A case of basal cell carcinoma arising in the lacrimal sac was reported. The patient, an 81-year-old female, had complained of epiphora of the right eye. The tumor had enlarged in the right medial canthal area over six months. MRI and CT scan showed that the tumor was located at the lacrimal sac with invasion into the anterior ethmoid and maxillary sinus with bone destruction. The tumor was resected with ethmoidectomy and partial maxillectomy. Direct invasion into the medial rectus muscle and occular globe was not seen. The pathological diagnosis was basal cell carcinoma, which was composed of nests of basoloid cells with focal squamous differentiation.

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The local control of oral, oropharyngeal, and maxillary cancers extending to the masticator space is poor because the surgical approach to the deep margin is difficult. We present an inf ratemporal f ossa approach for "en bloc" surgical resection of the masticator space. Seven cases involving the masticator space were surgically treated. Five cases were resected with inf ratemporal f ossa dissection (dissected group). Two cases were resected with the mandibular swing approach (non-dissected group). The local control rate of the dissected group was 80% and that of the undissected group was 0 %. The dissected group had functional problems of malocclusion and chewing, however they kept fair to good oral intake. To obtain better local control of deeply invaded cancers, "en bloc" dissection of the involved space is important.

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A rare case of recurrent pleomorphic adenoma of temporal bone in a 67-year-old woman is described. The primary tumor originated in the superficial lobe of the right parotid gland, and was treated with surgery 10 times over 30 years, followed by radiotherapy of 50 Gy. The secondary tumor appeared 32 months after radiotherapy in the right temporal bone, extending to the posterior cranial f ossa and foramen magnum. Right partial temporal bone resection and lateral suboccipital craniotomy were performed on this metastasizing pleomorphic adenoma. Metastasizing pleomorphic adenoma is a very unusual tumor, which appears more likely in cases after incomplete resection. While some of recurred pleomorphic adenoma are pathologically benign, their behavior may become metastatic or clinically malignant in the long run as in the case descrebed here.

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Kimura's disease is a chronic benign inflammatory disease which often presents as a tumor-like swelling in the subcutaneous soft tissue of the head and neck region with formation of lymphoid follicles and infiltration of eosinophiles. This is found chiefly in young males. Its etiology is unknown. The decisive therapy has not been established. We reported 6 cases of an eosinophilic granuloma of the soft tissue (Kimura's disease), that have been treated at Tokyo Women's Medical University during the past 10 years of 1993 to 2003. All patients were male and showed eosinophilic granuloma in the salivary glands.A blood examination showed a remarkable increase in the eosinophil and serum IgE levels in all cases.Among our 6 cases, 3 were positive in the allergic RAST test for Candida. The definite diagnosis depends upon the histopathological study, but such a characteristic clinical findings were also much useful. We treated in combination with surgery and chemotherapy using steroids, antiallergic drugs and nonsteroidal anti-inflammatory drugs (NSAIDs). Our observation for a prolonged period is necessary to prevent the recurrence.

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[in Japanese]

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Objective. Thyroid surgery is often conducted by two operators. It is difficult to provide the sufficient operation field by only two operators. And, we need adequate instrument for the cutting of the thyroid isthmus. Methods. We use the fishing hooks to retract the skin flaps and strap muscles for the provision of the sufficient operation field. And, we use a vertical curved forceps to cut the isthmus for division the thyroid lobes. Results. 646 patients were operated in our department during the period of 11 year and 10 months. For almost all patients, fishing hooks and forceps were used, and it is usefull and safe for the operations. Conclusions. We explain our technique to carry out thyroid surgery by two operators. Fishing hook is beneficial to provide the sufficient operation field, and easy for fixation and retoutchment. Vertical curved forceps is usefull to cut the isthmus for division of the balateral lobes.

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