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Small cell carcinoma in the oral and maxillofacial region is an extremely rare, high-grade malignancy. We report a case of small cell carcinoma in the palatal mucosa. An 80-year-old man was referred to our clinic with swelling in the right maxilla. An 80-mm lymph node was seen in the right neck. The clinical diagnosis was malignant tumor of the palatal mucosa and biopsy was performed. The histopathological diagnosis was small cell carcinoma. Systemic examination diagnosed cervical lymph node metastasis, liver metastasis and multiple bone metastases. Considering the clinical stage and performance status, best supportive care was selected. The patient died of multiple-organ failure 3 months after the first visit.

We report a very rare case of systemic amyloidosis occurring in bilateral mandibular condyles and showing condylar bone destruction and lesions in the buccal mucosa bilaterally. The patient was a 61-year-old man complaining of malocclusion in which the lower teeth extended abnormally over the upper teeth. He first noticed this about 1 year earlier. Medical history included renal cancer, rheumatic myalgia in multiple joints, osteoporosis, hypothyroidism, chronic hepatitis, malignant lymphoma and hemodialysis for renal failure. Panoramic radiography and computed tomography showed bone destruction in bilateral mandibular condyles and a soft tissue mass lesion around the condyle. Slightly raised mass lesions with areas of whitish and purplish coloration were also observed on the buccal mucosa bilaterally. Histopathological examination revealed amyloid deposition in these lesions, and AA and/or Aβ2M amyloidosis was diagnosed. However, we were informed that the patient died within 3 months from when he had a last check-up at our clinic due to systemic problems.

The patient was a 69-year-old woman. She initially consulted our institute with a chief complaint of swelling in bilateral submandibular glands and dry mouth. A localized, movable hard elastic mass was observed in bilateral submandibular and parotid glands. Oral dryness and atrophy of the lingual papilla were observed. The patient had a history of malignant lymphoma (mucosa-associated lymphoid tissue (MALT) lymphoma), for which she had undergone two courses of CHOP therapy (cyclophosphamide, doxorubicin, vincristine, and prednisone) in addition to radiotherapy at 48 years of age. Biopsy of the submandibular gland was performed in our department. The extracted submandibular gland was accompanied by elastic, hard induration. Amyloid deposition accompanying lymphocytic infiltration was histopathologically observed from the submandibular gland.

Objective Swallowing statuses in patients with advanced cancers that require reconstruction have not been studied well. The relationship between topography of the reconstructed upper airway and swallowing status was evaluated. Material and methods Subjects comprised 19 cases of tongue cancer and 10 cases of mandibular cancer who underwent resection of the primary lesion and reconstructive surgery with the vascularized free flap. CT image data preoperatively and postoperatively were utilized to evaluate morphological airway changes. Videofluorographic swallowing study (VFSS) was performed postoperatively. Aspiration and laryngeal penetration were noted and compared with morphological airway changes. Results Regarding postoperative airway morphology, no significant differences in postoperative airway changes were apparent between tongue and mandibular cancers. In postoperative VFSS, aspiration and/or laryngeal penetration was seen in 32% of the tongue cancer cases and 20% of the mandibular cancer cases. Conclusion Cases with aspiration and/or laryngeal penetration revealed less reduction of postoperative cross-sectional area compared to other cases.

Mikulicz's disease is a systemic IgG4-related condition that has recently been referred to as IgG4-related dacryoadenitis and sialoadenitis. We describe relapsed IgG4-related dacryoadenitis and sialoadenitis, so called Mikulicz's disease in a 69-year-old man who was administered with prednisolone (40 mg/day) during March 2007. The dosage was tapered to 0.5 mg/day over a period of 2 years with observation of the patient's clinical course. However, the bilateral submandibular and parotid glands became swollen in July 2009. A whole-body examination revealed no other illnesses or complications. A biopsy of the submandibular gland revealed IgG4-positive plasma cells. Relapsed Mikulicz's disease was diagnosed and the patient was started on prednisolone (40 mg/day) again. At the time of writing, the patient is being maintained on 7 mg/day of prednisolone.

Bare bone graft is a method of mandibular reconstruction involving vascularised iliac bone graft without a skin flap, and secondary epithelialisation of the exposed iliac bone surface in the oral cavity. We herein report two cases of bare bone graft with dental implant for mandibular defect after tumour resection. Case 1: A 36-year-old woman with odontogenic myxoma of the left mandible underwent reconstruction with a free vascularised iliac flap after segmental resection of the mandible. The exposed iliac bone surface in the oral cavity required about 2 months for epithelialisation. Two implants were placed into the reconstructed mandible 12 months after initial surgery, and prosthetic rehabilitation was performed successfully after 6 months of osseointegration period. Case 2: A 32-year-old woman with desmoplastic ameloblastoma of the right mandible underwent reconstruction using free iliac bone after segmental resection of the mandible. As the reconstructed bone failed after surgery, the left mandible was reconstructed using a free vascularised iliac flap. The exposed iliac bone surface in the oral cavity required about 2 months for epithelialisation. Four implants were placed into the reconstructed mandible 17 months after surgery, and prosthetic rehabilitation was performed successfully after 6 months of osseointegration period. In both cases, the mandibular contour and occlusal function were satisfactory.

A 45-year-old Japanese woman presented complaining of swelling of the right mandible. Initial histopathological diagnosis was cemental dysplasia. Because of rapid enlargement of the lesion, surgical resection was performed. The post-surgical second histopathological diagnosis was osteosarcoma. In spite of additional treatment with radiotherapy and chemotherapy, the patient died 32 months after the initial visit. Autopsy revealed osteosarcoma with metastases infiltrating of a number of organs, including the lungs, heart, and vertebrae.

Objective: The objectives of this study were to evaluate the efficacy and limitations of fluoro-2-deoxy- D-glucose—positron emission tomography for metastatic neck disease secondary to oral squamous cell carcinoma. This study specifically examined the limitations of the procedure. Materials and Methods: From April 2004 to October 2007, 35 patients with oral squamous cell carcinoma underwent computed tomography, ultrasound, and fluoro-2-deoxy-D-glucose—positron emission tomography before treatment with neck dissection. After neck dissection, the results of computed tomography/ultrasound and positron emission tomography imaging were correlated with the histopathological findings of the cervical lymph nodes. Results: Positron emission tomography of the cervical lymph nodes was positive for 20 patients, 16 of who were demonstrated to have metastases on histopathological examination. Of the 4 falsepositive results, 3 were reactive lymphadenitis and 1 was sarcoidosis. Positron emission tomography was negative for 15 patients. Two of these patients had false-negative results, as metastatic disease was found at neck dissection. In 1 patient, the metastatic lymph node was largely keratinised, while micrometastasis was evident in the other patient. Pathological findings were compared with imaging results to determine the relative efficacies of positron emission tomography (accuracy, 82.9%; sensitivity, 88.8%; specificity, 76.5%), computed tomography (accuracy, 85.7%; sensitivity, 88.8%; specificity, 82.4%), and ultrasound (accuracy, 88.6%; sensitivity, 88.8%; specificity, 88.2%). There were no significant differences on statistical analysis. Conclusion: Positron emission tomography appears to have significant potential for the detection of lymph node metastasis. However, fluoro-2-deoxy-D-glucose—positron emission tomography should not be used as the sole method of imaging for initial investigation of oral squamous cell carcinoma and cervical lymph node metastasis. The surgical management of neck lymph node metastasis should not be based on fluoro-2-deoxy-D-glucose—positron emission tomography findings alone. Use of other imaging modalities in addition to fluoro-2-deoxy-D-glucose—positron emission tomography should increase the diagnostic accuracy over fluoro-2-deoxy-D-glucose—positron emission tomography alone.

We describe the case of a 36-year-old Argentinean man who developed chronic paracoccidioidomycosis, with oral and cutaneous lesions, 13 years after last living in South America. The patient had lived in Argentina until 1991 before relocating to Japan.

A case of gingival squamous cell carcinoma producing G-CSF is reported.A 78-year-old man presented with a granulated mass in the right upper gingiva. Pathological examination of a biopsy specimen revealed a welldifferentiated squamous cell carcinoma. Laboratory ndings on admission showed marked leukocytosis (12.3×103/μl).We had planned a partial resection of the maxilla under general anesthesia. However, the operation was canceled on the originally scheduled day, because of fever and leukocytosis (13.6×103/μl).After 10 days, tumor resection was performed under general anesthesia, despite fever and leukocytosis (18.3×103/μl). Postoperatively, the patient's white blood cell count soon decreased, and the fever disappeared.Immunohistochemically staining with monoclonal anti-G-CSF antibody was positive. The serum G-CSF concentration reached an abnormally high level preoperatively, which soon decreased to the normal range postoperatively.We diagnosed the disease as gingival squamous cell carcinoma producing G-CSF.

The aim of this study was to determine the relationship between the level of IL-6 in periimplant crevicular fluid (PICF) and peri-implant conditions. Sixty-six implants were categorized into three different groups of peri-implantitis (PI), peri-implant mucositis (MI) and healthy implants (HI) based on the clinical parameters. IL-6 concentrations in PICF were detected by ELISA. The differences among HI (1.74 ± 1.66ng/ml), MI (5.53 ± 1.57ng/ml) and PI (9.36 ± 5.56ng/ml) were statistically significant (p

Invasion and cervical lymph node metastasis are two factors governing the poor prognosis of patients with tongue cancer. Matrix metalloproteinase-9 (MMP-9) has been implicated in invasion and lymph node metastasis of several tumor types. However, the relationship between MMP-9 expression and clinicopathologic characteristics in human tongue cancer has little been reported. This study included 48 patients with tongue cancer, of which 18 cases showed lymph node metastasis. The relationship between MMP-9 expression and the mode of invasion and nodal involvement was immunohistochemically examined. MMP-9 overexpression was identified in 31 cases (64.6 %). Frequent expression of MMP-9 was statistically significant (p

We report a case of oral ulceration during the treatment of type-2 diabetes mellitus with a dipeptidyl peptidase (DPP)-4 inhibitor, sitagliptin. The patient was a 77-year-old woman with oral ulceration of the left lower labial mucosa. The ulcer showed a flat, clean surface with no bleeding. Ulcer margins were slightly raised and showed no induration. Topical steroid proved ineffective and the ulcer was surgically resected, but soon recurred. After cessation of sitagliptin, the lesion epithelialized within 3 weeks. This report is the first report of oral ulceration induced by DPP-4 inhibitor.

Disability and the resulting lowered quality of life are serious issues accompanying increased longevity. Curiously, despite its potential contribution to aging theory, complete statistical and etiological structures of this common and unwelcome aging phenotype before death have not been well identified. Another neglected issue in aging and disability is the principles of phylogenesis and morphogenesis, which contemporary life science invariably starts with. In the present review these two related subjects are addressed, with an introduction of an analysis on patients and published data. Statistically rigorous log–normal and normal distributions distinguish disability for its duration and age-wise distribution, respectively. Multiple pathology and diverse effects of various endogenous diseases on disability are confirmed. The robust long-tailed log–normal distribution for various phases of disability validates the fact that patients in disability undergo series of stochastic subprocesses of many independent endogenous diseases until death. For 60% of patients, the log–normal distribution is mimicked by a random walk model. Diseases of core organs are major causes of the long tails. A declining force of natural selection after reproduction and trade-off of life history through pleiotropy of the genes are considered to be the roots of aging. The attenuated selection pressure and the resulting decrease of genetic constraints produce an increased opportunity for chance and stochastics. Elucidated stochastic behaviors of disability underscore the key role of chance in aging. Evolutionary modifications in the development of the structure tend to favor developmentally later stages first. Distal parts are developmentally last, therefore most subject to modification. The rate of molecular evolution of the genes is also found to be relatively slow at the core and rapid at the edge of cells and organs. Therefore, systems at the core must be relatively slow and inactive to comply with pleiotropy and trade-offs in comparison with systems at the edge. Hence, against flat and probabilistic aging, the core organs must be moulded to be more robust with a lower threshold for dysfunction, to age relatively slowly, and should have less of a disease quota in aging. The principle of core protective aging assures possibilities not only to reduce disability but also to accomplish the Third Age as well. Finally, it must also be acknowledged that the principle is a double-edged sword. Paradoxically, the developed biological and societal organization provides protection for the injured core, and so develops long tails of disability. The principle of core protective aging re-emphasizes the key role of prevention in order to reduce the amount of disability.

We investigated the clinical and histopathologic features of 26 cases of mucocele of the glands of Blandin-Nuhn. There was a female predominance, and most patients were younger than 20 years. Fifteen patients first visited a medical doctor and 9 visited a dentist before being referred to our department. The average duration from the time the lesion was first noticed to the patient's visit was 3.6 months. All lesions were located on the ventral surface of the tongue. In 17 patients, mucoceles were seen at the tip of the tongue, whereas 9 lesions occurred more posteriorly. Lesions were situated at the midline in 19 patients and laterally in 7 patients. All lesions presented as an exophytic mass, often with a polypoid appearance. All mucoceles were histopathologically of the extravasation type, suggesting that trauma may represent a frequent initiating factor.

Eight tumors metastasizing to the oral cavity were clinically investigated. The frequency of metastatic oral tumors was 2.6% among all oral malignant tumors (307 cases) treated at our department from 1977 to 1998. Of the 8 patients, 2 were male and 6 were female. At presentation 3 patients had a medical history of treatment for cancer arising in other organs. Four patients had metastasis to the mandible, 3 had gingival metastasis, and 1 had metastasis to the tip of the tongue. Common symptoms of bone metastasis were swelling of the gingiva and alveolar mucosa and pain of the mandible. Gingival and lingual metastasis was associated with a nodular formation resembling epulis. Panoramic radiographs showed infiltrative bony destruction with ill-defined margins or a moth-eaten appearance in 4 cases of mandibular metastasis, and irregular destruction of the alveolar process was observed in 3 cases of gingival metastasis. Three cases were clinically diagnosed as oral cancer, 3 as metastatic tumor, 1 as epulis, and 1 as mandibular osteomyelitis or trigeminal neuralgia. The pathological diagnosis of biopsy specimens or removed tissues was adenocarcinoma in 3 cases, renal cell carcinoma in 1, hepatocellular carcinoma in 1, acinic cell carcinoma in 1, adeno-squamous cell carcinoma in 1, and adenocarcinoma or small cell carcinoma in 1. On the basis of pathological findings and systemic examinations, the primary site was the stomach in 3 cases, the lung in 2, the kidney in 2, and the liver in 1. Surgical removal was performed in 3 cases with gingival or lingual nodular formation, radiotherapy in 3 with mandibular metastasis, and chemotherapy in 1 with mandibular metastasis. One case was not treated after biopsy because the patient and his family refused. The outcome of the patients was very poor, with a mean survival time of 6 months. When treating metastatic oral tumors, the patient's quality of the life must be adequately considered.

A case of calcifying odontogenic cyst associated with complex and compound odontoma which appeared in the maxilla of a 15-year-o1d Japanese girl was reported with immunohistological examination. Radiologically, the lesion showed a cystic radiolucent area with odontoma-like radiopaque masses. Histopathological examination revealed the presence of ghost cells, calcified tissues and structures of complex and compound odontoma. Immunohistochemically, MIB-1 positive ratio was very low, but significant expression of Bcl-2 was observed in the neoplastic odontogenic epithelium. These results suggest that inhibition of apoptotic cell loss is more important than cell proliferation activity to the growth of the lesion in our case.

A case of epignathus combined with cleft palate, lobulated tongue, and lingual hamartoma is reported. A newborn female presented with a large skin-covered mass arising from the palate, cleft palate, and lobulated tongue with a soybean-sized lingual lesion. The palatal and lingual masses were removed on the 9th day after birth. A cystic lesion was also found on the nasal septum after removal of the palatal mass; this lesion was resected at its base. Glossoplasty was performed after excision of the lingual lesion. Histologically, the palatal mass was diagnosed as epignathus. The cystic lesion was suspected to be meningothelial tissues on the basis of hematoxylin-eosin (HE) and immunohistochemical staining: Vimentin and epithelial membrane antigen were positive, and factor VIII was negative. The mass of the tongue dorsum was diagnosed as hamartoma. No recurrence of epignathus or evidence of meningocele have been observed after 5 years of follow up.