A case of a dentigerous cyst in the mandibular notch associated with actinomycosis is described. The patient was an 87-year-old woman who presented with swelling of the left cheek and trismus. Panoramic radiography and computed tomographic imaging revealed an ectopic impacted tooth with a cystic lesion in the left mandibular notch. A slit-like radiolucent area was observed from the left retromolar region to the cystic lesion. The impacted tooth and cystic lesion were removed with the patient under general anesthesia. The histopathological diagnosis was a dentigerous cyst associated with actinomycetes. After sugery, the patient orally received 500 mg/day of ABPC for 3 weeks. There was no sign of recurrence after treatment.
Thyroglossal duct cyst arises from the remnants of the thyroglossal duct produced by the descent of the thyroid anlage. It usually occurs between the cecal foramen of the tongue and the thyroid gland and rarely arises in the oral floor. We describe our experience with a case of thyroglossal duct cyst of the oral floor. A 50-year-old woman was referred to our hospital because of swelling of the oral floor with dyspnea and mogiarthria. An elastic soft mass, 4 mm in diameter, was palpable. Computed tomographic and magnetic resonance imaging examinations revealed a cystic structure extending from the deep part of the tongue to the oral floor. The cyst was successfully enucleated via an intraoral approach. The pathological diagnosis was a thyroglossal duct cyst. There has been no evidence of recurrence as of 3 years after surgery.
We report a case of myopericytoma arising in the buccal region. A 73-year-old woman was referred to our clinic because of a painless swelling in the left cheek. The first medical examination revealed a dark-purple, small hen's egg-size, elastic soft, movable nodule in the left side of the buccal region. Computed tomographic, magnetic resonance imaging, and angiographic image analysis indicated a clinical diagnosis of hemangioma. The tumor was surgically resected 48 hours after embolization of the left facial artery. Histopathologically, oval shaped, α-SMA positive cells were arranged circumferentially around stag horn-shaped blood vessels in a multilayered fashion. These findings indicated a pathological diagnosis of myopericytoma. There have been no signs of recurrence of the tumor for 7 years 1 month since the operation.
Pleomorphic adenoma (PA) is the most common salivary gland tumor. Tumors originating from the major salivary glands are frequently located in the parotid gland. In contrast, tumors originating from the minor salivary glands are frequently found in the palatal region. PA occurring in the lips, especially the lower lip, is relatively rare. In this paper, we present 2 cases of PA arising in the upper lip and lower lip, respectively. The first case arose in a 72-year-old woman. The patient visited a dental clinic because of swelling of the left side of the upper lip and was referred to our department. Palpation revealed a painless movable mass. The lesion was 15 mm in diameter and located in the subcutaneous tissue on the left side of the upper lip. The second case was in a 60-year-old man. This patient visited a dental clinic because of swelling of the left side of the lower lip and was referred to our department. Palpation revealed a painless movable mass. The lesion was 13 mm in diameter and arose in the subcutaneous tissue of the left side of the lower lip. The clinical diagnosis in both cases was a benign tumor of the lip. Surgical resection was performed under local anesthesia in both patients, and the histopathological diagnoses confirmed PA. In both patients, the upper and lower lips healed well after the operation. About 1 and a half years after surgery, there was no evidence of recurrence.
We describe a case of endogenous fungal endophthalmitis (EFE) in a 38-year-old woman. On the 28th day after surgery for tongue cancer and following the insertion of a central venous catheter (CVC), fungemia developed along with a high fever. The fever subsided after antifungal drugs were administered. We continued to administer the antifungal drugs, but the patient complained of myodesopsia. Funduscopic examination revealed an exudative lesion, and we diagnosed EFE. Antifungal drugs were administered for 34 days after the diagnosis of EFE, and the patient recovered. EFE occurs when a fungus enters the blood vessels via the site of an injury or catheter insertion in association with an opportunistic infection or an immunocompromised system caused by a comprehensive surgical procedure or by the long-term, high-dose administration of broad-spectrum antibiotics, antineoplastic agents, or immunosuppressive agents, resulting in fungemia. A CVC has been placed in 90 percent of all patients with EFE. When treated at an early stage, the course is normally excellent, but delayed initiation of treatment may result in loss of vision. Most previous cases of EFE have involved the digestive system. An extensive search of the literature revealed only three cases of EFE occurring in the head and neck region that have been reported in Japan, including the case that we treated.
We report a case of a giant adenocarcinoma, not otherwise specified (NOS) with bone-like tissue formation that arose in the right cheek following radiation therapy in combination with retinoic acid after vascular embolization. A 74-year-old man was referred to our department because of a fist-size tumor in the right cheek. Biopsy of the tumor showed characteristic features of adenocarcinoma (NOS). Because the patient had massive bleeding from the oral tumor on an operation to create a percutaneous endoscopic gastrostomy, vascular embolization of the right external carotid, facial, and lingual arteries, which were feeding arteries of the tumor, was performed. For palliative treatment, he underwent chemoradiation therapy in combination with retinoic acid therapy. At the completion of primary therapy, there was no distinct change in tumor size. However, 8 months after treatment computed tomographic scanning revealed, tumor regression, as well as the appearance of numerous radiopaque masses, suggesting bone formation in the tumor tissue.