Approximately 1% to 3% of malignant oral tumors are metastatic tumors from primary tumors arising in organs such as the lungs, stomach, and liver. In particular, renal cell carcinoma (RCC) rarely metastasizes to the oral and maxillofacial region. We report a case of metastatic RCC that initially presented as a tumor of the palatal mucosa. The patient was a 56-year-old man who visited our department because of a small tumor of the palatal mucosa. An excisional biopsy of the tumor suggested a metastasis from clear cell RCC. Further examinations revealed that the primary site was the left kidney. RCC with metastases to the lung, left adrenal gland, and left femur was also detected. The patient underwent nephrectomy, adrenalectomy, and radiotherapy for left thigh bone metastasis in the Department of Urology. He is now receiving molecular targeted therapy with axitinib and is given denosumab approximately every 4weeks for left thigh bone metastasis. Three years have passed since resection of the tumor in the palatal mucosa. There has been no recurrence at the primary lesion site or elsewhere in the oral cavity, and the other metastatic lesions are well controlled.
Since small cell carcinoma seldom arises in the maxilla, a standard treatment protocol has not been established. Thus, the treatment has been conducted by multimodal therapy including chemotherapy, referring to the guidelines for pulmonary small cell carcinoma. We report a case of maxillary small cell carcinoma in a 44-year-old man. Induction chemotherapy (CDDP+CPT-11), radiation therapy with concurrent intra-arterial chemotherapy (CDDP+TXT), surgical resection, and adjuvant chemotherapy (CDDP+CPT-11) were conducted. No recurrence or metastasis has occurred as of 20 months after treatment.
Poroid hidradenoma is a relatively rare cutaneous adenexal tumor and a subtype of poromas derived from eccrine sweat ducts, with both solid and cystic components confined entirely to the dermis, with no connection to the epidermis. Most cases of this tumor arise in the extremities and trunk, and poroid hidradenoma occurring in the orofacial region has not been reported previously. We present a case of poroid hidradenoma arising in the upper lip and review the literature on Japanese cases. A 82-year-old woman was referred for treatment of a painless mass on the upper lip. Magnetic resonance imaging showed a ball-like mass measuring 18×12×12mm in the upper lip. Histopathological examination of a biopsy specimen revealed a cutaneous adenexal benign tumor suspected to be a poroma, and the extirpated tumor was diagnosed to be a poroid hidradenoma. Although most cases of poroid hidradenoma have been treated by dermatologists or plastic surgeons, we should be aware that this tumor can arise in the oral region, especially the lip or cheek.
We report the case of a 73-year-old man with chronic inflammatory demyelinating polyneuropathy (CIDP) that developed during chemotherapy for oral floor carcinoma. While receiving chemoradiotherapy to treat the primary lesion and neck metastatic tumor, the patient had limb numbness, and muscle weakness gradually worsened. He had been given a diagnosis of CIDP on the basis of clinical evidence, the results of electrophysiological examinations, and a biopsy of the sural nerve. Cases of CIDP associated with carcinomas are sometimes reported, and the relevance of anticancer therapy and underlying disease has been suggested. We also considered that chemotherapy or the status of carcinoma was related to the development of CIDP in our patient.
Polymyalgia rheumatica (PMR) is an inflammatory disease of unknown etiology characterized by pain and stiffness affecting proximal portions of the arms and legs of elderly persons. A case of PMR associated with a chief complaint of temporomandibular joint symptoms, which has not been previously reported, is presented. An 81-year-old woman with fever and pain in the proximal parts of her arms and legs presented to our hospital because of pain and swelling of the right temporomandibular joint, locked jaw, and occlusal dysfunction. Temporomandibular joint suppurative arthritis was suspected on the basis of an increased C-reactive protein level and joint effusion of the right temporomandibular joint cavity on magnetic resonance imaging (MRI). She was given an intravenous drip infusion of antibiotics, but there was no response. Similar symptoms developed in the contralateral temporomandibular joint; consequently, the patient had difficulty in getting up in the morning and walking because of increasing pain and stiffness in the proximal parts of the arms and legs. She visited an internist and was given a diagnosis of PMR. Oral prednisone, 15 mg/day, was prescribed, and symptoms, including the temporomandibular joint symptoms, improved rapidly. However, because the patient is positive for anti-cyclic citrullinated peptide antibody there is a risk of elderly onset rheumatoid arthritis; longterm follow-up is therefore necessary.
We report a case of gas gangrene in the head and neck that spread to the mediastinum in a healthy patient. A 55-year-old man presented to our hospital because of swelling and pain of the left submandibular region. Gas gangrene was diagnosed on the basis of clinical symptoms and imaging findings. In addition, laboratory data on the initial visit indicated that the patient had systemic inflammatory response syndrome. Therefore, we administered appropriate antibiotics and performed an emergency tracheotomy as well as mediastinal drainage by transcervical and external approaches to the neck abscesses with the patient under general anesthesia. He was discharged from the hospital after complete recovery with no complications. Gas gangrene symptoms progress rapidly. Prompt diagnosis, surgical drainage, and a team approach in collaboration with other departments are required for successful treatment.
Congenital insensitivity to pain with anhidrosis（ CIPA） is associated with systemic sweating and loss of pain and temperature senses; the clinical symptoms include mental retardation, fever of unknown origin, frequent trauma and burns, and self-injury. CIPA is a rare autosomal recessive disorder classified as hereditary sensory and autonomic neuropathy type IV. We report a case of CIPA in an infant in whom intractable sublingual ulcers developed at the time of mandibular primary central incisor eruption. The patient was a 6-month-old boy with no abnormalities during pregnancy, labor, or after birth. Fever of unknown origin intermittently occurred since he was 1 month old. Because no signs of discomfort or crying were observed when securing peripheral blood vessels or inserting a needle for blood collection, and sweating had never been observed, the patient was suspected to have CIPA and thus underwent a sweat test at the pediatrics department of this hospital. There was no discoloration at the application site, which indicated anhidrosis. Because the patient had a poor response to pain stimuli, he was given a clinical diagnosis of CIPA. The patient was referred to the department of dentistry and oral surgery in this hospital because sublingual ulcer formation was observed at the time of mandibular primary central incisor eruption at 5 months of age. An approximately 10-mm shallow ulcer without bleeding was found on the sublingual mucosa. A corticosteroid ointment was topically applied to the affected area, and a mandibular protection device was provided. Although the ulcer appeared to be healing, self-injury might occur when teeth begin to erupt; therefore, close follow-up of the patient is required.
A 34-year-old woman was referred to our department because of trismus. Physical examination showed severe trismus and stiffness of the masseter muscles. She had a miscarriage in the Philippines a few days ago, received treatment, and went back to Japan. Maternal tetanus（ MT） was diagnosed on the basis of the clinical course and symptoms. The patient was immediately admitted to the intensive care unit. She was given anti-tetanus human immunoglobulin and antibiotics. The patient recovered without undergoing a tracheotomy or tracheal intubation. The World Health Organization（ WHO） has reported that maternal and neonatal tetanus（ MNT） has decreased in developing countries. However, delivery and miscarriage in an insanitary environment remain a problem. Tetanus is a fatal infectious disease if early treatment is not appropriately performed. An early warning symptom of tetanus is trismus. Patients with this disease may therefore initially consult a dentist or an oral surgeon. We should consider the possibility of tetanus when examining patients with trismus and observe them carefully.