Squamous cell carcinoma (SCC) is the most common malignancy of the oral cavity. Basaloid squamous cell carcinoma (BSCC), a rare variant of SCC, is a highly malignant tumor associated with high mortality rates. This report presents a rare case of exophytic BSCC arising at the posterior region of the tongue margin in a 74-year-old man. Excisional biopsy with a 10-mm safety margin around the base of the tumor was performed, and the wound was primarily sutured. The postoperative course was uneventful, with no local recurrence or metastasis. However, the patient died of cerebral infarction 4 years after operation.
We report on a 33-year-old woman who presented with swelling of the maxillary tuberosity. Leiomyosarcoma was histopathologically diagnosed on biopsy. A review of the literature is also provided. In April 2004, the patient visited a dental clinic because of gingival swelling around a right maxillary molar. Because the swelling around the right maxillary second molar was not improved by endodontic treatment, the patient was referred to our department on December M, 2004. At initial examination, bony enlargement of a right maxillary tuberosity was found. Orthopantomography revealed a mixed radiolucent/radio-opaque lesion involving the impacted third molar of the right maxilla. MR imaging showed heterogeneous signal intensity around the tooth. On March M, 2005, the lesion was diagnosed as a leiomyosarcoma on biopsy. On April 1, the tumor was surgically resected under general anesthesia. Thick and fascicular bundles of spindle cells with advanced atypia were recognized on examination of hematoxylin and eosin-stained sections. Anti-smooth muscle actin and HHF 35 were positive in the tumor cells on immunostaining. These findings confirmed the pathological diagnosis of leiomyosarcoma. At present, 11 months have passed since the operation, and neither recurrence nor metastasis has been detected.
Osteosarcoma arising in the jaws is very rare, accounting for only about 7% of all osteosarcomas. A combination of chemotherapy and surgery has been reported to improve the survival rate of patients with osteosarcoma. We describe a case of locally aggressive osteosarcoma arising in the maxilla of a 51-year-old woman that recurred after operation and irradiation with carbon ions. CT scans revealed a huge tumor, destroying the middle skull base and invading the right temporal lobe. At presentation, the case was evaluated to be inoperable by a brain surgeon. Therefore, we performed high-dose methotrexate (MTX) citrovorum factor therapy combined with doxorubicin hydrochloride (DXR), cisplatin (CDDP), ifosfamide (IFM), vindesine sulfate (VDS), carboplatin (CBDCA), and caffeine (CAF). The tumor responded remarkably to chemotherapy, but proliferated again after the ninth course of chemotherapy. To maintain the patient's quality of life (QOL), partial resection was done 4 times with salvage chemotherapy. This regimen for chemotherapy was considered effective against osteosarcoma of the maxilla. The importance of standard treatment for osteosarcoma, including neoadjuvant chemotherapy, tumor resection, and adjuvant chemotherapy, was suggested.
Idiopathic thrombocytopenic purpura (ITP) is a disease that causes a decrease in the platelet count without the presence of preexisting disease or causative drugs. We report a case of severe ITP detected by abnormal gingival bleeding. The patient was a 77-year-old woman with no preexisting disease who visited our emergency room because of persistent gingival bleeding. Although bleeding had already stopped on arrival, we suspected a basal hemorrhagic disease. As her platelet count was 0.6×104/μl, we referred her to a hematologist. She was hospitalized immediately and transfused platelets. Bone marrow aspiration showed no abnormality. She was given a diagnosis of ITP. On the fifth day in the hospital, her platelet count dropped to 0.2×104/μl Gingival bleeding recurred, but there was no severe abdominal or intracranial bleeding. After steroid and immunoglobulintherapy, the platelet count returned to the normal range. As ITP is occasionally discovered by abnormal gingival bleeding, accurate diagnosis and immediate treatment are necessary.
We clinically used a new surgical instrument, BoneHOGTM, which has been used in the United States, to harvest particulate cancellous bone and marrow (PCBM) from the ilium. Surgery was less invasive with this instrument than with previously used methods. The instrument was used in 10 patients with alveolar cleft who underwent bone graft surgery. The amount of harvested PCBM ranged from 2.5g to 8.0g, with an average of 5.2g. The time required for PCMB collection ranged from 40 to 69 min, with an average of 51 min. The visual analog scale (VAS) score (maximum score, 10) of iliac site pain at rest was assessed after surgery. The average VAS score of the 10 patients was 2.7 on the night of surgery, 2.9 on postoperative (p.o.) day 1, 0.8 on the p.o. day 7, and 0.1 on p.o. day 30. Harvesting PCBM with BoneHOGTM had some advantages: the length of the skin incision at the iliac site was less than 2cm, and neither a bone saw nor an electric engine bar was necessary. The procedure, including bone scraping, harvesting, and collecting, could be completed in a relatively short time. Not everyone can easily and safely collect bone with the use of BoneHOGTM. We consider experience and training in bone collection using BoneHOGTM necessary to complete the procedure safely.