantation of autogenous SKPs with a these mixed scaffold in the animal's mandibular defects. Materials and Methods: We isolated SKPs from the ears of adult 4 miniature pigs. The isolated SKPs were co-cultured with a mixed DMB and fibrin glue scaffold in a non-osteogenic medium for 1, 2, and 4 weeks. Histological characteristics of in vitro co-cultured cells and scaffold were evaluated. $1{\times}10^7\;cells/100\;{\mu}l$ of autogenous porcine SKPs were grafted into the mandibular defects with a DMB and fibrin glue scaffold. In the control sites, only a scaffold was grafted, without SKPs. After two animals each were euthanized at 2 and 4 weeks after grafting, the in vivo osteogenesis was evaluated with histolomorphometric and osteocalcin immunohistochemical studies. Results: Homogeneously shaped skin-derived cells were isolated from porcine ear skin after 3 or 4 weeks of primary culture. In vitro osteogenic differentiation of SKPs was observed after co-culturing with a DMB and fibrin glue scaffold in a non-osteogenic medium. Von Kossa-positive bone minerals were also noted in the co-cultured medium at 4 weeks. As the culture time progressed, the number of observable cells increased. Trabecular new bone formation and osteocalcin expression were more pronounced in the SKP-grafted group compared to the control group. Conclusion: These findings suggest that autogenous SKP grafting with a DMB and fibrin glue scaffold can serve as a useful alternative to bone grafting technique.

기저세포모반증후군과 관련된 악골의 다발성 치성각화낭종의 치험례

변준호(June Ho Byun),박성희(Seong Hee Park),김욱규(Uc Kyu Kim),박혜련(Hae Ryoun Park),정인교(In Kyo Chung) 대한구강악안면외과학회 2000 대한구강악안면외과학회지 Vol.26 No.3

The basal cell nevus syndrome is a well recognized entity, the major symptoms of which are basal cell nevi, multiple jaw cysts, skeletal anomalies, and ectopic calcification. The syndrome follows a hereditary pattern, which is characterized by a highly penetrant, autosomal dominant gene with multiple and variable effects. The patient often has a characteristic face, with frontal and temporoparietal bossing, which results in an increased cranial circumference. The eyes may appear widely separated, and 40 percent of patients have true ocular hypertelorism. Jaw cysts are one of the most constant features of the syndrome and are present in at least 75 percent of the patients. The cysts are odontogenic keratocysts and frequently multiple. Radiographically, the cysts in patients with basal cell nevus syndrome do not differ significantly from isolated keratocysts. The cysts in patients with this syndrome are often associated with the crowns of unerupted teeth; on radiographs they may mimic dentigerous cysts. We report a case of multiple odontogenic keratocysts associated with basal cell nevus syndrome with the literature of review.

하악골체부에 발생한 간엽성 연골육종:

변준호(June-Ho Byun),최문정(Moon-Jeong Choi),이종실(Jong-Sil Lee),노규진(Gyu-Jin Rho),김종렬(Jong-Ryoul Kim),박봉욱(Bong-Wook Park) 대한구강악안면외과학회 2008 대한구강악안면외과학회지 Vol.34 No.6

Mesenchymal chondrosarcoma is a rare malignant tumor of bone and soft tissue. This aggressive form of chondrosarcoma represents only 3% to 9% of all chondrosarcomas. This neoplasm is characterized by sheets or clusters of undifferentiated spindle or round cells surrounding discrete nodules of well-differentiated cartilage. We experienced a case of mesenchymal chondrosarcoma on mandibular body. Two years ago, the patient had been treated the intrabony cystic lesion on mandiblular left body. At that time, cartilage portion was not detected in the cystic specimen. Two years after cyst enucleation, the recurred large neoplasm in the mandibular left body was noted, and it was diagnosed as 4.5 cm sized mesenchymal chondrosarcoma. The mandibular tumor was widely resected and rigid-plate and cervical musculocutaneous flap were used for reconstruction of resected bone and soft tissues. No complications and recurrence were noted for 6 months postoperatively.

하악골 신장술 후 신생골 조직에서 자가분비성장능력의 활성에 대한 실험적 연구

변준호(June-Ho Byun),박봉욱(Bong-Wook Park),박성철(Seong-Cheol Park),김규천(Gyoo-Cheon Kim),박봉수(Bong-Soo Park),김종렬(Jong-Ryoul Kim) 대한구강악안면외과학회 2007 대한구강악안면외과학회지 Vol.33 No.4

Background: Distraction osteogenesis (DO) is a useful method for treating cases demanding the generation of new bone. During DO, the angiogenic activity is crucial factor in the new bone formation. The aim of this study was to detect the autocrine growth activity in the cellular components of the distracted bone with observation of the co-expression of vascular endothelial growth factor (VEGF) and its receptors following the mandibular DO. Materials and methods: Unilateral mandibular distraction (0.5 mm twice per day for 10 days) was performed in six mongrel dogs. Two animals were killed at 7, 14, and 28 days after completion of distraction, respectively. Immediately after the animals were killed, the right mandibles were harvested en block. Immunohistochemical staining was processed for observation of the VEGF expression, and double immunofluorescent staining was also processed for detection of the co-expression of osteocalcin and VEGF’s two distinct receptors (VEGFR-1 and VEGFR-2). Results: At 7 and 14 days after distraction, the expressions of VEGF were significantly increased in the osteogenic cells of the distracted bone. Up to 28 days after distraction, VEGF was still expressed moderate in the osteoblastic cells of distracted bone. The co-expressions of osteocalcin / VEGFR- 1 and osteocalcin / VEGFR-2 were observed in the distracted bone at 7 and 14 days after distraction. In the double immunofluorescent staining, the co-expression’s level of osteocalcin / VEGFR-1 was more than that of osteocalcin / VEGFR-2. Conclusion: Taken together, this study suggested that VEGF plays an important role in the osteogenesis, and these osteoblastic cell-derived VEGF might act as autocrine growth factor during distraction osteogenesis. In the other word, the cellular components, such as osteoblasts and immature fibroblast-like cellsor mesenchymal cells in the distracted bone, might have autocrine growth activity during distraction osteogenesis.

인간유두종바이러스 감염과 연관된 구강내 편평상피세포암;

변준호(June-Ho Byun),박봉욱(Bong-Wook Park),이정희(Jeong-Hee Lee),노규진(Gyu-Jin Rho),김종렬(Jong-Ryoul Kim) 대한구강악안면외과학회 2007 대한구강악안면외과학회지 Vol.33 No.5

Several investigators have shown that human papillomavirus (HPV) appear to play an etiologic role in oral and paranasal sinus carcinoma. It was known that 15-25 % of head and neck squamous cell carcinoma (SCC) showed HPV-positive infection. Among them, HPV 16 was the most common type but HPV 18 was observed only 2-4 % of HPV-positive head and neck cancers. In recent, we treated uncommon 2 oral SCC cases that associated with HPV infection. One is a case of tongue SCC after bone marrow transplantation (BMT), and the other is a case of SCC occurring with aspergillosis in the maxillary sinus. After surgery, HPV 16 and 18 were detected in the surgical specimens by the histological and polymerase chain reaction(PCR) examination. In this report, we present these cases with a review of literature.