[Malignant external auditory canal tumors : management of a rare tumor]. / Tumeurs malignes du conduit auditif externe : prise en charge d'une tumeur rare.

Malignant tumors of the external auditory canal are rare tumors and very often diagnosed at an advanced stage due to non-specific symptoms. The best treatment is the radical surgery, eventually followed by radiotherapy. A multidisciplinary team is essential to realize an optimal management. Prognosis remains unfavorable for advanced tumors.

Les tumeurs malignes du conduit auditif externe (CAE) sont rares et leur diagnostic est souvent retardé en raison de symptômes peu spécifiques. Le traitement de choix consiste en une chirurgie radicale, éventuellement suivie d'une radiothérapie. Une équipe multidisciplinaire est indispensable pour une prise en charge optimale. Le pronostic reste défavorable dans les tumeurs avancées.

PET/MR Imaging in Head and Neck Cancer.

Head and neck squamous cell carcinoma (HNSCC) can either be examined with hybrid PET/MR imaging systems or sequentially, using PET/CT and MR imaging. Regardless of the acquisition technique, the superiority of MR imaging compared to CT lies in its potential to interrogate tumor and surrounding tissues with different sequences, including perfusion and diffusion. For this reason, PET/MR imaging is preferable for the detection and assessment of locoregional residual/recurrent HNSCC after therapy. In addition, MR imaging interpretation is facilitated when combined with PET. Nevertheless, distant metastases and distant second primary tumors are detected equally well with PET/MR imaging and PET/CT.

Rosai-Dorfman disease presenting as stridor and hoarseness in a young female patient.

Rosai-Dorfman disease is a non-Langherans cell histiocytosis typically revealed by lymphadenopathy. Extranodal involvement occurs in 43% and most commonly involves the head and neck, skin, and bones. Few reports have described laryngeal lesions. We report the case of a Rosai-Dorfman disease in a 27-year-old female, presenting as an obstructing transglottic mass. We provide the results of the MRI and PET-scanner examination. As the treatment relies on surgical excision and the diagnosis depends on pathological examination, we also detail the analysis results that followed the surgical resection. This report highlights the necessity to consider Rosai-Dorfman disease as a potential diagnosis in case of a laryngeal submucosal mass.

Mediastinal abscess revealed by computed tomography after pharyngeal fish-bone impaction.

Fishbone impactions in the upper aerodigestive tract are frequent but rarely cause serious complications when recognized and treated early. In this report, we describe the case of a patient that sought medical attention as late as 2 weeks after the fishbone impaction. A 52-year-old male was presented with fever, odynophagia and a toxic appearance. CT scan revealed a large cervicomediastinal abscess. The patient was immediately started on large-spectrum antibiotics, treated by surgical drainage, and recovered uneventfully. This case report highlights the occurrence of severe complications of upper digestive tract fishbone impaction and the usefulness of a preoperative CT scanner in this context.

Detection of distant metastases and distant second primary cancers in head and neck squamous cell carcinoma: comparison of [18F]FDG PET/MRI and [18F]FDG PET/CT.

PURPOSE: This prospective study aimed to compare the diagnostic performance of [18]FDG PET/MRI and PET/CT for the detection of distant metastases and distant second primary cancers in patients with head and neck squamous cell carcinoma (HNSCC). METHODS: A total of 103 [18F]FDG PET/MRI examinations immediately followed by PET/CT were obtained in 82 consecutive patients for staging of primary HNSCC (n = 38), suspected loco-regional recurrence/follow-up (n = 41) or unknown primary HNSCC (n = 3). Histology and follow-up > 2 years formed the standard of reference. Blinded readers evaluated the anonymized PET/MRI and PET/CT examinations separately using a 5-point Likert score. Statistical analysis included: receiver operating characteristic (ROC) analysis, jackknife alternative free-response ROC (JAFROC) and region-of-interest (ROI)-based ROC to account for data clustering and sensitivity/specificity/accuracy comparisons for a score ≥ 3. RESULTS: Distant metastases and distant second primary cancers were present in 23/103 (22%) examinations in 16/82 (19.5%) patients, and they were more common in the post-treatment group (11/41, 27%) than in the primary HNSCC group (3/38, 8%), p = 0.039. The area under the curve (AUC) per patient/examination/lesion was 0.947 [0.927-1]/0.965 [0.917-1]/0.957 [0.928-0.987] for PET/MRI and 0.975 [0.950-1]/0.968 [0.920-1]/0.944 [0.910-0.979] for PET/CT, respectively (p > 0.05). The diagnostic performance of PET/MRI and PET/CT was similar according to JAFROC (p = 0.919) and ROI-based ROC analysis (p = 0.574). Sensitivity/specificity/accuracy for PET/MRI and PET/CT for a score ≥ 3 was 94%/88%/89% and 94%/91%/91% per patient, 96%/90%/91% and 96%/93%/93% per examination and 95%/85%/90% and 90%/86%/88% per lesion, respectively, p > 0.05. CONCLUSIONS: In HNSCC patients, PET/MRI and PET/CT had a high and similar diagnostic performance for detecting distant metastases and distant second primary cancers.

Rapidly progressive stridor in a case of GIST.

We report the case of an 84-year-old male patient suffering from a gastrointestinal stromal tumour (GIST) of the rectum who was referred to our ENT (Ear-Nose-Throat) clinic for a rapidly progressive stridor, aphagia and dysphonia. The clinical examination revealed a mass arising from the posterior wall of the pharynx, which obstructed the laryngeal inlet and thus the airway. A metastasis of the GIST was suspected. After completing the investigation with radiological imaging, the patient underwent surgery, which consisted of a tracheostomy to secure the airway and a biopsy of the mass. The pathological examination confirmed the suspected diagnosis of a GIST vertebral metastasis.

Minor Parotidectomy Complications: A Systematic Review.

OBJECTIVES: To report descriptive statistics for minor parotidectomy complications. METHODS: A systematic review was performed, selecting 235 studies for analysis. The incidence of complications was tabulated, and descriptive statistics calculated. Outlier studies, 1 standard deviation above the mean, were reexamined to determine potential causal factors for each complication. All studies were examined for statistically significant differences for any potential causal factor. RESULTS: The pooled incidence of minor complications reported were hematoma 2.9% (95% confidence interval [CI]: 2.4-3.5), wound infection 2.3% (95% CI: 1.8-2.9), sialocele 4.5% (95% CI: 3.5-5.7), salivary fistula 3.1% (95% CI: 2.6-3.7), flap necrosis 1.7% (95% CI: 1.1-2.5), scar issues 3.6% (95% CI: 2.4-5.4), numbness 33.9% (95% CI: 25.6-43.4), and deformity 11.8 (95% CI: 6.9-19.5). Implants result in more wound complications, such as hematoma, sialocele, or salivary fistula. Sialocele and salivary fistula appear more frequently after less extensive parotid surgery, whereas hematoma, wound infections, flap necrosis, and aesthetic considerations are worse with more extensive resections. CONCLUSIONS: Minor parotidectomy complications are more frequent than generally assumed and related to certain factors that should be investigated. Laryngoscope, 131:571-579, 2021.

HSP105 expression in oral squamous cell carcinoma: Correlation with clinicopathological features and outcomes.

BACKGROUND: Heat shock proteins (HSPs) are released in response to stress situations, such as heat, inflammation, and infection. They are also involved in the tumor cell proliferation and prevention of apoptosis. Heat shock protein 105 (Hsp105/110) is a high-molecular-weight protein, which has been reported in many cancer types but few studies have been carried out on oral squamous cell carcinoma (OSCC). In the current study, we have focused on HSP105 expression on OSCC and evaluated their correlation with tumor clinicopathological parameters and patients' survival. METHODS: A retrospective study included 70 patients with OSCC of which 50 patients (71.4%) were male and 20 (28.6%) were female. The patient's information, including age, location, TNM stage, histological grade, regional metastasis, recurrence, and survival, were collected. Immunohistochemical staining for HSP105 was performed. The healthy oral mucosa (n = 10) was used as a control. The staining intensity and percentage of stained cells were semi-quantitatively evaluated, and HSP105 expression was correlated with tumor clinicopathological features and patient survival. RESULTS: Statistical analysis for HSP105 showed that there was no significant correlation with tumor clinicopathological features. However, HSP105 overexpression was associated with a decrease in the duration of patients' survival (P = .042). CONCLUSION: This result suggests that the increased expression of the HSP105 in the OSCC could be a prognostic factor for malignancy.

Thyroid Rosai-Dorfman disease with infiltration of IgG4-bearing plasma cells associated with multiple small pulmonary cysts.

BACKGROUND: Rosai-Dorfman disease (RDD) is a rare histiocytosis which involves principally lymph nodes. Thyroid involvement in RDD is a very rare situation, and lung involvement is even rarer. CASE PRESENTATION: We report the case of a 46-year-old woman presenting a painless mass in the right side of the neck and subacute dyspnoea. Computerised tomography (CT) scans of the neck and thorax showed a large thyroid mass causing tracheal stenosis and multiple cystic lesions in both lungs. Subtotal thyroidectomy with a tracheal segment resection and histological analysis confirmed the diagnosis of nodal and extranodal (thyroid, tracheal and probably lung) Rosai-Dorfman disease (RDD) with the presence of increased numbers of IgG4-bearing plasma cells. Clinical, functional and radiological follow up 4 years after surgery without medical treatment did not show any disease progression. CONCLUSIONS: This case report indicates a benign course of nodal RDD with thyroid and tracheal infiltration following surgical resection, association of typical histological signs of RDD (emperipolesis) with IgG4-related disease features, and that lung cysts might be a manifestation of RDD.

Low prevalence of HPV-induced oral squamous cell carcinoma in Geneva, Switzerland.

OBJECTIVE: The main objective of this study was to analyze the presence of human papillomavirus (HPV) by polymerase chain reaction (PCR) in invasive squamous cell carcinomas of the oral cavity. MATERIALS AND METHODS: A selection was made of 155 cases of squamous cell carcinoma of the oral cavity treated at the University Hospital of Geneva. HPV detection was performed at the Laboratory of Molecular Pathology using a PCR technique followed by in situ hybridization of the viral DNA. Sections were studied for the immunohistochemical expression of P16INK4a . RESULTS: The presence of HPV-DNA was found in 3.3% of the cases (95% CI: 1.3%-7.5%). The only HPV genotype found was HR-HPV 16. In contrast, 7.7% (95% CI: 1.3%-7.5%) of the cases showed an overexpression of the P16INK4a . We found no significant differences in age, sex, or tobacco and alcohol consumption in relation to the P16INK4a or HPV positivity. CONCLUSIONS: Human papillomavirus is rarely associated with squamous cell carcinomas of the oral cavity. Our results suggest that an overexpression of the P16INK4a protein, even in the absence of the virus, is linked to an increase in the survival of the patient.

Utility of MRI with morphologic and diffusion weighted imaging in the detection of post-treatment nodal disease in head and neck squamous cell carcinoma.

PURPOSE: To determine the diagnostic performance of morphologic MRI with diffusion weighted imaging (DWIMRI) for the detection of post-treatment lymph node (LN) recurrence of head and neck squamous cell carcinoma (HNSCC). METHODS: This retrospective study is based on 33 HNSCC patients who underwent DWIMRI with apparent diffusion coefficient (ADC) measurements for suspected post-treatment loco-regional failure. Two radiologists, blinded to clinical/histopathological data, analyzed MR images according to established morphologic criteria and measured ADC values by drawing regions of interest on each normal/abnormal looking lymph node (LN). Histopathological findings in 40 neck dissections, 133 LN-levels and 755 LNs served as gold standard. RESULTS: Malignant LNs had lower ADCmean values than benign LNs (1.15 ±â€¯0.35 × 10-3 mm2/s versus 1.28 ±â€¯0.28 × 10-3 mm2/s, p = .028). The optimal ADCmean threshold to differentiate malignant from benign LNs was 1.1695 × 10-3 mm2/s. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values (95%CI in parentheses) of DWIMRI with morphologic criteria and ADCmean <1.1695 × 10-3 mm2/s were: (a) 100%(86.2;100), 44.4%(15.3;77.3), 86.1%(69.7;94.7), and 100%(39.5;100) per neck dissection; (b) 83.6%(69.7;92.2), 91.6%(83.0;96.2), 85.4%(71.6;93.4), and 90.5%(81.7;95.5) per LN-level; (c) 53.1%(43.5;62.4), 95.5%(93.5;96.9), 67.4%(56.6;76.7), and 92.0%(89.6;93.9) per LN, respectively. CONCLUSION: The high NPV of DWIMRI irrespective of analysis type (per neck dissection/per neck level/per lymph node) make it a useful follow-up tool after treatment.

Local recurrence of squamous cell carcinoma of the head and neck after radio(chemo)therapy: Diagnostic performance of FDG-PET/MRI with diffusion-weighted sequences.

PURPOSE: To determine the diagnostic performance of FDG-PET/MRI with diffusion-weighted imaging (FDG-PET/DWIMRI) for detection and local staging of head and neck squamous cell carcinoma (HNSCC) after radio(chemo)therapy. MATERIALS AND METHODS: This was a prospective study that included 74 consecutive patients with previous radio(chemo)therapy for HNSCC and in whom tumour recurrence or radiation-induced complications were suspected clinically. The patients underwent hybrid PET/MRI examinations with morphological MRI, DWI and FDG-PET. Experienced readers blinded to clinical/histopathological data evaluated images according to established diagnostic criteria taking into account the complementarity of multiparametric information. The standard of reference was histopathology with whole-organ sections and follow-up ≥24 months. Statistical analysis considered data clustering. RESULTS: The proof of diagnosis was histology in 46/74 (62.2%) patients and follow-up (mean ± SD = 34 ± 8 months) in 28/74 (37.8%). Thirty-eight patients had 43 HNSCCs and 46 patients (10 with and 36 without tumours) had 62 benign lesions/complications. Sensitivity, specificity, and positive and negative predictive value of PET/DWIMRI were 97.4%, 91.7%, 92.5% and 97.1% per patient, and 93.0%, 93.5%, 90.9%, and 95.1% per lesion, respectively. Agreement between imaging-based and pathological T-stage was excellent (kappa = 0.84, p < 0.001). CONCLUSION: FDG-PET/DWIMRI yields excellent results for detection and T-classification of HNSCC after radio(chemo)therapy. KEY POINTS: • FDG-PET/DWIMRI yields excellent results for the detection of post-radio(chemo)therapy HNSCC recurrence. • Prospective one-centre study showed excellent agreement between imaging-based and pathological T-stage. • 97.5% of positive concordant MRI, DWI and FDG-PET results correspond to recurrence. • 87% of discordant MRI, DWI and FDG-PET results correspond to benign lesions. • Multiparametric FDG-PET/DWIMRI facilitates planning of salvage surgery in the irradiated neck.

Pleomorphic Adenoma Originating from Heterotopic Salivary Tissue of the Upper Neck: A Diagnostic Pitfall.

Pleomorphic adenoma directly arising in the neck is thought to originate from heterotopic salivary gland tissue. In this article, we present the case of a 55-year-old female patient with a histologically proven pleomorphic adenoma located at the left mandibular angle, anteriorly to the sternocleidomastoid muscle and posteroinferiorly to the submandibular gland. As the patient also had an ipsilateral thyroid nodule with coarse calcifications, clinical and radiological features suggested a possible level II metastatic lymph node. However, ultrasound-guided fine needle aspiration cytology and postsurgery histopathological examination revealed a pleomorphic adenoma arising from heterotopic salivary gland tissue unrelated to a benign thyroid nodule. In this article, we provide a review of the existing literature on heterotopic salivary gland tissue and related neoplasms and discuss their imaging presentation.

Open Maximal Mucosa-Sparing Functional Total Laryngectomy.

BACKGROUND: Total laryngectomy after (chemo)radiotherapy is associated with a high incidence of fistula and therefore flaps are advocated. The description of a transoral robotic total laryngectomy prompted us to develop similar minimally invasive open approaches for functional total laryngectomy. METHODS: A retrospective study of consecutive unselected patients with a dysfunctional larynx after (chemo)radiation that underwent open maximal mucosal-sparing functional total laryngectomy (MMSTL) between 2014 and 2016 is presented. The surgical technique is described, and the complications and functional outcome are reviewed. RESULTS: The cohorts included 10 patients who underwent open MMSTL. No pedicled flap was used. Only one postoperative fistula was noted (10%). All patients resumed oral diet and experienced a functional tracheo-esophageal voice. CONCLUSION: MMSTL could be used to perform functional total laryngectomy without a robot and with minimal incidence of complications.

Synovial sarcoma of the hypopharynx in a pediatric patient: Case report.

INTRODUCTION: Synovial sarcoma (SS) is uncommon high grade soft tissue sarcoma, accounting for less than 10% of all head and neck sarcomas. Also, about 10% of SS occur within the Head & Neck. In the pediatric population, SS is an extremely rare head & neck malignancy. PRESENTATION OF CASE: We present a case of sixteen years old boy diagnosed with SS situated of the hypopharynx treated by surgical excision and post operative radio-chemotherapy. DISCUSSION: This anatomical location brings additional functional challenges (swallowing, phonation, respiration), especially in the pediatric population. Pre-operative and even post-operative histopathological diagnosis of SS remains difficult. Optimal treatment of Head & Neck SS has to balance functional and oncologic aspects. CONCLUSION: SS is an extremely rare head & neck malignancy in pediatric population. It has multifaceted challenges including pre and post-operative histopathological diagnosis and optimal modality of treatment. Clinical judgment, especially in the pediatric population, needs to balance tumor free margins and organ preservation in head and neck region.

Comparison of the incidence of osteoradionecrosis with conventional radiotherapy and intensity-modulated radiotherapy.

BACKGROUND: Modern techniques of radiotherapy are supposed to decrease the incidence of osteoradionecrosis of the mandible (ORNM). The purpose of this study was to compare the incidence of ORNM after intensity-modulated radiotherapy (IMRT) in comparison to conventional 3D conformal radiotherapy techniques (conventional RT). METHODS: We conducted a retrospective study of consecutive unselected patients treated in a single institution between 2002 and 2012. To minimize confounding effects, only patients with oropharyngeal carcinoma without surgery of the primary site were included. RESULTS: The cohorts included 145 patients in the conventional RT group and 89 patients in the IMRT group. Total incidence rate of ORNM was similar for both groups with rates of 11% versus 10% (n = 16 for conventional RT and n = 9 for IMRT; p = 1.0). Subanalysis revealed more ORNM in T4 classified lesions with IMRT (p = .007). Analysis of different risk factors showed no statistically significant difference between ORNM and no-ORNM patients. CONCLUSION: We found no reduction in ORNM with IMRT. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.

The superficial musculoaponeurotic system flap in the prevention of Frey syndrome: A meta-analysis.

OBJECTIVES/HYPOTHESIS: Evaluate the difference of the incidence in clinical Frey syndrome in studies comparing classical parotidectomy and parotidectomy with superficial musculoaponeurotic system (SMAS) flap elevation and suturing through meta-analysis methodology. STUDY DESIGN: Meta-analysis of controlled studies with and without SMAS flap. METHODS: Database search with the following key word combination: "Frey syndrome" and "SMAS." INCLUSION CRITERIA: parotidectomy, SMAS flap and control groups, minimal follow-up of 1 year. The outcome was the presence of clinical Frey syndrome. RESULTS: Eleven studies, mostly retrospective and not randomized. According to the fixed-effect model, SMAS technique is associated with a decrease of clinical Frey syndrome with an odds ratio (OR) of 0.42 (confidence interval [CI] 0.32-0.56). With the random-effect model, the difference remains significant (P = 0.006) with an OR of 0.25 (CI 0.09-0.66). The heterogeneity index I(2) is very high (85%). CONCLUSION: The use of SMAS flap and suturing is associated with a decreased incidence of Frey syndrome. Laryngoscope, 126:1581-1584, 2016.

Subcutaneous sarcoidosis in a rhinoplasty scar.

The presence of a subcutaneous hard bony-like lump at the lateral nasal wall after a septorhinoplasty procedure is an unfavourable result. The reported patient developed this complication 2 years after a revision surgery, in which percutaneous osteotomies were performed. An excision biopsy of the lump took place and the histopathological analysis revealed a granulomatous gigantocellular inflammation with absence of birefringent particles on polarised lamp and negative mycobacteria culture. After additional investigations, the final diagnosis was consistent with grade 2 pulmonary sarcoidosis associated with subcutaneous sarcoidosis. No treatment was initiated. The facial symptoms resolved without any additional treatment and the pulmonary function tests have not deteriorated after 1 year of follow-up. The polymorphism of cutaneous lesions in sarcoidosis, the absence of systemic symptoms and the unrecognised entity of subcutaneous sarcoidosis in a scar illustrate the diagnostic challenge with this patient.

FDG-PET/CT pitfalls in oncological head and neck imaging.

OBJECTIVES: Positron emission tomography-computed tomography (PET/CT) with fluorine-18-fluorodeoxy-D-glucose (FDG) has evolved from a research modality to an invaluable tool in head and neck cancer imaging. However, interpretation of FDG PET/CT studies may be difficult due to the inherently complex anatomical landmarks, certain physiological variants and unusual patterns of high FDG uptake in the head and neck. The purpose of this article is to provide a comprehensive approach to key imaging features and interpretation pitfalls of FDG-PET/CT of the head and neck and how to avoid them. METHODS: We review the pathophysiological mechanisms leading to potentially false-positive and false-negative assessments, and we discuss the complementary use of high-resolution contrast-enhanced head and neck PET/CT (HR HN PET/CT) and additional cross-sectional imaging techniques, including ultrasound (US) and magnetic resonance imaging (MRI). RESULTS: The commonly encountered false-positive PET/CT interpretation pitfalls are due to high FDG uptake by physiological causes, benign thyroid nodules, unilateral cranial nerve palsy and increased FDG uptake due to inflammation, recent chemoradiotherapy and surgery. False-negative findings are caused by lesion vicinity to structures with high glucose metabolism, obscuration of FDG uptake by dental hardware, inadequate PET scanner resolution and inherent low FDG-avidity of some tumours. CONCLUSIONS: The interpreting physician must be aware of these unusual patterns of FDG uptake, as well as limitations of PET/CT as a modality, in order to avoid overdiagnosis of benign conditions as malignancy, as well as missing out on actual pathology. TEACHING POINTS: • Knowledge of key imaging features of physiological and non-physiological FDG uptake is essential for the interpretation of head and neck PET/CT studies. • Precise anatomical evaluation and correlation with contrast-enhanced CT, US or MRI avoid PET/CT misinterpretation. • Awareness of unusual FDG uptake patterns avoids overdiagnosis of benign conditions as malignancy.