Norihiko Murai

A Case of a True Malignant Mixed Tumor of the Parotid Gland.

True malignant mixed tumor (carcinosarcoma) of salivary glands, with carcinomatous and sarcomatous components, is aggressive and extremely rare. We report a case of a true malignant mixed tumor in a parotid lesion.A 58-year-old man had a painless right inf raauricular mass that had been present for about 30 years. A 6×4cm elastic hard nodule existed from the tragus to the angle of the mandible. The patient underwent total parotidectomy with facial nerve preservation. The entire tumor was resected with the surrounding tissues except along the main trunk of the facial nerve. Histologically, the tumor showed a biphasic pattern composed of both carcinomatous and sarcomatous elements. The carcinomatous component was adenocarcinoma with ductal structure and the sarcomatous components varied from unclassified sarcoma to unequivocal chondrosarcoma. Two months later, the patient suddenly complained of right facial paralysis. Magnetic resonance imaging revealed a irregular mass extending to the parapharyngeal space. A radical operation, combined with chemotherapy and radiotherapy, was performed with neck dissection, partial mandibulectomy and facial nerve sacrifice. Despite these intensive therapies, an X ray study showed multiple pulmonary coin lesions three months after the second operation.We emphasize the necessity for radicality in initial operations when dealing with this type of tumor.

Two Cases Showing Dizziness during Recovery from Puffer Fish Poisoning.

Symptoms and neuro-otological test results in two patients with puffer fish poisoning (one severe case and the other mild) were reported. Both patients complained of dizziness one day after revival. The eye-tracking test showed a saccadic pattern in the severe case. The optokinetic pattern test showed overall poor pursuit in the severe case, while poor pursuit was only evident at high speeds in the mild case. The caloric test showed bilateral hypofunction in both cases. Tests results uniformly improved when dizziness disappeared. These observations suggest that tetrodotoxin may affect both the peripheral and central nervous systems.

Ectopic Tonsillar Tissue in the Hypopharynx; A Case Report.

A rare case of ectopic tonsillar tissue in the hypopharynx, meeting the 4 histological criteria for tonsil tissue as defined by Fioretti, is described in this report. A 68-year-old woman, in whom a mass in the hypopharynx had been found during endoscopic examination of the esophagus, was referred to our hospital. Endoscopic and X-ray examination revealed that the mass was located in the right postarytenoid region. Under general anesthesia, the tumor was extirpated by lateral pharyngotomy.

Focal Myositis in the Temporal Muscle; A Case Report.

Focal myositis is an inflammatory pseudotumor of the skeletal muscle that often mimics a growing neoplasm.We report the tenth case of focal myositis in the head and neck region; the first in the temporal muscle.A 42-year-old man was referred to our hospital with a subcutaneous mass in the right temporal region. An excisional biopsy was performed under general anesthesia. The mass was localized within the right temporal muscle. The histopathological diagnosis was focal myositis.Since focal myositis is a self-limited disease which regresses spontaneously, no further treatment is required. However, careful observation is necessary to exclude localized initial symptoms of polymyositis.