The incidence of oral cancer has been increasing in Japan and it is reported to have the highest prevalence in men aged 60 years or older. However, the prevalence in young patients has increased in recent years.
This retrospective study examined 36 patients who were less than 40 years of age （young patients） and who had tongue squamous cell carcinoma that was treated primarily at Tokyo Dental College from 1997 to 2016. Among a total of 369 patients with tongue squamous cell carcinoma treated in our department during this period, young patients comprised 9.8%. The proportion of young patients increased over the 20 years, and the male-female ratio of young patients was 1.25：1. On histopathologic examination, the most common type was the well-differentiated type, which accounted for 75.0%. The incidence of TNM stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ was 41.7%, 19.4%, 22.2%, and 16.7%, respectively. As risk factors for oral cancer, drinking habit, smoking habit, and mechanical irritation were reported by 38.9%, 41.7%, and 91.7% of the young patients, respectively. The 5-year overall and disease-free survival rates were 88.2% and 82.6%, respectively. Although the survival rate of young patients did not differ significantly from that of older patients, the outcomes were slightly more favorable in young patients than in older patients.

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The range of resection of malignant tumors of the lip is frequently extensive, and so reconstruction using flaps becomes necessary. A successful reconstruction requires appropriate esthetics, food ingestion, and speech function. A 79-year-old woman with upper and lower lip tumor was diagnosed with moderate squamous cell carcinoma. Resection of the upper and lower lip tumor was performed under general anesthesia. Reconstruction was conducted by applying an extended nasolabial flap, which was pedicle cheek skin with blood supplied from the angular artery and facial artery. A feature of this method is that it can be adapted to a wide range of lip defects and allows the operation time to be shortened.

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Background: Primary central nervous system lymphoma （PCNSL） occurs locally in the central nervous system （CNS）and accounts for less than 1% of all malignant lymphomas. Malignant lymphoma derived from other organs is rarely infiltrated into the CNS at the time of initial detection. We present a rare case of malignant lymphoma coexisting in the left mandible and the left temporal lobe at the initial detection.
Case Presentation: The case was a 64-year-old female with a symptomatic mass in the left mandible and hypoesthesia of the lower lip. As a left temporal lobe mass had been pointed out in a brain checkup two months earlier, it was planned to be examined. At the initial examination, a mass of elastic hardness and normal mucosa color was found in the buccal gingiva ranging from the left lower jaw canine to the molar teeth. CT and MRI showed a 50-mm large lesion with osteolytic change in the left mandibular bone. As a result of mandible mass biopsy, it was diagnosed as diffuse large B-cell lymphoma. To determine the treatment strategy, brain mass biopsy was performed by a neurosurgeon, and B-cell lymphoma was diagnosed as well. R-MPV therapy was immediately performed, resulting in complete response. After achieving remission, open reduction and internal fixation were performed on the pathological fracture of the mandible that occurred during R-MPV. Two months later, the left temporal lobe tumor relapsed. Although she received salvage chemotherapy, she died five months after the relapse.
Conclusion: PCNSL is a rare malignant lymphoma. To our knowledge, this is the first report in the literature of the simultaneous appearance of PCNSL and mandible DLBCL. ORIF was performed on the pathological fracture of the mandible that occurred during R-MPV. Fixation failure was not observed during the clinical course, and the patient’s QOL was maintained.

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Superior vena cava syndrome （SVCS）, as a potentially life-threatening oncologic emergency condition, is a group of congestive symptoms caused by the obstruction of the superior vena cava （SVC）. The main cause of SVCS is malignant tumors in the mediastinum, most commonly lung cancer. SVCS caused by oral cancer is rare. Here we describe a case of SVCS caused by secondary metastasis to a deep cervical lymph node in the supraclavicular fossa from lower gingival cancer.
A 77-year-old woman with lower gingival squamous cell carcinoma, T2N0M0, was surgically treated by marginal mandibulectomy with supraomohyoid neck dissection. Four years after the primary operation, metastasis to the level Ⅳ lymph node in the ipsilateral neck occurred. The tumor was palliatively irradiated with a total dose of 50Gy. Six months after the radiation, sudden edema developed on the ipsilateral face, neck, and arm accompanied with hoarseness, coughing, and headache. A CT revealed collapse of the SVC due to enlargement of the metastatic lymph node where the jugular vein and the subclavicular vein join to the brachiocephalic vein. Although the congestive condition was temporarily improved with administration of steroid and glycerol, the patient died at home 47 days after development of SVCS.

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