Postoperative Conversion Disorder in Elderly Oral Cancer Patient.

Conversion disorder is a condition in which psychological stress in response to difficult situations manifests as physical symptoms. Here, we report a case of postoperative coma due to conversion disorder in an elderly oral cancer patient. An 82-year-old woman was referred to Tokyo Dental College Chiba Hospital with a mass lesion on the tongue. A biopsy revealed a well-differentiated squamous cell carcinoma. Surgical treatment was performed for the tongue carcinoma and tracheotomy for management of the airway. On postoperative day 5, the patient exhibited loss of consciousness (Glasgow Coma Scale: E1, VT, M1; Japan Coma Scale: III-300). The patient's vital signs were all normal, as were the results of a full blood count, brain-CT, MRI, and MRA. Only the arm dropping test was positive. Therefore, the cause of the coma was diagnosed as conversion disorder. Seven hours later, the patient showed a complete recovery.

Carcinoma of Maxillary Gingiva with Non-specific Cervical Lymph Node Swelling.

Swelling of the cervical lymph nodes may indicate lymphadenitis, malignant lymphoma, or metastasis. Lymph nodes larger than 10 mm on computed tomography (CT) are strongly indicative of postoperative metastasis from carcinoma. Here, we report a case of large, inflamed lymph nodes mimicking metastasis. The patient was a 76-year-old woman who experienced discomfort in the left-side maxillary gingiva commencing in August 2011. By September, the area had become painful, causing her to visit the Tokyo Dental College Chiba Hospital, at which time a 75×50-mm swollen ulcer was observed in the maxillary gingiva on the left side. A CT image revealed a neoplastic lesion between the alveolar bone on the left side of the maxilla and the base of the maxillary sinus, together with evidence of osteoclastic activity. The bilateral cervical lymph nodes were Level II and had a uniform interior of approximately 5 mm. The lesion was subsequently excised under general anesthesia. At 34 days postoperatively, CT imaging revealed bilateral 40-mm internal heterogeneous lymphadenopathy at Level II. No inflammation of the maxillary gingiva was observed, however, and blood tests revealed no inflammatory findings. Bilateral cervical lymph node metastasis was diagnosed based on CT and oral cavity observation. Radical neck dissection of left cervical region was performed under general anesthesia. Histopathological examination of the lymph nodes revealed no metastasis at Levels I-V, however. The reason for this increase in lymph node size is discussed.

Osseous choristoma in child with strong vomiting reflex.

Osseous lesions within soft tissue such as the tongue are extremely rare. Here, we report an osseous choristoma on the posterior portion of the tongue in a patient with a strong vomiting reflex. The patient was an 11-year-old boy who presented with the chief complaint of swelling on the posterior portion of the tongue. A pedunculated tumor 8-mm in diameter with distinct borders was observed slightly to the right of the midline of the dorsum of the tongue and slightly anterior to the circumvallate papillae. The clinical diagnosis was a right lingual circumvallate papilla fibroma. A further examination conducted under general anesthesia in July 2012 confirmed a pedunculated and solid mass in the area of the circumvallate papillae. As these results suggested a benign tumor, the mass was resected. Histopathological findings on harvested bone and fibrous connective tissue covered with a layer of squamous cells led to a diagnosis of osteoma. At 18 months postoperatively, there were no signs of recurrence.