Publishing type：Research paper (scientific journal)  

61歳女性。左頬部と右頸部からの膿汁、顔面の腫瘤を主訴に近医の外科を受診、悪性腫瘍を指摘され、精査加療目的で著者らの施設へ紹介となった。所見では左頬部皮膚に瘻孔を認め、内部には膿汁が付着する肉芽組織が認められた。また、左耳下部や右鎖骨上窩にも潰瘍を伴う皮膚の硬結がみられた。以上、これらの所見に加え、血液検査および病理組織学的所見より、本症例は第2期の梅毒と診断され、アモキシシリンの内服を開始した。その結果、治療開始2ヵ月で皮膚瘻孔は瘢痕化したため、更に6ヵ月間にわたりアモキシシリンの内服を継続、1年後の血液検査ではSTS法は256倍から64倍へ、FTA-ABS法も1280倍から640倍へ改善した。尚、目下、初診から17ヵ月経過で皮膚瘢痕に変化なく、瘻孔形成は認められていない。

Publishing type：Research paper (scientific journal)  

<p>Syphilis is a sexually transmitted disease caused by <i>Treponema pallidum</i>. Although the incidence of syphilis in Japan has decreased, cases of oropharyngeal syphilis are often reported. We report a case of fistula of the cheek probably due to syphilis. A 61-year-old woman noticed purulent discharge from the submandibular skin 3 months before the first visit. She also noticed purulent discharge from the right side of the neck. She visited a nearby hospital owing to a tumor that developed on her face, and was referred to us for further examination. A fistula was observed on the skin of the left cheek that contained granulation tissue with pus. Cutaneous indurations were observed in the left parotid and right supraclavicular regions. Computed tomography imaging of the neck demonstrated multiple lymph nodes with ring enhancement. The results of serological tests including quantitative serologic tests for syphilis and fluorescent treponemal antibody absorption were both positive. The histopathological features of the granulation tissue obtained from the cheek were compatible with those observed in syphilis, although spirochetes were not detected. The proliferation of blood vessels was prominent, and the growth of endothelial cells caused the obstruction of blood vessels. Infiltration of inflammatory cells including multinucleated giant cells was also observed. After treatment with oral amoxicillin over a period of 6 months, the fistula closed, and serological test results for syphilis improved.</p>

DOI： 10.24805/jjsiao.4.2_128

CiNii Article

Publishing type：Research paper (scientific journal)  

頬部に発生する腫瘍として耳下腺に付属するステノン管および副耳下腺を由来とするものが認められるがともに頻度は少ない。また原発がステノン管なのか副耳下腺なのかはっきりしないことも多い。しかし過去の報告からはステノン管を原発とするものは扁平上皮癌が多く、副耳下腺を原発とするものは粘表皮癌が多く扁平上皮癌は少ない。今回われわれはステノン管が原発と考えられた扁平上皮癌を1例経験したので、若干の文献的考察を加えて報告する。症例は71歳の男性。右頬部腫脹を主訴に受診され、画像所見から副耳下腺扁平上皮癌として手術を施行した。術後の病理所見などを含めて総合的に判断すると、ステノン管が原発の扁平上皮癌と考えられた。(著者抄録)

Publishing type：Research paper (scientific journal)  

頬部に発生する腫瘍として耳下腺に付属するステノン管および副耳下腺を由来とするものが認められるがともに頻度は少ない。また原発がステノン管なのか副耳下腺なのかはっきりしないことも多い。しかし過去の報告からはステノン管を原発とするものは扁平上皮癌が多く、副耳下腺を原発とするものは粘表皮癌が多く扁平上皮癌は少ない。今回われわれはステノン管が原発と考えられた扁平上皮癌を1例経験したので、若干の文献的考察を加えて報告する。症例は71歳の男性。右頬部腫脹を主訴に受診され、画像所見から副耳下腺扁平上皮癌として手術を施行した。術後の病理所見などを含めて総合的に判断すると、ステノン管が原発の扁平上皮癌と考えられた。(著者抄録)

Publishing type：Research paper (scientific journal)  

症例は66歳男で、5年前から気管支喘息といわれ、呼吸困難時はステロイド点滴で対処していたが、点滴で改善しない呼吸困難が出現し、ファイバースコープで気管内腫瘤による気道狭窄を指摘された。CTで気管背側膜様部から内腔に突出する腫瘤を認め、MRIではT1強調像で筋肉より軽度高信号、T2強調像でわずかに高信号、拡散強調像で高信号を呈し、ADC mapで信号はやや低下していた。FDG-PETでは同部位にSUV 4.3の高集積を認めた。悪性腫瘍を疑って生検を行い、病理組織はやや紡錘形の細胞が認められる部位、好酸性細胞が目立つ部位や腺管構造、粘液豊富な間質など多彩な像を認め、気管内多形腺腫と診断した。経気管支鏡的摘出術が施行され、残存腫瘍はなく、断端も陰性で、術後2年経過し再発はない。

Publishing type：Research paper (scientific journal)  

Some of the tumors in the buccal region arise from Stensen's duct or the accessory parotid gland. Both of them, especially Stensen's duct, are rare. However, it is often difficult to distinguish the origin; we think that there is a histopathologic tendency in each origin. According to previous reports, the most frequent types of the tumor arising from Stensen's duct and the accessory parotid gland are squamous cell carcinoma and mucoepidermoid carcinoma, respectively.<br>We report another case of primary squamous cell carcinoma arising from Stensen's duct. A 71-year-old man suffering from swelling in his right cheek was referred to our hospital. We located the tumor arising from the accessory parotid gland and performed local resection penetrating the buccal region from the skin of the cheek to the buccal mucosa and total neck dissection. Following histopathological examination, we generally diagnosed the tumor as primary squamous cell carcinoma originating from Stensen's duct.

DOI： 10.5106/jjshns.24.201

CiNii Article

Publishing type：Research paper (scientific journal)  

顔面鈍的外傷後の縦隔気腫や喉頭浮腫に遭遇する機会は稀であるが、初期診断、初期治療が適切になされなければ致命的状況になりうる。今回われわれは顔面鈍的外傷後に縦隔気腫、喉頭浮腫を発症した症例を経験したので報告する。症例は68歳男性。飲酒後、自転車で走行中に転倒して下顎体右側から頬部を打撲した。徐々に咽喉頭違和感、発声困難が出現し、前医で喉頭蓋、披裂部の浮腫を指摘され大阪市立大学医学部付属病院に搬送となった。来院時、顔面にのみ擦過創を認めた。内視鏡検査で喉頭蓋、披裂部の腫脹を認めた。CTでは眼窩底骨折、眼窩内側壁骨折、眼窩内および副咽頭間隙、縦隔に気腫像を認めた。緊急入院とし気管切開を行い、絶飲食の上、抗生剤投与を行った。喉頭蓋腫脹の消失、CTで縦隔気腫の消失を確認し気管切開カニューレを抜去して第29病日退院となった。本症例では頸部捻転により咽頭粘膜に裂傷が生じ副咽頭間隙・縦隔気腫を形成したと考えられた。また喉頭浮腫は頸部捻転による循環障害、炎症により生じたと考えられた。頭頸部外傷症例では、頸部・胸部症状の有無にかかわらず喉頭浮腫、縦隔気腫をも念頭において適切な対応が必要であると考えられた。(著者抄録)

Publishing type：Research paper (scientific journal)  

気管切開時の輪状軟骨損傷、長期挿管と局所感染による気管内の不良肉芽増生が主な原因と考えられた声門下狭窄症例を経験し、喉頭截開による段階的な喉頭気管形成を行った。声門下狭窄にたいしては、保存的療法がおこなわれることが多いが、手術療法も非常に有効であると考えられた。(著者抄録)

Publishing type：Research paper (scientific journal)  

It is rare that blunt facial trauma causes mediastinal emphysema or laryngeal edema, but delayed diagnosis or management can bring about a fatal outcome. Here we report the case of a 68-year-old male who presented with mediastinal emphysema and laryngeal edema due to blunt facial trauma. Riding a bicycle under the influence of alcohol, the patient fell down and bruised his right mandibular body. Throat discomfort and speech difficulties emerged gradually. Before he was referred to the Osaka City University Hospital, he had presented with epiglottic edema. Abrasion was found only on his face. Flexible endoscopy revealed swellings in the epiglottis and bilateral arytenoids which obstructed the airway. CT imaging showed fractures of orbital floor and orbital wall on the right side, and emphysema in the orbital canal, parapharyngeal space, and mediastinum. He was hospitalized in an emergency due to aggravation of dyspnea, and underwent a tracheostomy under local anesthesia. The patient was administered antibiotics along with a few days of fasting treatment and was discharged on the 29th hospital day after the airway obstruction and emphysema findings disappeared. In this case, emphysema was assumed to have been caused by hyperfine pharyngeal membrane tear, although not clearly revealed by ocular inspection or flexible endoscopy. Laryngeal edema was thought to have occurred by circulatory disturbance of the mucosa or inflammation. For patients with head or neck trauma, appropriate diagnosis and careful management are necessary in cases when laryngeal edema or mediastinal emphysema occur, regardless of the presence or absence of cervical or thoracic symptoms.

DOI： 10.2468/jbes.63.262

CiNii Article

Publishing type：Research paper (scientific journal)  

We clinically examined 9 patients with metastatic cancers to the head and neck from the thoracoabdominal viscera treated in our department during the 15-year period from March 1994 to February 2009. The patients were 6 males and 3 females with a mean age of 67.9 years (range 58-78 years). Primary lesions included those in the lung (4 cases), kidney (2 cases), liver (1 case), stomach (1 case), and colon (1 case) in order of frequency. Sites of metastasis in the head and neck region included 4 cases in the mesopharynx (3 in the palatine tonsil and 1 in the root of the tongue), 3 in the oral cavity, 2 in the nose or paranasal sinus, and 1 in the thyroid gland. One patient had double cancers originating in the palatine tonsil and the oral cavity. The interval between detection of the primary cancer and the metastatic head and neck cancer ranged between within one month and 10 years, and in three cases was more than five years. In one of nine cases (gastric cancer), pathologic findings for the metastatic lesion were helpful in detecting the primary site. All cases exhibited other distant metastases outside the head and neck region, and the bone (5 cases) was the most frequent site followed by the brain (3 cases), adrenal gland (3 cases), and lung (2 cases).<br>Although previous studies found that the most frequent metastatic cancer to the head and neck from the thoracoabdominal viscera was renal cell carcinoma in the nose or paranasal sinus, our review of the literature published between 1983 and 2009 has revealed that metastasis of lung cancer to the pharynx is the most frequent.

DOI： 10.5981/jjhnc.35.416

CiNii Article

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)  

Presentation type：Oral presentation (general)