¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) is emerging as an important imaging modality and its popularity is growing in the field of oncology. In the management of head and neck cancer, PET/CT is useful for accurate staging, diagnosing metastases and recurrences, detecting secondary primary tumors, and detecting previously unknown primary tumors. In this article, we review the main indications for PET/CT, focusing especially on its role in staging, determining the therapeutic strategy and clinical follow-up based on the latest reports.

Acute vestibular syndrome (AVS) is a clinical condition characterized by dizziness or vertigo that develops acutely with nausea/vomiting, gait instability, and/or head-motion intolerance and lasts for a day or more. Most patients presenting with AVS are diagnosed as having a benign peripheral condition commonly called vestibular neuritis. However, central causes of AVS can also closely mimic benign peripheral AVS, particularly vestibular neuritis. Herein, we report a case of lateral medullary syndrome in a patient who presented with acute vertigo, in whom showing differential diagnosis from peripheral vertigo proved difficult by initial magnetic resonance imaging (MRI).

A 47-year-old male patient presented to the emergency room complaining of severe vertigo and headache. The initial brain MRI showed no evidence of bleeding or stroke. Physical examination revealed left-directional horizontal nystagmus and gait disorder. There were no abnormal findings on examination of the central nervous system, other than nystagmus. However, during the clinical course, several other neurological findings became evident. A follow-up MRI performed two days after the onset of vertigo showed lateral medullary infarction, suggestive of the diagnosis of lateral medullary syndrome, and the patient was admitted to a neurological department for further treatment.

Lateral medullary syndrome is caused by injury to the lateral part of the medulla in the brain. It has been reported that initial MRI of the brain sometimes fails to show abnormal findings in cases of lateral medullary syndrome. In patients presenting with acute vertigo, we should consider the possibility of central vertigo due to brainstem or cerebellar infarction, even in young patients without risk factors for cerebrovascular disorders. Although the initial MRI findings show no signs of brain infarction in some patients of the lateral medullary syndrome presenting with AVS, physicians should keep in mind the importance to repeated neurological examinations and also a second MRI examination, if needed, to rule out the diagnosis of lateral medullary syndrome.

Simple underlay myringoplasty, which was first described by Yuasa et al. in 1989, is widely used for repair of tympanic membrane (TM) perforation.

We analyzed the postoperative outcomes of the Yuasa method performed as day surgery under local anesthesia at our institution between December 2011 and June 2017 in 54 ears (46 cases of chronic otitis media, 6 cases of traumatic membrane perforation, and others). The closure rate of TM perforation and the success rate of hearing improvement based on the criteria of the Japan Otological Society were 87.0% and 87.0%, respectively.

The patient satisfaction level was examined using a questionnaire survey.

We also examined the “cases with failure” of the surgery and discuss our results.

Objective: We report a case of carotid-cavernous sinus fistula (CCF) occurring as a complication of surgery for palate cancer.

Findings: A 64-year-old man presented to us with palate cancer. We performed bilateral neck dissection, resection of the palate cancer, and reconstruction using a left forearm flap. On the day after the surgery, the patient developed chemosis, ptosis, dilatation of the pupil, and ocular motility disorder in his right eye. On the basis of the findings of head MRI, MRA and cerebral angiography, we made the diagnosis of CCF. We occluded the fistula by endovascular embolization with coils. While the chemosis began to improve gradually, the other symptoms remained. At 14 months after the first operation, strabismus surgery was performed. Ever since the surgery until date, the patient has shown no evidence of recurrence of either the palate cancer or the CCF.

Conclusion: CCF is commonly caused by direct head injury, but has rarely been reported after craniofacial surgery. We considered cutting of the pterygoid process as the reason for the occurrence of the CCF in this case. Appropriate and early treatment of CCF is useful for preventing the complications of cerebral infarction and bleeding.

Paradoxical response (PR), defined as clinical or radiological worsening of pre-existing lesions or the development of new lesions after initial improvement, occasionally occurs in patients with tuberculosis receiving anti-tuberculous treatment. The mechanism underlying the occurrence of PR has not yet been precisely clarified.

We encountered a case of PR in a human immunodeficiency virus-negative patient with pulmonary tuberculosis who presented with cervical lymphadenopathy while receiving anti-tuberculous treatment. We had some difficulty in arriving at the precise diagnosis, because the clinical characteristics of the enlarged cervical lymph nodes as a manifestation of PR were rather similar to those of tuberculous cervical lymphadenopathy. The clinical course of the patient with pulmonary tuberculosis, and the result of the DNA polymerase chain reaction (PCR) assay for tuberculosis, mycobacterial culture, and histopathology assisted us in arriving at the correct diagnosis. The PR improved with steroid therapy, without any complications.

The incidence of tuberculosis is increasing among elderly persons and foreign workers; accordingly, cases of PR may also be expected to increase. We should consider the possibility of PR in a patient with tuberculosis presenting with cervical lymphadenopathy while receiving anti-tuberculous therapy.

Mucoepidermoid carcinoma arising from the base of the tongue is relatively rare. The basic treatment for this type of minor salivary gland tumor is radical resection.

Several surgical approaches have been reported, including the transoral and external approaches. Median labiomandibular glossotomy is one of the techniques for approaching to the base of the tongue.

A 41-year-old woman visited our hospital complaining of pharyngeal discomfort, and was found to have a rather large tumor at the base of the tongue. A diagnosis of mucoepidermoid carcinoma was made by biopsy. Tumor resection was performed via a median labiomandibular glossotomy, and the patient showed satisfactory progress after the operation. No adjuvant therapy was offered, because histopathological examination revealed low-grade malignancy of the tumor, and that the margins were microscopically tumor-free. The patient experienced no functional disorders or tumor recurrence during the follow-up period.

Median labiomandibular glossotomy is effective for treating mucoepidermoid carcinoma of the base of the tongue, in terms of the low rate of damage of vessels and nerves.

Malignant lymphomas represent approximately 6%–9% of all malignant neoplasms of the head and neck. In this report, we describe the case of a 42-year-old woman who presented with the complaint of swelling of the right cheek and was referred to our hospital. MR imaging revealed a relatively well-defined tumor anterior to the masseter muscle. Some trials of fine needle aspiration cytology failed to lead to a definitive diagnosis. Tumor biopsy was necessary to obtain a histopathological diagnosis. In consideration of the aesthetic aspect, tumor biopsy with facial skin incision was considered undesirable. Therefore, we adopted the core needle biopsy technique usually used in the realm of breast surgery, gastroenterology, nephrology and orthopedic surgery. This patient was finally diagnosed as having a B-cell lymphoma arising from the subcutaneous tissue. She was then referred to a hematologist, who treated her by chemotherapy and local irradiation.

We reviewed the published literature concerning primary extranodal lymphoma of the soft tissue of the cheek, and found that only 8 cases have been reported so far in Japan. In most of these cases, an excisional biopsy was performed to obtain a histological diagnosis. We present this case with a discussion of the usefulness and complications of core needle biopsy.

In conclusion, the core needle biopsy technique is a useful technique, that could be recommended for cases where more invasive techniques need to be avoided.

Sinonasal teratocarcinosarcoma is an extremely rare, highly malignant neoplasm that frequently invades the surrounding soft tissues, as well as the orbit and cranium, from an early stage. We encountered a case of sinonasal teratocarcinosarcoma that extended into the cranium and present a report of the case here. The patient was a 66-year-old man who presented with an 8-month history of nasal obstruction and anosmia, was examined at the otolaryngology department of a local hospital. The patient was diagnosed as having a nasal cavity tumor and was referred to our department. Examination revealed a milky white mass in left middle meatus. CT and MRI revealed that the tumor was mainly located in the left ethmoidal sinus, but had invaded the nasal cavity, maxillary sinus, sphenoidal sinus, orbit, and cranium. Biopsy findings led to the suspicion of nasal cavity squamous cell carcinoma or olfactory neuroblastoma, but a definitive diagnosis could not be arrived at. PET-CT, revealed accumulation in the primary tumor, with a max SUV of 8, but no evidence of other metastasis. Anterior cranial base surgery was performed and based on the variegated pathological picture of the resected specimen, a diagnosis of teratocarcinosarcoma was made. As the tissue type showed a high degree of malignancy, the patient was treated by surgery followed by postoperative chemoradiotherapy using cisplatin. Survival was confirmed for 3 years 9 months from the onset. A nasal cavity tumor eroding the skull base with a variegated pathological picture should raise the possibility of teratocarcinosarcoma.

Spindle cell carcinoma is a two-stage cancer with a squamous cell cancer component and spindle cell component showing sarcomatoid growth, but rarely occurs in the maxillary sinus. We report our experience with a case of spindle cell carcinoma of the maxillary sinus.

A 69-year-old male was referred to our hospital with the chief complaints of recurrent episodes of bleeding from the left nostril and swelling of the left cheek. A neoplastic lesion was found in the left nasal cavity and a biopsy was performed. However, because a definitive diagnosis could not be established, we decided to carry out surgery for verifying the diagnosis. We did not recognize any specific structure or characterristic differentiating tendency, but eventually made the diagnosis of spindle cell carcinoma based on all the findings plus the result of immunostaining. Chemotherapy with cisplatin (2 courses) and radiation therapy were conducted according to the treatment for squamous cell carcinoma, but a follow-up CT revealed no evidence of tumor reduction. Because sarcoma constituted the predominant component on histopathology, we decided to treat the patient with pazopanib, which is used for malignant soft tissue tumors, which resulted in cytoreduction. We did not find tumor enlargement for 10 months during the drug administration, but after withdrawal of the drug because of an adverse effect, the patient died of rapid worsening of pulmonary metastases.

Castleman’s disease was first reported by Castleman et al. in 1954 as a mediastinal lymph node hyperplasia similar to thymoma, and is a lymphoproliferative disease with a unique histology.

Subsequently, Keller et al. classified the disease into hyaline-vascular type and plasma cell type based on the histological features, however, the etiology of the disease is still unknown. Puncture suction cytology or needle biopsy alone is not sufficient for diagnosis, and it is considered difficult to diagnose before surgery, based on most past reports.

We report two cases of Castleman’s disease diagnosed after removal of a cervical mass under general anesthesia.

Case 1 was a 54-year-old male patient who underwent puncture aspiration cytology and open biopsy of the cervical mass, neither of which revealed a definitive diagnosis. In addition, the cervical mass was resected under general anesthesia for diagnostic purposes, because of the increase in the number/size of the nodules in both lungs. Histopathological examination revealed the diagnosis of Castleman’s disease, plasma cell type. Case 2 was a 36-year-old female patient who presented with a cervical mass. Preoperative examination failed to reveal a definitive diagnosis, and the mass was resected. Histopathological examination revealed the diagnosis of Castleman’s disease, hyaline-vasucular type. Castleman’s disease is difficult to diagnose before surgery. If examination/biopsy of the neck swelling does not lead to a diagnosis, it is thought that resection of the mass under general anesthesia or biopsy with sufficient sample volume should be performed. As cervical swelling may be the presenting manifestation of Castleman’s disease, it is necessary for otolaryngologists and head and neck surgeons to have adequate knowledge of the disease and its treatment. Castleman’s disease has been designated in Japan as an intractable disease since 2018, and diagnostic criteria have been proposed.