We reported a case of pseudomalignant polypoid mass arising at the mandible, both clinically and histopathologically.
A 65-year-old man visited our hospital because of a mass at the left mandible. Oral examination revealed a polypoid mass at the molar region of the left mandible, which was elastic, soft and covered with normal mucosa. We diagnosed a reactive mass due to the marginal periodontitis of 78, so we planned to extract these teeth and extirpate the mass. A week later, the polypoid mass grew rapidly with an ulcer formation, and a biopsy was performed. The specimen comprised inflammatory granulation tissue with an ulcer, which contained scattered large bizarre spindle or stellate cells with enlarged and hyperchromatic nuclei. Moreover, mitotic figures and nuclear pleomorphism were occasionally observed in the overlaying mucosa. Immunohistochemical examination showed that the large cells expressed vimentin, and were negative for cytokeratins (CAM5.2, AE1/AE3) and p63. These finding suggested a benign inflammatory lesion as well as malignant lesions such as spindle cell carcinoma and sarcoma.
The patient underwent the biopsy again at the deep site near the alveolar bone when simultaneously being taken off the metal prosthesis (5678). The secondary biopsy specimen showed only proliferation of the granulation tissues without the large bizarre cells. The polypoid mass reduced in size and its surface became smooth a week after removing the prosthesis. Finally, we diagnosed that the polypoid mass was inflammatory gingival hyperplasia with pseudomalignant change. It was excised in association with the extraction of the lower left second and third molars. No sign of recurrence was noted three months after the treatment.

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The incidence of oral cancer is increasing yearly and the number of oral cancer and pharynx cancer patients exceeded 10,000 in 2002 according to the statistics of National Cancer Center in Japan, and reached 10959 cases (National Cancer Center, cancer information service and cancer information service). The number of patients increased 4.39-fold that of 1975. Moreover, 6018 cases died in 2005. It is expected that the incidence of cancer will continue to increase in the future and it will reach 1.5-fold in 2023. We could have an educational campaign for earlier detection and could provide better treatment when thinking what we oral surgeons can do in such a situation. The definition of modalities on the basis of clinically meaningful evidence is desirable. Evidence is sometimes lacking because of various population biases, which obliges us to perform treatment based on the rule of thumb. Furthermore, it is not necessarily convincing that evidence-based guidelines of American cancer centers is applicable to Japanese. We have accumulated medical data from 1977 in Osaka University Dental Hospital the 1^st Department of Oral & Maxillofacial Surgery. This review focuses the factors that influence the survival rate of carcinoma of the oral cavity in accordance with the concept of Evidence-Based Medicine (EBM), especially cervical lymph node metastasis, and will be used for clinical practice in the future.

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