Adequate surgical skills of surgeons is essential to provide safe surgical treatment to patients needing surgery. Surgeons usually learn surgical techniques through lectures, surgical videos, and, if possible, hands-on practice using models or animals. If young surgeons can use cadavers donated to the anatomy department to learn basic surgical techniques, and specialists, can simulate rare and difficult cases before surgery on cadavers, a reduction of medical accidents could be expected. In addition, research and development (R&D) efforts on cadavers is also important for the development of new medical technologies and medical devices. Cadaver surgical training (CST) in the clinical anatomy laboratory (CAL) varies considerably by country in terms of the laws, public attitudes, medical professionals’ perspectives, and administrative support. In Japan, the most basic requirement for implementing CST is the dedication of members of the donor registry organization and efforts of the anatomy department. Numerous challenges exist, such as the sustainability of CAL as an organization, ethical issues, and the framework for R&D in industry-academia collaboration. This paper describes the current status and future prospects of CST in Japan.

A perilymphatic fistula (PLF) is an abnormal communication between the perilymph-filled inner ear and outside the inner ear. Perilymph leak through the communication causes cochlear and vestibular dysfunctions. PLF due to a transcanal injury, such as that caused by an earpick, is categorized as traumatic PLF. Based on the triggers, symptoms, and clinical findings, it is often easy to diagnose cases of traumatic PLF. However, in terms of treatment, the optimal timing of fistula repair surgery remains controversial. Herein, we report on 6 cases of traumatic PLF that were treated by us between April 2013 and March 2023 and discuss the clinical features and management of these cases. Earpick trauma was the cause of the traumatic PLF in all cases, and all of the cases had tympanic membrane perforation. The most frequent location (n = 4) of the tympanic membrane perforation was the posterior superior quadrant of the tympanic membrane (PSQ). In patients presenting with traumatic perforation in the PSQ, the possibility of concomitant traumatic PLF should be borne in mind, because the PSQ is close to the incudostapedial joint, through which transcanal forces may be transmitted to the inner ear. Of the 6 cases, 3 had elevated bone conduction thresholds, which improved within 2 to 4 days of fistula repair surgery in all the 3 cases. Furthermore, preoperative CT showed stapes luxation into the oval window in all the 3 cases. The present study suggests that early surgical intervention produces better hearing results in patients with traumatic PLF, especially those with elevated bone conduction thresholds and/or CT evidence of the stapes luxation into the oval window.

Glomus tumors (paragangliomas) are benign neuroendocrine tumors derived from the paraganglia. Temporal bone paragangliomas are classified as glomus tympanicum or glomus jugulare according to their location. Total surgical removal is the treatment of first choice for glomus tympanicum.

A 60-year-old man presented to us with the symptom of ear fullness. Contrast-enhanced CT showed a non-enhancing soft-tissue lesion in the middle ear. We performed exploratory tympanotomy to examine the histology, and intraoperative surgical pathology indicated that the soft tissue was an inflammatory granuloma. We did not perform total removal of the lesion, as the granulation tissue surrounded the stapes, and we wished to preserve the bone conduction hearing.

Postoperative histopathological diagnosis revealed that the tumor was a paraganglioma. Since paraganglioma is a slow-growing benign tumor, we decided to observe the residual lesion. During nine years of observation, the lesion gradually increased in size and the patient’s hearing level worsened. Therefore, we performed reoperation for total removal of the lesion. At present, two years since the surgery, the patient’s hearing has been stable and no recurrence of the lesion has been observed.

The standard treatment for glomus tympanicum is total removal. However, if close observation is possible, partial removal is acceptable as an alternative strategy to preserve the bone conduction hearing.

In 2018, the International Otology Outcome Group proposed the SAMEO-ATO framework, a new classification for middle ear surgery, aimed at international standardization of the surgical procedures and terminology. We utilize this classification for the surgical treatment of middle ear cholesteatoma at our institution and in this study, we evaluated the practicability and usefulness of this system. Based on our findings, we propose some amendments to further improve the framework of the system. We enrolled a total of 62 patients (63 ears) with acquired middle ear cholesteatomas who underwent surgical treatment at our institution between January 2020 and December 2021 for this study. The diagnosis and staging of the cholesteatomas were based on the criteria established by the Japan Otological Society. We conducted a retrospective review of the surgical records, postoperative otoscopy findings, and computed tomographic images of the enrolled patients. All items of the classification (S: stage of surgery; A: approach; M: mastoidectomy; E: external ear canal reconstruction; O: obliteration of the mastoid cavity; A: access to the middle ear; T: tympanic membrane; and O: ossicular chain) were evaluated. However, as the reporting method during the revision surgery is not mentioned for the last six items (MEO-ATO), we excluded 12 cases of revision surgery from the analysis. Since the MEO items were interrelated, they were analyzed collectively. In almost all cases, T was classified as T2 (50/51) and divided into T2a (~25%) and T2b (~50%), according to the area of the tympanic membrane involved. In regard to O, since repositioning the incus was not applicable to the current options, it would be better to establish a new option. With these additional supplements and modifications, the SAMEO-ATO framework is expected to be a more convenient and accessible diagnostic and staging tool.

In recent years, the number of cases of fungal paranasal sinusitis has been increasing, both due to the increasing number of patients with compromised immune status due to diabetes, malignancy, oral steroid use, etc., as well as the widespread use of imaging tests such as CT and MRI. In this study, we reviewed the data of 100 cases of chronic noninvasive paranasal sinus mycosis treated at Matsuyama Red Cross Hospital between January 2017 and December 2021. The patients comprised of 27 men and 73 women aged 44 to 90 years, with a mean age of 71.9 years. The primary fungal lesion was in the maxillary sinus in 67 patients, in the ethmoid sinus in 1 patient, in the frontal sinus in 1 patient, in the sphenoid sinus in 22 patients, and in multiple sinuses in 9 patients. All patients underwent endoscopic sinus surgery. While cure had been achieved in 89 cases, poor outcomes were obtained in the remaining 11 patients, including persistent mucositis, recurrent sinusitis, and recurrent fungal infections. In 3 cases, a fungal mass was found when the sinuses were surgically opened, whereas the CT had shown only mucosal thickening and the presence of a fungal mass had not been suspected prior to the surgery.

In cases of chronic noninvasive paranasal sinus mycosis, it should be kept in mind, especially while considering surgical options, that lesions may be present in multiple adjacent or distant sinuses.

The BMPR1A gene and PTEN genes are located in close proximity to each other on the long arm of chromosome 10, and are the causative genes of juvenile polyposis syndrome and Cowden disease, respectively. We report a case of pharyngeal polyposis with a deletion detected in chromosome 10 that presented with an airway emergency and was initially suspected as a case of juvenile polyposis or Cowden disease. The patient was a 5-year-old boy with malformative syndrome who visited our pediatrics department. Since he was 1 year old, he had undergone lower endoscopic polypectomy every six months for juvenile polyposis. Four months ago, he began to snore while sleeping, and one month ago, he had begun to have cough and labored breathing. Clinical examination revealed pneumonia affecting the right lung and he was admitted to the pediatrics department for observation and treatment. At the time of admission, we received a reference to see the patient, and found bilateral enlargement of the tonsils and a polyp-like mass in the pharynx on visual inspection. A sleep test was considered during hospitalization, but on the day of hospitalization, the patient exhibited frequent episodes of apnea, and the SpO₂ decreased to 80%. Therefore, securing the airway was judged as being highly urgent, and on the day after admission, pharyngeal polyp resection and bilateral palatal tonsillectomy were performed under general anesthesia. After the operation, the patient was managed in the ICU, and he was extubated the following day. He was discharged 7 days after surgery because the oxygenation was adequate, there were no complications, and the pneumonia had improved. Histopathology of the resected specimens revealed no malignant findings, and we made the diagnosis of follicular hyperplasia. A microdeletion in chromosome 10 was considered as the cause of the pharyngeal polyposis in this case. Until now, 6 months have passed since the operation, and there has been no evidence of recurrence. We propose to continue to follow up the patient carefully in the future.

Langerhans cell sarcoma (LCS) is an extremely rare disease, with only a few reported cases so far of the condition involving the palatine tonsil. We report a case of a 69-year-old man with a lesion in the right palatine tonsil, who was referred to our hospital with a history of a mass detected in the right palatine tonsil two weeks earlier and multiple lymphadenopathies in the right cervical region. Biopsy revealed an increased number of Langerhans cells with prominent nuclear dysmorphism and polymorphism. Immunohistochemistry revealed positive staining for S-100 protein and CD1a. Based on these findings, we made the diagnosis of LCS. PET-CT showed strong FDG accumulation in multiple enlarged lymph nodes, as well as FDG accumulation in the lungs, liver, bones, and skin. The patient received chemotherapy and autologous peripheral blood stem cell transplantation and remains alive. LCS is a very rare disease, and there is no established treatment. Treatment options include surgery, chemotherapy, and bone marrow transplantation, selected depending on the degree of disease progression.

The most important differential diagnoses in patients presenting with cystic cervical lymph node metastasis are human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma and papillary thyroid carcinoma. The diagnostic criteria for follicular thyroid carcinoma are histological confirmation of at least one of capsular invasion, vascular invasion, or metastasis outside the thyroid gland, and cell atypia has no role in distinguishing between benign and malignant disease. We report a case of follicular nodular disease in a cervical lymph node that required to be differentiated from cervical lymph node metastasis secondary to papillary or follicular thyroid carcinoma.

A 35-year-old man with bilateral thyroid tumors and cystic lymphadenopathy of the left neck was referred to our department. We performed left neck dissection and total thyroidectomy, and considered that the patient may have had cervical lymph node metastasis from follicular nodular disease. Since the case was diagnosed as a case of follicular thyroid carcinoma by definition, close follow-up is required.

[Objective] Cervical lymphadenopathy is mostly due to inflammatory diseases such as bacterial or viral infections and autoimmune diseases, while malignant diseases such as malignant lymphomas and cancer metastasis could also be the cause. Differentiating between inflammatory diseases and malignant diseases using non-invasive tests including blood tests and fine needle aspiration cytology (FNA) is important to decide whether a lymph node biopsy is necessary or not and to determine the course of treatment. In this study, we compared the clinical and laboratory findings of patients with cervical lymphadenopathy with a focus on differentiating between inflammatory and malignant diseases.

[Subjects and methods] A total of 183 patients with enlarged cervical lymph nodes who visited our hospital over the past four years and nine months were included in this study. Patients were divided into the inflammatory group and the malignant disease group. The breakdown of diseases, age distribution, duration of illness, presence/absence of pain, serum soluble IL-2 receptor levels, and the accuracy of FNA were examined retrospectively.

[Results] There were 125 patients in the inflammatory disease group and 58 patients in the malignant disease group. The inflammatory disease group showed a lower age, shorter disease duration, and higher proportion of patients with pain than the malignant disease group. Soluble IL-2 receptor levels were higher in the malignant disease group (884.5 U/ml) than in the inflammatory disease group (510.5 U/ml). The specificity, sensitivity, and diagnostic accuracy of FNA were 78.4%, 98.8%, and 91.2%, respectively. False negative results of FNA were found in 11 cases, of which 10 were cases of malignant lymphoma.

[Conclusion] Serum soluble IL-2 receptor levels and FNA were useful for differentiating between the inflammatory and malignant disease groups. Lymph node biopsy should be performed if malignant lymphomas cannot be excluded, especially bearing in mind the limitations of non-invasive tests, even if comprehensive, in the diagnosis of malignant lymphoma.

Waldenström’s macroglobulinemia (WM) is a distinct clinicopathologic entity characterized by the presence of lymphoplasmacytic lymphoma (LPL) in the bone marrow and IgM monoclonal gammopathy in the blood, with diverse clinical presentations, including cytopenias linked to bone marrow infiltration, hyperviscosity syndrome, fever, lymphadenopathy, and recurrent infections. We report a case of a patient who was diagnosed as having WM after he presented with a deep cervical abscess, which resulted in death.

The patient was a 72-year-old man who visited our emergency department with a one-month history of anorexia, 2-week history of weakness in the lower extremities, and a day’s history of fever. Blood examination revealed high levels of inflammatory response markers and he was urgently admitted and started on treatment with intravenous antibiotics at the department of internal medicine. The following day, computed tomography (CT) revealed a deep cervical abscess, and the patient was transferred to the otolaryngology department, where an incisional drainage procedure was performed under local anesthesia. On the fifth day of hospitalization, expansion of the abscess cavity necessitated incision and drainage under general anesthesia. On day 14th of hospitalization, the patient again developed fever and increased levels of inflammatory response markers, and CT showed pneumonia, although the abscess cavity had reduced in size. On the 19th day of hospitalization, anemia and thrombocytopenia became clinically apparent. On the 22nd day of hospitalization, the inflammatory response marker levels had improved, but the patient continued to have fever and developed impaired consciousness, and he was referred to an internist. On day 35 of hospitalization, the patient was diagnosed as having WM based on increased levels of M protein and findings on bone marrow biopsy. Because of the patient’s poor general condition, he was started on steroid treatment, while chemotherapy was withheld. Unfortunately, however, his condition began to deteriorate rapidly and he died two days later.

In patients with a deep cervical abscess without underlying diseases such as diabetes, the possibility of underlying hematological disorders associated with immunosuppression or increased vulnerability to infections, such as WM, should be borne mind.

We retrospectively analyzed the background factors associated with postoperative complications in patients with advanced hypopharyngeal cancers who underwent total pharyngolaryngectomy followed by free jejunal flap reconstruction. A total of 23 subjects, including 21 men and 2 women in age range of 49 to 83 years (average, 72.3 years) were enrolled in this study. Mild and moderate/severe complications occurred in 5 and 7 cases, respectively. The most common complication was stricture of the esophagojejunal anastomosis (9 cases). Other complications, including tracheostomal stenosis, pneumonia and chyle leakage occurred in 2, 1, 1 cases, respectively. The free jejunal flap survived in all cases. The disease-free survival rate was 47.8% at 52 weeks after surgery. The platelet count was significantly lower (18.8 ± 1.9 × 10⁴/μL vs. 27.7 ± 1.8 × 10⁴/μL; P = 0.008) in patients with moderate/severe complications than in those without. The percentage of stage IV cases and intraoperative blood loss tended to be greater in patients with complications than in those without. We should be aware of these potential risk factors for the development of postoperative complications in order to satisfactorily manage the clinical course of patients with advanced hypopharyngeal cancers.