The number of patients with oral cancer is tending to increase in Japan. It has been reported that oral cancer is most highly prevalent in men 60 years or older. However, the number of the affected young patients and female patients has tended to increase in recent years. Thirty-eight patients 40 years or younger (young patients) with oral cancer, treated primarily at Tokyo Dental College Chiba Hospital from 1987 through 2012, were retrospectively studied. Among a total of 758 patients with oral cancer treated in our department during this period, young patients comprised 5%. The ratio of young patients with oral cancer significantly increased during the 25 years. The male-female ratio of young patients was 1.38:1, while that of the other patients was 1.41:1. The tongue was the most frequency encountered primary site among young patients, accounting for 76.3% of cases. Well-differentiated type was most common, accounting for 39.5%, on histopathological differentiation typing. The incidences of stage I, II, III, and IV oral cancer according to the TNM staging system were 28.9%, 23.7%, 23.7%, and 23.7%, respectively. The 5-year overall survival rate was 94.3%. The 5-year disease-free survival rate was 88.2%. The survival rate of young patients did not differ significantly from that of the other patients, although outcomes were slightly more favorable among young patients than other patients.
Lipoma is a common benign tumor of the soft tissue. It predominantly occurs in subcutaneous regions, but can also be found in intramuscular, retroperitoneal, and intraosseous locations. According to the literature, the incidence of intraosseous lipoma is less than 0.1% of all bone tumors. Intraosseous lipoma generally occurs in the metaphysis of long bones and the calcaneus, and is rarely seen in the jawbone. To our knowledge, only 25 cases of intraosseous lipoma of the jawbone were reported from 1948 to 2014. There have been no documented cases of intraosseous lipoma arising in the mandibular condyle. In this paper, we reported a rare case of intraosseous lipoma arising in the right mandibular condyle and causing marked mandibular deviation in an 86-year-old woman.
Burkitt lymphoma is a high-grade and aggressive malignant lymphoma classified as a mature B-cell neoplasm. Although the disease is generally carries a poor prognosis, some cases are curable. Its rapid growth and trend toward multifocal and often extranodal spread including the central nervous system are the main causes of its poor prognosis. We describe a case of Burkitt lymphoma arising in the oral region that was detected because of numbness of the lower lip. A 28-year-old woman felt numbness of the lower lip and swelling of the lower gingiva. She was admitted to our hospital for neurological examination, and a biopsy of the right lower gingiva revealed Burkitt lymphoma. The patient was transferred to hematology ward. Whole-body positron-emission tomography and computed tomography showed mass shadows in the mandible, breasts, abdomen, pelvis, and femoral bone. Therefore, the disease was evaluated to be stage IV according to the Murphy staging system. Multicycle chemotherapy including R-hyper CVAD and preventive intrathecal treatment finally resulted in disappearance of the gingival swelling and other tumors. Clinical symptoms also resolved. Clinical remission has been maintained for 4 years.
Diffuse large B cell lymphoma (DLBCL) is a typical malignant tumor classified as a non-Hodgkin lymphoma. Rare cases in which DLBCL is a ssociated with diverse neurological symptoms such as chin numbness and ophthalmoplegia have been reported previously. We describe a case of paresthesia of the contralateral mental region suspected to be an early symptom of DLBCL. The patient was a 73-year-old woman. Her chief complaints were desensitization and sharp pain in the lips and the right submandibular region. During treatment for these symptoms, the left submandibular region became acutely swollen. She underwent a biopsy of a mass lesion in left mandibular molar gingiva. The histopathological diagnosis was DLBCL. Eight cycles of R-CHOP treatment were administered in a hematology unit in our hospital. Although a reduction in the tumor was confirmed by on combined positron-emission tomography and computed tomography performed after R-CHOP, the paresthesia of both mental regions persisted. She is currently under follow-up observation in our department.
Organized hematoma (hematocele, blood boil) is defined as a hemorrhagic pseudotumor of unknown cause in the maxillary sinus. It is difficult to differentiate this lesion from a malignant tumor owing to similar features. We report the case of 65-year-old woman with an organized hematoma in the right maxillary sinus, which extended into the oral cavity. She visited our hospital to undergo a complete examination of swelling in the right upper gingiva. At the first visit, she presented with swelling of the right cheek and a feeling of mild nasal obstruction. Computed tomography and magnetic resonance imaging showed a tumor-like lesion filling the right maxillary sinus. The surrounding bone was displaced expansively and thin. A contrast study suggested that tumor had high blood flow. Histopathologically, a biopsy specimen demonstrated only necrotic tissue and scar tissue, with no tumor cells. On the basis of these findings, we diagnosed a benign tumor of the maxillary sinus and planned surgical enucleation of the tumor. Separation of the tumor from the surrounding tissue was uncomplicated, and there were no tumor cells in the excised specimen. Finally, we diagnosed an organized hematoma. The patient remains free of disease as of 4 years after surgery.
Pleomorphic adenomas rarely form a giant cyst. In this report, we describe the case of 44-year-old man who had a pleomorphic adenoma of the submandibular gland with a giant cyst. Extraoral examination showed an elastic hard, movable mass measuring 45 × 27 mm in the left submandibular region. Magnetic resonance imaging revealed a mass with high intensity in the left submandibular region, associated with border irregularity and internal heterogeneity on both T1-weighted images and T2-weighted images. Enhanced computed tomography showed a low-density area in the mass. Fine-needle aspiration cytology was subsequently performed, but a tentative diagnosis was not obtained. We then planned to surgically resect the tumor according to the pathological diagnosis obtained on intraoperative frozen section analysis, performed with the patient under general anesthesia. Resection of the mass was planned if the lesion was benign, and resection with upper neck dissection was planned if the lesion was a malignant tumor. A pleomorphic adenoma was diagnosed on intraoperative frozen section analysis, and the tumor was surgically resected. Histopathological examination of the excised specimen finally showed a pleomorphic adenoma with hematoma in the cyst-like cavity.
Herein we describe the case of a 59-year-old woman with a history of pemphigus foliaceus (PF), but no skin lesions. She was referred to our department for further evaluation of gingival erosion. A histopathological examination of the areas of erosion showed basal cells with cleft formation and acantholysis. Direct immunofluorescence of the affected regions revealed deposition of IgG and C3 between epithelial cells. These findings were consistent with those of mucosal dominant pemphigus vulgaris. However, only desmoglein (Dsg) 1 was positive, and Dsg 3 was negative on immunoserological testing, which are atypical results. The erosion in the oral cavity was associated with only slight pain, and corticosteroid ointment was prescribed. Approximately 5 months after the treatment, the oral cavity symptoms had disappeared, but several small blisters appeared on the skin of the back. At this point, anti-Dsg 1 Ab levels were elevated. Histopathological and direct immunofluorescence findings suggested recurrent PF. The skin symptoms continued to recur and abate, but the oral cavity symptoms have not recurred. We described a case of anti-Dsg 1 Ab-positive pemphigus in which oral lesions appeared after skin symptoms had disappeared, followed by the reappearance of skin lesion. This case demonstrates that patients with pemphigus sometimes, albeit rarely, exhibit autoantibody profiles that do not reflect the Dsg compensation theory. In such cases, macroscopic, histopathological, and direct immunofluorescence findings are considered important for diagnosis.
Cementoblastoma is a rare odontogenic tumor that tends to occur in the jaws of young people. It is most commonly characterized by a circumscribed radiopaque mass attached to the tooth roots and rimmed by a radiolucent zone. To our knowledge, few reports have documented an increase in the size of this tumor. We studied a cementoblastoma arising in the mandibular left first molar of a 13-year-old girl and analyzed the growth of this tumor on computed tomography. During a period of 5 months, the tumor diameter increased by about 4 mm, and the volume increased from 6.484 cm3 to 11.955 cm3.
We report on a 54-year-old Japanese man who was referred to the Department of Oral and Maxillofacial Surgery with the symptoms of erosive stomatitis and ulcer on the upper and lower gingivae and bilateral buccal mucosae. Laboratory tests showed elevated levels of anti-desmoglein 1 and 3 antibodies. Although steroid therapy was advised under a diagnosis of pemphigus vulgaris to prevent exacerbation, only a topical steroid was applied to the oral mucosae because of the patient’s nonadherence to his medication. One month after the initial visit, dermal vesicles and erosion were reported on the entire body. An underlying neoplasm was not identified on whole body positron emission tomography imaging or gastrointestinal endoscopic examination. Pemphigus vulgaris was diagnosed on the basis of clinical, pathological, and laboratory findings. Medication therapy with prednisolone (50 mg/day) and topical steroid ointment were performed under hospitalization. The erosions were successfully treated with the steroid therapy. However, 14 days after receiving treatment during hospitalization, the patient died of pulmonary hemorrhage approximately 2 months after the initial visit.
Mönckeberg's sclerosis is a non-inflammatory vascular disease characterized by calcification of muscular arteries. However, the relation between the symptoms and clinical features of this disease in the oral and maxillofacial region is unclear. We report a case of Mönckeberg's sclerosis of the facial artery accompanied by orofacial pain. An 81-year-old Japanese woman was referred to our hospital with the chief complaint of pain associated with her denture in November 2013. A hard tissue lesion with a diameter of 10 mm was palpable on the right lower border of the mandible. Computed tomography showed a radiopaque region (30 × 5 mm) on the lateral aspect of the mandibular body. The clinical diagnosis was calcified sclerosis of the right facial artery, and resection of the lesion of the right calcified facial artery was performed with the patient under general anesthesia in December 2013. Postoperatively, the contact pain disappeared. Surgery is indicated for Mönckeberg's sclerosis of the facial artery accompanied by orofacial pain.
Metastatic tumors to the jaws and oral cavity account for 1% to 2% of all oral cancers. We report the clinical characteristics of the tumors in 11 patients among a total of 697 cases of oral cancer treated in the Section of Oral and Maxillofacial Surgery, Kyushu University Hospital from 1985 through 2010. At the first visit, 9 of the 11 patients had a history of primary tumor, while the primary cancer sites were uncertain in the other 2 patients. Six of the 9 patients had recurrence or metastasis of their primary tumors, and in the other 3 patients tumor spread was controlled. The tumor was detected in mandibular and maxillary bones in 9 patients and 2 patients, respectively. Ten of the 11 patients had metastases in the molar region. Five of the 8 patients with mandibular molar metastasis had symptoms of hypoesthesia in the lower lips and chin. Seven of the 11 cases were adenocarcinoma. Regardless of treatment such as surgical resection, radiotherapy, or chemotherapy, alone or combined, all patients had poor outcomes, and the average survival time from the first visit was 3.2 months.
We report a case of neck injury caused by a piece of glass penetrating into the oral cavity in a patient who was receiving benzodiazepine agents. A 52-year-old man accidentally fell towards a room door with a piece of previously broken glass and received a submandibular wound about 15 cm in length with continuous bleeding. The patient was transferred to the emergency room in our hospital and underwent tracheal intubation. A computed tomographic scan showed swollen soft tissue and extensive hematoma around the jaw, but no foreign body was detected. Emergency surgery was performed to arrest the bleeding and close the wound. Despite early ambulation of the patient postoperatively, delirium developed on the 4th hospital day owing to the following risk factors : long-term administration of multiple benzodiazepine agents and drastic changes in perioperative circumstances and body sensation. The symptoms were controlled by antipsychotic therapy. The patient was discharged on the 21th postoperative day without wound infection or insufficient healing. Treating severe trauma in patients who are receiving multiple benzodiazepine agents requires appropriate physical and psychiatric management in collaboration with related sections because of the high-risk for the development of postoperative delirium.
We surgically treated a carcinoma of the tongue that developed during pregnancy while continuing the pregnancy and achieved a successful outcome for both mother and baby. Our patient was a 45-year-old woman who was referred to our institution to have a white lesion located on the right edge of her tongue examined and treated. She was 16 weeks 3 days pregnant at the first medical examination. She was given a diagnosis of carcinoma of the tongue (T2N0M0). We performed a right partial glossectomy with the patient under general anesthesia at 20 weeks 3 days of pregnancy. The patient delivered a girl at 39 weeks 3 days of pregnancy (after surgery). After 3 postoperative years, both the mother and child remain healthy.