Recently, a growing number of studies have suggested that solitary fibrous tumors (SFTs) occur throughout the body in multiple organs, other than the pleura. Reports on local recurrence and metastasis have proposed that extra-pleural SFTs (including soft-tissue tumors) are medium-grade malignancies among fibroblastic and myofibroblastic tumors according to the World Health Organization tumor classification. We report a case of solitary fibrous tumor in the submandibular region. Our subject was a 23-year-old woman who presented with a painless swelling in the right side of the submandible. We confirmed the presence of a well-defined, oval tumor (38× 25 mm) in the right side of the submandible on magnetic resonance imaging. T1-weighted images showed uneven low signal intensity, while T2-weighted images showed uneven high signal intensity. Gadolinium-enhanced T1-weighted imaging showed contrast enhancement in a large portion of the tumor. Based on the clinical diagnosis of a benign tumor of the submandibular gland, the tumor was resected with the patient under general anesthesia. Histopathological analysis revealed that the tumor was restricted to the fibrous membrane, with a dense proliferation of spindle/ short-spindle cells. Immunohistochemical staining was positive for CD34 and bcl-2, which confirmed the diagnosis of SFT. Neither recurrence nor metastasis has occurred as of 34 months after surgery.
A follicular carcinoma of the thyroid can be difficult to differentiate from a follicular adenoma, a benign tumor of the thyroid, on the basis of histopathological findings. In such cases, the tumor is not diagnosed as malignant until distant metastasis develops. We report a case of follicular carcinoma of the thyroid that was definitively diagnosed when an osteolytic lesion developed in the right mandibular ramus. A 66-year-old woman visited our department because of gingival swelling at the posterior part of the right mandibular molar region. Diagnostic imaging revealed a mandibular lesion that had destroyed the inside of the bone and then progressed outward. In addition, a calcified lesion was found in the left lobe of the thyroid gland, and evidence suggesting multiple bone and lung metastases was also found. A biopsy of the mandibular lesion indicated that bone metastasis from a thyroid carcinoma was most likely. However, the histopathological diagnosis of the excised thyroid specimen was follicular adenoma, thus casting doubt on the possibility of metastasis from the mandibular lesion. A segmental resection of the mandible was performed as radical treatment for the mandibular lesion because it showed a trend toward enlargement. Histopathological examination of the resected lesion showed scant cellular atypia; however, it was definitively diagnosed as a follicular carcinoma of the thyroid on the basis of osteolytic findings in the specimen and distal metastasis to the mandible.
Myofibroma is a rare benign nodular tumor arising in soft tissue, bone, or internal organs. We describe an intraosseous myofibroma that occurred in an adult. A 38-year-old woman was referred to our hospital because of mobility of the right mandibular first molar in April 2007. She was aware of mobility of the mandibular molar since 2004. Panoramic radiography demonstrated a well-defined multilocular radiolucent lesion in the mandibular body. Although repeated biopsy examinations were conducted, a definitive diagnosis was difficult, and the lesion was considered a mesodermal tumor. We additionally performed immunohistochemical staining and diagnosed the tumor as a myofibroma. We resected the mandibular tumor from the right mandibular first molar to the right mandibular ramus. Microscopic examination of the surgical specimen revealed dense proliferation of spindle-shaped tumor cells forming fascicles and a pericytomatous pattern with dilated capillaries. A few mitotic figures were observed in the tumor cells, but high cellular atypia was not found. Immunohistochemically, the tumor cells were positive for vimentin and a-SMA and were negative for desmin, S-100, and NFP. There has been no evidence of recurrence as of 5 years after surgery.
Congenital lower lip fistula is a rare deformity. Symmetrical lower lip fistulae with concomitant cleft lip, palate, or both characterize Van der Woude syndrome (VWS), one of the autosomal dominant disorder syndromes. However, cases associated with only lip fistulae without any other physical anomalies have been infrequently reported in VWS. We describe a 12-year-old girl and her father who had congenital fistulae of the lower lip with no other general anomalies. We suspected a diagnosis of VWS based on familial congenital deformity. The fistulae were removed cosmetically, and the results satisfied both us and the patient.
Disseminated intravascular coagulopathy (DIC) is an acquired bleeding disorder characterized by an imbalance in the hemostatic process, resulting in extensive thrombosis and hemorrhagic complications. DIC exists in both acute and chronic forms. Chronic DIC (compensated DIC) may be associated with subclinical signs and symptoms, and the bleeding disorder may only be identified by laboratory findings. In this paper we report a case of refractory post-extraction hemorrhage compromised by chronic DIC. A 69-year-old man was referred to our hospital because of prolonged bleeding after tooth extraction. The patient had a medical history of large thoracic and abdominal aortic aneurysms. Clinical examination revealed continuous bleeding at the tooth extraction site. Other clinical signs of a hemorrhagic diathesis were not evident. The results of laboratory examinations suggested the possibility of chronic DIC. In this patient, oral bleeding was finally managed by continuous intravenous infusion of heparin. After that, the patient received careful medical and dental follow-up treatment in our hospital and had no further problems.
We performed extraction of a third molar in a carrier of hemophilia A inhibitor who received bypass hemostatic treatment with a recombinant activated clotting factor VII（ rFVIIa） preparation. The favorable results obtained are reported, along with findings from other relevant reports. A 25-year-old man known to possess hemophilia A inhibitor visited our department because of pain in the left third molar. We consulted the Division of Hematology of our hospital in preparation for tooth extraction. For hemostatic management, an rFVIIa preparation was transfused before and after the extraction procedure. The postoperative course was generally favorable.
A 60 -year- old man visited our hospital because of pain and discomfort around the left temporomandibular joint on maximum mouth-opening. The patient had been treated with nonsteroidal antiinflammatory drugs and corticosteroids by an otolaryngologist for a diagnosis of otitis externa, but the pain did not improve. There were no symptoms on turning his head and neck. Panoramic radiography and 3-dimensional computed tomography revealed a hypertrophied styloid process and ossified styloid ligament extending to the hyoid bone on the left side. The length of the styloid process and styloid ligament complex was 83 mm. Styloid process syndrome was diagnosed. With the patient under general anesthesia, reduction surgery of the styloid process was performed by a transcervical approach. Histopathological examination of the surgical specimen revealed bone tissue with thick trabecular bone and bone marrow. Cartilage tissue connected to the trabecular bone was also observed in the specimen. The patient's symptoms resolved after operation. Thirteen months after surgery, the patient remains free of symptoms.