The main causes of the need for care by the elderly are dementia, cerebrovascular disease (stroke), weakness due to old age, falls/fractures, and joint diseases. It is necessary to improve the quality of life of the aged by the medical treatment and the intervention of social resources, and at the same time, to reduce the enormous medical cost. In cancer treatment development,“extension of survival time” has been a goal. However, a large-scale survey has revealed that older people do not seek medical treatment for “extension of survival time.” Elderly people are vulnerable to various internal and external stresses, and are often followed by hospitalization, falls, decreased ADL, and death. Geriatric Assessment (GA) is recommended as a means for objectively grasping the physical, mental, social and economic problems of the elderly and leading them to intervention. GA is useful in recognizing hidden problems in elderly cancer patients, predicting adverse events and prognosis, and determining treatment policy. It is desirable that multidisciplinary teams collaborate based on the results of GA and lead to effective intervention.

The histopathology of metastatic lesions are usually the same as primary lesions in malignant tumors. We report a rare case of malignant melanoma that was mixed with a cervical lymph node metastatic lesion of undifferentiated cancer occurring in the maxillary gingiva. The patient was referred to our department because of pain in the area of the maxillary anterior teeth. After confirmation of undifferentiated cancer by biopsy, a right partial maxillectomy and extended supraomohyoid neck dissection were performed. Histopathological examination revealed that the primary lesion was undifferentiated cancer and the metastatic lesion was malignant melanoma. We suggested the possibility that a malignant melanoma of unknown primary origin and the undifferentiated cancer in the maxillary gingiva metastasized to the same cervical lymph node as a collision tumor.

Histological images of myoepithelioma and myoepithelial carcinoma vary widely. In many cases, myoepithelioma is diagnosed based on preoperative biopsy. Here, we report our experience with a case of myoepithelial carcinoma diagnosed as a result of operative treatment for myoepithelioma.

　The patient was a 63-year-old female with a 30-year history of a palatal tumor, who was admitted to our hospital because the tumor had grown. Intraoral examination revealed a tumorous lesion in the left palate that crossed the midline. Imaging findings revealed swelling of the bone cortex on the palatal side. The cortices of the left nasal floor, the left maxillary sinus floor, and the posterior maxillary bone were thinned, and some bone defects were observed. A biopsy led to the diagnosis of myoepithelioma. In July 2012, a tumor resection was performed under general anesthesia. Based on histopathological and immunohistological findings, we suspected myoepithelial carcinoma. Because the patient refused additional resection, follow-up observation was performed. In June 2018, a submucosal mass accompanied by tenderness was observed in the gingival-buccal transitional area in the left maxillary anterior tooth region, and contrast-enhanced computed tomography (CT) was performed. We biopsied the lesion because it was near the postoperative site and extended to the maxilla. Since we could not rule out a malignancy, we considered the lesion to be myoepithelial carcinoma and reoperation was performed in October 2018. At present, it is unknown if local recurrence, regional lymph node metastases, or distant metastases have occurred.

Hobnail hemangiomas are benign vascular lesions, and their occurrence in the oral cavity is relatively rare. Here, we report a case of hobnail hemangioma that occurred on the tongue. The patient, an 84-year-old woman, was referred to our oral and maxillofacial surgery by the internal medicine department in June 2018. The mass on the lower surface of the right side of her tongue was a 6 × 6-mm-sized dark-brown, elastic, relatively hard, and elevated lesion that did not fade when pressure was applied. Total resection was performed under local anesthesia. Histopathological examination revealed a biphasic growth pattern with irregular, dilated, thin-walled vessels in the superficial parts of the lesion and slit-like vessels in the deeper portion. The plump endothelial cells in the superficial vessels showed the characteristic“ hobnail” appearance. Immunohistochemically, the endothelial cells were positive for endothelial markers and/or lymphatic endothelial markers to varying degrees. Based on the clinical and histopathological findings, the lesion was diagnosed as hobnail hemangioma. However, recurrence occurred 6 months after resection, so the mass and surrounding tissue were totally resected. The patient’s prognosis is currently favorable, with no signs of recurrence two years after the second resection.

Madelung disease is a benign nontumorigenic disease characterized by multiple and symmetrical unencapsulated adipose tissue deposits on the neck, shoulders and upper extremities. Simultaneous systemic and oral expressions are very rare. We report a case of Madelung disease arising from tongue.

　The patient was a 53-year-old man who presented with bilateral swelling of the tongue. The patient had a history of alcoholic hepatitis and depression. MRI showed bilateral mass lesions under the tongue and on the neck. An excisional biopsy was performed on the left-side nodule because of tongue injury caused by accidental biting. The histopathological diagnosis was lipomatosis. Two years have passed since the operation and there has been no recurrence.

Severe congenital protein C (PC) deficiency, one of the autosomal dominant diseases, causes purpura fulminans (PF) during the neonatal period. These patients usually receive long-term anticoagulant therapy to prevent thrombosis, therefore we should pay attention to both thrombotic tendency and hemorrhagic diathesis when performing surgical treatment. We report a case of perioperative management of a tooth extraction in a patient with severe congenital PC deficiency who has repeatedly developed PF since the neonatal period. A 20-year-old woman, previously diagnosed with severe congenital PC deficiency, was referred to our department for extraction of the left mandibular first and second molars with severe caries. We planned to carry out the tooth extraction without suspending anticoagulant therapy, with the attending physician in charge of hematology. The patient underwent the tooth extraction with sufficient local hemostasis. She left hospital 4 days after surgery without any complications. However, she was readmitted two days after discharge because of post-extraction bleeding. The bleeding was easily stopped with local hemostatic treatment, however purpura developed on her right leg. It was treated with antithrombotic therapy and gradually disappeared without necrosis.