Head and Neck Optical Diagnostics Society最新文献

The present study summarizes our experience in treating a patient with a suspected granulocyte colony-stimulating factor (G-CSF)-producing squamous cell carcinoma (SCC) of the lower gingiva, which is a rather rare entity. A 56-year-old woman underwent surgical excision of palate leukoplakia in 1996. In 2009, however, a leukoplakic superficial tumor was detected in the lower left gingiva, for which the patient underwent gingivectomy. This was subsequently diagnosed as SCC. The patient also underwent superselective arterial injection chemotherapy combined with radiotherapy, after local recurrence was observed. The patient was subsequently found to have bone metastasis. After chemotherapy combined with radiotherapy, the patient underwent segmental resection of the lower left jaw, left supraomohyoid neck dissection, and lower jaw reconstruction using titanium plates. Resection of the left femoral tumor and left total knee replacement were also performed. Computed tomography scan performed 1 month after the surgeries revealed multiple lung, liver, spine, and subcutaneous metastases. The patient also exhibited a sudden increase in her white blood cell (WBC) count and a fever that could not be alleviated, despite treatment with antibacterial drugs. A G-CSF-producing tumor was therefore suspected. Serum G-CSF level was high at 250 pg/ml. The patient's WBC count increased to 32 × 10(3)/ml and her general condition suddenly deteriorated, and she died as a result of multiple organ failure. A final diagnosis of G-CSF-producing SCC of the lower gingiva was made based on the patient's clinical course.

Background: The management of cervical lymph node metastases from an unknown primary tumor remains a controversial subject. Recently, Positron Emission Tomography (PET) has proved useful in the detection of these tumors, even after an unsuccessful conventional diagnostic workup. This study was performed to assess the role of PET in the detection of occult primary head and neck carcinomas.

Methods: A retrospective analysis of a four year period at a tertiary referral oncology hospital was conducted.

Results: Of the 49 patients with cervical metastases of carcinoma from an unknown primary, PET detected a primary in 9 patients and gave 5 false positive and 4 false negative results. Detection rate, sensitivity, specificity and accuracy were of 18.4%, 69.2%, 86.1% and 81.6%, respectively. PET was also of substantial benefit in detecting distant metastatic disease and, thus, altered therapeutic strategies in a significant amount of patients.

Conclusions: Therefore, PET is a valuable tool in the management of patients with occult primary head and neck carcinoma, not only because it provides additional information as to the location of primary tumors, but also due to the fact that it can detect unexpected distant metastases.

Introduction: Burkitt's lymphoma is a highly aggressive lymphoma. The endemic form is present with Epstein - Barr virus. The most common sites are the mandible, facial bones, kidneys, gastrointestinal tract, ovaries, breast and extra-nodal sites. We present the first reported case of a primary Burkitt's lymphoma of the postnasal space occurring in an elderly Caucasian male.

Case presentation: A 72-year-old Caucasian male farmer presented with a 6-week history of a productive cough and a painless left sided cervical swelling. Examination of the neck revealed a 5 cm by 5 cm hard mass in the left anterior triangle. A CT scan of the head and neck showed a soft tissue swelling in the postnasal space. Histology of the postnasal space mass showed squamous mucosa infiltrated by a high grade lymphoma. Immunohistochemical staining and in situ hybridisation confirmed the tumour to be Epstein - Barr virus Ribonucleic acid negative suggesting this was a rare sporadic form of the tumour presenting in a location that is atypical for the clinical subtype and age of the patient.

Conclusion: This is the first reported case of sporadic Burkitt's lymphoma of the postnasal space of an elderly Caucasian male in the absence of Epstein - Barr virus or human immunodeficiency virus infection and further serves to illustrate the diversity of histological subtypes of malignancies that may develop at this concealed site.

Background: The 'Worse-Stable-Better' (W-S-B) question was introduced to capture patient-perceived change in University of Washington Quality of Life (UW-QOL) domains.

Methods: 202 head and neck cancer patients in remission prospectively completed UW-QOL and Patients Concerns Inventory (PCI). For each UW-QOL domain, patients indicated whether over the last month things had worsened (W), remained stable (S) or were better (B).

Results: 202 patients at 448 attendances selected 1752 PCI items they wanted to discuss in consultation, and 58% (1024/1752) of these were not covered by the UW-QOL. UW-QOL algorithms highlighted another 440 significant problems that the patient did not want to discuss (i.e. the corresponding items on the PCI were not selected).After making allowance for UW-QOL algorithms to identify 'significant problems' and PCI selection of corresponding issues for discussion there remained clear residual and notable variation in W-S-B responses, in particular to identify patients with significant problems that were getting worse, and patients without significant problems that wanted to discuss issues that were getting worse. Changes in mean UW-QOL scores were notably lower for those getting worse on the W-S-B question, typically by 10 or more units a magnitude that suggests clinically important changes in score.

Conclusions: The W-S-B question adds little questionnaire burden and could help to better identify patients who might benefit from intervention. The results of this study suggest that the UW-QOL with the W-S-B modification should be used together with the PCI to allow optimal identification of issues for patient-clinician discussion during routine outpatient clinics.

Background: Oral cancer accounts for roughly 3% of cancer cases in the world with about 350,000 newly reported cases annually and a 5-year survival rate of only 50%. Majority of oral cancers are squamous cell carcinomas that originate in the oral mucosal epithelial linings. We have previously shown that in human malignant squamous cells carcinoma (SCC-25) as well as in dysplastic oral keratinocytes (DOK), a small leucine-rich multifunctional proteoglycan decorin is aberrantly expressed and localized in the nucleus where it interacts with nuclear epidermal growth factor receptor (EGFR). Post-transcriptional silencing of nuclear decorin significantly reduced IL-8 and IL8-dependent migration and invasion in these dysplastic and malignant oral epithelia. The objective of this study was to further examine the effects of nuclear decorin silencing on angiogenesis and angiogenesis related mediators in this oral cancer progression cell line model.

Methods: We have used multiplex PCR, western blotting, and in vitro endothelial tube formation assay to study angiogenesis and related pathways in nuclear decorin silenced (stable knockdown) DOK and SCC-25 cells.

Results: Nuclear decorin knockdown resulted in significant down regulation of IL-8 expression, however IL-10, and TGF-β expression was not affected in either DOK or SCC25 cells as measured by multiplex RT PCR. IL-8 receptor CXCR 1 and 2 expression was slightly lower in nuclear decorin silenced cells indicating a contributing mechanism in previously shown reduced IL-8 mediated migration and invasion phenotype in these cells. IL-8 is known to induce Matrix metalloproteinase 9 (MMP9) which not only plays a role in tumour migration and invasion but also induces angiogenic switch. We found MMP9 to be significantly reduced in nuclear decorin silenced dysplastic and malignant oral epithelia. Other potent angiogenic mediators, VEGF189 and ANG-1 were either significantly reduced or completely abrogated in these cells. Angiogenesis as measured by endothelial tube-like formations of HUVEC cells was reduced by almost 50 percent when HUVECs were incubated in the presence of conditioned medium form nuclear decorin silenced dysplastic and malignant cell lines as compared to respective controls.

Conclusions: Together these results indicate that aberrantly expressed nuclear localized decorin strongly influences angiogenic potential of dysplastic and malignant oral epithelial cells.

Background: Optical coherence tomography (OCT) is a non-invasive optical technology using near-infrared light to produce cross-sectional tissue images with lateral resolution.

Objectives: The overall aims of this study was to generate a bank of normative and pathological OCT data of the oral tissues to allow identification of cellular structures of normal and pathological processes with the aim to create a diagnostic algorithm which can be used in the early detection of oral disorders.

Material and methods: Seventy-three patients with 78 suspicious oral lesions were referred for further management to the UCLH Head and Neck Centre, London. The entire cohort had their lesions surgically biopsied (incisional or excisional). The immediate ex vivo phase involved scanning the specimens using optical coherence tomography. The specimens were then processed by a histopathologist. Five tissue structures were evaluated as part of this study, including: keratin cell layer, epithelial layer, basement membrane, lamina propria and other microanatomical structures. Two independent assessors (clinician and pathologist trained to use OCT) assessed the OCT images and were asked to comment on the cellular structures and changes involving the five tissue structures in non-blind fashion.

Results: Correct identification of the keratin cell layer and its structural changes was achieved in 87% of the cohort; for the epithelial layer it reached 93.5%, and 94% for the basement membrane. Microanatomical structures identification was 64% for blood vessels, 58% for salivary gland ducts and 89% for rete pegs. The agreement was "good" between the clinician and the pathologist. OCT was able to differential normal from pathological tissue and pathological tissue of different entities in this immediate ex vivo study. Unfortunately, OCT provided inadequate cellular and subcellular information to enable the grading of oral premalignant disorders.

Conclusion: This study enabled the creation of OCT bank of normal and pathological oral tissues. The pathological changes identified using OCT enabled differentiation between normal and pathological tissues, and identification of different tissue pathologies. Further studies are required to assess the accuracy of OCT in identification of various pathological processes involving the oral tissues.

We briefly highlight the growing body of recent evidence linking unprotected oral sex with the development of some types of head and neck cancer in younger patients. These tumours appear to be increasing in incidence although the development of more sensitive methods of HPV detection may be a confounding factor.

Background: Squamous cell carcinoma mainly afflicts patients older than 40 years of age however, few cases are seen in younger patients. The aim of this study therefore was to determine the incidence of squamous cell carcinoma of the oral cavity and oropharynx in patients less than 40 years of age with a view to assessing the prognosis over a period of time.

Methods: This was a 20 years retrospective review of patients who were histologically diagnosed with squamous cell carcinoma of the oral cavity and the oropharynx at the Department of Cranio-Maxillo-Facial Surgery of the Hannover Medical School, Germany and had not received treatment anywhere else. Records of these patients were analysed for age and sex distribution, tumour staging and differentiation, location, treatment given, recurrences and metastasis, time between diagnosis and death or last contact with patient, and possible cause of death. Comparisons were also made with patients older than 40 years of age.

Results and discussion: A total of 977 patients treated for squamous cell carcinoma of the oral cavity and the oropharynx in the 20-year period of this study were included. Thirty eight (3.9 %) of the overall patient population were under 40 years of age. Among these, 30 (78.9%) were males and 8 (21.1%) were females. The incidence was highest in the 30-39 year age group accounting for 31 (81.6%) of the 38 patients. The moderately differentiated carcinoma was commonest (24; 63.2%). The floor of the mouth had the highest number of tumours (15; 39.5%), but none was seen in the oropharynx. Surgery alone was the main stay of treatment given to 26 (68.4%) patients. At the end of the study period, 13 (34.2%) patients had died of the tumour and the 5-year survival rate was 66.2%. In the older patient group (>40 years), 42.7% died from the tumour and the 5-year survival rate was 57.6%.

Conclusion: The results from the present study showed that young adults may have a better prognosis especially in terms of long term overall survival from oral and oropharyngeal carcinoma.

The thyroid gland is a known but an unusual site for metastatic tumors from various primary sites. Despite the fact that it is one of the largest vascular organs in the body, clinical and surgical cases have given an incidence of 3% of secondary malignances of the organ. Nevertheless, thyroid metastases are not an exceptional finding at autopsy, they are encountered in 2% to 24% of the patients with malignant neoplasm.Soft tissue sarcomas metastatic to the thyroid are extremely rare as the majority of thyroid metastasis are caused by tumors of the kidneys, lungs, mammary glands, ovaries , and colon or by melanomas.We report a case of 22-years-old woman with right leg rhabdomyosarcoma metastatic to the thyroid gland.

Objectives: Neurilemmomas are benign tumors deriving from Schwann cells of the nerve sheath. They occur in all parts of the body. The highest incidence of neurilemmoma is in the head and neck region (38-45%), but involvement of the nose and paranasal sinus is quite rare, with only sporadic cases having been reported in the world literature. Fewer than 4% of these tumors involve the nasal cavity and paranasal sinuses. We describe the clinical, pathologic, and computed tomography (CT) features of five nasal neurilemmomas.

Methodology: CT features of five patients with nasal schwannoma proved by operation and pathology were investigated.

Results: Schwannomas tend to be solitary and are usually well-circumscribed tumors with an oval, round or fusiform shape in the unilateral nasal cavity. The lesions usually have a mottled central lucency with peripheral intensification on contrast-enhanced CT scans. The heterogeneous appearance is related to areas of increased vascularity with adjacent non-enhancing cystic or necrotic regions.

Conclusions: Schwannoma should be considered in the differential of unusual nasal masses. Certain clinical and CT patterns may be of use in the differential diagnosis.