Journal of Japanese Society of Oral Oncology
Online ISSN : 1884-4995
Print ISSN : 0915-5988
ISSN-L : 0915-5988
Volume 33, Issue 3
Displaying 1-10 of 10 articles from this issue
Original
  • Masashi Kimura, Isao Kato, Kenichiro Ishibashi, Akio Shibata, Shusuke ...
    2021 Volume 33 Issue 3 Pages 81-89
    Published: 2021
    Released on J-STAGE: September 22, 2021
    JOURNAL FREE ACCESS
    This study aimed to evaluate the prognostic significance of two major indices of intratumoral heterogeneity of 18F-fluorodeoxyglucose uptake by positron emission tomography (PET)/computed tomography (CT), namely heterogeneity index (HI) and heterogeneity factor (HF), in patients with oral squamous cell carcinoma. We performed a retrospective analysis of 62 patients who underwent resective surgery. HI, HF, maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were obtained from pretreatment PET. HI was obtained by dividing SUVmax by SUVmean for the primary lesion; HF was obtained by taking the derivative (dV/dT) of the volume-threshold function from 30 to 70%. Univariate and multivariate analyses for the overall survival (OS) and disease-free survival (DFS) were performed using PET and clinicopathological parameters. Univariate and multivariate analyses of OS revealed that higher HI levels (threshold for SUVmean is 30% of SUVmax) were associated with poorer OS [hazard ratio (HR)=11.57; 95% confidence interval (CI)=1.45–92.28; P=0.021]. Moreover, univariate and multivariate analyses of DFS revealed that higher TLG levels (threshold for MTV and SUVmean is SUV of 4.0) were associated with poorer DFS (HR=14.48; 95% CI=1.27–164.78; P=0.031). HI and TLG may be statistically significant prognostic factors for OS and DFS, respectively.
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  • Saki Hayashida, Souichi Yanamoto, Mitsunobu Otsuru, Taro Miyoshi, Keis ...
    2021 Volume 33 Issue 3 Pages 91-97
    Published: 2021
    Released on J-STAGE: September 22, 2021
    JOURNAL FREE ACCESS
    Osteoradionecrosis of the jaw (ORN) is a serious late adverse event after radiation therapy for head and neck cancer. Surgical treatment has been avoided because bone and soft tissue at the irradiation site are strongly damaged. We conducted a clinical study of 20 patients with ORN in our Department (6 maxillas, 13 mandibles, 1 both). As an initial treatment, conservative therapy was performed in 18 patients (20 jaws) and surgery in 2 patients (2 jaws). Only one patient (one jaw) was cured by conservative therapy. Surgical method and treatment outcome was examined in 2 patients (2 jaws) undergoing surgery as an initial therapy and 13 patients (15 jaws) undergoing surgery later due to poor progress of conservative therapy. Healing was obtained in all 3 jaws with maxillary bones by removal of sequester. In 12 jaws with mandibular bones, 8 jaws were cured by a single surgery (removal of sequester in one jaw, marginal mandibulectomy in 4 jaws, and segmental mandibulectomy in 3 jaws), 3 jaws were cured by multiple surgery (2 surgeries in 2 jaws, 4 surgeries in 1 jaw), and one jaw recurred after the first surgery and re-operation is currently planned. In patients undergoing multiple surgeries, more than segmental mandibulectomy was finally performed in all cases. In these cases, 14 of the 15 jaws that underwent surgery were finally cured. Since the cure rate of conservative therapy is low and the lesions tend to expand during conservative therapy, selecting surgical therapy as the initial treatment in patients who can undergo surgery may be one of the future options.
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Case Reports
  • Eiji Kondo, Hirokazu Tanaka, Makiko Kawamoto, Hironobu Fukuda, Yoshito ...
    2021 Volume 33 Issue 3 Pages 99-105
    Published: 2021
    Released on J-STAGE: September 22, 2021
    JOURNAL FREE ACCESS
    Spindle cell squamous cell carcinoma is characterized by multiplication of polygonal cells, mainly spindle cells, and is classified as a particular kind of squamous cell carcinoma. We report a rare case of spindle cell squamous cell carcinoma of the mandible that was considered an intraosseous carcinoma.
    A 67-year-old man had undergone enucleation of a mandibular tumor (30×15mm radiolucent mass including an impacted third molar). There had been no abnormal symptoms in the oral mucosa. Pathological examination of the surgical specimen revealed that the lesion was spindle cell squamous cell carcinoma, and so the patient was referred to the Department of Dentistry and Oral Surgery, Shinshu University School of Medicine for further treatment. Elective neck dissection, segmental mandibulectomy, and reconstruction with metal plate and recto-abdominal myocutaneous free flap were carried out, followed by adjuvant chemoradiotherapy. There has been no evidence of recurrence for 5 years.
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  • Yuki Koto, Tadahide Noguchi, Yoshiyuki Tsuchiya, Yukio Ooyatsu, Naruo ...
    2021 Volume 33 Issue 3 Pages 107-112
    Published: 2021
    Released on J-STAGE: September 22, 2021
    JOURNAL FREE ACCESS
    Stitch abscesses may occur following surgery for head and neck cancer. The clinical symptoms and image findings cannot always differentiate them from local recurrence or lymph node metastasis.
    We report a case of multiple stitch abscesses which occurred in the surgical site following a neck dissection for squamous cell carcinoma of the oral floor.
    A 71-year-old female underwent bilateral supra-omohyoid neck dissection, tumor resection of the oral floor, and reconstruction using a vascularized free forearm flap of the right side of the oral floor. About four months after the surgery, subcutaneous abscesses were found in the bilateral submandibular region, and suture threads were found in these abscesses. Consequently, a diagnosis of stitch abscesses was made. Thereafter, multiple subcutaneous mass lesions were found from the submandibular to the middle region of the neck. Although CT, MR, and FDG-PET indicated cervical recurrence, ultrasonography revealed foreign bodies suspected to be stitches. We biopsied a subcutaneous tumor in the submandibular region and silk thread used for ligation was found in the abscess. Histopathological examination indicated local inflammatory cellular infiltration surrounding the stitches with granulation tissue due to angiogenesis. Consequently, a diagnosis of stitch abscesses was made. Similar findings were indicated under the skin in the donor forearm site. The removed specimens revealed a stitch abscess.
    The change to absorbable sutures for vascular ligation still has many problems in Japan. Effective use of energy devices under appropriate conditions may be one method to reduce the risk of stitch abscess formation.
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  • Chiharu Ogawa, Shin Usuda, Hidetaka Miyashita, Seiji Asoda, Ikuhiro Uc ...
    2021 Volume 33 Issue 3 Pages 113-118
    Published: 2021
    Released on J-STAGE: September 22, 2021
    JOURNAL FREE ACCESS
    Epithelioid sarcoma is classified as a group of malignant soft tissue tumors with undetermined differentiation direction in the 2020 WHO classification of soft tissue tumors. It is characterized by slow growth but high recurrence and metastasis rates, and unlike most soft tissue sarcomas, it tends to metastasize to the lymph nodes. Extensive resection is the first line of treatment. Epithelioid sarcoma is most frequently found in the distal upper extremities of young adults, with occurrences in the oral cavity being extremely rare. Herein, we report a case of small epithelioid sarcoma arising in the soft tissue of the lower lip.
    The patient, a 62-year-old female, became aware of induration of the left lower lip around June 2018. At the time of the initial examination, a hard, 5-mm-diameter, elastic nodule with somewhat unclear borders was found under the mucosa of the left lower lip. Based on the findings of an open biopsy under local anesthesia, the histopathological diagnosis was epithelioid sarcoma. Computed tomography (CT), magnetic resonance imaging, and positron emission tomography-CT showed no neck or distant metastasis. In February 2019, she underwent wide lower lip excision, left radical neck dissection (type Ⅲ), and left forearm skin valve reconstruction under general anesthesia. Five courses of AI therapy (doxorubicin+ifosfamide) were then administered at the Department of Musculoskeletal Oncology at our hospital. Two years have passed since the surgery, and the patient is now doing well with no recurrence or metastasis.
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  • Tomofumi Naruse, Hiroki Tsuchihashi, Souichi Yanamoto, Kohei Furukawa, ...
    2021 Volume 33 Issue 3 Pages 119-125
    Published: 2021
    Released on J-STAGE: September 22, 2021
    JOURNAL FREE ACCESS
    Fanconi anemia (FA) is a rare autosomal recessive genetic disorder characterized by an increased risk of cancer. We report a case of squamous cell carcinoma of the tongue in a patient with FA.
    A 23-year-old man was referred to our department with a mass and pain on the left side of the tongue. He had been diagnosed with FA at 3 years of age and had undergone hematopoietic stem cell transplantation at 7 years of age. Clinical examination showed an ulcerated mass measuring 45×18×28mm. He underwent tumor resection with bilateral modified radical neck dissection and reconstruction using a rectus abdominis musculocutaneous flap.
    He developed recurrence 4 months postoperatively and underwent salvage surgery. He received bioradiotherapy including cetuximab for recurrence of unresectable disease, 2 months after salvage surgery. He died of progressive recurrent disease 18 months after the primary surgery.
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  • Keiichi Ohta, Hayato Itoi, Takashi Ryoke, Satoshi Yamamoto, Hisato Yos ...
    2021 Volume 33 Issue 3 Pages 127-135
    Published: 2021
    Released on J-STAGE: September 22, 2021
    JOURNAL FREE ACCESS
    Ameloblastic carcinoma (AC) is a malignant form of ameloblastoma and an extremely rare odontogenic tumor. Herein, we report a case of AC of the maxilla. A 62-year-old woman presented to a dental clinic with tenderness of the right cheek. A panoramic radiograph showed a radiolucency in the right maxilla, and she was referred to another hospital. With a provisional diagnosis of a benign lesion, she underwent surgical removal of the maxillary mass, following which a pathological diagnosis of AC was made. Subsequently, she was referred to our department for further treatment, and she underwent partial maxillectomy. She remained disease-free at 3-year follow-up. We performed a literature review of AC cases reported in the last decade. Of 36 AC cases, 63.9% were clinically diagnosed as benign lesions; among them, 52.2% cases were clinically diagnosed as ameloblastoma. Conversely, 92.6% cases were diagnosed as malignant lesions on biopsy; among them, 76% cases were pathologically diagnosed as AC. These findings suggest that clinical and imaging findings may complicate the differentiation of AC from ameloblastoma; however, performing a biopsy can help obtain a correct diagnosis, leading to appropriate treatment planning.
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  • Yasuhiro Nakai, Fumi Nakai, Chisato Goda, Mao Fushimi, Minoru Miyake
    2021 Volume 33 Issue 3 Pages 137-141
    Published: 2021
    Released on J-STAGE: September 22, 2021
    JOURNAL FREE ACCESS
    We report a case of lower gingival carcinoma undergoing vagus nerve stimulation (VNS) therapy for intractable epilepsy. The patient was a 65-year-old man. He was referred to our hospital because of pain in the left mandibular gingiva. His medical history was secondary epilepsy due to sequelae of cerebral hemorrhage, which was difficult to control with drugs alone, therefore, he was treated with VNS therapy. The left mandibular gingiva had a surface papillary mass measuring 30×20mm. Based on biopsy and imaging examinations, a diagnosis of lower gingival carcinoma (SCC, T2N0M0) was made. Subsequently, he underwent a left mandibular segmentectomy and free fibular flap reconstruction, including left neck dissection (Level 1-2). VNS was in the Level 3 area and was not exposed to the operative field. Because of VNS, he could not undergo an MRI or use of an electric scalpel. After the operation, we confirmed the validation of VNS with the manufacturer. Three implants were placed in the reconstructed bone 1 year and 1 month after the operation, and implant overdenture was performed. About 3 years have passed since the operation, and there is no evidence of recurrence or metastasis.
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  • Shoma Tsuda, Tomofumi Naruse, Kohei Furukawa, Taro Miyoshi, Shuichi Fu ...
    2021 Volume 33 Issue 3 Pages 143-149
    Published: 2021
    Released on J-STAGE: September 22, 2021
    JOURNAL FREE ACCESS
    Plasmacytoma is a malignant tumor consisting of neoplastic proliferation of plasma cells, and it is extremely rare to be isolated in the jaw. We treated a patient with solitary plasmacytoma in the mandible.
    A 42-year-old woman was referred to our hospital for further investigation of an osteolytic lesion in the mandible. A 16×9mm radiolucent area in the right mandibular ramus was found on panoramic radiography. The osteolytic lesion had expanded compared to panoramic radiography 6 years earlier. The patient underwent an excisional biopsy under general anesthesia. Histopathological examination confirmed the diagnosis of plasmacytoma. As there were no abnormal findings in whole body bone, bone marrow aspiration, blood test, or urine test, she was diagnosed with solitary plasmacytoma of the mandible. The patient underwent local radiotherapy with a total dose of 45Gy. To date, 41 months after radiotherapy, there have been no signs of recurrence or progression to multiple myeloma.
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  • Toshiyuki Nakasone, Akira Matayoshi, Syou Miyamoto, Shimpei Goto, Fusa ...
    2021 Volume 33 Issue 3 Pages 151-158
    Published: 2021
    Released on J-STAGE: September 22, 2021
    JOURNAL FREE ACCESS
    Ganglioneuroma (GN) is a rare benign neural tumor that is thought to arise from the ganglia of the sympathetic chain or parasympathetic nervous system. A 3-year-old boy presented with tumors in the adrenal gland and the right orbit, and was diagnosed with neuroblastoma (NB) stage Ⅳ After chemotherapy, the tumors were resected and the pathological diagnoses of ganglioneuroblastoma (GNB) in the adrenal gland and GN in the orbit were made. The tumor relapsed at the intracranial dura mater 21 years after the initial diagnosis and was diagnosed as GN based on a biopsy sample. The GN in the mandible was detected in the left mandible 24 years later and in the right mandible 27 years later, and was resected. Histopathologically, the tumor consisted of mature ganglion cells. Furthermore, immunohistochemistry showed that the tumor cells were immunoreactive for vimentin, S-100, neurofilament, glial fibrillary acidic protein (GFAP), and synaptophysin, while they were non-reactive for α-smooth muscle actin (α-SMA) and cytokeratin AE1/AE3. The Ki-67 labeling index (LI) was 1%. Finally, this led to a diagnosis of GN. This case is extremely rare in that GN was found in the bilateral mandible. This is a very rare case of metastatic NB of the adrenal gland that developed in the bilateral mandible after a long period.
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