Prognostic quality of the Union Internationale Contre le Cancer/American Joint Committee on Cancer TNM classification, 7th edition, for cancer of the maxillary sinus.

BACKGROUND: Carcinomas of the maxillary sinus are classified according to the Union Internationale Contre le Cancer (UICC)/American Joint Committee on Cancer (AJCC) TNM classification. The purpose of this study was to assess the prognostic significance of the UICC/AJCC TNM classification seventh edition, which was introduced in 2010. METHODS: One hundred thirteen patients with malignant tumors of the maxillary sinus were included in this study. The prognostic impact of the TNM classification and the UICC/AJCC seventh edition's stage grouping were analyzed in univariate and multivariate analysis. RESULTS: The UICC/AJCC stage grouping, the T classification, and the N classification had a significant impact on overall survival (OS) in univariate analysis (p < .05). No significant differences were observed between the groups T4a and T4b (p = .109). In multivariate analysis, the UICC/AJCC stage grouping (p = .031), the N classification (p = .014), and age (p < .001) had a significant impact on OS. CONCLUSION: Although UICC/AJCC stage grouping and the N classification provided a significant prediction of OS in univariate and multivariate analysis, T classification only influenced OS in univariate analysis.

Integration of HPV6 and downregulation of AKR1C3 expression mark malignant transformation in a patient with juvenile-onset laryngeal papillomatosis.

Juvenile-onset recurrent respiratory papillomatosis (RRP) is associated with low risk human papillomavirus (HPV) types 6 and 11. Malignant transformation has been reported solely for HPV11-associated RRP in 2-4% of all RRP-cases, but not for HPV6. The molecular mechanisms in the carcinogenesis of low risk HPV-associated cancers are to date unknown. We report of a female patient, who presented with a laryngeal carcinoma at the age of 24 years. She had a history of juvenile-onset RRP with an onset at the age of three and subsequently several hundred surgical interventions due to multiple recurrences of RRP. Polymerase chain reaction (PCR) or bead-based hybridization followed by direct sequencing identified HPV6 in tissue sections of previous papilloma and the carcinoma. P16(INK4A), p53 and pRb immunostainings were negative in all lesions. HPV6 specific fluorescence in situ hybridization (FISH) revealed nuclear staining suggesting episomal virus in the papilloma and a single integration site in the carcinoma. Integration-specific amplification of papillomavirus oncogene transcripts PCR (APOT-PCR) showed integration in the aldo-keto reductase 1C3 gene (AKR1C3) on chromosome 10p15.1. ArrayCGH detected loss of the other gene copy as part of a deletion at 10p14-p15.2. Western blot analysis and immunohistochemistry of the protein AKR1C3 showed a marked reduction of its expression in the carcinoma. In conclusion, we identified a novel molecular mechanism underlying a first case of HPV6-associated laryngeal carcinoma in juvenile-onset RRP, i.e. that HPV6 integration in the AKR1C3 gene resulted in loss of its expression. Alterations of AKR1C gene expression have previously been implicated in the tumorigenesis of other (HPV-related) malignancies.

Does the hypopharyngeal cavernous body protect the development of Zenker's diverticulum?

OBJECTIVE: The aim of this study was to examine the morphology of the cavernous body at the pharyngoesophageal segment. METHODS: In 47 cadavers the submucosal vascular plexus of the pharyngoesophageal segment and the cricopharyngeal muscle were examined. RESULTS: A vascular plexus which was macroscopically non visible or slightly identified was observed in the majority of the specimens (28 or 59.6%). Fourteen of the cadavers (29.8%) exhibited macroscopically lightly observable blood vessels which were covering a discontinuous area of the hypopharyngeal wall. In the other five specimens (10.6%) the vascular plexus was covering a large part of the dorsal wall of the pharyngoesophageal segment as a compact mass. The grade of dilation of the vascular plexus corresponded to the degree of protrusion of the cricopharyngeal muscle. CONCLUSIONS: In the case of a persistent constricted cricopharyngeal muscle, the dilation of the hypopharyngeal cavernous body may protect from developing a Zenker's diverticulum by reinforcing the Killian's dehiscence.

Multiple craniocervical chordomas presenting as a parapharyngeal mass.

BACKGROUND: Chordomas are malignant neoplasms of the axial skeleton that have rarely been seen in the cervical area. METHODS: A 55-year-old woman presented to our department with a history of a left cervical mass protruding into the throat with the symptoms of dysphagia and hoarseness. RESULTS: The radiological examination revealed 3 polycyclic masses in the neck, 2 on the left side and 1 small mass on the right side. After the neurosurgical excision of the intraspinal parts of the tumor, we performed the surgical resection of the cervical tumors via a lateral collotomy. The histological examination showed a chordoma. Because of the advanced stage of the tumor, a postoperative radiotherapy was performed. CONCLUSIONS: Meticulous radiological workup is essential in order to identify the exact extension of the tumor and to reveal possible multifocal lesions. The current literature and treatment recommendations for this rare tumor at this localization are discussed.

Definitive radiochemotherapy of advanced head and neck cancer with carboplatin and paclitaxel : a phase II study.

PURPOSE: To report outcome and toxicity of concurrent radiochemotherapy with carboplatin and paclitaxel in advanced squamous cell carcinomas of the oropharynx and hypopharynx. PATIENTS AND METHODS: Advanced inoperable carcinomas of the oropharynx and hypopharynx were treated with either hyper-fractionated, accelerated radiotherapy (50.0 Gy/2.0 with concomitant boost to 69.2 Gy/1.6) or conventional fractionated radiotherapy (70.2-72 Gy/1.8) concurrent with paclitaxel 40 mg/m2 and carboplatin AUC 1 weekly for 6 weeks. Acute and long-term toxicity was measured according to WHO- and CTC-criteria. RESULTS: A total of 84 patients were included between 2000 and 2008. Median follow-up time of patients alive was 36 months. Conventionally fractionated radiotherapy was given to 16 patients, while 68 patients were treated with concomitant boost. Finally, 88.1% of patients received full dose paclitaxel. Acute mucositis ≥ grade 3 was present in 51.2% of patients, while 6% of patients experienced ≥ grade 3 leucopenia and thrombopenia. A supportive gastric feeding tube was implanted in 89.1% of patients. Overall survival after 2 years was 46.3%, progression-free survival after 2 years was 41.0%. There was no significant survival difference between the different radiotherapy protocols. CONCLUSION: Concomitant carboplatin and paclitaxel is feasible and effective in advanced carcinomas of the head and neck.

Morphometric and anthropometric analysis of Killian's triangle.

OBJECTIVES/HYPOTHESIS: To determine the prevalence and the morphometric characteristics of Killian's triangle and to examine their relationship with the anthropometric features of the person. STUDY DESIGN: Prospective. METHODS: The hypopharyngeal wall was examined on 47 human cadavers. After a standardized method of dissection, the muscular structures of the hypopharyngeal wall were demonstrated and the existence or absence of Killian's triangle was determined. The triangle was examined in regard to its morphometric characteristics. In addition, anthropometric examinations of the whole body and of the head and neck regions on these cadavers were done, and the results were compared with the features of Killian's dehiscence. RESULTS: A triangle of Killian was present on 60% (9/15) of the males and on 34% (11/32) of the females. The mean height for the males was 7 mm and for the females 4 mm, and the width was on average 16 mm and 12 mm, respectively. The dimensions of the triangle were correlated significantly with the dimensions of the body and with the length and the descensus of the larynx. CONCLUSIONS: The frequency and the dimensions of Killian's triangle appear to be greater in males than in females. Furthermore, the morphometric characteristics of the dehiscence show a correlation with the anthropometric features of the person. These findings can be an explanation for the higher incidence of Zenker's diverticulum with men and for the geographical differences of the diverticulum's frequency.

Second-look microlaryngoscopy to detect residual carcinoma in patients after laser surgery for T1 and T2 laryngeal cancer.

CONCLUSIONS: The presented concept of second-look microlaryngoscopy in patients treated with transoral laser surgery (TLS) for early glottic carcinoma is promising and warrants further studies to evaluate its benefits. OBJECTIVES: Clear surgical margins at the primary site influence the course of the disease in patients with laryngeal carcinoma who undergo TLS. Several factors may lead to a reduced sensitivity in detecting tumor remnants at the time of the initial procedure. We therefore developed the concept of second-look microlaryngoscopies to enable a microscopic and histologic reassessment at the primary tumor site to exclude residual carcinoma. PATIENTS AND METHODS: Patients were scheduled for two second-look microlaryngoscopies under general anesthesia at 8-10 weeks and 16-20 weeks after the initial TLS procedure. We analyzed the histopathologic findings of biopsies taken in the second-look microlaryngoscopies and the survival parameters of 181 patients treated with TLS for early laryngeal carcinoma. RESULTS: Carcinoma at the primary site was found in 5.1% of all patients within the first and in 11.5% of all patients within the second second-look microlaryngoscopy, although the preoperative indirect laryngoscopy was inconspicuous in most cases. The survival analysis showed a 5-year and 10-year disease-free survival of 96.3% and 92.7%, respectively. The disease-free survival was significantly decreased when carcinoma was found in the second-look microlaryngoscopy (p=0.004).

Survivin and epidermal growth factor receptor expression in surgically treated oropharyngeal squamous cell carcinoma.

BACKGROUND: The epidermal growth factor receptor (EGFR) and the inhibitor of apoptosis protein survivin play important roles in the regulation of cellular proliferation and survival in squamous cell carcinomas. Their correlation in oropharyngeal squamous cell carcinoma (OSCC) has not been evaluated yet. METHODS: In this multicenter study, we analyzed the expression of survivin and EGFR in tissue specimens from 73 selected patients with OSCC using immunohistochemistry. RESULTS: Higher cytoplasmic survivin scores were significantly correlated with high scores of EGFR expression (p=.013). Nuclear survivin expression was associated with a poor overall survival rate with an estimated 3-year overall survival probability of 17.3% versus 87.4% for non-nuclear expression of survivin (p<.001). Multivariate analysis revealed that nuclear survivin expression was an independent negative prognostic factor (p=.008). CONCLUSION: Considering the strong impact of nuclear survivin expression on survival, the survivin expression should be prospectively evaluated to select patients with an increased risk for disease recurrence.

Mapping of Ki-67 protein distribution on whole organ serial sections of the larynx.

CONCLUSIONS: Immunostaining of whole organ serial sections of the larynx is feasible and will allow analysis of cellular alterations in the undisturbed anatomical context of whole organ serial sections of the larynx. OBJECTIVES: Whole organ serial sections of the larynx have to date been used for conventional macroscopic evaluation of laryngeal tissues. The aim of this study was to establish a protocol for immunohistochemistry of whole organ sections of the larynx. MATERIALS AND METHODS: Five laryngectomy specimens were obtained during surgery for advanced laryngeal carcinoma. Using a novel method for paraffin embedding, we chose the proliferation marker Ki-67 antigen as a model target for immunoreactivity on serial sections. RESULTS: We were able to produce whole organ serial sections that could then be immunostained for Ki-67. A complete mapping of proliferating cells throughout the tumour, at the tumour front and in skip lesions was subsequently obtained.

Long-term results of surgical treatment for recurrent respiratory papillomatosis.

CONCLUSIONS: The presented results add further support to the observation that laser microsurgery is the preferential surgical treatment for recurrent respiratory papillomatosis (RRP). A meticulous follow-up for early recognition of local recurrence and malignant transformation is recommended. OBJECTIVES: Endoscopic microsurgery continues to be the treatment of choice for RRP. The aim of this study was to evaluate the outcome of patients treated surgically. We focused on demographic data, recurrence rates, and treatment-related complications. PATIENTS AND METHODS: The charts of 194 patients treated at our institution between 1963 and 1993 were analyzed retrospectively. RESULTS: In all, 64 patients (33%) underwent a total of 137 operations using the CO2 laser; 130 patients (67%) underwent a total of 565 microlaryngeal operations by surgery with cold instruments. Five percent of the patients treated with conventional microlaryngeal surgery and none of the patients treated with laser surgery required tracheostomy (p<0.05). Postoperative glottic webs and scar formations were found in 6% of all patients after laser surgery and 20% after conventional surgery (p<0.05). The different methods of treatment did not affect the rate of recurrence (p=0.61) Malignant transformation or secondary airway carcinoma were observed in 4% of all patients.

Results of a European survey on current controversies in otology.

OBJECTIVE: Various topics in otology cause controversy among otologists internationally. The resulting variety of diagnostic and surgical concepts reflects differences between surgical schools and the lack of structured studies in the field. INTERVENTIONS: During the "Third Instructional Workshop of the European Academy of Otology and Neuro-Otology," we interviewed 100 invited instructors using a written questionnaire on 13 controversial topics in otology. RESULTS: The analyses of the survey showed a variety of different approaches in most otologic topics. CONCLUSION: A further exchange of experiences and discussions in expert panels such as the Instructional Workshop of the European Academy of Otology and Neuro-Otology may help standardize concepts in otology for a safe, efficient, and cost-effective standard of care in otology.

Submandibular gland excision: 15 years of experience.

PURPOSE: The surgical management of submandibular gland diseases has always been a challenge because it carries a considerable risk of nerve injury. The aim of this study was to review a single institution's experience of a nonselected case series of submandibular gland excision over 15 years. MATERIALS AND METHODS: We retrospectively analyzed 258 unselected submandibular excisions of a tertiary university center for the histopathologic diagnosis and postoperative morbidity; 119 patients (46%) with sialolithiasis, 88 patients (34%) with sialadenitis, and 51 patients (20%) with submandibular tumors were operated. RESULTS: We found a high rate of malignant tumors (42%) in the group of submandibular gland tumors. A low rate of transient palsies of the mandibular branch of the facial nerve (9%) and lingual nerve (2%) was observed. One patient developed a permanent paresis of the mandibular branch (<1%). CONCLUSION: Our large series has shown that standardized submandibular sialadenectomy is a safe operation with a low rate of complications. Malignant disease is frequent in tumors of the submandibular gland.

Outcome of multimodal treatment for oropharyngeal carcinoma: a single institution experience.

The clinical management of patients with primary oropharyngeal squamous cell carcinoma remains controversial. The results of a combined approach involving surgery for the primary tumor, neck dissection, and postoperative radiotherapy were reviewed. A retrospective review was carried out for 211 patients meeting the inclusion criteria of resectable squamous cell carcinoma of the oropharynx. Overall survival and disease-free survival rates were calculated using the Kaplan-Meier method. Univariate (Log-rank test) and multivariate (Cox proportional hazards models) statistical analyses were carried out to investigate the role of clinical factors as significant prognostic markers. The 2- and 5-year disease-free survival rates were 79.8% and 68.8%, respectively. In univariate and multivariate analyses, positive resection margins were the only and independent significant prognostic markers for impaired disease-free survival (Log-rank: p=0.0238; Cox model: p=0.045; hazard ratio 2.48 [95% confidence interval 1.02-6.05]). In univariate analysis, male sex was the only significant negative prognostic factor for overall survival (Log-rank: p=0.0453), whereas Cox multivariate analysis identified extracapsular spread as an independent prognostics marker (p=0.049; hazard ratio 1.86 [95% confidence interval 1.00-3.43]). We conclude that the presented multimodal approach of surgery for the primary tumor and the neck followed by postoperative radio(chemo)therapy seems to be superior to non-surgical treatment protocols, as it results in better disease-free and overall survival. To assess this multimodal treatment approach, morbidity and economic considerations need to be further analyzed.

A rare differential diagnosis in dysphagia: wound botulism.

The incidence of wound botulism is increasing dramatically among intravenous drug users. Efficient intensive care and early treatment with antitoxin is essential to avoid lethal courses. The clinical picture of botulism is of descending, symmetric, flaccid paralysis. Early symptoms include cranial nerve palsies resulting in blurred vision and diplopia, difficulty in focusing, ptosis, facial weakness, dysphagia, dysphonia, and dysarthria. Because patients presenting with dysarthria and dysphagia will often be seen by an ear, nose and throat specialist initially, this rare but upcoming neurologic disease must be considered in the differential diagnoses.

Successful OK-432 therapy for a supraclavicular lymphocele: report of a case.

Surgery is considered the gold standard in the treatment of lymphoceles, however this is not feasible for all cases. We report the successful treatment of a supraclavicular lymphocele by intralesional application of the sclerosing agent OK-432. After a total of three intralesional injections of OK-432, the cyst had disappeared completely and the patient was free of symptoms. Thus, intralesional application of OK-432 is considered a highly effective treatment for cystic masses such as lymphoceles.