Herein we report a rare case of follicular lymphoma in the cheek of an HTLV-1 carrier. The patient was a 59-year-old woman who had been diagnosed as an HTLV-1 carrier and was undergoing follow up in the hematology department when a tumor was discovered in her left cheek. We extracted the tumor upon suspicion of adult T-cell leukemia lymphoma; however, its pathological diagnosis was follicular lymphoma. About five months later, follicular lymphoma was observed throughout the body. She was treated with rituximab, and has shown no signs of recurrence. She is currently receiving regular follow-up.
Pyoderma gangrenosum (PG) is a refractory ulcerative skin disorder of unknown etiology. The lesions are often caused by surgery and minor trauma. It has been reported that more than half of PG patients have inflammatory bowel disease. PG lesions develop in the limbs or head and neck in many cases, but oral mucosa lesions are rarely found. The patient was a 68-year-old woman. She had attended the local hospital for ulcerative colitis and chronic aphthous stomatitis. She had difficulty with food-intake because of fever and aggravative stomatitis, and was hospitalized suddenly. Subsequently, the oral ulcer worsened and perforated the cheek skin, leading to necrosis, therefore she was transferred to our hospital. She was diagnosed with PG due to her clinical course and pathological findings, and was administrated with steroid and other drugs for ulcerative colitis. We conducted interventional pain control, oral care, and nutritional management. Twenty days later, her skin ulcers had reduced in size and the oral ulcers had improved. Finally, skin grafting was performed. There has been no PG recurrence after 3 years.
Choristoma is a tumor-like mass of normal cells in an irregular location. Osseous choristoma occurring in soft tissue in the oral cavity is rare. Herein we report a case of a 51-year-old male patient who was diagnosed with osseous choristoma of the hard palate. A painless mass measuring approximately 21 × 21 × 10 mm and covered by smooth, normal mucosa was observed on the left side of the posterolateral hard palate. Subsequent examination indicated a pedunculated mass with bone-like hardness. CT findings showed a bone-like radiopaque image that was clearly separate from the hard palate. The mass was surgically removed under general anesthesia. Histological examination of the excised specimen revealed that the tumor contained mainly osseous tissue, and no connection to the bone tissue of the hard palate was observed. According to these findings the mass was diagnosed as an osseous choristoma of the hard palate.
Metastatic malignancies transferring to the oral and maxillofacial region from other organs account for about 1% of oral malignancies, and the prognosis is poor. Herein we report a case of lung adenocarcinoma discovered as a first indication of mandibular metastasis, which has been successfully controlled with alectinib, an Anaplastic Lymphoma Kinase (ALK) inhibitor. The patient was a 68-year-old women who visited our hospital complaining of swelling of the left mandibular gingiva and tooth mobility. Contrast-enhanced CT showed an ill-defined bone destruction in the left lower molar region of the mandible, and a biopsy was performed on the suspicion of a malignant tumor on the left mandible. The histopathological diagnosis was adenocarcinoma. An FDG-PET / CT examination showed accumulation of FDG in the S10 region of the right lung, and a medical oncologist clinically diagnosed mandibular metastasis of lung adenocarcinoma. Since immunohistochemical examination revealed positive for the ALK fusion gene and PD-L1 protein, the ALK inhibitor alectinib was administrated. At six months after the start of administration, the lesions of the primary and mandibular metastases disappeared from the image, and as of 3 years and 6 months after the start of administration, alectinib has been continued without major adverse events.