Catheter-related bloodstream infection (CRBSI) is one of the serious complications of chemotherapy in various cancer treatments and often causes cessation or temporary withdrawal of treatment. We investigated CRBSIs associated with retrograde superselective intra-arterial chemoradiotherapy for oral cancer. A total of 160 patients with oral cancer who had received catheterization from the superficial temporal or occipital arteries to the tumor-feeding arteries in our institution between January 2010 and December 2014 were studied retrospectively. All intra-arterial catheter tips were sent for culture, and catheter bacterial cultures were positive in 67 patients (41.9%). Blood culture tests were performed in 50 patients who had fever with a temperature of 38℃ or higher, and blood cultures were positive in 20 patients (12.5%). Both catheter cultures and blood cultures were positive in 12 patients. The same bacteria were detected in 7 patients (4.4%), fulfilling the criteria for CRBSI. The incidence ratio of CRBSI was 0.83 per 1,000 catheter days. All CRBSIs were eventually controlled by appropriate antimicrobial therapy and catheter replacement or decannulation.

Although lymphocyte-to-monocyte ratio (LMR) has been shown to be a prognostic indicator in various cancers, the prognostic value of preoperative LMR in patients with oral squamous cell carcinoma has not been reported. The aim of this study was to evaluate whether preoperative LMR could predict the outcomes of patients with oral squamous cell carcinoma. We studied 210 patients who underwent curative surgery for oral squamous cell carcinoma in Tokyo Dental College, Chiba Hospital between January 2007 and December 2011. LMR was calculated from the preoperative peripheral blood cell counts. The optimal cutoff point of LMR was determined on the basis of a time-dependent receiver operating characteristics curve for overall survival. A total of 94 patients met the inclusion criteria. The low LMR group had a significantly lower survival rate than the high LMR group (p= 9.44 × 10^-11, log-rank test). Univariate analysis using a Cox proportional-hazards model showed that N classification, disease stage, and pretreatment LMR were significantly associated with poor outcomes. Multivariate analysis showed that pretreatment LMR (hazard ratio ［HR］: 0.07; 95% confidence interval ［CI］: 0.01-0.37, p= 2.12×10^-3) remained as a risk factor for cancerrelated death. Thus, pretreatment LMR might be an independent prognostic biomarker in patients with oral squamous cell carcinoma.

Thyroid follicular carcinomas account for 5% to 10% of all thyroid cancers and are classified as minimally or widely invasive. Minimally invasive thyroid follicular carcinomas rarely show distant metastasis and are thus thought to have a relatively good prognosis. We report a case of minimally invasive follicular thyroid carcinoma that became apparent after mandibular metastasis. The patient was aware of mobility of the right mandibular second molar. After the tooth was extracted at a family dental clinic, the wound healed poorly. The patient consulted a former doctor of our hospital. A biopsy was performed and the pathological diagnosis was metastasis from a follicular thyroid carcinoma. The clinical diagnosis was follicular thyroid carcinoma with mandibular metastasis and sternal multiple metastases. The patient underwent total thyroidectomy and mandibular bone segmental resection, followed by reconstruction with a vascularized latissimus dorsi muscle dermal flap. Radioactive iodine was given as postoperative therapy. There has been no tumor recurrence at the surgical site as of 1 year 1 month postoperatively, and the patient maintains a general diet.

Castleman’s disease (CD) is a lymphoproliferative lesion that primarily occurs in the mediastinal region followed by the cervical lymph nodes. CD in the facial region is rare. In the present article, we report a rare case of CD arising in the buccal region and review the literature. A 39-year-old woman with a painless mass arising in the right buccal region was referred to our division. Her facial appearance was symmetrical. A relatively hard, well-defined and mobile mass was palpable in the right side of the cheek. Computed tomography showed an oval-shaped, homogeneous radiopaque mass measuring approximately 10 mm in diameter. Magnetic resonance imaging of the mass revealed low signal intensity on T1-weighted images, slightly higher signal intensity than muscle on T2-weighted images, and moderate signal intensity on STIR images, similar to the signal intensity of the palatal tonsils. We clinically diagnosed a benign mesenchymal tumor. Intraoral surgery was performed with the patient under general anesthesia to excise the mass through the buccinator muscle. The histopathological diagnosis was a hyaline-vascular type of CD. No lymphoproliferative lesions were detected on whole-body 18 fluoro-2-deoxyglucose positron emission tomography postoperatively. The postoperative course was uneventful, with no evidence of recurrence as of 2 years 5 months after surgery.

Tenosynovial giant-cell tumors are classified into diffuse and localized types. The diffuse type develops primarily in major joints and rarely in the temporomandibular joint. We report a diffuse-type tenosynovial giant-cell tumor that developed in the temporomandibular joint, along with a discussion of the literature. A 27-year-old woman visited our hospital because of pain in the right temporomandibular joint and difficulty in mouth opening as chief complaints. Radiological examination showed a lesion in the right side of the temporomandibular joint. The histopathological diagnosis on biopsy was a tenosynovial giant-cell tumor of the diffuse type, and we performed tumor excision with the patient under general anesthesia. There has been no evidence of recurrence as of 3 years 2 months after the operation. However, continuous strict follow-up is needed in consideration of the high recurrence rates.

We report a case of methotrexate-associated lymphoproliferative disorders (MTX-LPD) simultaneously arising in the maxilla and the nasal mucosa of a patient who was receiving bisphosphonate. A 72-year-old woman was referred to our university hospital for suspected medication-related osteonecrosis of the jaw (MRONJ), affecting the maxilla. She had been receiving methotrexates (MTX) to treat rheumatoid arthritis and bisphosphonates to treat osteoporosis. Ulceration in the anterior region of the maxilla accompanied by bone necrosis was observed. A computed tomographic examination revealed edematous swelling of the left nasal mucosa in addition to the maxillary lesion. Histopathological examinations revealed Epstein-Barr viruspositive diffuse large B-cell lymphoma (DLBCL). These findings led to the final diagnosis of MTX-LPD. This is the first report to histopathologically document multiple extranodal MTX-LPD occurring simultaneously in the head and neck regions. After withdrawal of MTX therapy, gradual regression of these lesions was observed. Sixteen weeks after withdrawal, spontaneous complete remission was judged to have been achieved. Subsequently, the osteonecrosis of the maxilla was surgically resected with the patient under general anesthesia. The resected specimen showed chronic osteomyelitis and no malignancy. There has been no evidence of disease recurrence as of 31 months after complete remission of the lesions.

Mucocele generally occurs in salivary glands, but very rare arises in submandibular glands. Moreover, the diagnosis of submandibular gland mucocele is complicated because of the similarity between submandibular gland mucoceles and plunging ranulas. In this report, we describe a case of submandibular gland mucocele. An 11-year-old girl who had a painless swelling in the right submandibular region was referred to our department. Magnetic resonance imaging showed a lesion extending from the right submandibular space to the sublingual space. The lesion emitted high signal intensity on T2-weighted images. We found leakage of contrast media around the lower side of the right submandibular gland on sialography of the submandibular gland. We therefore diagnosed a mucocele arising in the submandibular gland. The cystic lesion and submandibular gland were completely excised. There have been no signs of recurrence or disease complications as of 60 months after surgery.

Congenital ranulas in infants have been rarely reported. We report a case of congenital ranula. The female baby, one of twins, was delivered by cesarean section. On the day after birth, a pediatrician noticed swelling of the left side in the oral floor. She was followed up without treatment because there was no sucking disorder or unusual systemic problems. Five months later, the swelling increased, and magnetic resonance imaging revealed a serpentine tube-form structure extending from the left submandibular gland to the oral floor. An exploratory puncture was performed with the patient under intravenous anesthesia in the hospital. The puncture wound was enlarged with mosquito forceps, and steroid ointment was applied to the lesion without inserting a piece of gauze or suturing the oral mucosa. Laboratory analysis of the fluid showed that 97.2% of the aspirated material was saliva-type amylase isozyme. As of 9 months after the operation, there has been no recurrence of the lesion.

A 63-year-old woman underwent a partial glossectomy for squamous cell carcinoma (SCC; T1N0M0) arising in the left side of the tongue in May 2011. Seventeen months after the glossectomy, computed tomographic (CT) examination showed a 13.4 × 9.0 mm lesion similar to a lymph node with rim enhancement in the right submandibular region. The mass was diagnosed as benign on ultrasound-guided fine-needle aspiration cytology (FNAC). Three months after FNAC, the mass increased to 19.5 × 10.6 mm on CT and was suspected to be a delayed neck metastasis from tongue cancer or a metastatic cervical carcinoma from an unknown primary site. On fluorodeoxyglucose positron emission tomography, the mass showed mild fluorodeoxyglucose uptake, but other regions showed no uptake. However, metastasis and malignant tumor in the pharyngeal, laryngeal, and thyroidal regions remained unlikely. On the basis of the pathological diagnosis obtained from intraoperative frozen-section analysis, surgical resection of the mass or radical neck dissection was planned with the patient under general anesthesia. A lymphoepithelial cyst was diagnosed, and the mass was surgically resected. Histopathological examination of the excised specimen indicated SCC arising from the wall of the lymphoepithelial cyst. The patient remains disease-free without additional treatment as of 3 years 8 months after mass resection.

A 17-year-old girl with mixed-phenotype acute leukemia was admitted to our hospital to receive induction chemotherapy. Because she had pain, swelling, and fever in the left cheek after starting chemotherapy, our department was consulted. There was no evidence of infection or tooth abscess formation in the oral region at the first visit to our department; however, Fusarium species were detected on blood culture and sinus bacteria tests, and follow-up computed tomographic scanning showed the formation of an abscess in the left masseter muscle. A left buccal phlegmon was diagnosed and drained with the patient under the general anesthesia. Fusarium was detected on bacterial testing of the affected area. The multiple abscesses were caused by disseminated Fusarium infection in the muscles and subcutaneous tissues of the entire body as well as in the spleen. Drainage and treatment with antimicrobial agents were therefore performed. In recent years, mortality from disseminated Fusarium infections has increased in association with the intensification of chemotherapy. We conclude that meticulous attention is required to prevent disseminated Fusarium infection in immunosuppressed individuals.