Takao Tokumaru

Pleomorphic adenoma presenting with conductive hearing loss in the ear canal: a case report and review of the literature

IntroductionPleomorphic adenoma accounts for 65 percent of all salivary gland tumors. It has been identified in several anatomical regions, but pleomorphic adenoma arising in the ear canal, first described in 1951, is extremely rare.Case presentationA 40-year-old Japanese man’s left ear canal was obstructed by a pleomorphic adenoma that caused mild conductive hearing loss. The tumor was resected and he remains disease-free two years after surgery.ConclusionsPleomorphic adenoma usually arises from a major and minor salivary gland, but pleomorphic adenoma of the ear canal is derived from the ceruminous gland. We discuss the present case and 37 other case reports in our effort to clarify the clinical features and the course of pleomorphic adenoma in the ear canal.

Ultrastructual morphology of juvenile psammomatoid ossifying fibroma.

We investigated the ultrastructural morphology of the hard tissue in a fibro-osseous lesion. Bone samples were obtained from a juvenile psammomatoid ossifying fibroma and were observed under a scanning electron microscope. The lesion had a spongy lamellar structure containing bony tissue. On histological examination, resorbing preexisting lamellar bone associated with a large number of cathepsin K-positive osteoclasts was confirmed. Scanning electron microscopy revealed the bony material to have a cribriform structure and to indicate resorption related to osteoclasts throughout the tumor. These characteristic findings revealed the presence of active bony reconstruction and destruction in this lesion. The spongy calcified structure observed by scanning electron microscopy expressed the characteristic ground glass appearance in computed tomography of this patient. This remarkable activation of osteoclasts may deeply relate to characteristic calcified structure in this lesion. Observation of hard tissue structure under a scanning electron microscope may shed light on the pathology of fibro-osseous lesions in the head and neck.

Cancer of the mandibular gingiva metastasizing to the small intestine

Head and neck cancer metastasizing to the small intestine is very rare. Here we report a case of cancer of the mandibular gingiva metastasizing to the small intestine. The patient was an 82-year-old man who had squamous cell carcinoma of the mandibular gingiva staged as T2N2bM0. Two months after surgery, he presented with lower abdominal pain accompanied by signs of peritoneal irritation. Urgent abdominal surgery was performed, during which a crater-shaped perforation was noted on the wall of the ileum. Microscopic findings at this site confirmed a diagnosis of metastatic squamous cell carcinoma in the small intestine from the mandibular gingiva. To our knowledge, this is the first case report of oral cancer metastasizing to the small intestine. If gastrointestinal symptoms appear in a patient with advanced oral cancer, a differential diagnosis of metastasis to the gastrointestinal tract should be kept in mind.

The selection of treatment strategy for stage III, IV laryngeal and hypopharyngeal squamous cell carcinoma: —an evaluation of predictable parameters for concurrent chemoradiotherapy—@@@―化学放射線同時併用療法の選択基準についての考察―

In the treatment strategy for advanced laryngeal or hypopharyngeal cancer, it is not so easy to decide whether patient should be performed concurrent chemoradiotherapy (CCRT) or wide resection with total laryngectomy. One hundred-fifty three patients were divided into two groups according to the modality for primary site ; CCRT group and the other wide resection group, and we retrospectively examined whether we could predict the case of having high sensitivity and curative possibility to CCRT. Clinical parameters ; T stage, subsite of tumor, tumor volume, existence of laryngeal paresis and tumor growth pattern, all of them were not predictable. The response to induction chemotherapy was not also predictable. Relapse free survival rate, regional free survival rate and disease specific survival rate were 58.2%, 55.2% and 30.1% in CCRT group and 91.6%, 76.4% and 61.1% in wide resection group and there were significant differences between them.