[A Clinical Study of a Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma of Salivary Glands].

Malignant lymphoma involving the salivary glands is a rare entity that accounts for only 1 to 4% of all salivary gland tumors. We have analyzed the clinical features of MALT lymphoma of the salivary glands in 7 patients whom we have treated in the past 10 years, including data from 43 patients in the literature. The most common symptom was persistent or progressive swelling of the salivary glands without pain or facial palsy. The affected glands were the unilateral parotid in 62%, the unilateral submandibular gland in 6.8%, and the bilateral parotid or submandibular gland in 6.8%. The salivary gland swelling as evaluated by MRI or ultrasonography consisted of a localized solitary tumor in 68.9%, multiple tumors in 10.3%, and diffuse swelling of the gland in 26.1%. In 24 out of 50 patients, MALT lymphoma developed on the basis of Sjögren's syndrome. As for diagnosis, malignant lymphoma was suspected only in 4 cases out of 11 (36.7%) based on the fine needle aspiration cytology. In all patients, a definitive diagnosis was obtained based on histopathological study of the localized tumor or the biopsy specimens. When patients with Sjögren's syndrome have developed persistent swelling of the salivary glands, it is necessary to rule out malignant lymphomas, especially MALT lymphoma, by combination of ultrasonography, MRI, FNA, and biopsy or open surgery depending on image findings. The treatment of MALT lymphoma has not yet been standardized because MALT lymphoma is a rare entity. The choice of initial treatment is important because it is related to its prognosis. If MALT lymphoma remains in a local site, we should undertake an operation or radiotherapy. If MALT lymphoma has dissemineated systemically, we should choose chemotherapy.

[A Clinical Study of the Sclerotherapy for Large Venous Malformations of the Pharyngolarynx with Airway Stenosis].

We treated four cases of airway stenosis associated with large venous malformations of the pharyngolarynx. The patients ranged in age from 33 to 53 years, and consisted of one male and three females. The venous malformation was located in the posterior wall of the oropharynx in two cases, in the hypopharynx in. one case, and in the anterior wall of the oropharynx in one case. All the patients complained of shortness of breath upon adopting the supine position. The patients were tracheotomized under general anesthesia and treated by sclerotherapy under videolaryngoscopic guidance. We used absolute ethanol, polidocanol or monoethanolamine oleate, as appropriate, depending on the case. In regard to the efficacy of the sclerotherapy, the venous malformation disappeared in one case and reduced in size in the remaining three cases, and no severe adverse events were recognized in any of the cases. All the patients were discharged from the hospital within two weeks and did not need tracheostomy. Sclerotherapy umder videolaryngoscopic guidance is effective for the treatment of large venous malformations in the pharyngolarynx.

[The efficacy of superselective intra-arterial chemo-radiotherapy for cervical neck lymph node metastases].

We report herein on 32 cases of head and neck carcinoma with cervical lymph node metastases treated by radiotherapy and concomitant intraarterial cisplatin (RADPLAT) from April 2009 to May 2013. N3 cases revealed residual disease of the cervical lymph nodes in 7/9 cases. Among the 22 patients excluding N1 and N3 cases, the pathological CR rate was 63.6%. Among the 13 patients in whom the anticancer drug was directly infused into the cervical lymph nodes, the pathological CR rate was 76.9%, whereas in the 9 patients without direct infusion of the cervical lymph nodes, the pathological CR rate was 44.4%. Therefore, we recommend the direct infusion into cervical lymph node metastases for not only N3 cases but also N2 cases if a feeding artery is identified easily. When clinical examination after RADPLAT leads to suspected residual disease, neck dissection should be adapted. If the clinical examination leads to a diagnosis of CR, we recommend a biopsy of the original cervical lymph nodes because the cases which we diagnosed as CR revealed residual disease of the cervical lymph nodes in 4/16.

[Four cases of extracranial trigeminal benign neurogenic tumors].

Extracranial trigeminal schwannomas are rare tumors accounting for about 10% of all trigeminal schwannomas. We report herein on four cases of extracranial trigeminal benign neurogenic tumors. The patients were aged between 39 and 75 years; they consisted of one male and three females. The origins of the schwannomas consisted of the maxillary nerve in two cases and the mandibular nerve in two cases. All cases were surgically treated using a transmaxillary approach in three cases, and a combination of the transcervical-parotid approach with a midline mandibulotomy in one case. In two cases, the schwannomas located in the pterygopalatine fossa were removed using a transmaxillary approach with the endoscope and the surgical microscope. Two patients underwent selective intravascular embolization of the feeding artery to reduce intraoperative bleeding, and they were less invasively treated via the transmaxillary approach.

[A clinical study on 8 cases of sarcoidosis with a cervical mass as a symptom].

Sarcoidosis is a multiorgan granulomatous disease of unknown origin, which frequently involves the lung and the eyes. It is rare that sarcoidosis causes cervical lymphadenopathy and a chronic continuous salivary gland swelling. In the present study, we examined how to diagnose sarcoidosis in patients complaining of a cervical mass and its clinical presentation according to 8 cases which we experienced. We undertook biopsy of the cervical lymph nodes in 7 cases, and biopsy of the parotid gland in 1 case. In cases non-caseating epithelioid cell granuloma was proved, diagnosed as sarcoidosis histopathlogically. In 6 patients, the sarcoidal lesion was in other organs, whereas in 2 patients the sarcoidal lesion was confined in the head and neck. Bilateral hilar lymphadenopathy and an elevated level of angiotensin-converting enzyme which are typical in sarcoidosis were confirmed in only one of our patients. Therefore, the diagnostic value of these tests is low for the diagnosis of sarcoidosis in the patients whose chief complaint is a cervical mass. Because 4 out of 7 cases were positive for the tuberculin test, it is imperative to distinguish between sarcoidosis and cervical tuberculous lymphadenitis by combining the culture of acid-bacilli and TB-PCR with histopathological evaluation of the biopsy specimen. We experienced one patient in whom the sarcoidal lesion developed in the skin and the eyes 20 years after the onset of cervical lymphadenopathy. It is important to follow the patients carefully, even if we diagnose the disease as sarcoidosis confined in the head and neck.

[A clinical study on 10 cases of cervical tuberculous lymphadenitis].

Cervical tuberculous lymphadenitis is sometimes difficult to differentiate from sarcoidosis. We treated 10 patients with cervical tuberculous lymphadenitis from April 2002 to December 2011. Their ages ranged from 42 to 78 years old (mean 63.2 years), and the male-to-female ratio was 4: 6. All patients presented to our hospital with the chief complaint of a cervical mass. All patients underwent open biopsy of the cervical lymph nodes, and 8 patients were diagnosed histopathologically as having cervical tuberculous lymphadenitis. In the remaining 2 patients, caseous necrosis could not be recognized histopathologically and they were diagnosed as having sarcoidosis. However 8 weeks later, the culture of the acid-fast bacilli turned positive, and the diagnosis was corrected to cervical tuberculous lymphadenitis. In our cases, the culture of acid-fast bacilli was positive in 6 out of 9 cases (66.7%), and TB-PCR was positive in 4 out of 9 cases (44.4%). These results show that sensitivity of individual tests is rather low. For the diagnosis of cervical tuberculous lymphadenitis, it is important to suspect this disease from the findings of the sedimentation rate, tuberculin test, and ultrasonography with fine needle aspiration cytology. On performing an open biopsy of the cervical lymph nodes in the suspected patients, it is essential to combine histopathological study, TB-PCR and the culture of the acid-fast bacilli simultaneously.

[Two cases of spontaneous cerebrospinal fluid (CSF) otorrhea with meningitis].

We report on two cases of spontaneous CSF otorrhea, which were considered to have been caused by enlarged arachnoid granulation with bone erosion of the posterior fossa. Both cases visited us complaining of severe headache, due to bacterial meningitis. In the first patient, a 68-year-old male, a high resolution CT scan showed a bony defect in the posterior fossa plate in the right temporal bone, where CSF leakage was confirmed during the operation. In the second patient, a 54-year-old female, a bony defect was located in the posterior fossa in the left temporal bone. In both cases, the bony defects were repaired by occlusion with the pedicled temporal muscles after the meningitis had been treated. CSF otorrhea disappeared after the surgery, and has not recurred during the postoperative observation period of 1 to 3 years.