Purpose. Lining epithelium of odontogenic keratocysts is classified into parakeratosis and orthokeratosis. The WHO classified odontogenic keratocysts with parakeratosis as keratocystic odontogenic tumors （KCOT） in 2005. In addition, odontogenic keratocysts with orthokeratosis were not classified as odontogenic tumors,although they are also referred to as orthokeratinized odontogenic cysts （OOC）. To clarify differences between these two lesions, we investigated their biological characteristics by immunohistochemical studies of cytokeratin （CK） in KCOT and OOC.
Materials and Methods. We studied 15 cases of KCOT and 8 cases of OOC diagnosed according to the new WHO classification of 2005 at Osaka Dental University Hospital. We examined the immunohistochemical expression of CK10, 13, 17, and 19. To evaluate immunohistochemical staining, we divided the lining epithelium of these lesions into three layers（keratin layer, spinous layer, basal layer）, and we evaluated staining according to three levels: （−）, less than 10 ％ positive cells in each layer; （＋）, 10-50 ％ positive cells in each layer; and （＋＋）, more than 50 ％ positive cells in each layer.
Results. 1） In KCOT, only 3 keratin layers were（＋）for CK10. 7 keratin layers and 12 sinous layers were （＋）, and 8 keratin layers and 12 spinous layers were（＋＋）for CK13. 12 keratin layers and spinous layers were （＋）, and 3 keratin layers and spinous layers were（＋＋）for CK17. 10 keratin layers were（＋）and 5 keratin layers were（＋＋）, and all spinous layers were（＋）and 6 basal layers were（＋）for CK19. 2）In OOC, 4 keratin layers and 3 spinous layers were（＋）, and 4 keratin layers and 5 spinous layers were（＋＋）for CK10. All cases were（−）for CK13 and CK17. All keratin layers and spinous layers were（−）, and 5 basal layers were （＋）for CK19. As for the expression of CK10, 13, 17, and 19, there were significant differences in the keratin layer or spinous layer between KCOT and OOC.
Conclusions. There were differences in the expression of CKs between the lining epithelium of KCOT and that of OOC. These results provide evidence that KCOT has tumor-like characteristics.

抄録全体を表示

Pleomorphic adenoma is the most common tumor involving the salivary glands. However, pleomorphic adenoma of the sublingual gland is extremely rare. We report on a 45-year-old woman with pleomorphic adenoma of the sublingual gland. Her chief complaint was a painless mass in the right side of the oral floor. Under general anesthesia, the patient underwent removal of the tumor, including the capsule and sublingual gland. The histological diagnosis was pleomorphic adenoma. There has been no evidence of recurrence for 9 years after the operation. In this report, we discuss this case and the related literature.

抄録全体を表示

We report a case of cavernous hemangioma arising in the submandibular gland.
Most salivary gland tumors occur in the parotid glands, and cavernous hemangioma rarely arises in the submandibular gland.
A 61-year-old woman presented with swelling in the left submandibular region.
The clinical diagnosis was a submandibular gland tumor.
The tumor was extirpated with the patient under general anesthesia.
The tumor was histopathologically diagnosed as a cavernous hemangioma.

抄録全体を表示

Pleomorphic adenoma arises commonly in the palate, and most lesions are within 30 mm. We report the case of a large pleomorphic adenoma arising in the palate. An 83-year-old woman presented to our department because of an eating disorder and snoring noticed by her family in July 2006. She had dementia, and her voice faded away as she spoke in daily life. Clinical examination revealed a 60-mm elastic-soft mass in the palate. The overlying mucosa was normal, except for a 14 × 20 mm ulcer. There was no induration around the tumor, and the tumor was movable. The cytodiagnosis was class II. In September 2006, tumor resection was performed with the patient under general anesthesia for a clinical diagnosis of pleomorphic adenoma. The tumor did not closely adhere to the surrounding tissue. The excised specimen measured 52 × 32 × 37 mm and was histopathologically diagnosed to be a pleomorphic ademona. The postoperative course was uneventful; snoring disappeared and feeding improved. Two years after surgery, there has been no evidence of recurrence.

抄録全体を表示

Odontogenic myxoma is a comparatively rare lesion of the jaw bone. A case of odontogenic myxomaoccurring in the mandible of a young girl that was treated by two-stage surgery to preserve the form of themandible is presented. A 12-year-old girl was referred to our hospital because of a painless swelling in the rightlower molar region. Radiographic examinations revealed multilocular radiolucency with a fine“soap bubble”appearance, accompanied by impacted second and third molars, at presentation.
As much as possible of the tumor was removed by an intraoral approach with the patient under general anesthesia. To conserve jaw and mouth function, segmental resection was not performed. Histological examination revealed a tumor consisting of proliferative spindle cells without nuclear atypia in an abundant myxoid stroma. Islands of odontogenic epithelium were found within the tumor. A pathologic diagnosis of odontogenic myxoma was made. Three years later, secondary surgical removal of the tumor was carried out after the bone had regenerated. At present, 3 years after secondary surgery, bone has formed in the cavity remaining after the operation, and the tumor has not recurred. The patient will be carefully observed for tumor recurrence hereafter.

抄録全体を表示

A rare case of chondrosarcoma occurring in the incisal region of the mandible is presented. A 65-yearold woman underwent extraction of a mandibular incisor and a biopsy at another dental hospital. Histological examination of the periapical tissue revealed chondrosarcoma of the mandible, and she was referred to our hospital for radical therapy.
The X-ray and CT images showed a relatively localized tumor in the incisal region of the mandible. No metastases to regional lymph nodes or distant organs were detected. She underwent a marginal mandiblectomy under general anesthesia. The histological diagnosis of the resected specimen was low-grade chondrosarcoma of the mandible. There has been no recurrence of the tumor as of 2 years postoperatively.

抄録全体を表示

Solitary fibrous tumor （SFT）, a spindle cell neoplasm, is well-recongnized in the pleura. This tumor rarely arises in the oral cavity. In particular, SFT with vascular pedicles has not been reported previously. We encountered a case of SFT of the palate associated with hypervascularity. A 67-year-old woman left a mass of the right side of the palate untreated for 2 years since it was pointed out at a dental clinic. Because the mass had gradually increased in size, she referred to our department of Kyushu Central Hospital.
The size of the tumor was 30 × 20 mm. The tumor pulsated when it was pressed with a finger. Computed tomographic scans and magnetic resonance imaging with gadolinium enhancement showed an heterogenously enhanced mass with the same intensity level as blood vessels. Because the tumor was fed by the right maxillary artery, percutaneous embolization was first performed. Then the tumor was enucleated successfully with little intraoperative blood loss. The diagnosis was SFT on histopathological and immunohistochemical examinations. The patient has been followed up for 1 year without evidence of recurrence or metastasis.

抄録全体を表示

We report a case of anti-laminin 332 mucous membrane pemphigoid that was localized in the oral cavity. The patient was a 63-year-old woman who had noticed gingival erosion for 3 weeks. As the symptom did not improve, she visited our department in late June 2006. Her physical condition and nutritional status were good,and no skin or mucosal abnormalities were found in any part of the body. In the oral cavity, an erosion was observed in the gingiva of the right mandibular molar region. Direct immunofluorescence revealed IgG and C3　deposition in the basal membrane zone, while indirect immunofluorescence using 1 M NaCl split skin showed deposition of IgG and IgA on the epidermal side and IgG on the dermal side. Because the patient was positive for the γ2 subunit on immunoblotting using purified laminin 332, anti-laminin 332 mucous membrane pemphigoid was diagnosed. The oral lesion resolved following oral administration of 15 mg/day prednisolone. In the present case, which was considered rare because the lesion was localized in the oral cavity, a favorable course was attributed to early diagnosis and steroid administration.

抄録全体を表示

Actinomycosis is a chronic granulomatous inflammatory disease that can lead to tissue fibrosis.Recently, because the frequency of typical cases of actinomycosis has decreased, it has become difficult to clinically diagnose this lesion. We report a rare case of actinomycosis mimicking the clinical appearance of a benign tumor in the lower lip.
A 73-year-old man was referred to our hospital because of a tumor in the lower lip. The mucosal surface of the right lower lip showed a small white, elastic hard tumor, which measured 10 mm in diameter and was tender.After the lesion was surgically resected, it was histopathologically diagnosed to be actinomycosis, although the clinical diagnosis was a benign tumor. The postoperative course was uneventful, and no recurrence had occurred as of 15 months after surgery. The above findings suggest that actinomycosis should therefore be included in the differential diagnosis of tumors of the lips.

抄録全体を表示

Mantle cell lymphoma （MCL） is a rare lymphoma of B-cell origin. We report a case of MCL with immune thrombocytopenia detected by abnormal gingival bleeding as a primary symptom.
A 76-year-old man was referred to our hospital because of gingival bleeding. Gingival bleeding of the anterior maxillary region and purpura of the lower extremity was detected. Because the platelet count was 0.0 × 10⁴/μl ,we suspected blood disorders such as ITP. We referred the patient to a hematologist, and he was hospitalized immediately. He received adrenocortical steroid therapy, and the platelet count returned to the normal range.Because bone marrow puncture showed infiltration of malignant lymphoma cells （MCL）, MCL （Stage IV A） with thrombocytopenia was diagnosed. He received chemotherapy with rituximab-2CdA. After treatment, remission was achieved, and there has been no evidence of recurrence.
Immediate examination and accurate diagnosis are essential in patients who are referred because of oral hemorrhage with a primary symptom of blood disorders.

抄録全体を表示