title: Massive myoepithelial carcinoma originating from the submandibular gland that was successfully treated with surgical excision, using a part of the lengthened skin as a local flap.
abstract: Myoepithelial carcinoma is rare and mostly originates from the major salivary glands. Sometimes, it is difficult to differentiate the benign from the malignant histologically, and its clinical behavior and histological features may vary. Here, we describe the case of a 55-year-old woman who presented with a massive myoepithelial carcinoma, which hung like a temple bell from her right side of the jaw, and she refused to go to the hospital for 3 years. Based on its size and location, we initially thought that, before surgical resection, neoadjuvant therapy would be necessary to reduce the tumor volume. However, after careful evaluation of the tumor characteristics (low-grade histology with outward expansion and little invasion of the adjacent tissues) and imaging findings, we decided that excision was possible. The tumor was encapsulated and had a clear border; it weighed 10.5 kg. By setting the incision line posterior to the equatorial plane and using the lengthened skin posterior to the tumor as a large local flap for the skin defect, we successfully reconstructed the skin defect without harvesting additional flap from other areas. No additional treatment was administered because a sufficient surgical margin was maintained, pathologically. She regained her daily life without recurrence or distant metastasis for 2 years. When treating a massive tumor, careful consideration of its characteristics and location is important, and in this case, we were able to use a simpler and less invasive treatment than we initially envisioned.
authors: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Otolaryngology-Head and Neck Surgery, Moriyama Memorial Hospital, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Kawasakinanbu Hospital, Kanagawa, Japan; Department of Ear, Nose, and Throat, Juntendo University School of Medicine, Tokyo, Japan; and Department of Pathology, Juntendo University School of Medicine, Tokyo, Japan.
authors: Ayato
authors: A
authors: Hayashi
authors: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Otolaryngology-Head and Neck Surgery, Moriyama Memorial Hospital, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Kawasakinanbu Hospital, Kanagawa, Japan; Department of Ear, Nose, and Throat, Juntendo University School of Medicine, Tokyo, Japan; and Department of Pathology, Juntendo University School of Medicine, Tokyo, Japan.
authors: Junkichi
authors: J
authors: Yokoyama
authors: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Otolaryngology-Head and Neck Surgery, Moriyama Memorial Hospital, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Kawasakinanbu Hospital, Kanagawa, Japan; Department of Ear, Nose, and Throat, Juntendo University School of Medicine, Tokyo, Japan; and Department of Pathology, Juntendo University School of Medicine, Tokyo, Japan.
authors: Rumiko
authors: R
authors: Sato
authors: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Otolaryngology-Head and Neck Surgery, Moriyama Memorial Hospital, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Kawasakinanbu Hospital, Kanagawa, Japan; Department of Ear, Nose, and Throat, Juntendo University School of Medicine, Tokyo, Japan; and Department of Pathology, Juntendo University School of Medicine, Tokyo, Japan.
authors: Hidekazu
authors: H
authors: Yoshizawa
authors: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Otolaryngology-Head and Neck Surgery, Moriyama Memorial Hospital, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Kawasakinanbu Hospital, Kanagawa, Japan; Department of Ear, Nose, and Throat, Juntendo University School of Medicine, Tokyo, Japan; and Department of Pathology, Juntendo University School of Medicine, Tokyo, Japan.
authors: Rica
authors: R
authors: Tanaka
authors: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Otolaryngology-Head and Neck Surgery, Moriyama Memorial Hospital, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Kawasakinanbu Hospital, Kanagawa, Japan; Department of Ear, Nose, and Throat, Juntendo University School of Medicine, Tokyo, Japan; and Department of Pathology, Juntendo University School of Medicine, Tokyo, Japan.
authors: Yuhei
authors: Y
authors: Natori
authors: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Otolaryngology-Head and Neck Surgery, Moriyama Memorial Hospital, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Kawasakinanbu Hospital, Kanagawa, Japan; Department of Ear, Nose, and Throat, Juntendo University School of Medicine, Tokyo, Japan; and Department of Pathology, Juntendo University School of Medicine, Tokyo, Japan.
authors: Shinichi
authors: S
authors: Ohba
authors: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Otolaryngology-Head and Neck Surgery, Moriyama Memorial Hospital, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Kawasakinanbu Hospital, Kanagawa, Japan; Department of Ear, Nose, and Throat, Juntendo University School of Medicine, Tokyo, Japan; and Department of Pathology, Juntendo University School of Medicine, Tokyo, Japan.
authors: Yuki
authors: Y
authors: Fukumura
authors: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Otolaryngology-Head and Neck Surgery, Moriyama Memorial Hospital, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Kawasakinanbu Hospital, Kanagawa, Japan; Department of Ear, Nose, and Throat, Juntendo University School of Medicine, Tokyo, Japan; and Department of Pathology, Juntendo University School of Medicine, Tokyo, Japan.
authors: Atsushi
authors: A
authors: Arakawa
authors: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Otolaryngology-Head and Neck Surgery, Moriyama Memorial Hospital, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Kawasakinanbu Hospital, Kanagawa, Japan; Department of Ear, Nose, and Throat, Juntendo University School of Medicine, Tokyo, Japan; and Department of Pathology, Juntendo University School of Medicine, Tokyo, Japan.
authors: Hiroshi
authors: H
authors: Mizuno