Potential role of hybrid positron emission tomography in pre-operative assessment of primary salivary gland carcinomas.

OBJECTIVE: The added value of hybrid positron emission tomography is increasingly recognised in head and neck cancer. However, its potential role in salivary gland carcinomas has been scarcely investigated. METHODS: A consecutive cohort of 45 salivary gland carcinoma patients who underwent pre-therapeutic hybrid positron emission tomography and surgical resection was reviewed. This study investigated whether maximum standardised uptake value correlated with tumour phenotype. RESULTS: Tumours of high-grade disease on histology (salivary duct carcinoma, carcinoma ex pleomorphic adenoma) had higher maximum standardised uptake value (Kruskal-Wallis test, p = 0.011) than low-grade tumours (adenoid cystic carcinoma and acinic cell carcinoma). Patients with pathologically confirmed node-positive disease had significantly higher maximum standardised uptake value of the primary tumour than patients with pathologically confirmed node-negative disease (Kruskal-Wallis test, p = 0.012). CONCLUSION: Maximum standardised uptake value of the primary tumour may guide clinical decision-making in patients with salivary gland carcinomas, as a high maximum standardised uptake value is associated with high-grade tumour histology and the presence of lymph node metastases. Clinicians may consider more aggressive surgery for these patients.

Relevance of sentinel node procedures in head and neck squamous cell carcinoma.

The management of the clinically and radiologically negative neck (cN0) in patients with early oral and oropharyngeal squamous cell carcinoma (OSCC) is still a matter of debate, though most centers favor an active policy and perform END for staging of the neck and removal of occult disease. In the past decade SNB has been successfully implemented in early stage head and neck carcinomas. A large number of validation studies have shown an excellent safety profile with good sensitivity for the identification of occult neck metastases. The status of the neck is more accurately assessed by step-serial sectioning (SSS) and immunhistochemistry (IHC) of the sentinel lymph nodes (SN) compared to routine histopathologic work up of a comprehensive lymph node dissection specimen. Gain in experience as well as technical developments have lead to a wider use of SNB even in the complex lymphatic system of the Head and Neck region. First observational trials have documented its oncological accuracy and safety with success rates in controlling the neck comparable to END. The role of small tumor deposits only detectable by the extensive histopathologic work-up of the SNB-protocol is controversial. The overview comprises an introduction of the sentinel node procedure and indications in the head and neck region. The methodology as well as the histological work up and reporting of SNB is described. Finally, the clinical application, prognostic significance and future perspectives of SNB are summarized.

Isolated fungus ball mimicking mucocele or frontal sinus tumour: a diagnostic pitfall.

OBJECTIVE: To demonstrate the clinical, radiological and diagnostic pitfalls of managing an isolated frontal sinus fungus ball, and to compare with the literature. MATERIAL AND METHODS: Retrospective analysis of two cases and literature review. RESULTS: Isolated frontal sinus fungus ball is a rare cause of frontal sinus disease. We present two cases of isolated frontal sinus fungus ball which pre-operatively were suspected to be either a tumour or a mucocele. In both cases, cheesy, clay-like material was found intra-operatively within the frontal sinus, suggesting a fungus ball. Effective treatment included surgical debridement via an exclusively endoscopic or an external approach, variously. Final histopathological and mycological analysis revealed Aspergillus fumigatus. A literature review revealed 20 reported cases of isolated frontal sinus fungus ball, confirming the low prevalence of the disease. CONCLUSIONS: Frontal sinus fungus ball should be considered in the differential diagnosis of chronic, nonspecific forehead symptoms. To evaluate the underlying disease, computed tomography scans should first be performed, followed by magnetic resonance imaging if malignancy is suspected. It is essential to be aware of the possibility of an atypical fungus ball appearance on computed tomography and magnetic resonance imaging scans. If bony destruction and calcification coexist on radiological images, then endoscopic biopsy is an indispensable part of the diagnostic procedure, and should be performed to collect material for both histological and mycological analysis, and to aid surgical planning. In cases of sinus fungus ball, an endoscopic approach for biopsy may be curative.