Case report of API2-MALT1 fusion-positive MALT lymphoma arising from bilateral submandibular glands with no evidence of autoimmune syndromes.

Mucosa-associated lymphoid tissue (MALT) lymphoma arising from the salivary glands is usually associated with chronic infection or autoimmune syndromes, such as primary Sjogren syndrome. The occurrence of t(11;18)/API2-MALT1 is rare in salivary MALT lymphoma. Here we describe a case of API2-MALT1 fusion-positive MALT lymphoma of the bilateral submandibular glands with no evidence of autoimmune syndromes. A 70-year-old man complained of a painless swelling in the bilateral submandibular gland. Serology examination results were negative for anti-SSA and anti-SSB. His right submandibular gland was dissected, and he was diagnosed with MALT lymphoma with the API2-MALT1 fusion gene. Positron emission tomography/computed tomography scanning indicated mild fluorine-18-fluorodeoxyglucose uptake in the left submandibular gland and liver. He was treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone. After 6 years, the patient is alive and disease free. In the present case, the patient with API2-MALT1 fusion-positive MALT lymphoma had a good outcome despite the advanced clinical stage.

The prognostic significance of intratumoral heterogeneity of 18F-FDG uptake in patients with oral cavity squamous cell carcinoma.

PURPOSE: This study aimed to evaluate the prognostic significance of two major indices of intratumoral heterogeneity of 18F-fluorodeoxyglucose uptake by positron emission tomography (PET)/computed tomography (CT), namely heterogeneity index (HI) and heterogeneity factor (HF), in patients with oral squamous cell carcinoma. METHODS: We performed a retrospective analysis of 62 patients who underwent resective surgery. HI, HF, maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were obtained from pretreatment PET. HI was obtained by dividing SUVmax by SUVmean for the primary lesion; HF was obtained by taking the derivative (dV/dT) of the volume-threshold function from 30 to 70%. Univariate and multivariate analyses for the overall survival (OS) and disease-free survival (DFS) were performed using PET and clinicopathological parameters. RESULTS: Univariate and multivariate analyses of OS revealed that higher HI levels (threshold for the SUVmean is 30% of the SUVmax) were associated with poorer OS [hazard ratio (HR) = 11.57; 95% confidence interval (CI) = 1.45-92.28; P = 0.021]. Moreover, univariate and multivariate analyses of DFS revealed that higher TLG levels (threshold for the MTV and SUVmean is 4.0 of the SUV) were associated with poorer DFS (HR = 14.48; 95% CI = 1.27-164.78; P = 0.031). CONCLUSIONS: HI and TLG may be statistically significant prognostic factors for OS and DFS, respectively.

Quantitative analysis of chronological changes in the volume of flaps used for reconstruction of oral cavity defects.

Reconstruction of oral defects using flaps following resection of oral cancer has become a standard approach for restoration of oral function. The purpose of this study was to investigate chronological changes in the volume of such flaps used for reconstruction and the factors affecting flap volume. We performed a retrospective analysis of 17 patients who had undergone oral cancer resection and reconstruction with flaps. Measurements were performed using data from computed tomography, and the flaps were selected semi-automatically using a computer-operated region-of-interest system. The data indicated that the change in total flap volume at 1 year after surgery was 30.6%, and that body weight loss was a risk factor for volume reduction. Our results suggested that flaps should be at least 30% larger than the defects they are intended to repair. However, as large flaps have the potential to cause upper airway obstruction, flap volume should be determined on an individual basis according to defect size and location.

Cervical chyloma after neck dissection: a case report.

Cervical chylomas are rare pseudocystic collections that lack an epithelial lining and arise from the thoracic duct or its tributaries; although they typically develop after neck surgery or trauma, they can arise from unknown causes. Treatment options include not only conservative therapy, such as dietary modification, repeated aspirations, and sclerotherapy, but also include surgical excision. We describe a case of a chyloma in a 64-year-old Japanese woman with squamous cell carcinoma of the gingiva. The chyloma developed following left segmental mandibulectomy with radical neck dissection and reconstruction, using a titanium plate and a pectoralis major myocutaneous flap. One month after surgery, a left supraclavicular swelling was noted, so ultrasound-guided fine-needle aspiration and cytology were performed to exclude a recurrence of neck metastasis. The aspiration yielded a milky fluid without atypical or malignant cells on cytology, confirming the diagnosis of chyloma. Although we performed continuous compressive dressing and started the patient on a low-fat diet, the mass persisted. When the patient died of bone, lung, and liver metastases five months after the second surgery, the mass had not changed in size. Awareness of this complication is important to ensure timely diagnosis and appropriate treatment.

A Case of Sialolithiasis in a Minor Salivary Gland of the Buccal Mucosa.

Sialolithiasis is a common disease of the major salivary glands. In contrast, Sialolithiasis of Minor Salivary Glands (SMSG) is very rare. Only 2% of all cases of sialolithiasis develop in minor salivary glands and sublingual glands. Furthermore, the clinical and imaging features of SMSG frequently differ from those encountered in major salivary glands thus, hindering proper clinical diagnosis of SMSG. Histologically, SMSG is characterized by ductal ectasia (sometimes with deep cystic dilatation), acinar atrophy and periductal inflammation. Herein, we describe a patient suffering from SMSG in the left buccal region. Based on the clinicopathological findings of this case and a review of the literature, we propose that this entity should be included in the differential diagnosis of intra-mucosal nodules.