Yumi Mochizuki

Perioperative assessment of psychological state and quality of life of head and neck cancer patients undergoing surgery

This study assessed psychological state and quality of life (QOL) in head and neck cancer patients during the perioperative period. Patients who had undergone primary surgery at the Department of Oral and Maxillofacial Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan were enrolled. After obtaining informed consent, three tests were administered: the Hospital Anxiety and Depression Scale (HADS) to assess psychological state, and the Functional Assessment of Cancer Therapy General (FACT-G) and Functional Assessment of Head and Neck (FACT-H&N) to assess QOL. Japanese language versions of all tests were administered. Tests were administered 1 day before surgery, 1 week after surgery, and 1 and 6 months after discharge. Test scores were analyzed, as were relationships between psychological state, QOL and clinical factors. Anxiety was greatest before surgery, while depression was greatest immediately after surgery. QOL in the somatic and specific domains also decreased immediately after surgery. QOL in most domains improved 1 month after discharge. This study offers important information regarding perioperative psychological state and QOL in head and neck cancer patients.

Chronic mandibular osteomyelitis with suspected underlying synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome: a case report

Chronic mandibular osteomyelitis is an intractable disease. In recent years, some case reports have related this disease process to synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, which is chronic with frequent remissions and exacerbations. This report describes a case of chronic mandibular osteomyelitis suspected to be SAPHO syndrome. A 68-year-old woman presented with pain on the left side of the mandible. On the basis of clinical and radiological findings, chronic mandibular diffuse sclerosing osteomyelitis was initially diagnosed. We administrated oral clarithromycin (400 mg daily) and levofloxacin (500 mg daily), and her pain subsequently resolved. On 99mTc-labeled methylene diphosphonate scintigraphy, tracer uptake in the asymptomatic mandible was unchanged, but there was increasing tracer uptake in the sternocostal and sternoclavicular joints, compared with 99mTc-labeled methylene diphosphonate scintigraphic findings of the first visit. We diagnosed SAPHO syndrome and administrated oral sodium risedronate hydrate (2.5 mg daily). Although there has been no pain or swelling in the area of the left mandibular lesion, we have followed up on other skin and osteoarticular manifestations in conjunction with other medical departments.

Clinical characteristics of multiple primary carcinomas of the oral cavity

OBJECTIVES This study aimed to clarify the clinical characteristics of multiple primary carcinomas of the oral cavity. MATERIALS AND METHODS We retrospectively reviewed the cases of 1015 patients who were treated during follow up for oral cancer at Tokyo Medical and Dental University between March 2001 and December 2012. We compared the clinical characteristics of 961 patients who developed single primary oral squamous cell carcinoma (SCC) during follow up and 54 patients who subsequently developed multiple primary carcinomas in the oral cavity. RESULTS Mean age at first diagnosis was significantly higher in patients with multiple primary carcinomas than single primary carcinoma. Multiple primary carcinomas showed a female predilection, were most prevalent in the gingiva, and tended to show earlier tumor and nodal stages than single primary carcinoma. The local recurrence rate was higher for multiple primary carcinomas than single primary carcinoma, and it increased with the number of multiple primary occurrences. The disease-specific survival rate at 10 years for patients with single primary carcinoma was 85.3% and that for patients with multiple primary carcinomas was 79.6%. The cumulative incidence rate for metachronous second multiple primary carcinomas after the onset of first carcinoma at 10 years was 8.0%. The recurrence of multiple primary carcinomas did not decrease the survival rate. CONCLUSION Differences were found in the clinical characteristics between patients with single oral SCC and those with multiple primary oral carcinomas. Early diagnosis and treatment as well as close long-term follow up are needed for patients with multiple primary oral carcinomas.

Functional outcomes and patient satisfaction after vascularized osteocutaneous scapula flap reconstruction of the mandible in patients with benign or cancerous tumours

Pre- and postoperative longitudinal assessment of oral functions including masticatory force, masticatory ability with solids, speech intelligibility, and subjective satisfaction was conducted for patients who underwent vascularized osteocutaneous scapula flap reconstruction after mandibulectomy. Postoperative changes in oral function and patient satisfaction were examined in relation to tumour type (i.e., cancerous vs. benign). A change in masticatory force was associated with a reduction in the number of occlusal support zones after surgery and clearly differed by tumour type. Despite all patients showing reduced masticatory force postoperatively, all were satisfied with the improvements in eating and chewing, which were greater in patients with benign tumours than in those with cancerous tumours. Although both groups of patients expressed satisfaction with the aesthetic appearance after surgery, patients with cancerous tumours were more satisfied. However, both groups showed decreased speech intelligibility scores and lower satisfaction with speech after surgery. Preoperative support in the form of reassurance and helping to alleviate anxiety about postoperative appearance would be beneficial for all patients, with additional support provided based on the specific tumour type.

Preoperative predictive model of cervical lymph node metastasis combining fluorine-18 fluorodeoxyglucose positron-emission tomography/computerized tomography findings and clinical factors in patients with oral or oropharyngeal squamous cell carcinoma

OBJECTIVE This study aimed to construct a preoperative predictive model of cervical lymph node metastasis using fluorine-18 fluorodeoxyglucose positron-emission tomography/computerized tomography ((18)F-FDG PET/CT) findings in patients with oral or oropharyngeal squamous cell carcinoma (SCC). STUDY DESIGN Forty-nine such patients undergoing preoperative (18)F-FDG PET/CT and neck dissection or lymph node biopsy were enrolled. Retrospective comparisons with spatial correlation between PET/CT and the anatomical sites based on histopathological examinations of surgical specimens were performed. We calculated a logistic regression model, including the SUVmax-related variable. RESULTS When using the optimal cutoff point criterion of probabilities calculated from the model that included either clinical factors and delayed-phase SUVmax ≥0.087 or clinical factors and maximum standardized uptake (SUV) increasing rate (SUV-IR) ≥ 0.100, it significantly increased the sensitivity, specificity, and accuracy (87.5%, 65.7%, and 75.2%, respectively). CONCLUSIONS The use of predictive models that include clinical factors and delayed-phase SUVmax and SUV-IR improve preoperative nodal diagnosis.

Myoepithelioma of the Parotid Gland Presenting as a Retroauricular Cutaneous nodule: A Case Report

We are reporting a case of recurrent myoepithelioma of the parotid gland, that emerged as a cutaneous mass. She had a retroauricular subcutaneous mass with an underlying diagnosis of a cutaneous myoepithelioma, which was excised at a hospitals Dermatology Department 2 years earlier. The tumour was observed above the platysma and it was considered as a cutaneous myoepithelioma without the parotid gland structures. She had undergone a partial parotidectomy approximately 20 years earlier. At her first visit to our department, there was no evidence of facial nerve palsy or cervical lymphadenopathy. The radiological findings showed a multinodular growing mass of the parotid gland, just beneath the retroauricular skin and a total parotidectomy was performed. It was considered that even if the cutaneous mass emerged, the relationship between the cutaneous mass and the parotid gland should be pre-surgically examined by computed tomography (CT) or Magnetic resonance image (MRI). A long-term continuous follow-up was also needed.

A case of primary combined neuroendocrine carcinoma with squamous cell carcinoma in the upper gingiva.

Neuroendocrine carcinoma is a rare neoplasm that occurs widely in various organs and tissues. The biological behavior of this tumor in the oral region remains poorly understood. We encountered an extremely rare case of combined neuroendocrine carcinoma with squamous cell carcinoma, occurring at the buccal gingiva in a 62-year-old woman. Left partial maxillectomy was performed. Histological examinations revealed solid nests with extensive necrosis and nuclear palisading at the periphery. The tumor also showed areas of stratified neoplastic squamous differentiation. Immunohistochemically, tumor nests stained positive for synaptophysin, chromogranin, N-CAM (CD56), and neuron-specific enolase. Strong positivity was seen for K14 and K17 in the squamous component and for K7 in the neuroendocrine component. Both components showed K19 staining. Cells with squamous differentiation and K14 staining occasionally expressed p63. The patient showed no evidence of disease as of 23 months postoperatively. Given the aggressive characteristics of neuroendocrine carcinoma, strict follow-up has been performed.

A distinctive subgroup of oral EBV+ B-cell neoplasm with polymorphous features is potentially identical to EBV+ mucocutaneous ulcer

Epstein-Barr virus-positive mucocutaneous ulcer (EBVMCU) is a newly recognized provisional entity included in mature B-cell neoplasm in the latest 2016 World Health Organization Classification. It has a self-limited growth potential with a high predilection for oral cavities and occurs in age-related or iatrogenic immunodeficiency with indolent clinical courses. However, it shares histological features with EBV-positive diffuse large B-cell lymphoma (DLBCL), and this often leads to diagnostic challenges and controversies in patients with an oral EBV-positive B-cell neoplasm. The aim of this study was to better characterize and comprehend the pathophysiology of DLBCL and EBVMCU in the oral cavity. We conducted clinicopathologic and recurrent gene mutation analysis of 49 cases (14 EBV positive, 35 EBV negative), including cases diagnosed as DLBCL or B-cell lymphoproliferative disorders with high-grade morphology in the oral cavity. All EBV-positive cases matched the criteria of EBVMCU, with significantly earlier clinical stages than the EBV-negative group (P=.0006). Besides, histological analysis showed that all EBV-positive cases presented polymorphous features, whereas 91.4% (32/35) of the EBV-negative cases showed diffuse and monotonous proliferation (P<.0001). Furthermore, EBV-positive cases presented favorable clinical outcomes without disease-related death or recurrence. Gene mutation analysis (MYD88, CD79A, CD79B, CARD11, and EZH2) revealed that 33.3% (9/27) of EBV-negative cases harbored at least 1 gene mutation, whereas no gene mutation was observed in the EBV-positive group (0/11). These results suggest that oral EBV-positive B-cell lymphoid proliferation with polymorphous features often fulfill the criteria for EBVMCU, with clinicopathologically and genetically distinctive properties.

Value of real-time tissue elastography for squamous cell carcinoma of the tongue

Objectives: Real-time tissue elastography is an ultrasound tomography technique that can objectively display tissue elasticity. The aim of this study was to evaluate the strain ratio of tongue carcinoma and the normal tongue and to investigate how clinico-pathological factors influenced the strain ratio. We also investigated differences in the strain ratio between tumor and non-tumor tissue after preoperative chemo-radiotherapy. Materials and methods: Patients with tongue carcinoma were categorized into two groups: 38 patients who underwent surgery alone and who underwent preoperative elastography (group 1), and 12 patients who underwent elastography before and after preoperative chemo-radiotherapy (group 2). Results: The mean strain ratios in group 1 were 0.16 ± 0.13 in tumor tissue and 0.82 ± 0.35 in normal tissue. Statistical analysis revealed that the strain ratio of tumor significantly correlated with tumor thickness. In group 2, the mean strain ratio of tumor tissue, scar tissue, and normal tissue were 0.19 ± 0.18, 0.51 ± 0.28, and 0.77 ± 0.58, respectively. The mean strain ratio of scar tissue was 0.51 and had lower elasticity than tumor tissue and higher elasticity than normal tissue. Conclusions: It was useful to characterize the tissue distortion using the strain ratio. Additional studies to establish a cutoff value for tumor tissue might help expand the indications for limited surgery. Correspondence to: Hiroyuki Harada, Professor, Oral and Maxillofacial Surgery, Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan, Tel: +81-3-5803-5508, Fax: +81-3-5803-0199, E-mail: hiro-harada.osur@tmd.ac.jp Received: October 27, 2016; Accepted: November 04, 2016; Published: November 07, 2016 Introduction Preservation of function is important to preserve quality of life for patients undergoing treatment for oral cancer. The tongue is an essential organ for speech, food bolus formation and deglutition. Alternatively, this site is a good candidate for organ preservation techniques with the goal of preserving speech and swallowing function. Fortunately, preoperative chemo-radiotherapy has enabled many patients to avoid surgery and to improve cancer control with few side effects for patients with large unresectable cancers. These combined (chemo-radiotherapy) modality treatments lead to higher cure rates while maintaining the patient’s quality of life [1,2]. Indeed, advances in anticancer agent and radiotherapy have resulted in a potent antitumor effect in many patients. However, some patients treated with this strategy develop induration in the center of their tumor that histologically varies from viable tumor to scar tissue. If a determination could be made as to whether the remaining induration is tumor or scar tissue, it may be possible to establish criteria for limited resection versus no surgery [3-5]. Many diseases cause changes in the mechanical properties of tissues. The tissue flexibility is decreased by pathologic tissue changes, such as inflammation and tumor growth. Indeed cancer growth results in an increase in tissue stiffness, even during the early stages of cancer. Real-time tissue elastography is an ultrasound tomography modality that can objectively display tissue elasticity [6]. Basic principles including calculated method of strain ratio had been well described in the literature accompanied with a new guideline [7]. The strain distributions in tissues in response to external compression are closely related to the distribution of tissue elasticity. These strain images can give a clear illustration of underlying tissue stiffness and provides useful clinical information. Erastography is currently under investigation for diagnosing malignant breast tumor, thyroid tumor and cervical lymph node metastases [8,9]. However, there are no reports of its use in the evaluation of primary oral cancers. This method relies of the phenomenon in which compression of living tissue results in marked distortion of flexible tissues without affecting the shape of stiff tissues. When applying different levels of compression or relaxation, the elasticity imaging algorithm measures the displacement and strain by analyzing the RF (radiofrequency) signal in real time with subsequent conversion to a color-coded image. Using this method, the elasticity and strain ratio of squamous cell carcinoma of the tongue was measured, and the elasticity and strain ratio of the scar portion was quantified in cases in which preoperative therapy was performed [10]. Materials and methods Eligibility criteria The study was conducted between August 2011 and April 2015 in the Department of Oral and Maxillofacial Surgery of the Tokyo Medical and Dental University, Japan. All study protocols were approved by the institutional ethics committee (Approval number 729). All patients Aktar D (2016) Value of real-time tissue elastography for squamous cell carcinoma of the tongue Volume 2(6): 371-375 Dent Oral Craniofac Res, 2016 doi: 10.15761/DOCR.1000181 provided written informed consent before entry into this study. The subjects comprised 50 patients (38 men, 12 women; mean age, 59.1 years; age range, 30-86 years) who were treated for squamous cell carcinoma of tongue. Patients were categorized into two groups. Group 1 included 38 patients. These patients underwent surgery alone and elastography before glossectomy. Patients in group 1 underwent surgery for partial glossectomy (n=14) or for hemi-glossectomy (n=24). Group 2 included 12 patients who underwent elastography before and after preoperative chemo-radiotherapy. Patients in group 2 underwent surgery for hemiglossectomy (n=7) or for subtotal glossectomy (n=5). Preoperative therapies were chemoradiotherapy in 5 patients and chemotherapy in 7 patients. Preoperative chemoradiotherapy consisted of a total dose of S-1 at 65 mg/m2 per day for 5 consecutive days over 4 consecutive weeks with concomitant radiotherapy (40 Gy, provided at a fractional dose of 2 Gy for 5 days/week) in 4 patients. Preoperative chemotherapy consisted of a regimen of CDDP 80 mg/m2 (day 1) and 5-FU 800 mg/ m2 per day (days 1-5) plus a regimen of CDDP 60 mg/m2 and docetaxel 60 mg/m2 (day 1) and 5-FU 600 mg/m2 per day (days 1-5) for each one course plus 40 Gy of radiotherapy in one patient. Preoperative chemotherapy consisted of a regimen of CDDP 80 mg/m2 (day 1) and 5-FU 800 mg/m2 per day (days 1-5) for one course in 2 patient and for 2 courses in 2 patients. Preoperative chemotherapy consisted of a regimen of CDDP 60 mg/m2 and docetaxel 60 mg/m2 (day 1) and 5-FU 600 mg/m2 per day (days 1-5) for one course in one patient and for 2 courses in 2 patients. The median interval between end of preoperative treatment was 22.5 days (range, 13-35 days). T classification (group 1/ group 2) was T1: 6/0, T2: 26/4, T3: 6/8, and the N classification was N0: 30/3, N1: 4/1, N2b: 4/3 and N2c: 0/5. Histological classification of malignancy In group 1, the histological classification of malignancy was evaluated according to the multifactorial system proposed by Anneroth (Table 1) [11]. The histologic malignant score was determined using blocks of tissue that showed the maximum cross-sectional area. The number of mitoses was assessed by evaluating five random fields (magnification x400).

Primary Diffuse Large B-cell Lymphoma Arising in the Tongue Accompanied by Ataxia-telangiectasia: A Case Report.

Ataxia-telangiectasia (AT) is a rare autosomal recessive disorder that is characterized by progressive cerebellar ataxia, telangiectasia, immunodeficiency, and a predisposition to leukemia/lymphoma. Here we report a rare case of lymphoma of the tongue accompanied by AT. Tumour extirpation was performed and diffuse large B-cell lymphoma was diagnosed following pathologic examination. A whole-body survey showed no other enlarged lymph nodes or tumour. The female patient then received a modified dosage of COPAD (cyclophosphamide, vinblastine, pirarubicin, and prednisolone) plus rituximab to avoid severe complications. As of follow-up after 3 years and 5 months, she remains in complete remission. Patients showing AT need careful surveillance and long-term continuous follow-up.