Because soft tissue sarcoma rarely arises in the oral cavity, there are few reports on this lesion in the head and neck region. Eight cases of soft tissue sarcoma treated at our department during the past two decades were studied clinicopathologically. Some small lesions were clinically given a diagnosis of benign tumor at presentation, followed by excisional biopsy. It was difficult to achieve an exact pathologic diagnosis from the biopsy specimens. The definitive diagnosis based on the resected material differed from the original diagnosis in some cases. Six of the eight cases were subjected to immunostaining to analyze their cytologic characteristics. Alteration of the p53 tumor suppressor gene was detected in 4 cases, and loss of p16 was noted in 5 cases. The average proliferation cell nuclear antigen labeling index of the soft tissue sarcomas was 31.3%, higher than the value for oral squamous cell carcinoma. All soft tissue sarcomas expressed metalloprotease (MMP)-2 and MMP-9 and showed low intratumoral microvessel density. These results suggest that soft tissue sarcomas have high proliferation potential and aggressive growth without angiogenesis.
Polymorphous low-grade adenocarcinoma (PLGA) is a rare malignant tumor arising from the minor salivary glands. We report a case of PLGA occurring in the soft palate. An 82-year-old man had been aware of a soft-palate mass for 7years. The mass was relatively large, measuring 50×60mm, and caused dysphagia and dysphonia. The lesion was clinically diagnosed as a tumor, and the patient underwent resection under general anesthesia. The mass was pathologically diagnosed as PLGA. The postoperative course was uneventful. There has been no recurrence or distant metastasis for 4years.
An extremely rare case of combined large cell neuroendocrine carcinoma of the lower gingiva associated with focal differentiation to squamous cell carcinoma is presented. Travis et al. proposed a new, distinctive clinicopathologic type of pulmonary neuroendocrine tumor, termed large cell neuroendocrine carcinoma(LCNEC). It is defined as a poorly differentiated, high-grade neuroendocrine tumor that has morphologic and biologic features intermediate between atypical carcinoid and small cell carcinoma. A 59-year-old man presented with bleeding and swelling of the lower gingiva. The pathological diagnosis of a biopsy specimen was poorly differentiated squamous cell carcinoma. The patient therefore underwent surgical resection of the tumor. The tumor was composed of larger cells than those of small cell carcinoma and exhibited solid, trabecular, and slightly rosette-like growth patterns with a high mitotic rate in normal subepithelial interstitial tissue. Grimelius staining was positive, and chromogranin A and neural cell adhesion molecule (CD56)immunostaining was positive. The tumor was diagnosed as large cell neuroendocrine carcinoma on microscopic and immunohistochemical studies. On hematoxylin and cosin staining, there were no signs of transition between neuroendocrine carcinoma and carcinoma in situ. However, at the circumference of neuroendocrine carcinoma, a mass of cells associated with differentiation to squamous cell carcinoma was seen. These cells showed positive CAM5.2(lowmolecular-weight cytokeratin)immunostaining. Therefore, the tumor was finally diagnosed as a combined large cell neuroendocrine carcinoma of the lower gingiva associated with focal differentiation to squamous cell carcinoma.
Melanotic neuroectodermal tumor of infancy (MNTI) is a rare tumor cathegorized as a benign tumor by the World Health Organization. We describe a case of MNTI arising in the mandible of a 3-month-old boy. After admission, the tumor grew very rapidly. The tumor was surgically removed and measured 20×25 mm. The bone surface after complete removal of the tumor showed no specific or abnormal findings. The histopathological diagnosis was MNTI. After 3 years of follow-up, no local recurrence or metastasis has been noted.
We report a case of postoperative reflex sympathetic dystrophy in a 56-year-old woman who had undergone excision of oral cancer and reconstruction with a free forearm flap. The patient was referred to our department because of an ulcer of right side of the soft palate on March 17, 1998. Because a biopsy specimen of the ulcer showed squamous cell carcinoma, we performed excision of the tumor, functional neck dissection, and reconstruction of the soft palate with a left free forearm flap. One year after surgery, the patient complained of severe burning and tenderness of her left forearm, which rapidly spread to the upper part of the arm. Her symptoms strongly suggested reflex sympathetic dystrophy, and stellate ganglion block was attempted to reduce the pain. At present, 2 years after the onset of pain, she still has moderate pain. We are seeking a more effective therapy for her condition.
Amyloidosis is a condition in which amyloid, a specific protein with a fibrous structure, is deposited extracellularly. We report a case of localized amyloidosis of the sublingual gland with calcification, revealed by radiographic examination of the oral floor. A 68-year-old man came to the oral surgery outpatient clinic because of ‘stickiness’ in his mouth. The oral floor was swollen, and an X-ray film revealed calcification. A biopsy of the sublingual gland was done, and amyloidosis was diagnosed. Amyloid deposition was not found elsewhere. There is no treatment available for this condition. The patient is still being followed up periodically. There has been no change in his condition.
A case of superior vena cava syndrome (SVCS) with swelling of the cheek is presented. A 67-year-old man was referred because of painless bilateral swelling of the parotid region. Physical examination revealed no cause of the swelling. However, chest radiographs and computed tomographic scans demonstrated that the superior vena cava was compressed by a mass. On biopsy, the mass was histologically diagnosed as poorly differentiated large cell carcinoma of the lung. Radiotherapy was effective against the tumor, alleviating compression of the superior vena cava, and the cheek swelling concomitantly disappeared. Consequently, the swelling was diagnosed as a component of SVCS subsequent to pulmonary cancer. The present case suggests that SVCS should be included in the differential diagnosis of lesions with cheek swelling.
A 24-year-old woman complaining of a toothache was referred to our department in February 1999. She had a long history of hypersensitive reactions to drugs, recurrent dislocation of the shoulder joints, and hyperthyroidism. She underwent allergy testing for local anesthetics at the second department of anesthesiology of our university. Shortly after the test, she fell into respiratory insufficiency, lost consciousness, and was transferred to the intensive care unit. After a week she was discharged. Further examinations for drug allergy at the department of dermatology of our university revealed that she was not allergic to diclofenac sodium or mepivacaine hydrochloride. We speculated that the allergic reactions may have been psychogenic. At the same time, Ehlers-Danlos syndrome was diagnosed. After successful dental treatment, both temporomandibular joints were dislocated while eating. Repositioning was possible under local anesthesia with mepivacain hydrochloride. Subsequently, temporomandibular joint dislocation has occurred several times. The joint has usually been repositioned by a physician, with the patient under local anesthesia. However, the patient has sometimes successfully done repositioning by herself.
We report on problems encountered during perioperative management in a 46-year-old woman with deaf-mutism and loss of multiple teeth who underwent orthognathic surgical correction of a jaw deformity. She consulted a dentist because of poorly fitting dentures when she was 26 years old. The dentist could not treat her, and she was referred to our hospital. However, the patient did not visit a dentist regularly because of lack of understanding. Nineteen years later, she came to us again and was accompanied by a sign-language interpreter. Her chief complaints were masticatory dysfunction and esthetic dissatisfaction. We performed orthognathic surgical correction after understanding each other through the interpreter. Preoperatively and postoperatively, we promoted mutual understanding through the interpreter. During hospitalization, we managed to communicate mainly by gestures and cards. Masticatory function and facial esthetics were successfully improved in this patient.
Recently, treatment for jaw deformities has diversified. This report describes the treatment and outcome of a patient who underwent hi-maxillary osteotomy aided by lateral expansion with midline distraction osteogenesis. The patient was a 31-year-old woman. She was given a diagnosis of mandibular prognathism with crowding of the anterior teeth and an extremely narrow hi-maxillary arch width. Procedures were used Le Fort I osteotomy and median palate osteotomy in the maxilla and sagittal split ramus osteotomy and a median osteotomy in the mandible. A rapid lateral expansion device was attached to the maxilla preoperatively and an original bone distraction device was attached to the mandible at the midline during operation. This device consisted of two intermaxillary fixation screws, serving as anchors for expansion. The maxilla was lengthened laterally by 5.5mm and the mandible by 4.5mm. Immediately after distraction was completed, orthodontic treatment was started, followed by periodontal treatment and prosthodontic treatment. One year after the operation, the patient has normal occlusion and is satisfied with the results.
Actinomycosis of the lip is very rare. This report describes a case of actinomycosis affecting the lower lip. A 43-year-old man presented with a swelling of the right side of the lower lip. Incision with drainage was performed to treat the abscess. Drusen was found in the pus. The histopathological diagnosis was actinomycosis. The patient received 750mg LAPC three times daily for 40 days. Subsequently, the condition completely resolved.
Lupus anticoagulant (LA) is defined as an autoantibody that inhibits phospholipid-dependent blood coagulation, without suppressing individual blood coagulation factors. We encountered a LApositive patient who needed surgical treatment. The patient was a 32-year-old woman who came to our hospital because of right cheek swelling. A right buccal abscess due to 76 periapical periodontitis was diagnosed on the basis of the clinical manifestations and radiographic findings. The activated partial thromboplastin time (APTT) was remarkably prolonged to 65.5 seconds. The blood platelet count, other peripheral blood variables, and chemical data were within the normal range. After performing the cross mixing test and rarefaction prothrombin time (PT) test, the patient was found to be LA positive. She had no autoimmune diseases, such as systemic lupus erythematosus, which frequently accompanies LA, and there was no history of drugs that could induce LA. Thrombosis or thrombocytopenia occur frequently in LA-positive patients. Therefore, we managed her condition during the perioperative period taking this problem into consideration. APTT normalized, and LA became negative after surgery. The transient LA positivity in our case was attributed to infection.