[Clinical analysis and surgical treatment evaluation of 23 cases with primary parapharyngeal space tumors].

Objective: To analyze the clinical characters and surgical treatment of primary parapharyngeal space (PPS) tumors. Methods: A total of 23 cases of primary PPS tumors which were treated from November 2011 to December 2017 were included for the retrospective analysis in this study. Results: Twenty-three cases of patients with primary PPS tumors were analyzed in this study. Surgical approach was as follows: transcervial approach applied in 7 cases, transparotid approach in 4 cases, transoral approach in 2 cases, transmandibular approach in 4 cases, and the combined approaches on 6 cases. Besides, among 7 cases with upper PPS tumor, we applied the surgical navigation system in the surgery of 3 cases. The mean surgery duration of these cases, 3.5 h, was shorter than unused ones, while the mean maximum size (MMS) of tumors, 5.7 cm, was also larger. So far, 23 cases had no recurrence and metastasis. The most frequent histopathological type of all the cases was pleomorphic adenoma (8 cases), followed by Schwannoma (5 cases). With an 8-to-72-months follow up, 23 cases had no recurrence, metastasis or death. Conclusions: Surgical resection is preferred in the treatment of PPS tumors. In the upper PPS tumor cases, the surgical navigation system could reduce the operative duration significantly and is more suitable for larger tumors.

Postoperative radiotherapy is dispensable for OSCC patients with micrometastases in lymph nodes.

Lymph node metastasis is a decisive factor for performing postoperative radiotherapy for oral squamous cell carcinoma (OSCC). However, whether OSCC patients with only micrometastasis need postoperative radiotherapy is unclear. In this study, OSCC patients (n = 311) with negative (n = 247), only micrometastasis (n = 44) and macrometastasis (n = 20) were detected and selected by HE staining. Micrometastasis was re-assessed using immunohistochemical staining of cytokeratin (CK) in HE-negative patients to find out the false negative cases. The results indicated that, among the negative lymph node cases (n = 247), the positive rate of CK was 4.94% (n = 12). Besides, the clinical features of the primary tumor in relation to the only micrometastatic status and the value of the postoperative radiotherapy on the only micrometastasis patients were evaluated. Patients with only micrometastasis had higher T stage and inferior worst pattern of invasion (WPOI) than patients without micrometastasis, but they had longer overall survival (OS), metastasis-free survival (MFS), and disease-free survival (DFS) than macrometastasis patients. However, the survival time of only micrometastasis patients with or without postoperative radiotherapy was comparable, even in patients with inferior WPOI. Radiotherapy, however, may only benefit patients with IV/V levels of micrometastasis. These data indicated that postoperative radiotherapy is dispensable for only micrometastasis OSCC patients.

Hyalinizing clear cell carcinoma of salivary gland origin in the head and neck: clinical and histopathological analysis.

Hyalinizing clear cell carcinoma (HCCC) is an extremely rare neoplasm of salivary gland origin with a low-grade indolent nature. It is difficult to distinguish from other malignant salivary gland tumours. Clinical outcomes following surgery are generally reported as good. The aim of this study was to further determine the features of HCCC. This study was approved by Medical ethics review of affiliated hospital of jiangsu university. Fourteen new cases of HCCC are reported. The clinical and histopathological data of these 14 cases were analysed alongside those of 141 cases identified in a systematic review of the literature (up to 2016). Demographic data, histopathological findings, clinical presentation, primary treatment, and outcomes were extracted. Histologically, HCCC tumour cells had a clear cell morphology with hyalinized stroma. Immunohistochemical results were positive for cytokeratins and EMA, but negative for SMA, S100, vimentin, and calponin. Twelve of the 14 patients showed EWSR1 translocation. Local nodal metastasis on presentation was present in 17.3% and the overall recurrence rate was 17.7% in the total population (N=155), compared with 35.7% and 21.4%, respectively, in the new cases alone. Focal necrosis and local metastasis were identified as possibly associated with recurrence. The overall prognosis was good: only 3.8% of patients died of the disease. HCCC is less indolent than was previously thought, but overall the prognosis is good. Risk factors for recurrence may include focal necrosis and local metastasis at presentation. The best treatment for patients with HCCC is wide local excision combined with regional lymph node dissection.

[Evaluation and influencing factors of surgical margin status of oral squamous cell carcinoma].

Surgical resection with adequate margins is an essential component of the treatment for patients with oral squamous cell carcinoma (OSCC). A distance of 5 mm or more between healthy tissue to the tumor front is generally accepted as a safe margin. It is very important for surgeons to precisely evaluate the resection area of tumor both pre- and intra-operatively and try to achieve a safe margin, which will result in a decreased risk of local recurrence. The relationship of surgical margin status to patients' prognosis, and factors which will affect surgical margin distance demand are discussed in this paper. We recommend that adequate margins evaluation should take consideration of many factors such as anatomical location, depth of tumor invasion, pattern of tumor invasion, mucosal dysplasia grade and so on. With the development of molecular biology, surgical margin study at molecular level can give us a new strategy to evaluate its adequacy.

Keratocystoma of the parotid gland: a clinicopathological study and literature review.

The authors investigated the clinicopathological characteristics of keratocystoma of the parotid gland. Two cases of parotid gland keratocystoma in the files of Nanjing Stomatological Hospital were analysed. These slowly growing parotid gland tumours occurred in two women aged 29 and 49 years. The cut surface showed multilocular cystic lesions filled with keratin materials. Histologically, there were multi-cystic spaces and solid epithelium islands, containing keratinized lamellae. Without cytological atypia, the lining stratified squamous epithelium showed apparent keratinization through an orthokeratotic or parakeratotic pathway. No skin appendage formation was observed. Both cases immunoreactively stained positively for AE1/AE3 and CK5/6 but negatively for CK8/18, S-100 and Calponin. There was no evidence of recurrence 3 or 4 years after superficial parotidectomy. The data from these two cases and cases previously published suggest that keratocystoma of the parotid gland is a benign cystic neoplasm. Surgical resection is apparently sufficient for cure.

Peripheral blood dendritic cells and vascular endothelial growth factor in oral squamous cell carcinoma: correlation analysis and in vitro study.

Vascular endothelial growth factor (VEGF) may cause functional deficiency in dendritic cells (DCs) in vitro. The roles of peripheral blood dendritic cells (PBDCs) and VEGF in patients with oral squamous cell carcinoma (OSCC) are not well understood. The authors analysed the correlation between VEGF and PBDC in 81 OSCC patients. They assessed the effect of VEGF on DC function in vitro. VEGF levels were significantly increased in OSCC patients compared with control subjects (P < 0.05), but PBDC levels were significantly lower (P < 0.05). VEGF expression in TNM I-II (67%) and T1-T2 (74%) was significantly lower, compared with TNM III-IV (88%, P < 0.05) and T3-T4 (89%, P < 0.05). Increased VEGF expression in primary tumours was significantly correlated with elevated serum VEGF levels, but reduced PBDC levels. In vitro cultured DC exposed to VEGF showed significantly decreased expression of functional proteins, enhanced endocytosis activity, and elicited weaker proliferation of T cells, compared with that of free VEGF (P < 0.01). These findings suggest that decreased PBDC and elevated VEGF occur in OSCC patients. Higher VEGF levels may affect precursor cells, resulting in decreased numbers of functional DC.

[Advances of construction of tissue engineered blood vessels].

OBJECTIVE: To discuss the approaches of tissue engineered blood vessels (TEBV) reconstruction. METHODS: The recent literatures about TEBV were widely reviewed. We summarized various types of biomaterials served as scaffold for TEBV and evaluated the construction model of TEBV. And the biological properties of some TEBV were compared. RESULTS: Although the final model of construction of TEBV was not clear, reports in the last two years had shown several important advances in this exciting field. CONCLUSION: Mimicry of some or all of the properties of three layers of natural healthy blood vessels has been the strategy of all TEBV approaches.

[Observation in vivo histological response induced by imlplanted domestic poly-DL-lactic acid plates]

OBJECTIVE:To analyze the histological response and biocompatibility to implanted domestic PDLLA plates in vivo METHODS:Bilateral artificial fractures were created in mandibular bodies in dog and internal fixed with domestic PDLLA plate,TM plate respectively;meanwhile,a domestic PDLLA plate was imlplanted in femur.The interfacial soft tissue around the plates were collected and performed histological study RESULTS:All the skin wound healed well without abscess and fistula formation. From 2 to 4 weeks after the operation,the inflmmatory granulomatous response around the intenal fixation PDLLA plates was more serious than that of the control,in which more macrophages,plasmocytes and less lymphocytes,mononuclear cells infiltrated CONCLUSION:Domestic PDLLA plate is an inert internal fixation material with good biocompatibility, which induced a non-speciflc foreign reaction

[Observation of clinical and pathological responses in short-term following immunochemotherapy for oral squamous cell carcinoma]

24 patients with oral SCC in Stage T3 or T4 were randomly divided into two groups,and treated with two inductive therapies,13 cases of whom received an immumochemotherapy regimen(Sapylin 15 KE+CDDP 70mg/m(2)+VCR 1.4mg/m(2)+PYM 80mg,S-PVP) and 11 cases,a chemotherapy regimen(CDDP 90mg/m(2)+VCR 1.4mg/m(2)+PYM 80mg,PVP) as control.The clinical response and pathological effect after immunochemotherapy or chemotherapy were evaluated through the clinical measurement of tumor size and pathological examination of the specimen.The results showed that the rate of clinical and pathological responses in S-PVP group were 92.3% and 84.6%,respectively;and in PVP group,72.7% and 45.5%.There was a significant difference between two groups in pathological effect(P<0.05),which indicated that the S-PVP regimen in short-term was better than of inductive chemotherapy.It may be relatively objective and accurate in comparison with clinical investigation which could act as an important supplement to the evaluation of clinical response.

[Effect on intratumoral T lymphocyte and its subset in oral squamous cell carcinoma following immumnochemotherapy]

The relative numbers of CD(3)(+),CD(3)(+),CD(8)(+) and HLA-RD(+) cells in the tumor tissue before and after inductive therapy was counted using immunohistochemical technique of Avidin Biotin-Peroxidase Complex(ABC),and then the effect on local immune cell following two different inductive therapies was comparatively analysed.The results showed that S-PVP therapy could result in significant increasing in numbers of CD(3)(+)and CD(4)(+) cells intratumorally as compared with pre-therapy(P<0.05),and in slignt increasing in numbers of CD(8)(+) and HLA-DR(+) cell,which is no significant difference between pre-and post-therapy.In the PVP group,there was no significant difference in numbers of CD(3)(+),CD(4)(+),CD(8)(+) and HLA-DR(+) cells between pre-and post-treatment.The results suggested that T lymphocyte in the tumor site could significantly increase in numbers following the S-PVP therapy,and PVP chemotherapy did not obviously affect the local cellular immunity.

[Yield and cytotoxicity of tumor-infiltrating lymphocyte(TIL) following immunochemotherapy]

Tumor-infiltrating lymphocyte (TIL) in the primary site of oral SCC treated with S-PVP of PVP therapy was collected respectively and its yield,that is calculating the amount of TIL per tumor tissue.The cytotoxicity of TIL against the target,Tca8113 was detected.The results showed that the yield of TIL in S-PVP group was three times over that in PVP group.At the ratio of 5 to 1 (effector to target) the cytotoxicity was 38% in S-PVP group and 32% in PVP group.There was no significant difference in its cytotoxicity between two groups.The results revealed that immunochemotherapy of S-PVP regimen for treating oral SCC had neither direct damage to tumor cell from the agents nor antitumor immune reactivity with BRM stimulating an increasing in numbers of TIL.

[A prospective study evaluating effectiveness of TMJ arthroscopy for particular stages of internal derangement]

The purpose of this prospective study is to evaluate effect on particular stages of internal derangement by TMJ arthroscopy.According to Wilkes-Bronstein classification,the distributions between 81 joints and particular stages of ID were:25 joints in II stage,18 in III,24 in IV,and 14 in V.The total 81 joints were undergone by arthroscopic surgery,the total success rates of different stages of ID were:24/25 joints in II stage,16/18 in III,13/24 in IV,and 7/14 in V particularly.The success rates were no statically significance (P>0.05) between II stage and III stage or between IV and V or V stages.The conclusion is that these cases in II or III stages of ID choose arthroscopic surgery than those cases in IV or V stages.

Treatment of habitual dislocation of the temporomandibular joint with subsynovial injection of sclerosant through arthroscope.

Five patients with habitual dislocation of the temporomandibular joint (TMJ), failing in conservative therapy, were treated with subsynovial injections of sclerosant through an arthroscope, and this treatment was proved to be effective over the short-term. Compared with operation, this method is easily performed and produces less damage and no significant sequelae, but the long-term effects have yet to be observed.