To clarify risk factors for neck failure, we analyzed the clinical and histopathological findings in node-positive cases of squamous cell carcinoma of the tongue. We reviewed the records of 342 patients with controlled primary tongue lesions who were treated between January 1974 and June 1999 at Chiba Cancer Center Hospital. Two hundred fifty-one patientswho had clinically or pathologically negative nodes or both were excluded from study. Among 91 patients with positive nodes, neck disease was controlled in 81, and neck failure developed in 10. The relations of various factors to the pattern of cervical lymph node metastasis in the 91 patients were investigated by multivariate analysis. Multiple logistic regression analysis showed that the odds ratio for neck failure diminished in the following order: level of metastasis 6.732 (p=.0197), presence of nodal adhesion 3.329, extracapsular spread 2.444, number of positive nodes 1.421, and node size 1.097. Of the 10 patients with neck recurrence, 9 had recurrence in areas confirmed to have positive nodes. Five patients with nodal adhesion had recurrence at the location of nodal adhesion. The presence of lower neck involvement may be a decisive factor for postoperative treatment. Patients with nodal adhesion should receive extended radical neck dissection with a sufficient margin, and postoperative treatment should be considered.
A 64 year-old woman visited our hospital because of a firm, painless, and freely movable mass (11×9mm) on the left lateral edge of the tongue. Ultrasonography showed a hypoechoic mass with a smooth and clear border. The lesion was removed with a margin of normal tissue and overlying mucosa and was pathologically diagnosed to be a chondroma. Postoperative healing was uneventful, with no sign of recurrence during 4 months' follow-up. A cell strain was isolated from the tumor, and the chondrogenic characteristics were studied. These cells showed fibroblastic shapes and formed extracellular matrix positively stained with alcian blue in the presence of L-ascorbic acid. Immunocytochemical studies of these cells revealed positive staining for type II collagen, type IX collagen, and type XI collagen in the cytosome. Furthermore, RT-PCR analysis demonstrated that these cells expressed mRNA for type II collagen, type IX collagen, type X collagen, type XI collagen, osteopontin, alkaline phoshatase and condromodulin-I. These results indicate that cells derived from the lingual chondroma possess characteristics of normal chondrocytes and are useful for studying the origin of chondroma in soft tissue.
We encountered a 48-year-old man with a suspected diagnosis of T-cell lymphoma associated with extensive mucosal necrosis of the palate. Definitive diagnosis was very difficult. Histopathological examination revealed infiltration of vascular tissue by tumor cells and severe necrotic changes. Immunohistochemical studies revealed that most of the tumor cells were CD45-RO-positive, CD 3-positive, CD56-negative, and CD20-negative. In situ hybridization did not reveal any Epstein-Barr (EB) virus mRNA. Furthermore, the EB virus gene was notidentifiable on polymerase chain reaction (PCR). Based on these findings, the patient was given a diagnosis of suspected T-cell lymphoma of the palate not associated with the EB virus.
Giant cell tumor most commonly occurs in the epiphysis of long bones. This tumor is extremely rare in the maxillofacial region. We describe a case of giant cell tumor of the maxilla. The patient was a 33-year-old woman with a diffuse swelling on the left side of her face and a mass on the left alveolar bone of the maxilla. An orthopantomogram showed a round soft tissue shadow with an area of osteolysis and resorption of the roots of the premolars in the left side of the maxilla. Biopsy revealed a giant cell tumor, and a left partial maxillectomy was performed intraorally. The final diagnosis was giant cell tumor. No tumor recurrence has occurred during 2 years of follow-up.
A case of extensive multifocal recurrent pleomorphic adenoma arising primarily in the parapharyngeal space is reported. A 51-year-old woman was referred to Chiba Cancer Center Hospital. She had a snoring-like voice for 2 months and had pharyngeal discomfort for 1 month. Computed tomography showed a tumor measuring 6.0×4.0 cm in the prestyloid space.The tumor was suspected to originate from the minor salivary glands. A pleomorhic adenoma was suspected on fine needle aspiration cytology, and the tumor was removed via a cervicalapproach. The histopathological diagnosis was pleomorphic adenoma. Nine years after surgery, she noticed a tumor in the parotid region and was reexamined. The recurrent tumor filled the parapharyngeal space, and multiple discrete masses spread extensively throughout theparotid and upper neck regions. The patient underwent resection of the tumor via a mandibular swing approach with total parotidectomy and neck dissection. The histopathological diagnosis of the specimen was recurrent pleomorphic adenoma. In this patient, a mandibular swing approach with neck dissection was done to obtain a wide field for salvage operation and resect a large recurrent pleomorphic adenoma of the parapharyngeal space.
We report a case of pleomorphic adenoma in the retromolar region. The lesion was initiallydiagnosed as a malignant neoplasm on the basis of clinical features and biopsy findings. The patient was a 70-year-old man whose chief complaint was swelling of the left retromolar region. Examination at presentation revealed a tumor measuring 25×15mm accompanied by an ulcer. The lesion was identified as squamous cell carcinoma on examination of a biopsy specimen at another hospital. However, a biopsy done before surgery revealed mucoepidermoid carcinoma. With the patient under general anesthesia, the tumor was resected with the submaxillary lymph nodes. The final histopathological diagnosis was pleomorphic adenoma. The tumor apparently originated from the molar glands.
A rare case of intravascular papillary endothelial hyperplasia (IPEH) arising in the upperlip is reported. A 83-year-old woman noticed a mass in the upper lip, which gradually grewand became tender. The patient presented at our hospital. Initial examination showed a mass with a black central area surrounded by a whitish band and a raised, rolled margin. The tumor, clinically suspected to be a malignant melanoma, was excised without biopsy. Histological and immunohistochemical examinations indicated that the lesion was IPEH. The diagnosis was based on characteristic findings such as papillary endothelial growth within vascular space, few mitotic figures and endothelial cell dysplasia. The patient is well with noevidence of recurrence.
Two cases of necrotizing fasciitis in the cheek and temporal region caused by dental infection and treated with limited doses of antimicrobial agents are reported. Patient 1, a 70-year-old woman with hepatic cirrhosis and diabetes mellitus, had swelling of the right cheek and temporal regions due to pericoronitis of a lower wisdom tooth. Patient 2, a 71-year-old woman with renal insufficiency, had swelling of the left side of the neck, submandibular region, cheek, and temporal region due to pericoronitis of a lower wisdom tooth. Computed tomography demonstrated a gas-forming abscess in the subcutaneous tissue and musclein both patients. The patients were given a diagnosis of necrotizing fasciitis, and surgical drainage was performed. Necrosis of the superficial fascia and subcutaneous tissues wasfound and involved the deep fascia. and muscles. Chemotherapy with a limited dose was started. Daily debridement and irrigation with hydrogen peroxide solution, povidone isodine solution, or benzalkonium chrolide solution, resulted in improvement of symptoms. The importance of early diagnosis followed by appropriate treatment including prompt drainage, localirrigation, administration of antibiotics, and management of general condition is emphasized.
We describe a patient who underwent skin graft fixation using cyanoacrylate. Cyanoacrylatewas used as the glue between a denture and the skin graft. The denture was subsequently attached to the raw surface. After a week, the prognosis for survival of the grafted tissue was excellent. This novel method represents an extremely promising theraupeutic approach for skin graft fixation.
A cervical island myocutaneous flap is useful for reconstruction of surgically induced defects in the oral region. The blood supply to this flap is, however, problematic because of the complex vasculature. We report on 5 patients who received cervical island myocutaneous flaps composed of submental or mandibular angle-based flaps in terms of blood supply.
A 56-year-old woman presented to our clinic with a mass in the floor of the mouth. This patient had been given a diagnosis of sleep apnea syndrome at the Department of Respiratory Disease of our hospital. The body mass index was 34.4, indicating slight obesity, and the apnea hypopnea index (AHI) was 38.2/hr. Oral examination revealed a bony eminence arising bilaterally from the mandible anterior to the tongue and extending to the premolar region.After resecting the mandibular eminence, the AHI improved to 20.9/hr. However, since sleepapnea persisted, control of obesity by weight reduction was considered necessary.
We examined the positivity of hepatitis B surface (HBs) antigen, hepatitis C virus (HCV) antibody, human T-lymphotropic virus type- I (HTLV) antibody, and Treponema pallidum(TP) antibody by performing serological tests in 1446 inpatients who underwent surgery at our hospital. All patients had interviews with us before operation about their medical history and the possibility of being infected with blood-transmissible pathogens. After the interviews, we took a blood sample from the subjects and examined HBs antigen, HCV antibody, HTLV antibody, and TP antibody. Only 9 of 27 HBs antigen-positive persons, 17 of 40 HCVantibody-positive persons, and 1 HTLV carrier reported that they may have been infected with the pathogens. The overall prevalence of positivity for HBs antigen, HCV antibody, HTLVantibody, and TP antibody were 1.9%, 2.8%, 0.1%, and 1.3%, respectively. Our results indicate that the reliability of patient reports is limited and strongly suggest that cliniciansshould take strict measures to prevent the spread of blood-transmissible infections regardless of what patients report.