We describe our experience with a case of squamous cell carcinoma of the mandibular gingiva in a patient who developed pulmonary thromboembolism during cetuximab with FP therapy.
A 57-year-old man was referred to our hospital because of pain in the left mandible. On the basis of imaging findings, cervical lymph node metastasis involving the cavernous internal carotid artery was found. We administered cetuximab with FP therapy because unresectable tumors were diagnosed.
Enhanced computed tomography revealed a number of microthrombi in the pulmonary artery during systemic therapy because of disorientation and minimal dyspnea. Systemic therapy was discontinued, and anticoagulant therapy was given. Disappearance of the thrombus was confirmed 3 weeks later, so tumor resection was performed. There was no recurrence or re-thromboembolism during the 4-year 9-month follow-up period.

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Polymyalgia rheumatica （PMR） is a chronic inflammatory disease of unknown cause associated with malignant tumors. We report a case of PMR due to pain in the shoulder joint and chronic inflammatory reaction after surgery for oral floor cancer. The patient was an 81-year-old woman who visited our department with a chief complaint of ulceration of the oral floor. With the diagnosis of SCC cT4aN0M0 of oral floor cancer, resection of the oral malignant tumor and reconstruction with a scapular flap were performed. After surgery, inflammatory responses with frequent pyrexia and persistent high C-reactive protein （CRP） were noted. There was no obvious site of infection. On the 69th day after the operation, the white blood cell count was 7,990/μl and CRP was 20.724mg/dl, and strong shoulder joint pain was noted. Therefore, the patient was examined in consideration of the possibility of autoimmune disease. The erythrocyte sedimentation rate increased to 103mm/h, and the autoimmune antibody was negative, satisfying the diagnostic criteria for PMR. Prednisolone （PSL） 15mg/day was started, and the pain improved remarkably. Currently, at PSL 8mg/day, the progress is uneventful without relapse. PMR is difficult to diagnose because its symptoms are similar to those of perioperative invasion and aspiration pneumonia, but the symptoms can be significantly improved by early diagnosis and treatment; such possibility should be kept in mind.

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High grade transformation （HGT） is an uncommon phenomenon among adenoid cystic carcinomas （AdCC） and is associated with increased tumor aggressiveness, with a high propensity for lymph node and distant metastasis. The patient was a 69-year-old woman with the chief complaint of swelling in the midpalate. At the first visit, a broad basal mass measuring 30×15mm was found slightly to the left of the center of the palate. As a result of the biopsy, it was diagnosed as a salivary gland malignant tumor, but a definitive diagnosis was not reached. Therefore, total resection was performed. By then, the tumor had significantly increased. A resected specimen showed that the tumor was composed of both a conventional low-grade AdCC and a HGT carcinoma. The part of the tumor that had increased rapidly from the first visit to the time of surgery was histopathologically occupied by HGT-AdCC. A positive margin was found in the histopathological specimen, and postoperative radiation was performed. Subsequent image evaluation revealed metastatic lung tumor and so concurrent chemoradiotherapy was performed, however, death resulted.

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Cystadenoma is a rare salivary gland benign tumor and consists of monolocular or multilocular cysts in the tumor. This type of tumor accounts for 2–4.7％ of all minor salivary gland tumors and it usually occurs on the lip, palate, and buccal mucosa, but rarely in the retro-molar region. We present a case of cystadenoma arising from the left retro-molar region in an 83-year-old male patient. The clinical evaluation showed a solitary mass of 15×18mm which was elastic soft, with a smooth surface, partially purply blue color, and a clear border. The MRI findings revealed that the tumor was well defined with rim-enhanced mass. The clinical diagnosis was a benign tumor. The lesion was resected under general anesthesia, and the histopathological diagnosis was cystadenoma. There was no evidence of recurrence 3 years after resection.

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We report a case of maxillary gingival carcinoma producing granulocyte colony-stimulating factor （G-CSF） with diffuse uptake of FDG in the bone marrow of the spine and pelvis. A 65-year-old male was referred to our department with the chief complaint of a granulated mass in the left maxillary gingiva. Pathological examination of a biopsy specimen resulted in a diagnosis of squamous cell carcinoma of the maxillary gingiva. Blood testing revealed an increased white blood cell （WBC） count and serum concentrations of G-CSF. FDG-PET scanning showed diffuse uptake of FDG in the bone marrow of the spine and pelvis. These findings suggested a G-CSF producing tumor. Thirty days after the initial presentation, tumor resection was performed under general anesthesia. Postoperatively, the patient’s WBC count and serum concentrations of G-CSF soon decreased. Locoregional recurrence was detected 5 months after surgery, and the patient died 11 months postoperatively. FDG-PET findings are useful in the diagnosis of G-CSF producing tumor.

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EBV-positive mucocutaneous ulcer （EBVMCU） was first proposed in 2010 by Dojcinov et al. as a series of EBV-positive ulcerative lesions on the mucosa of the oropharynx, skin, and gastrointestinal tract. It was newly classified as an independent group of diseases with good prognosis in the fourth edition of the WHO classification in 2017. In this article, we report three cases of oral mucosal ulcer diagnosed as EBVMCU and the treatment progress with a review of 25 patients reported in Japan.
Patient 1: A 75-year-old woman with an ulcer on the upper left gingiva of the molar region. She had been taking methotrexate （MTX） to treat her rheumatoid arthritis （RA）. Patient 2: A 67-year-old man with an ulcer on the lower left gingiva of the incisor region. He had been taking MTX to treat his RA. Patient 3: A 77-year-old woman with an ulcer on the upper right gingiva and palate of the incisor region. She had been taking MTX to treat her RA.
The clinical diagnosis was a suspected malignant tumor in two patients and severe oral mucositis in one patient, but a definitive diagnosis of EBVMCU was obtained by careful hearing of the medical history and biopsy in all three patients. They discontinued administration of MTX and the lesions disappeared.

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Angioleiomyoma occurs frequently in the extremities with prominent smooth muscle cells but is relatively rare in the oral cavity. We report a case of angioleiomyoma of the palate with a review of the literature in Japan.
A 72-year-old male was referred to our hospital because of painless swelling of the hard palate. Clinical examination revealed a 12×15mm, well-defined, elastic soft, nodular lesion on the hard palate. Under the clinical diagnosis of benign tumor, he underwent resection of the lesion. The histological diagnosis was angioleiomyoma.
We further reviewed 92 patients with angioleiomyoma of the oral cavity in Japan. It often occurs in males, about two-thirds of the cases occurred in the hard palate and lips, and the histological type was mostly the venous type. Preoperative diagnosis was difficult, and the final diagnosis was made by postoperative histological examination with various immunostaining. Surgery was often performed as a treatment, and the prognosis was good.

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Langerhans’ cell histiocytosis （LCH） is a rare disease caused by monoclonal proliferation of Langerhans’ cells. We report a case of LCH arising in the temporal bone with trismus.
The patient was an 8-year-old girl who was referred to our department because of trismus. Contrast-enhanced computed tomography （CT） and magnetic resonance （MR） imaging revealed a neoplastic lesion with bone destruction in the left temporal bone and zygomatic bone. Positron emission tomography-CT revealed the accumulation of fluoro-deoxy glucose in the left temporal region and multiple lymph nodes. We performed a biopsy of the lesion under general anesthesia and obtained a histopathologic diagnosis of LCH. Based on these findings, multi-system LCH was clinically diagnosed.
She was treated with multi-drug chemotherapy for 54 weeks after initial diagnosis and obtained a complete remission. She has shown no evidence of disease for 3 years after the initial treatment.

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