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1/7. Angiosarcoma of the submandibular salivary gland: case report and review of the literature.

    OBJECTIVES: The purpose of this report is to describe an example of angiosarcoma (AS) of the submandibular salivary gland. The clinical and immunohistopathologic features of these lesions are also reviewed. MATERIAL AND methods: A 17-year-old male high school student was admitted to our clinic with a 1-year history of a slow-growing, tender mass in the left submandibular region. physical examination on initial presentation revealed a diffuse soft tissue mass 6 cm in diameter involving the left submandibular region. MRI analysis revealed a mass located superolateral to the submandibular salivary gland, measuring 4.0 x 2.0 cm2. The mass was excised completely together with the left submandibular salivary gland. Histopathologic analysis led to a diagnosis of AS. Immunohistochemical studies were also used to determine endothelial cell differentiation. Owing to the lateralized nature of the lesion, a left functional neck dissection was performed and postoperative radiotherapy was planned. RESULTS: AS is a malignant tumor of endothelial cell origin that may occur in any region of the body. The commonest sites include the extremities and the retroperitoneal space, with only 4% of AS tumors arising in the head and neck area. The submandibular salivary gland is an extremely rare location for this tumor. Based on a literature review, this case report represents only the second reported case of AS of the submandibular salivary gland. CONCLUSIONS: In most cases, radical surgery and postoperative radiotherapy are advocated to treat patients with AS tumors, with lymph node clearance recommended in cases of lateralized lesions In some patients, distant metastasis may occur after many years, which necessitates long-term follow-up. The prognosis is poor in most cases of AS.
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2/7. Pleomorphic adenoma of the submandibular salivary glands with marked ossification.

    This article describes an unusual case of pleomorphic adenoma arising in the submandibular salivary glands that was associated with marked ossification. CT scan showed an irregular high-density mass in the left submandibular region. Histologic examination of the resected mass revealed a well-circumscribed pleomorphic adenoma with chondroid tissue intermingled with glandular and trabecular epithelial components. Irregularly formed osseous tissue was present in the chondroid tissue. The osseous tissue showed bone matrix on von Kossa's staining. alkaline phosphatase expression was restricted to the vicinity of osseous tissue. Tartrate-resistant acid phosphatase-positive osteoclasts were observed at the periphery of the osseous tissue. CD34 staining demonstrated many microvascular vessels in both the chondroid and osseous tissues. We conclude the osseous tissue in pleomorphic adenoma was bone in nature, and via the process of endochondral ossification most likely depended on angiogenesis.
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3/7. Small-cell undifferentiated carcinoma of the submandibular gland: an extremely rare extrapulmonary site.

    The occurrence of small-cell undifferentiated carcinoma (SCUC) has seldom been reported in the submandibular gland. A primary SCUC with immunoreactivity for neuron-specific enolase and chromogranin-A antibodies was reported in the submandibular gland of a 39-year-old man. The patient received primary tumor excision and adjuvant chemotherapy with 6 courses of cisplatin and etoposide. The patient remained free of symptoms for 12 months after treatment. submandibular gland is an extremely rare site of extrapulmonary SCUC. Primary tumor excision and adjuvant chemotherapy with cisplatin and etoposide could be a viable option. The clinicopathologic features, differential diagnoses, and the nature of the disease are discussed.
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4/7. macroglossia secondary to systemic amyloidosis: case report and literature review.

    amyloidosis is characterized by an abnormal extracellular deposition of amyloid in different tissues and organs, where it usually causes some type of dysfunction. Its cause is unknown. The two main forms of amyloidosis are systemic and localized; the latter is rare. No satisfactory treatment for systemic amyloidosis has been discovered, and mean survival is poor, ranging from 5 to 15 months depending on the presence or absence of multiple myeloma. We report a case of primary systemic amyloidosis in a 71-year-old man. The diagnosis of amyloidosis was established by tongue biopsy, and its systemic nature was identified by analysis of aspirated abdominal fat. At the 1-year follow-up, the patient's clinical condition had not changed, and he was thereafter lost to follow-up.
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5/7. Intraoral ultrasonic scanning as a diagnostic aid.

    Since ultrasonographic examination has the advantages of being non-invasive, rapid and easily reproducible, this technique can be a valuable aid in diagnosing oral lesions. However, the relatively large size of commercially available transducers and the acoustic attenuation by the air space within the oral cavity have been deterrents to the intraoral application of this technique. To resolve these problems a small intraoral transducer was developed and employed clinically in the diagnosis of oral soft tissue lesions. Performance tests reveal that this transducer provides 1mm axial resolution and 2 mm lateral resolution with a 30 mm focus. It can be easily employed within the oral cavity, using a small water bag or polymer gel as an acoustic coupling agent to the oral mucosa. Clinical application of this technique to oral soft tissue lesions allows definition of margins, size and location of lesions, and their relationship to adjacent structures, as well as discrimination between cystic, benign or malignant nature, by the sonic character. These results suggest that intraoral ultrasonic scanning can be useful in the diagnosis of oral soft tissue lesions.
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6/7. Metastasis to the choroid complicating adenoid cystic carcinoma.

    Two months after a complete response to doxorubicin hydrochloride and cyclophosphamide administered for systemic effects, with the disappearance of pulmonary and pleural metastases from adenoid cystic carcinoma of salivary origin, a patient experienced symptomatic choroidal metastasis with no other evidence of active disease. Irradiation produced complete disappearance of the choroidal metastasis and restoration of visual acuity. The literature is reviewed, and the unusual nature of this metastasis is discussed.
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7/7. Malignant lymphoepithelial lesion of the submandibular gland.

    A case of malignant lymphoepithelial lesion affecting the submandibular gland of a 48-year-old Japanese man is described. Histologically, a well-encapsulated tumorous mass replacing almost the whole gland was composed of lymphoid and epithelial elements, and the latter revealed severe anaplasia with frequent mitotic figures indicating malignant changes. There is no sign of recurrence up to now, 32 months after the operation. Ultrastructural studies on a formalin-fixed sampling from the gland demonstrated the squamous nature of the epithelial component. This is the first case of malignant lymphoepithelial lesion of the submandibular gland detected in japan.
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