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Hiroki Tanaka, Yukiyoshi Hyo, Dai Shibata, Tamotsu Harada
2015 Volume 144 Pages
2-3
Published: 2015
Released on J-STAGE: November 28, 2015
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Primary macroglobulinemia is called Waldenström’s macroglobulinemia (WM), which is defined as lymphoplasmacytic lymphoma (LPL). The excessive and abnormal production of immunoglobulin M (IgM) monoclonal macroglobulin protein in bone marrow is characteristic of WM.
Clinical signs and symptoms are presented by hyperviscosity with excessive IgM protein disordering the vessel flow with sensory and motor peripheral neuropathy derived from the myelin-associated glycoprotein (MAG) in IgM.
The clinical features in the hyperviscosity syndrome are the different kinds of mucosal hemorrhage, retinal vein thrombosis and hemorrhage, headache, vertigo, hearing loss and so on. However, sensorineural hearing loss is rarely caused by WM, and WM with hearing loss has been reported only in eight studies to the best of my knowledge. Although the etiology of the hearing loss is unclear, but the past reports have concluded that the most probable of the cause of the hearing loss is the hyperviscosity syndrome and reported that hearing loss improved with plasma exchange treatment or chemotherapy.
We experienced a case which proved to be WM after the recovery of sensorineural hearing loss with steroid therapy followed by plasma exchange and chemotherapy. The patient reached remission status for the WM and the hearing loss has not recurred.
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Kazuki Sugizaki, Tetsuo Ikezono, Susumu Shindo, Han Matsuda, Yasuhiro ...
2015 Volume 144 Pages
4-5
Published: 2015
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Introduction: The perilymph fistula (PLF) has been described as a rare complication of eustachian tube insufflation (ETI). We report a case of PLF induced by ETI with a catheter, in which the definitive diagnosis was made using the Cochlin-tomoprotein (CTP) detection test.
Case Presentation: A 66-year-old male patient had been undergoing ETI for treatment of recurrent otitis media with effusion in a local clinic. Immediately after ETI, he experienced otalgia and dizziness. Dizziness persisted for three months and remained incurable despite conservative treatment, and the patient was subsequently referred to our clinic. He had left-sided mixed hearing loss, as well as nystagmus in the head positioning, positional, and head-shaking tests. We suspected barotraumatic PLF, and the CTP testing yielded positive results. We performed PLF repair surgery, and the vestibular symptoms gradually improved from the day after surgery.
Conclusion: A positive result for the CTP detection test is one of the diagnostic criteria for definitive PLF, and in this case, facilitated determination of the treatment strategy, which comprised surgery that effectively relieved the patient’s intractable dizziness. Therefore, the CTP detection test is useful for diagnosis and determination of a treatment strategy in such cases.
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Ryosuke Kitoh, Kentaro Mori, Shin-ichi Usami
2015 Volume 144 Pages
6-7
Published: 2015
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Recently, the gradual acceptance and performance of intratympanic (IT) steroid therapy for idiopathic sudden sensorineural hearing loss (ISSHNL) has been reported in Japan, but it has not yet become popular.
We report herein on our results of IT steroid injections as initial therapy and salvage therapy for patients with ISSHNL.
Methods:
One hundred and thirty-four patients with ISSHNL treated in our institution were enrolled and analyzed. For the analysis of the effect of salvage therapy, patients showing poor response (hearing improvement <30 dB) to initial systemic steroid therapy were enrolled.
Results:
Fifteen patients were treated with IT steroid injection as initial therapy.
In these patients, hearing improvement >10 dB and >30 dB were 86.7% and 60%, respectively. This hearing recovery was slightly better compared with the recovery of the patients on systemic steroid therapy as initial therapy.
Seventy-eight patients were enrolled for the analysis of the effect of salvage therapy. Thirty-nine patients were treated with IT steroid injection as salvage therapy, 14 patients were treated with systemic steroid therapy, and in 25 patients no additional steroid therapy was performed. Compared with the latter two groups, patients in the IT steroid group achieved significantly better hearing recovery, especially those receiving IT steroid therapy within 3 weeks.
Conclusions:
IT steroid therapy for ISSHNL was considered an effective treatment as both initial and salvage therapy.
There was a high degree of variability in the IT steroid therapy regarding frequency and intervals and the total number of injections across studies. Future studies are therefore required to elucidate the optimum protocol for IT steroid therapy.
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Ryo Suzuki, Shinichi Sato, Kazuyuki Ichimaru, Tomoyuki Haji, Juichi It ...
2015 Volume 144 Pages
8-9
Published: 2015
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The postoperative results of type I tympanoplasty performed for 150 cases of tympanic membrane perforation and simple underlay myringoplasty performed for 46 cases of tympanic membrane perforation were analyzed comparatively in this study.
The final tympanic closure rate in the patients treated by type I tympanoplasty was 90.7%, and favorable hearing results were obtained in 92.1%. The final tympanic closure rate in the patients treated by myringoplasty was 82.6%, although the rate tended to decrease as the size of the perforation increased. The haring results were favorable.
To achieve the high closure rate, it is important to monitor the status of the tympanic membrane and ensure adequate postoperative care as necessary.
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Tomohisa Kato, Takao Ogawa, Hideaki Kouzaki, Takeshi Shimizu
2015 Volume 144 Pages
10-11
Published: 2015
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We report three cases of myeloperoxidase-perinuclear anti-neutrophil cytoplasmic antibodies (MPO-ANCA)-positive otitis media with ANCA associated vasculitis (OMAAV). Case 1 was a 75-year-old female. She had right hearing loss and kidney involvement. Treatment with oral prednisolone was initiated and the MPO-ANCA titers decreased. Sensorineural hearing loss remained. Case 2 was a 77-year-old male. He had bilateral hearing loss and lung involvement. Treatment with oral prednisolone and oral cyclophosphamide was initiated. Serum MPO-ANCA became negative, and both hearing loss and lung involvement improved. However, serum PR3-ANCA became positive and he developed myelitis. Case 3 was a 71-year-old male. He had bilateral hearing loss but no other sites of involvement, such as lung and kidney. Treatment with oral prednisolone and oral cyclophosphamide was initiated. The MPO-ANCA titers became negative. He recovered from his hearing loss, however, he developed multiple cranial nerve palsy.
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Noboru Yamanaka
2015 Volume 144 Pages
12-13
Published: 2015
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We conducted an epidemiological survey of patients with acute otitis media (AOM) and evaluated the effects of use of the protein-conjugated pneumococcal vaccine (PCV7) and of the newly developed antimicrobials tosufloxacin (TFLX) and tebipenem pivoxil (TBPM-PI) on the incidence of AOM and the frequency of myringotomy in Japan. The 7-year study between 2007 and 2013 was based on the Japan Medical Data Center (JMDC) Claims Database of neonates to children less than 15 years old. The number of AOM patients did not change significantly during the study period. On the other hand, the myringotomy rate showed a significant decline over time after 2010. In Japan, large-scale PCV7 vaccination was started in 2011 under public assistance, and the newly developed antimicrobials TFLX and TBPM-PI were introduced in the market in 2009 and 2010, respectively, before the large-scale PCV7 vaccination initiative was launched. The major antimicrobial agents used for AOM are amoxicillin, cefditoren pivoxil, and amoxicillin clavulanate, and rate of use these drugs did not change during study period. On the other hand, the number of prescriptions for TFLX and TBPM-PI increased over time, and also, the number of prescriptions for these drugs showed a significant negative correlation with the myringotomy rate. Based on this evaluation, while adoption of PCV7 vaccination may not have had a strong influence on the incidence of AOM or the myringotomy rate in Japan, wider use of the newly developed antimicrobials TFLX and TBPM-PI appears to have played an important role in the decline of the myringotomy rate over time.
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Yang Tao, Hidenaga Yamamoto, Kiichiro Shinkawa, Maya Moriyasu, Manami ...
2015 Volume 144 Pages
14-15
Published: 2015
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A lateralized tympanic membrane is one of the complications that may arise after surgery of the middle ear. This is mainly due to the layer of skin associated with the tympanic membrane that is displaced outside the ring of the eardrum, and results in conductive hearing loss. As a method of treatment, surgery to return the tympanic membrane to the original position is usually performed, but the results are inconsistent. In many cases, a reconstructed tympanic membrane may become lateralized again when the surgery is performed. For these cases, we have developed a longer artificial ceramic columella to reconstruct the tympanic cavity without changing the position of the lateralized tympanic membrane. Better results have been shown during short-term observation of 6 months.
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Risa Kato, Hisashi Sugimoto, Makoto Ito, Tomokazu Yoshizaki
2015 Volume 144 Pages
16-17
Published: 2015
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We report herein on a rare case of schwannoma of the chorda tympani with facial palsy. A 34-year-old woman was referred to our hospital because of right facial palsy which was resistant to steroid intervention and anti-viral drugs. In the physical examination, a white mass was observed in the posterior superior quadrant of the tympanic membrane and the facial palsy score was 0/40. Computed tomography revealed a tumor in the right chorda tympani, extending from the branch of facial nerve to the malleus. Based on the physical, physiological and imaging tests, the patient was diagnosed as having a tumor of the right chorda tympani with facial palsy. For the purpose of resection and definitive diagnosis of the tumor, a surgical intervention was performed. Histologically the tumor was diagnosed as a schwannoma, and immunohistochemically the tumor cells were positive for S-100. After surgery, the patient’s facial palsy completely resolved in six weeks. There has been no finding of recurrence two years after surgery.
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Aiko Oka, Tsunehisa Oono, Ken Iwanaga, Shin-ichi Sato
2015 Volume 144 Pages
18-19
Published: 2015
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Facial nerve schwannomas may occur in any segment of the facial nerve, from the cerebellopontine angle to the parotid gland. Extracranial facial nerve schwannomas are uncommon, and tumors around parotid grand may be misdiagnosed as parotid tumors, such as pleomorphic adenoma or Warthin’s tumor. Facial paralysis should be borne in mind as a complication of surgical treatment for facial nerve schwannoma. We encountered a case of extratemporal facial nerve schwannoma that was preoperatively diagnosed as a parotid tumor, but intraoperatively confirmed as a facial nerve schwannoma.
A 35-year-old female was referred to us because of a slight swelling in the anterior part to the right ear. The swelling was slightly tender, but there was no facial paralysis. Physical examination revealed a mass measuring about 3 cm in diameter, that was elastic in consistency and freely mobile. Magnetic resonance imaging (MRI) showed a solid tumor anterior to the parotid grand, visualized as a hypointensity on T1-weighted images and as a well-circumscribed hyperintensity on T2-weighted images. Fine-needle aspiration biopsy revealed class I cytology. Based on these findings, a parotid tumor was suspected, and surgical resection was undertaken. The intraoperative histopathology revealed a schwannoma with an influx of peripheral facial nerve fibers. The postoperative clinical course was good, and there has been no facial paralysis or recurrence during the 10 months since the surgery.
The preoperative diagnosis of facial nerve schwannoma is difficult because of the lack of dindistinctive MRI findings and the low diagnostic sensitivity of fine-needle aspiration biopsy. If the tumor is diagnosed as schwannoma preoperatively or intraoperatively, its location and the pre-operative facial nerve function can affect the decision on the surgical treatment. While functional preservation should be an important goal of surgical treatment, complete removal is also important, as subtotal resection has been shown to be associated with unacceptably high recurrence rates in the long term.
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—Comparison with 103 Cases—
Hitoshi Shibasaki, Noriko Tamaruya, Kazunari Nakao
2015 Volume 144 Pages
20-21
Published: 2015
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Treatment targeting facial nerve schwannomas in the parotid gland have been controversial because of the occurrence of facial paralysis after excision. We experienced a single case of a facial nerve schwannoma in the parotid gland.
A 67-year-old woman was referred to us for evaluation of a tumor in the deep lobe of the left parotid gland that was detected by chance during magnetic resonance imaging at another department. Although excision of the deep parotid gland lobe was planned, a facial nerve schwannoma in the parotid gland was considered according to the preoperative and intraoperative findings. Only a biopsy was performed, after which the incision was closed. The pathological diagnosis was schwannoma. Although 2 years have passed since the operation, physical examination and magnetic resonance imaging findings have not revealed any aggravation.
Because postoperative facial palsy consequent to excision of a facial nerve schwannoma can remarkably reduce the quality of life, the goal should be function preservation to the greatest extent possible.
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Mizuo Umakoshi, Hiromi Nagano, Yuichi Kurono
2015 Volume 144 Pages
22
Published: 2015
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Glomangiopericytomas (sinonasal-type hemangiopericytomas) are a rare tumor entity deriving from pericytes. Less than 0.5% of hemangiopericytomas occur in the nasal cavity and are characterised by a rather benign nature with low tendency for metastasis.
A 69-year-old man presented with epistaxis. Endoscopic and radiographic examination revealed a bilateral mass involving the nasal cavity and paranasal sinuses. Histopathological features were consistent with a glomangiopericytoma. Immunohistochemically, the tumor cells were positive for vimentin and α-smooth muscle antigen. Complete endoscopic resection with free margins was achieved without embolization.
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Hirofumi Sei, Taro Takagi, Masahiro Okada, Hirotaka Takahashi, Naohito ...
2015 Volume 144 Pages
24-25
Published: 2015
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Hereditary hemorrhagic telangiectasia (HHT) is an uncommon disease characterized by the presence of abnormal telangiectasia and arteriovenous malformations that cause recurrent episodes of epistaxis. In case of recurrent epistaxis, the management of bleeding could be difficult in HHT patients. Systemic complication, such as arteriovenous shunt in lung and liver, can also occur in the clinical course. Once a systemic complication occurs, epistaxis can be severe and uncontrollable.
We experienced a female patient with HHT which was complicated with infective endocarditis. Though several hemorrhages were treated with argon plasma coagulation (APC), her epistaxis did not improve. After an aortic valve replacement was performed for infective endocarditis, the incidence of recurrent bleeding was reduced. It was considered that heart failure due to infective endocarditis caused the intractable nose bleeding. These clinical findings suggested that the management of systemic complications are most probably important for the control of recurrent epistaxis in HHT patients.
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Noriko Taniguchi, Takaki Inui, Tatsuro Kuriyama, Kengo Ichihara, Koute ...
2015 Volume 144 Pages
26-27
Published: 2015
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We report a case of a button battery as a nasal foreign body in a 3-year-old male child. An otolaryngologist at another hospital removed the foreign body, however, the child was referred to our hospital the following day with severe damage of the nasal mucosa. We carried out endoscopic nasal surgery under general anesthesia; the damaged tissue was removed and the nasal cavity was flushed copiously with distilled water. At 4 months since this procedure, the child remains asymptomatic.
Button batteries as nasal foreign bodies can lead to clinical complications such as nasal septal perforation, atrophic rhinitis, anterior nasal atresia, etc., which can persist or develop several months after removal of the foreign body. These batteries can cause damage both through physical pressure and electrical and alkali burns. The alkaline component of the cell cathode may persist submucosally, to cause chronic damage for several months even after removal. In conclusion, to avoid permanent damage, it is important not only to remove the foreign body promptly, but also to treat or remove any tissues that have been chemically damaged.
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Jumpei Nota, Tadahiko Saiki, Yoshihisa Okochi, Futoshi Watanabe
2015 Volume 144 Pages
28-29
Published: 2015
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We investigated the data of 489 patients with epistaxis who visited our hospital between 2009 and 2013. Epistaxis was more frequent in males (298 cases) than in females (191 cases).
The mean age was 57.1 years, with the largest number of patients were in their 70s, 60s and 50s, in that order. Epistaxis occurred more often in the winter and spring, with a significantly lower number of patients in the summer and autumn. The most frequent onset time was in the morning from 6 am to 8 am. The sites of bleeding were Kiesselbach’s area (50.7%), followed by unidentifiable site (25.2%), nasal septum (11.5%), inferior meatus and turbinate (7.4%), and middle meatus and turbinate (3.7%). Of all the patients, 42.7% were treated by electrical coagulation with or without a rigid endoscope, 40.5% were managed by observation, and 16.6% by gauze packing. Of the 489 patients, 48 (9.8%) required hospitalization, and re-bleeding occuered in 64 (13.1%) cases. The major underlying disease was hypertension (32.5%), while 25.8% of all cases were receiving anticoagulant therapy.
It is most important to identify the bleeding site by flexible fiberoptic and/or rigid endoscopy. Electrical coagulation with a rigid endoscope was a very useful procedure in the treatment of epistaxis, especially that occurring from the posterior part of the nasal cavity.
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Keiichi Miyashita, Junichiro Ohori, Yuichi Kurono
2015 Volume 144 Pages
30-31
Published: 2015
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Juvenile angiofibroma (JAF) is a benign tumor that arises from the sphenopalatine foramen in adolescent males. It accounts for about 0.05% of all head and neck tumors. JAF manifests with a triad of symptoms, including nasal obstruction, epipharyngeal mass lesion, and recurrent epistaxis. Since this tumor frequently invades the surrounding tissues, causing bony destruction, it is not easy to treat the condition surgically without damaging the oropharyngeal function or aesthetics. Herein, we report the case of an 11-year-old boy with JAF who was successfully treated by endoscopic surgery via the transmaxillary approach combined with endoscopic intranasal surgery. Based on this experience, the advantages and disadvantages of the procedure are discussed.
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Momoyo Matsuoka, Yoshiaki Kitamura, Aki Endo, Koji Abe, Noriaki Takeda
2015 Volume 144 Pages
32-33
Published: 2015
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We report herein on a 75-year-old woman with sinonasal-type hemangiopericytoma (HPC). She complained of nasal bleeding and a nasal tumor originated from the left nasal septum was found. It was successfully resected using endoscopic sinus surgery without preoperative embolization, because we were uncertain of its feeding artery. Its pathological examination gave a diagnosis of sinonasal-type of HPC. The sinonasal-type HPC is a rare benign sinonasal tumor, but WHO has classified it as a borderline malignancy, because it may have multiple relapses. Our patient remained free of relapse 36 months after the treatment.
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Takatoshi Furukawa, Nobuo Ohta, Tomoo Watanabe, Tsukasa Ito, Yusuke Su ...
2015 Volume 144 Pages
34-35
Published: 2015
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When the eye socket is damaged for various reasons, the oculomotor nerve, the trochlear nerve, the abducens nerve, the first trigeminal nerve branch and the optic nerve can be damaged, and the orbital-apex syndrome is exhibited. Reported causes for this include external injury, leukemia, cancer, mycosis and Hodgkin’s disease, and reports of orbital-apex syndrome due to sphenoidal sinus cysts are rare. We report herein on our rare experience with a 73 years old male patient in whom a sphenoidal sinus cyst caused orbital-apex syndrome. His visual function was highly inhibited. Endoscopic sinus surgery on day 8 enabled improvement in the visual function. We present herein the course of this case with several references to previous literature.
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Midori Tateishi, Satoshi Seno, Takeshi Shimizu
2015 Volume 144 Pages
36-37
Published: 2015
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Cavernous sinus syndrome may become fatal if it is misdiagnosed and its treatment is delayed. We report herein on the case of 42-year-old woman with sphenoid sinusitis who developed cavernous sinus syndrome and hypopituitarism. She presented to our hospital with a history of continued headache and swelling of the right eyelid. She was diagnosed as having hypopituitarism based on blood examinations, and computed tomography (CT) imaging revealed right sphenoid sinusitis. Magnetic resonance imaging (MRI) showed local meningitis, right orbital cellulitis and inflammation of the right cavernous sinus.
Endoscopic sinus surgery (ESS) was performed immediately and broad-spectrum antibiotics were administered intravenously before and after the surgery. The patient’s condition improved postoperatively, and she was discharged without any complication after 6 days. The pituitary function returned to normal in 1 month without hormonal support.
For the management of cavernous sinus syndrome, enhanced MRI is useful to reveal important intracranial and sinus findings. Although cavernous sinus syndrome is rare, delay in diagnosing may lead to serious complications such as meningitis, brain abscess, visual disturbance and hypopituitarism. Immediate surgical drainage is essential for the treatment of cavernous sinus syndrome caused by sinusitis.
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Yosuke Nakamura, Hiromi Takeuchi, Kei Fukushima, Rie Morizane, Hiroya ...
2015 Volume 144 Pages
38-39
Published: 2015
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Chronic rhinosinusitisis a commonly encountered disease in the field of otolaryngology, and with the advances in therapeutic technologies, cure has been achieved in many cases. However, in patients with a handicap, the standard drugs cannot be administered and the technically complex endoscopic sinus surgery (ESS) cannot be performed on account of medical and/or social reasons in some cases. Use of a navigation system lends useful support for ESS in cases with marked anatomic modifications. We present a case of navigation-guided ESS in a patient of chronic rhinosinusitis with severe skull deformation and motor and intellectual disabilities.
The patient was a 20-year-old man who had undergone brain surgery for traumatic intracranial hemorrhage at the age of 10 months. He was subsequently left with the sequelae of epilepsy, spasticity limb palsy, and serious motor development deficits, and had scoliosis, cervical retroflexion, and flattening of the right side of the face with growth.
He was hospitalized at our institution in the department of pediatric neurology for acute respiratory failure. He had a history of rhinorrhea and postnasal drip, and was referred to our hospital because CT revealed advanced pansinusitis on both sides. As conservative medical management was considered to be potentially insufficient, surgery was scheduled. Use of the navigation system helped in making the approach route safer and avoiding dangerous manipulation in the area of anatomic deformity. Although the patient developed mycoplasma pneumonia and recurrence during the first postoperative year, both resolved with conservative medical treatment for one month. Subsequently, these problems did not recur and the postoperative progress was good.
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Risako Hayashi, Takashi Yamatodani
2015 Volume 144 Pages
40-41
Published: 2015
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The frontal sinus is prone to blockade because of the anatomical structure of its excretion path, the frontonasal duct, and it is often difficult to treat frontal sinusitis and frontal sinus cysts. When conservative management is ineffective, frontal sinus operations are performed via nasal endoscopes or an external approach, however, the incidence of postoperative recurrence is high. Obstruction of the front nasal duct causes stagnation of secretions in the frontal sinus, which may result in pressure necrosis of the sinus wall, and rarely, formation of a frontal sinus fistula on the forehead.
Herein, we report a patient with no history of operation or trauma who had refractory frontal sinusitis with a cutaneous fistula. The 60-year-old male had been diagnosed as having frontal sinusitis and undergone five operations over a period of eight years.
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Takahiro Kitamura, Hironori Takebayashi, Emi Maeda, Ryosuke Koike, Tak ...
2015 Volume 144 Pages
42-43
Published: 2015
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In 2014, the Onodi cell was defined as the most posterior ethmoid cell which is situated laterally and/or superiorly to the sphenoid cell. It is closely connected to the optic nerve. So, if it is not recognized during endoscopic sinus surgery, it may result in some optic nerve injury or failure to open the sphenoid sinus.
The objective of the present study was to determine the prevalence of the Onodi cell and variations of the optic canal. Paranasal thin slice CT scans obtained from 237 patients in Osaka Kouseinenkin Hospital were analyzed. Patients with previous histories of facial trauma, paranasal sinus surgery or nasal cancer were excluded.
The prevalence of the Onodi cell was 27.4% (130 sides). The optic canal exposure types were classified into 4 groups: A: posterior ethmoid only; B: Sphenoid sinus only; C: posterior ethmoid and sphenoid sinus; and D: no exposure. Group A comprised 97 sides, group B 300 sides, group C 49 sides, and group D 28 sides. The prevalence of a pneumatized anterior clinoid process was 21.7% (103 sides). There was a significant correlation between the Onodi cell and sphenoid sinus and paranasal sinus lesions in the Chi-square test. Our data should prove useful in endoscopic sinus surgery. We must take care to avoid the optic nerve injury in patients with Onodi cell and a pneumatized anterior clinoid process.
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Seiji Ooyagi, Ichiro Tateya, Yo Kishimoto, Morimasa Kitamura, Shigeru ...
2015 Volume 144 Pages
44-45
Published: 2015
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Ameloblastic carcinoma is a rare odontogenic tumor which arises in the mandible or maxilla. It is classified into the primary and secondary types, and the latter one is extremely rare.
We report herein on a case of secondary ameloblastic carcinoma in a 36-year-old man who complained of indolent swelling at the left side of the mandible. CT and MRI images revealed a multiocular mass with bone destruction in the mandible, and the existence of the ameloblastic carcinoma was confirmed with multiple biopsies. The lesion was resected en bloc with a 1.5 cm safety margin, and reconstructed with an osteocutaneous fibula flap. The histological features of the tumor were consistent with secondary ameloblastic carcinoma. Neither recurrence nor metastasis has been found for one year after the surgery. The clinical, radiological and histological features of the ameloblastic carcinoma are discussed with reference to the relevant literature.
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Toru Ishikawa, Satoshi Takei, Takekatsu Fujimine
2015 Volume 144 Pages
46-47
Published: 2015
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We report a case of malignant melanoma in the submandibular region. The patient was a 67-year-old man, who presented with the chief complaint of swelling of the submandibular region on the right side. CT demonstrated a cystic lesion adjacent to the submandibular gland, and the result of fine-needle aspiration cytology was Class III. Submandibular glandectomy was performed, and pathological examination revealed features consistent with metastasis from a malignant melanoma. We attempted to identify the site of the primary lesion, but failed. We suspected that a primary lesion in the head or neck may have disappeared spontaneously, or that there was no primary lesion to begin with. As partial biopsy of a malignant melanoma in the head and neck region may worsen the patient’s prognosis, it is important to consider complete biopsy of a mass in the head and neck region suspected to be a carcinoma of unknown primary.
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Yukiko Yamashita, Junichi Ishitoya, Yasunori Sakuma, Nobuhiko Oridate
2015 Volume 144 Pages
48-49
Published: 2015
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IgG4-related disease is a syndrome characterized by hyper-IgG4 gamma-globulinemia and infiltration of tissues by IgG4+plasma cells. Although glucocorticoid therapy can improve both the symptoms and serum IgG4 concentrations, differential diagnosis from other similar disorders is necessary. We report the cases of 5 patients who presented with swelling of the salivary glands and elevated serum IgG4 concentrations, and were suspected as having IgG4-related disease. Of the 5 patients, 2 were histopathologically diagnosed as having IgG4-related disease, the diagnosis remained unclear due to a lack of biopsy findings in 2 patients, and the remaining 1 patient was diagnosed as having malignant lymphoma after follow-up for 3 years. To obtain a definitive diagnosis, histopathological examination may have to be performed several times.
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Keisuke Naito, Aki Shimada, Masakazu Goda, Aki Endo, Yoshiaki Kitamura ...
2015 Volume 144 Pages
50-51
Published: 2015
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The adenomatoid odontogenic tumor (AOT) is a rare benign odontogenic tumor that is mostly found in jawbone. It is generally found in the incisor region of the maxilla of young females. It rarely extends into the paranasal sinuses. This article describes a case of AOT found in the maxilla and occupying the maxillary sinus and nasal cavity.
A 20-year-old woman was referred to our department because of swelling of the left cheek. CT examination showed a cystic lesion in the left maxillary sinus including calcified structures and an impacted tooth. A biopsy specimen of the lesion revealed an adenomatoid odontogenic tumor. We performed tumor extirpation combined with the Caldwell-Luc operation. There is no evidence of recurrence 3 years after the operation.
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Keiko Ohno, Yurika Kimura
2015 Volume 144 Pages
52-53
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Advances in antibiotic therapy have reduced the incidence of retropharyngeal abscesses. However, the morbidity and mortality rate are high in immune-compromised patients or when diagnosis and treatment are delayed. In the present report, we describe a rare case of a retropharyngeal abscess associated with pyogenic cervical osteomyelitis and a spinal epidural abscess. An 83-year-old man presented to the emergency department of our hospital with disorder of consciousness (Japan coma scale I-2), weakness of the limbs, and a 4-day history of neck pain. Laboratory blood tests revealed a high white blood cell count and C-reactive protein level, and marked hyperglycemia. Thereafter, he was admitted to the internal medicine department with a diagnosis of hyperosmolar hyperglycemia syndrome and a bacterial infection of an unidentified focus. Cerebrospinal fluid examination performed on hospital day 2 indicated aseptic meningitis. Computed tomography performed on hospital day 3 showed a retropharyngeal abscess, after which he was referred to our otolaryngology department. Posterior pharyngeal wall swelling and airway obstruction were observed. Therefore, we performed an emergency tracheotomy and trans-oral incision and drainage of the retropharyngeal abscess. Blood, urine, and pus cultures indicated positive results for Group B
Streptococcus. Magnetic resonance imaging performed on hospital day 6 demonstrated pyogenic osteomyelitis and a spinal epidural abscess. We continued conservative antibiotic therapy after consultation with the orthopedics department. However, upper limbs paralysis was noted on hospital day 17. The patient was diagnosed as having myelopathy and an epidural abscess, and he underwent an emergency laminectomy (C2–6). After the surgery, the upper limb paralysis improved. Based on the literature and our experience, we believe that although rare, spinal epidural abscesses are a critical complication that could result in a severe decline in neurologic function or death if diagnosis and treatment are delayed.
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Tomofumi Okamiya, Motoaki Miyashita, Masahiko Muroi, Junko Hirato, Kaz ...
2015 Volume 144 Pages
54-55
Published: 2015
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We report herein on a rare case of a retropharyngeal abscess associated with infectious mononucleosis. A 7-year-old girl was admitted with symptoms of severe sore throat and dyspnea. Under an initial diagnosis of retropharyngeal abscess, we performed tonsillectomy of the left palatine tonsil and drainage of the abscess, and the patient recovered steadily. Unexpectedly, the resected tonsil revealed a pathological finding of acute Epstein-Barr virus infection which led us to reach a final diagnosis of retropharyngeal abscess associated with infectious mononucleosis.
Abscesses around the pharynx rarely occur concomitantly with acute Epstein-Barr virus infection. We must analyze the specific features of infectious mononucleosis in detail to reach the precise diagnosis of Epstein-Barr virus infection obscured by severe bacterial infections.
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Takafumi Yamano, Masaru Miyazaki, Toshifumi Sakata, Takashi Nakagawa
2015 Volume 144 Pages
56-57
Published: 2015
Released on J-STAGE: November 28, 2015
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Herein, we report the results of evaluation of the swallowing functions by video fluorography in three patients who had undergone an extraction procedure to remove a foreign body lodged in the laryngopharynx. Prolongation of the “laryngeal elevation delay time (LEDT)” and dysfunction of pharyngeal clearance were commonly observed in all the cases. Dysphagia, which is a common cause of accidental lodging of a foreign bodies in the laryngopharynx, in addition to other underlying disease and a history of intake of medications for conditions such as schizophrenia.
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Hiroki Takeda, Masako Masuda, Eiji Yumoto
2015 Volume 144 Pages
58-59
Published: 2015
Released on J-STAGE: November 28, 2015
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Fish bone foreign bodies in the pharynx are common and can usually be removed on an outpatient basis. However, fish bones in the larynx or the extraluminal digestive tract are rare. We treated four cases in which a fish bone foreign body was found in the larynx or the extraluminal digestive tract. In the first case, a fish bone was found at the larynx (subglottis) in a 2-year-old boy. The second case was a fish bone in the retropharyngeal region which had migrated into the submucosal layer in a 74-year-old man. The third case was a 74-year-old woman with a fish bone puncturing the thyroid gland, resulting in a chronically progressing neck abscess. The forth case was a 61-year-old woman with a fish bone completely lodged in the thyroid gland. The post-operative course was uneventful in all cases. Computed tomography (CT) images were effective for making the diagnoses.
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Tomohisa Hirai, Noriyuki Fukushima, Nobuyuki Miyahara, Ayako Miyoshi, ...
2015 Volume 144 Pages
60-61
Published: 2015
Released on J-STAGE: November 28, 2015
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We treated 62 cases of peritonsillar abscess between January 2011 and July 2014. The patients were classified into 2 groups according to whether the abscesses was located in the superior pole (superior pole group; 50 cases) or the inferior pole (inferior pole group; 12 cases). There were significant differences between the inferior pole group and superior pole group in the age of onset (52.6±6.6 vs. 39.5±2.6,
P=0.04), leukocyte count (15900±1600/μl vs. 12800±5600/μl,
P=0.02), degree of the laryngeal edema (58% vs. 22%,
P=0.01), size of the retropharyngeal abscess (8% vs. 0%,
P=0.04) and the percentage of patients needing drainage construction (33% vs. 88%,
P<0.01).
In addition, all the patients were classified into four groups depending on the type of antimicrobial agents administerd, namely, the “penicillin” group, “penicillin or cephem plus clindamycin (CLDM)” group, “doripenem (DRPM)” group, and the “DRPM plus CLDM” group. We selected DRPM as the carbapenem antibiotic. All of the patients of the inferior pole group who were treated with DRPM with or without CLDM were cured. Three patients of the superior pole group were not cured with a penicillin, with or without CLDM.
The overall efficacy rates in the “penicillin” group, “penicillin or cephem plus CLDM” group, “DRPM” group, and “DRPM plus CLDM” group were 50%, 77%, 86% and 67%, respectively. There were significant differences in the efficacy between the “penicillin” group” and the other groups (
P<0.01).
We concluded that a cephem/penicillin plus CLDM should be selected for the treatment of peritonsillar abscesses in the superior pole. For abscesses in the inferior pole, the selection of a carbapnem would be the more desirable for the purpose of preventing exacerbations. However, we need to revise the treatment policy from the viewpoint of proper use of antimicrobials.
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Fumiko Takenaga, Nobusuke Hohchi, Risa Takahashi, Jun-ichi Ohkubo, Sho ...
2015 Volume 144 Pages
62-63
Published: 2015
Released on J-STAGE: November 28, 2015
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We retrospectively analyzed the clinical characteristics of 193 consecutive patients with orbital blowout fracture who consulted us between March 2005 and July 2013. They were 140 males and 53 females ranging in age from 2 to 91 years (average; 36.6 years). About two thirds of patients (122/193=63.2%) were in their teens, twenties and thirties.
There were 87 floor fractures, 56 medial-wall fractures and 50 combined fractures. Seventy-two patients did not show spontaneous improvement of diplopia within the initial follow-up period of 1–2 weeks after injury, and underwent surgery (surgical cases). The other 121 patients were conservatively managed (nonsurgical cases). The percentage of the medial wall fracture was significantly higher in the nonsurgical cases than in the surgical cases (42/121=34.7% vs. 14/72=19.4%,
P=0.023). The average interval between injury and surgery was 13.9 days (range; 0–53 days). Endoscopic sinus surgery was performed in the majority of the cases (62/72=86.1%) solely or in combination with the transmaxillary or transorbital approach. Complete recovery was achieved in 41 patients (56.9%), partial recovery in 28 patients (38.9%), and no improvement in 3 patients (4.2%). Patients who reached complete recovery within 1 month were significantly younger than those who did not (25.6±14.0 vs. 38.2±23.1 years,
P=0.048). The Hess area ratio at the initial consultation was significantly higher in the nonsurgical cases than in the surgical cases (92.2±13.9 vs. 75.9±21.8%,
P<0.001). Patients with complete recovery were likely to have a longer indwelling period of their balloon catheter than those without (6.9±1.3 vs. 6.4±1.1 days,
P=0.082). The surgical outcome did not show significant correlation with the interval between injury and surgery.
These results suggest that the indication of surgical treatment for orbital blowout fracture should be determined after the initial follow-up period of 1–2 weeks from injury, taking the patient’s age, type of fracture and Hess area ratio into consideration, unless the extraocular muscle(s) are incarcerated.
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Tomoaki Mori, Toshikazu Shimane, Hidenori Kanai, Kojiro Hirano, Yukiom ...
2015 Volume 144 Pages
64-65
Published: 2015
Released on J-STAGE: November 28, 2015
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A 70-year-old woman was admitted to our hospital with acute heart failure, and was managed on a ventilator for 3 days. She was extremely hoarse after extubation, and was referred to the otolaryngology department, but there were no abnormal findings. Three months after discharge, she was admitted with extreme hoarseness. Tumors were observed on the bilateral vocal cords which had almost closed the airway, and which we determined as requiring surgical resection. At first the patient underwent tracheotomy and the tumors were resected. Since then, no new granulation has been permitted.
Because of the choking hazard, a huge granuloma requires surgical resection. Prevention is the most important strategy in intubation granulomas, so we believe that it is important to eliminate as many factors involved in the development of granuloma as possible.
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Kota Kida, Takashi Fujii, Tadashi Yoshii, Motoyuki Suzuki, Shinji Otoz ...
2015 Volume 144 Pages
66-67
Published: 2015
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Pleomorphic adenomas most commonly arise in the major salivary glands and rarely in the larynx. We report herein on a case of pleomorphic adenoma of the larynx. A 65-year-old female complained of hoarseness for 6 months. Laryngoscopy revealed a tumor located under the mucosa of the left false vocal cord. Tumor resection was performed via an external approach. The tumor was 24×21×13 mm in diameter and consisted of a white solid mass. The histological diagnosis was pleomorphic adenoma. More than 4 years after surgery, the patient has shown no evidence of recurrence and no subjective symptoms. According to the anatomical location, we considered that the tumor had arisen from the laryngeal glands in the laryngeal ventricle. To treat pleomorphic adenomas of the larynx, surgical resection is primarily recommended. An external approach through the thyrohyoid membrane was selected because we thought it was possible to exfoliate the tumor easily from the surrounding tissue and transoral resection was difficult based on the size, location and shape.
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Takahisa Tabata, Tetsuro Wakasugi, Toshiaki Sanka, Takuro Kitamura, Gu ...
2015 Volume 144 Pages
68-69
Published: 2015
Released on J-STAGE: November 28, 2015
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Laryngeal cancer is the third most common of the head and neck cancers in Japan. We retrospectively analyzed the data of 112 newly diagnosed patients with laryngeal cancer who were treated at our department between 2005 and 2012. The subjects consisted of 102 males and 10 females, ranging in age from 40 to 88 years (average, 69.2 years). The follow-up period ranged from 1 to 95 months (median: 33 months).
Our treatment protocol was as follows: Patients with T1a glottic or T1 supra/subglottic cancer were administered radiotherapy alone at 60 Gy/30 fractions. Patients with T1b glottic or T2 cancer received hyperfractionated radiotherapy with concurrent daily carboplatin (25 mg/m
2). Responders at 30–40 Gy continued receiving chemoradiotherapy up to a total of 64.8 Gy, whereas nonresponders underwent surgery. For patients with T3 or T4 cancer, 1–2 courses of induction chemotherapy (docetaxel 60 mg/m
2 (day 1), cisplatin 60 mg/m
2 (day 1), and 5-fluorouracil 600 mg/m
2 (days 1–5)) were administered. Responders among the T3 patients were given hyperfractionated radiotherapy with concurrent daily carboplatin, whereas all T4 patients and nonresponder T3 patients were treated by surgery after induction chemotherapy.
The overall 5-year crude survival, disease-specific survival and laryngeal preservation rates as determined by the Kaplan-Meier method were 73.5%, 81.9% and 64.2%, respectively. The survival rates were significantly higher in patients with stage I/II disease than in those with stage III/IV disease (stage I: 93.8% (crude)/100% (disease-specific), stage II: 93.3%/100%, stage III: 62.1%/80.8%, stage IV: 24.2%/31.2%). The laryngeal preservation rate was significantly higher in patients with T1/2 disease than in those with T3/4 disease (T1: 89.7%, T2: 92.0%, T3: 19.3%, T4: 0.0%). The survival rate of patients with stage IV disease and the laryngeal preservation rate of patients with T3 disease were somewhat low and unsatisfactory as compared to previous reports.
These results indicate the importance of early detection and the need for improvement of the treatment protocol for stage IV/T3 cases.
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Hirotaka Kikuoka, Jin Hoshi, Takeshi Shimizu
2015 Volume 144 Pages
70-71
Published: 2015
Released on J-STAGE: November 28, 2015
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Schwannomas, which are tumors originating from the Schwann cells, are well-capsulated benign tumors, and are not common in the larynx. We describe the case of a 70-year-old woman with schwannoma of the epiglottis. The patient, who was scheduled to undergo mastectomy, was found to have a spherical mass in the larynx during intubation for general anesthesia. The mass was located on the pharyngeal aspect of the epiglottis. As she complained of a sense of incongruity of the pharynx, the tumor measuring 2 × 2 cm in size was completely resected by laryngomicrosurgery. Histopathology of the resected specimen revealed a laryngeal schwannoma. The nerve from which the tumor originated was uncertain. No recurrence has been noted during a follow-up period of more than 1 year.
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Tomohisa Hirai, Noriyuki Fukushima, Nobuyuki Miyahara, Ayako Miyoshi, ...
2015 Volume 144 Pages
72-73
Published: 2015
Released on J-STAGE: November 28, 2015
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Gastroesophageal reflux disease (GERD) has been known to cause pharyngeal symptoms such as globus pharyngeus, cough, hoarseness and swallowing disturbance. Non-erosive reflux disease (NERD) is thought to be more difficult to treat than erosive reflux disease (e-GERD) due to the high prevalence of proton pump inhibitor (PPI) resistance. Mosapride citrate improves gastrointestinal peristalsis by promoting the acetylcholine isolation in the gastrointestinal nerve plexus.
We administrated mosapride citrate for 4 weeks in 22 patients with NERD who were diagnosed with the laryngoscope and upper gastrointestinal endoscopy, and the subjective symptoms were assessed on a frequency scale for the symptoms of GERD (FSSG). The overall symptom improvement degree was 68.2%, which was approximately equal to other reports. Mosapride citrate improved both the acid reflux-related scores and the dyspeptic symptom scores on FSSG.
We concluded that mosapride citrate is effective on some patients with NERD.
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Haruo Hirakawa, Yasuyuki Nishi, Makoto Tada, Taisuke Watanabe
2015 Volume 144 Pages
74-75
Published: 2015
Released on J-STAGE: November 28, 2015
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We have been applying superselective intra-arterial chemoradiotherapy (SIACRT) to advanced squamous cell carcinomas of the maxillary sinus and upper gingiva since 2009. We reported the outcomes of SIACRT in this journal recently. SIACRT is a promising therapy to preserve the patient’s quality of life both during and after the treatment, without sacrificing the cure rate. However, we cannot but use imaging to evaluate the SIACRT response, because visual observation of the lesion is difficult with the maxillary sinus not fenestrated in our therapeutic method. We use
18F-FDG-Positron emission tomography-computed tomography (PET/CT) to evaluate the SIACRT response. This report shows the PET/CT findings of the same patients we reported in this journal recently, before and after SIACRT. We also mention squamous cell carcinoma antigen (SCC) of the patients as a guide to the response evaluation. The 1st PET/CT around 3 months after SIACRT showed false positive in many of the cases. Another PET/CT 1–2 months later could evaluate the SIACRT response more correctly. SCC might help for the evaluation using PET/CT.
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Yuri Ueda, Kiyoaki Tsukahara, Kazuhiro Nakamura, Ray Motohashi, Minoru ...
2015 Volume 144 Pages
76-77
Published: 2015
Released on J-STAGE: November 28, 2015
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Pediatric salivary gland carcinomas are a rare neoplasm with a prevalence of 0.9 per million people. On the other hand, 30 to 40% of pediatric salivary gland tumors are malignant. We report herein on a case of submandibular gland carcinoma in a child. The patient was a 9-year-old girl with a right submandibular swelling from three years previously. Ultrasonography revealed a tumor in the right submandibular gland. Fine needle aspiration cytology was performed, and the tumor was diagnosed as class III. There were some atypical findings associated with a benign tumor based on ultrasonography and cytology findings. To make a definite diagnosis, excision of the right submandibular gland was performed. The frozen section showed malignant findings, thus neck dissection was added. The final pathological diagnosis was a low-grade mucoepidermoid carcinoma. There has been no recurrence or metastasis for 12 months without adjuvant therapy. An operation should be considered even in children if there are suspicious findings of malignancy.
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Haruka Tanaka, Yasunori Aoyagi, Hiromitsu Akizuki, Ryota Mashiko, Yasu ...
2015 Volume 144 Pages
78-79
Published: 2015
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The 126 patients were surgically treated for thyroid tumors in our hospital between April, 2002 and July, 2013. Female patients were more frequent than males. In 66.7% of the cases the tumors were benign (adenomatous goiter was the most frequent) and malignant tumors accounted for 33.3% (papillary carcinoma was the most frequent). There were patients who had no subjective symptoms, when their thyroid tumors were discovered incidentally during a routine medical examination. In fine needle aspiration cytological diagnosis, the sensitivity value was 96.0% and specificity value was 84.2%, and accuracy value was 87.1%. In TNM classification, 71.4% of the cases comprised T1 and T2. N1 accounted for 52.4% and N0 for 47.6%. Among those patients with malignant tumors, 2 died. The remaining 40 patients are alive at present. Recurrence was found in 6 cases.
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Hiroki Takeda, Satoru Miyamaru, Koichi Haba
2015 Volume 144 Pages
80-81
Published: 2015
Released on J-STAGE: November 28, 2015
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We report herein on a case of interdigitating dendritic cell sarcoma (IDCS) of a neck lymph node. A 43-year-old man was seen for left neck swelling. The left neck was found to have a smooth and soft tumor. We found atypical cells with fine needle aspiration cytology, and performed a cervical lymph excisional biopsy. Diagnosis was confirmed by histology and immunostaining. After the lymph node biopsy, additional radiation therapy was performed. Generally, diagnosis of IDCS is difficult. In this case, the tumor lesion was limited to a cervical lymph node and fine needle aspiration cytology suggested the possibility of malignancy. Treatment resulted the patient’s being desease-free at 18 months after radiation therapy.
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Yushi Ueki, Meiko Kanemaru, Ryusuke Shodo, Yutaka Yamamoto, Sugata Tak ...
2015 Volume 144 Pages
82-83
Published: 2015
Released on J-STAGE: November 28, 2015
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We present herein an 85-year-old patient with advanced hypopharyngeal carcinoma who developed thrombocytopenia during treatment with cetuximab plus radiotherapy. He had a medical history of diabetes mellitus and atrial fibrillation and was taking 3.5 mg of oral warfarin per day. At the time when the third dose of cetuximab was administered, the patient experienced a high-grade fever—thought to be an infusion reaction—followed by thrombocytopenia, which improved with platelet transfusion. After radiotherapy was finished, a hematoma was observed in the iliopsoas muscle on a CT scan. The prothrombin time-international normalized ratio (PT-INR) was elevated to an extremely high level of >8.0, which caused by warfarin. Thrombocytopenia owing to cetuximab is a very rare but adverse event that may occur severely in elderly patients. Therefore, it is necessary to choose the treatment carefully for them. In addition, patients with carcinoma receiving anti-coagulant therapy should be assessed for risk factors and frequently monitored for blood coagulation during anti-cancer treatment.
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Yuri Ueda, Yasuo Ogawa, Akira Shimizu, Hiroyuki Ito, Mamoru Suzuki
2015 Volume 144 Pages
84-85
Published: 2015
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Objective: Extrapulmonary small cell carcinoma (EPSCC) is a cancer with a poor prognosis. The treatment of EPSCC has not been established because of its rarity. We encountered a case of EPSCC involving the maxillary sinus, which had been treated with irinotecan (CPT-11), carboplatin (CBDCA) and radiotherapy.
Case report: A-79-year-old woman visited our clinic with bloody rhinorrhea and nasal obstruction. Physical examination revealed a rough nasal polyp in the left nasal cavity. CT scans revealed a soft tissue shadow in the left maxillary sinus. Endoscopic sinus surgery was performed. The nasal polyp was pathologically diagnosed as a small cell carcinoma. There was no evidence of metastasis, and the tumor was staged as maxillary cancer, T2N0M0. Chemotherapy with CPT-11 combined with CBDCA and radiotherapy (total 50 Gy) were started. After 3 cycles, the chemotherapy was discontinued due to severe anemia. The CT scan at this time demonstrated no signs of tumor progression. The disease has remained stable with no recurrence for 3 year and 6 months.
Discussion: Recently, some articles about extensive-disease small cell lung carcinoma have shown that the IP therapy comprising CPT-11 combined with platinum, is more effective than the EP therapy comprising etoposide and platinum. However, for limited-disease small cell lung cancer, the IP therapy combined with thoracic radiotherapy is not indicated in general, due to its severe toxicity such as radiation pneumonitis. However, for EPSCC, the IP therapy with radiotherapy can possibly be performed more safely, because radiation for EPSCC does not target the lungs. In the present case, no severe side effect developed except for anemia, suggesting the usefulness of the IP therapy combined with radiotherapy for EPSCC.
Conclusion: We present herein on a case of EPSCC treated with chemoradiotherapy with CPT-11 and CBDCA. Tumor growth has been controlled for the period of 3 year and 6 months.
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Shinya Agena, Takayuki Uehara, Yukashi Yamashita, Sen Matayoshi, Masah ...
2015 Volume 144 Pages
86-88
Published: 2015
Released on J-STAGE: November 28, 2015
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Since bone and soft tissue sarcomas arising from the head and neck region are very rare, the standard treatment protocol has yet to be established. In the present study, 13 cases with bone and soft tissue sarcomas treated from 2007 to 2014 were analyzed. The mean period from initial visit to final pathological diagnosis was approximately 3 weeks, and 38.5% of the cases needed several biopsies for an accurate diagnosis. Death occurred early for those cases in which more than 40 days was needed to obtain the histological diagnosis. The 3-year overall survival in 13 cases was 35.2%. As the cause of death was uncontrolled local lesion, the locoregional control was more important than distant metastasis control for the prognosis. Tumor location, TNM stage, and histological grade affected the prognosis of the sarcomas. Radiation therapy including heavy ion and proton beam radiotherapy was not so effective as the primary treatment, as was the case with salvage treatment of sarcomas in the head and neck. Although the primary treatment of sarcomas was surgical treatment with an adequate margin, an efficient treatment protocol should be established to obtain a better prognosis.
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Kohei Yamahara, Juichi Ito, Yohei Kumabe, Shinzo Tanaka, Yasuyuki Hira ...
2015 Volume 144 Pages
90-91
Published: 2015
Released on J-STAGE: November 28, 2015
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Carcinoma ex pleomorphic adenoma is a rare aggressive malignant carcinoma developing in a pre-exisiting pleomorphic adenoma. Capsular invasion has an oppressive prognosis. On the other hand, intracapsular carcinoma ex pleomorphic adenoma is known to have a benign clinical behavior. We report a rare case of intracapsular carcinoma ex pleomorphic adenoma of a minor salivary gland in the parapharyngeal space revealed by prior cervical lymph node metastasis. A 35-year-old male presented with a month-long history of progressive enlargement of the left cervical mass. We performed a biopsy of the mass and the diagnosis of a metastatic adenocarcinoma of undetermined origin was made. To detect the primary tumor, several investigations were performed using various diagnostic modalities. We found a tumor in the left parapharyngeal space. But, unlike the metastatic cervical lymph node, this tumor showed neither FDG uptake nor enhancement on either CT or MRI. These imaging findings did not favor this tumor as the primary site. We were unable to confirm that the tumor in the parapharyngeal space was the primary carcinoma. We performed a left modified radical neck dissection, removal of the tumor in the parapharyngeal space and hemithyroidectomy of the left lobe. Histological examination revealed that the tumor in the parapharyngeal space was carcinoma ex pleomorphic adenoma. We diagnosed it as the primary carcinoma. Despite the absence of capsular invasion, this case featured high-grade malignancy with cervical lymph metastasis.
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Koichiro Yamada, Shinzo Tanaka, Yasuyuki Hiratsuka, Yohei Kumabe, Yosh ...
2015 Volume 144 Pages
92
Published: 2015
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Objective: Papillary thyroid carcinoma (PTC) is generally well-recognized as having a good prognosis. However, there are some cases in which the tumor becomes life-threatening for the patient. The aim of this study was to detect high-risk factors in PTC patients.
Patients and Methods: The study included 225 patients (mean age 57.0±14.6 years, 45 men and 180 women, mean follow-up 12.3±4.8 years) who underwent surgical treatment at Osaka Red Cross Hospital between 1991 and 2005. TNM classification and staging were based on the UICC 7th classification. Sixty-three patients were classified as T1–2, 121 as T3, and 41 as T4. One hundred six patients were classified as N0, 57 as N1a, and 62 as N1b. A total of 220 patients were classified as M0 and 5 patients as M1. Seventy-two patients were classified as stage I–II, 77 as stage III, and 76 as stage IV. Overall survival and disease-specific survival rates were calculated by the Kaplan-Meier method and were compared using the log-rank test.
Results: Eighteen patients died from PTC. The overall 10-year survival rate was 88.6%, and the 15-year survival rate was 74.4%. The disease-specific 10-year survival rate was 95.7%, and the 15-year survival rate was 91.3%. Univariate analysis revealed age (≧50), T4, N1b, M1 and stage IV were significant risk factors. T4, N1b and M1 were significant risk factors, based on the multivariate analysis.
Conclusion: PTC generally had a good prognosis. Age (≧50), T4, N1b, and/or M1 at diagnosis showed a clearly lower disease-specific survival. Multivariate analysis revealed T4, N1b and M1 were significant risk factors.
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Jiro Aoi, Kahori Hirose, Taisuke Kobayashi, Masamitsu Hyodo
2015 Volume 144 Pages
94-95
Published: 2015
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Salivary duct carcinoma (SDC) is a highly malignant salivary gland tumor. Because of its low incidence, it has been impossible to standardize the optimal treatment strategies for SDC including adjuvant systemic therapy. Recently, it has been reported that SDC resembles mammary ductal carcinoma (DC). Over-expression of human epidermal growth factor type-2 (HER-2) protein has been shown in SDC as in mammary DC. We report herein on a successful treatment experience for a patient with advanced SDC using trastuzumab, a humanized monoclonal antibody.
A 56-year-old male was hospitalized with lumbalgia. Radiological examination indicated a tumor in the right accessory parotid gland and multiple metastatic tumors in the left skull base, ribs, lumbar vertebrae and sacral bone. Incisional biopsy of the right accessory parotid gland revealed SDC. Immunostaining for HER-2 was highly positive. He underwent concurrent radiation- and chemoradiotherapy (intensity-modulated radiotherapy [IMRT 60 Gy], nedaplatin and docetaxel), which resulted in a poor response. Thereafter, trastuzumab was administered. He obtained a significantly effective response after 8 courses of treatment for the metastatic lesions.
In contrast to previous reports of a poor response to chemotherapy and poor survival rate of patients with SDC, our patient demonstrated that trastuzumab was a highly effective modality as a therapeutic choice for SDC.
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Shigeru Kasugai, Shoji Watanabe, Yoshihiro Akazawa, Masahiko Fukasawa, ...
2015 Volume 144 Pages
96-97
Published: 2015
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Radical neck dissection (RND) has been used as a standard operative technique in the surgical management of lymph node metastases from head and neck cancer. To improve patients’ quality of life (QOL), various modifications to RND have been proposed. Several studies have demonstrated that spinal accessory nerve (SAN) damage causes deterioration of the QOL, and rehabilitation of the shoulder is very important in the recovery process after such surgical procedures. Also, lack of rehabilitation in the early stage after surgery leads to severe stiffness and constriction in the neck and shoulder not only in cases where the SAN was cut, but also where it was preserved.
We analyzed the presence or absence of significant differences before and after rehabilitation with regard to shoulder function, stiffness and constriction, focusing on whether the SAN was preserved or not, and how long after surgery rehabilitation was started.
We divided 29 patients into two groups, one of which was the group of 21 cases in 17 patients in whom the SAN was preserved in 16 and resected in 5. In this group, rehabilitation was started at an early stage after the surgery (group A). The other group was comprised of 18 cases in 12 patients, with SAN preservation in 7 and resection in 11, and in whom rehabilitation was started more than six months after surgery (group B). Those two groups were analyzed regarding range of motion (ROM) and a pain questionnaire.
In group A, flexion and abduction of ROM angles and the pain score significantly improved after rehabilitation, compared to group B. In those patients in group A in whom the SAN was preserved, the rehabilitation results was significantly better than those in the non-preservation group. On the other hand, no significant difference was found between these subgroups of patients in group B. When the SAN-resection cases were compared between groups A and B, improvement in the ROM data was seen after the rehabilitation in group A.
Rehabilitation should be begun in the early stage after neck dissection no matter whether the SAN was preserved or not.
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Masami Nakajima, Yasuhiro Kase, Tatsuro Sekine
2015 Volume 144 Pages
98-99
Published: 2015
Released on J-STAGE: November 28, 2015
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Primary nasopharyngeal Hodgkin lymphoma (HL) is a rare, but important differential diagnosis of nasopharyngeal tumors. If not diagnosed early and correctly, it may cause life-threatening complications and be difficult to treat. We report the case of a patient with nasopharyngeal tumor, in whom the diagnosis of primary nasopharyngeal HL was established by partial resection. We also provide a review of published reports on primary nasopharyngeal HL. A 32-year-old Japanese man presented to us with the chief complaint of nasal obstruction, which was diagnosed as being caused by a nasopharyngeal tumor. The nasopharyngeal tumor biopsy was negative, therefore, partial resection of the nasopharyngeal tumor was performed. Histopathological examination of the resected specimen showed Reed-Sternberg cells and immunohistochemistry showed positive staining for CD30, which confirmed the diagnosis of classical HL, mixed cellularity type. He was treated by involved field radiation therapy (IFRT) alone, to avoid azoospermia. Until now, 10 months since the completion of treatment, good local control is maintained. Nasopharyngeal HL should be included in the differential diagnosis of a nasopharyngeal mass and may be diagnosed by partial resection in the event of failure of diagnosis at the initial biopsy.
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Kumiko Suzuki, Shintaro Sato, Mikio Monji, Yuichiro Kuratomi
2015 Volume 144 Pages
100
Published: 2015
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Epithelial-myoepithelial carcinomas (EMCs) are classified as a low grade malignant tumor arising from the salivary gland and comprises approximately 1% of all salivary gland tumors. We report herein on a patient with EMC arising from the deep lobe of the parotid gland who presented with facial nerve paralysis as an initial symptom, and then developed otalgia and glossopharyngeal pain, and finally presented multiple cranial nerve disorders.
A 76-year-old woman was referred to us because of right otalgia lasting for 2 years and abnormal lesions in her mastoid cavity seen on magnetic resonance imaging (MRI). She had developed right facial nerve paralysis 6 years before the first visit to us. On otoscopic findings, her right tympanic membrane appeared normal. MRI revealed multiple lesions in the right mastoid air cells and along the glossopharyngeal nerve, and there was suspicion of a faint shadow in the deep lobe of the parotid gland. Medical treatments for the glossopharyngeal neuralgia showed little effect. The patient developed right laryngeal paralysis, and then developed right soft palate and accessory nerve paralyses six to eight months after the first visit. A mastoidectomy was performed which revealed multiple tumors in the mastoid air cells without bone destructions. Histologically, the tumor was diagnosed as an epithelial-myoepithelial carcinoma arising from the parotid gland. Positron emission tomography revealed a metastatic lesion in her cervical spine and, therefore, she underwent carbon-ion radiotherapy. Eighteen months after the treatment, the tumor size was stable. It was presumed that the tumor developed in the deep lobe of the parotid gland, and then invaded the mastoid cavity causing the facial nerve paralysis, and finally infiltrated medially along with the internal jugular vein giving rise to multiple cranial nerve (IX～XI) disorders.
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Chiaki Suzuki, Satoshi Ohno, Shinji Takebayashi, Akiyoshi Yasumoto, Sa ...
2015 Volume 144 Pages
102-103
Published: 2015
Released on J-STAGE: November 28, 2015
JOURNAL
OPEN ACCESS
We report two cases of spindle cell carcinoma (SpCC), one of the maxillary sinus and another of the larynx. SpCC is extremely rare in the head and neck region, especially in the paranasal sinuses. It has been reported that the larynx, oral cavity, and pharynx are the sites of predilection of this cancer in the head and neck.
Case 1 (66-year-old, male) was initially diagnosed as having squamous cell carcinoma (SCC) of the maxillary sinus (cT4aN2cM0). An extensive operation was performed via a lateral rhinotomy approach, with reconstruction performed after induction chemotherapy. Histopathological examination of the resected specimen revealed the diagnosis of SpCC. Case 2 (66-year-old, male) with SCC of the larynx (cT1bN0M0) was administered radiation therapy at 66 Gy. However, the tumor recurred locally two years after completion of the radiation therapy, and cordectomy was performed. However, a local recurrence was detected again after two years, and finally SpCC was diagnosed and total laryngectomy was performed. Both patients are doing well until date, without any evidence of local recurrence or distant metastasis.
SpCC is defined as a biomorphic carcinoma that contains both squamous cell and spindle cell components. Therefore, it is sometimes misdiagnosed as SCC in small biopsies. However, it is reported as a highly aggressive tumor with a poor prognosis, therefore, biopsies of adequate depth and size are recommended for precise diagnosis of SpCC.
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