A Retrospective Multicenter Italian Analysis of Epidemiological, Clinical and Histopathological Features in a Sample of Patients with Acinic Cell Carcinoma of the Parotid Gland.

BACKGROUND: The acinic cell carcinoma (AciCC) of the parotid gland is a rare tumor with an indolent behavior; however, a subgroup of this tumor presents an aggressive behavior with a tendency to recur. The aim of this multicenter study was to identify and stratify those patients with AciCC at high risk of tumor recurrence. METHODS: A retrospective study was carried out involving 77 patients treated with surgery between January 2000 and September 2022, in different Italian referral centers. Data about tumor characteristics and its recurrence were collected. The histological specimens and slides were independently reviewed by a senior pathologist coordinator (L.C.) and the institution's local head and neck pathologist. RESULTS: The patients' age average was 53.6 years, with a female prevalence in the group. The mean follow-up was 67.4 months (1-258, SD 59.39). The five-year overall survival (OS) was 83.2%. The 5-year disease-free survival (DFS) was 60% (95% CI 58.2-61.7). A high incidence of necrosis, extraglandular spread, lymphovascular invasion (LVI), atypical mitosis, and cellular pleomorphism was observed in the high-risk tumors compared to the low-risk ones. CONCLUSION: AciCC generally had an indolent behavior, optimal OS, DFS with few cervical node metastases, and rare distant relapses. This multicenter retrospective case series provides evidence of the need for clinical-epidemiological-histological stratification for patients at risk of poor outcomes. Our results suggest that the correct definition of high-risk AciCC should include tumor size, the presence of necrosis, extraglandular spread, LVI, atypical mitosis, and cellular pleomorphism.

Prevalence of Otolaryngology Diseases in an Urban Homeless Population.

OBJECTIVE: Otolaryngology diseases are common among people experiencing homelessness; however, they are seldom evaluated in a specialist setting, and investigations on their prevalence have rarely been conducted. The aim of this retrospective study was to evaluate the prevalence of otolaryngology conditions in an urban homeless population. STUDY DESIGN: Retrospective study. SETTING: Primary health care facility. METHODS: The clinical records of patients referred to the medical facilities of the Primary Care Services of the Eleemosynaria Apostolica, Vatican City, between October 1, 2019, and July 31, 2021, were retrospectively reviewed; those reporting at least 1 otolaryngology disease were included in the study. RESULTS: A total of 2516 records were retrospectively reviewed, and 484 (19.24%) were included in the study. The most common otolaryngology disease was pharyngotonsillitis (n = 118, 24.13%), followed by rhinitis with nasal obstruction (n = 107, 21.88%), hearing loss (n = 93, 19.01%), otitis (n = 81, 16.56%), abscess (n = 46, 9.40%), and sinusitis (n = 33, 6.74%). Head and neck cancer or precancerous lesions were reported in 34 subjects (7.02%). More than 1 simultaneous otolaryngology disorder was found in nearly 50% of our sample. A wide range of comorbidities was also reported. CONCLUSIONS: Our results confirm an elevated otolaryngology demand in the homeless population and encourage the development of more efficient and effective strategies for a population-tailored diagnosis and treatment of these conditions.

Prevention of withdrawal symptoms in alcoholic patients with head and neck cancer.

BACKGROUND: The role of alcohol abuse is common in the onset of cancer of the upper aerodigestive tract, especially that affecting the tongue, floor of the mouth, palatine tonsil and piriform sinus. The consequences of the abuse of alcohol immediately after surgery in these patients are less known. But they are very important to achieve good final results. METHODS: To try to understand the best treatment for withdrawal symptoms in a group of Italian patient with head and neck cancers, we administered a 10-item questionnaire. Subsequently, we decided to send the questionnaire to the main Italian centers of head and neck oncology using the platform of online surveys SurveyMonkey. RESULTS: The results show clearly that it is not easy, within the Italian "latin" culture and lifestyle to correctly identify the alcoholic patient (patients in the last stage of the of the disease with a "behavioral dependency") and that the centers which address these problems mostly use a drug treatment, employing in particular two classes of drugs, associated or not with thiamine, with a varying quantity of other vitamins. CONCLUSIONS: It is important to know the early withdrawal syndrome to assess the ideal treatment. We propose a personal protocol to present this complication.

Steroid-Eluting Ethmoidal Stent Versus Antero-Posterior Ethmoidectomy: Comparison Of Efficacy And Safety In Allergic Patients.

BACKGROUND: Allergic and chronic rhinosinusitis is a disabling pathological condition with an 8% prevalence in the European population and 5% in the Italian one. The ethmoidal sinus is the first one involved in the inflammation. The typical surgical procedure to manage ethmoidal sinusitis is an endoscopic antero-posterior ethmoidectomy. Recently introduced on the European market balloon called Relieva Stratus MicroFlow Spacer can be inserted within the ethmoid, with a local slow release of a steroid drug. This study had the aim to evaluate the efficacy and safety of the steroid-eluting ethmoidal stent in the management of allergic chronic rhinosinusitis in comparison with the traditional endoscopic ethmoidectomy. Methodos: 70 allergic patients who presented chronic rhinosinusitis were randomly divided into 2 groups and receive respectively the steroid-eluting ethmoidal stent or endoscopic ethmoidectomy. RESULTS: The most significant observation coming from the comparative analysis of the results is the substantial equivalence of the treatment with the steroid-eluting ethmoidal stent (SEES) compared with endoscopic ethmoidectomy in the management of ethmoid chronic rhinosinusitis with the exception of a reduction of overall discomfort and nasal secretion and better functional results at rhinomanometry in the steroid-eluting ethmoidal stent group. CONCLUSION: in our experience, the SEES was efficacious in the treatment of allergic patients with ethmoidal CRS when conventional medical treatment had failed, or when wishing to avoid the classic endoscopic ethmoidectomy (EE). However, further long-term studies will be performed in order to confirm the safety and stability, over time, of the results obtained.

TNM classification of the oral cavity carcinomas: some suggested modifications.

TNM system is a universally recognized cancer classification. It's based on the assessment of anatomical extent of tumor (T), nodal (N) and distant metastases (M). The first edition of TNM was published in 1968 and has since been updated several times. Relevant characteristics that affect prognosis prognosis, such as depth of invasion, tumor volume, surgical margin infiltration, and the number of involved nodes as well as the presence of extracapsular spread (such data should be determined by the pathologist and included in pTNM staging ­ ed. note) are not included in the TNM classification. Following a discussion on most recent classification updates we will discuss the factors, which in our opinion and in concordance with the most recent literature, deserve special consideration and influence management of oral carcinomas.

Leiomyosarcoma of the base of the tongue and free edge of the epiglottis: a case report.

INTRODUCTION: We present the case of a man with a leiomyosarcoma of the base of the tongue. We feel this case is important as this kind of pathology, though rare, can occur at a site where carcinomas are more frequent. CASE PRESENTATION: A 77-year-old Caucasian man had been reporting difficulty in swallowing and hoarseness for a month before admission to our department. After several preliminary tests, including a biopsy which was positive for a malignant epithelial neoplasm which required further immunohistochemical study, we decided to operate, removing the base of our patient's tongue and performing a total laryngectomy. Histological examination of the specimen revealed a high-grade leiomyosarcoma of the base of the tongue and of the free edge of the epiglottis. CONCLUSIONS: We wish to stress the rarity of this clinical case, related to the site of implantation of the tumor, as confirmed by the difficulties in finding reference to this topic in the international literature. In fact, several cases of leiomyosarcoma have been described, but in different locations from that seen in our patient's case.

Peri-orbital foreign body: a case report.

INTRODUCTION: Foreign bodies inside the orbital cavity are rare. They can cause more or less serious complications, depending on their nature and size. CASE PRESENTATION: We report a case of a work-related accident involving a peri-orbital foreign body. The patient was a 50-year-old Caucasian man whose face was injured on the right side while he was working with an agricultural machine. On admission, he was fully conscious and did not have any neurological deficits. He had no loss of vision or ocular motility, but had a laceration of the lateral side of his right upper eyelid. A computed tomographic scan revealed a 6-cm-long bended metal object lodged in the lateral bulbar space of the right orbit. The patient recovered well after surgery and a course of antibiotic therapy. CONCLUSION: The original aspects of this case are the singularity of the foreign body and its relative harmlessness in spite of its large size.