Time trends in pharyngeal cancer incidence in Norway 1981-2005: a subsite analysis based on a reabstraction and recoding of registered cases.

OBJECTIVE: Incidence rates of oropharyngeal squamous cell carcinoma (SCC) have been reported to be increasing in several countries in recent decades, contrasting with trends of SCCs diagnosed in neighboring anatomical sites. We investigated whether changes in classification systems and/or coding/registration practices might explain the trends in Norway, focusing on changes in oropharyngeal cancer. METHODS: Trends in cancers of the oropharynx, base of tongue, nasopharynx, hypopharynx were graphically presented for the period 1981-2005, before and after recoding. Age-period-cohort and future prediction models were fitted to oropharyngeal SCC incidence. RESULTS: A total of 85 (3.7%) of the 2315 pharyngeal cancers required recoding. Rates of oropharyngeal cancer in Norway were consistently two to three times higher in men, with rapid increases in both men (5% per annum) and women (4.2% per annum). Assuming generational effects, male cohorts born 1915-1950 were at increasingly higher risk of the disease. The number of oropharyngeal cancer cases is expected to double in Norway by 2020. CONCLUSIONS: The trends were not considered materially biased by potential artefacts. The increasingly higher proportion of oropharyngeal SCC cancers is more likely explained by other factors, including an increasing high-risk HPV prevalence among recent cohorts. These results will likely have consequences on treatment and health care provision in the near future.

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.

Cancer of the oropharynx: classification and natural history.

The development, comparative anatomy, and function of the oropharynx are briefly described. The text book descriptions of the anatomical boundaries of the oropharynx are commented on and an attempt is made to define these boundaries more rigidly and accurately. Although the advantages and limitations of the UICC classification of oropharyngeal cancer is accepted, an alternative classification is suggested based on the function of the site involved rather than its descriptive anatomy. This has resulted in a necessary rearrangement of the tumor sites and subsites. Subdivision into three sites is suggested: 1. An anterior or glosso-epiglottic; 2. Lateral or tonsillar; 3. Postero-superior or pharyngoepiglotti. The main change has been in the lateral group, the faucial pillars being separated from the tonsil and reallocated. Three different forms of tonsillar cancer are described in some detail; the linguo (glosso) tonsillar sulcus receives mention. A general account is given of the remaining anterior and posterior sites.

Classification of human upper respiratory tract tumors.

An outline of human upper respiratory tumors is presented, based on the World Health Organization's classification of such tumors. The discussion and illustrations are devoted mainly to the nasal passages, and emphasis is placed on lesions that are potentially confusing because of problems of terminology or unusual histologic features.

Epstein-Barr virus-associated extranodal NK/T-cell lymphoma, nasal type of the hypopharynx, in a renal allograft recipient: case report and review of literature.

Posttransplant lymphoproliferative disorders (PTLPDs) are predominantly B-cell lymphoproliferations, whereas a T-cell origin is rarely observed. In contrast to B-cell PTLPD, T-cell PTLPDs show an inconsistent association with Epstein-Barr virus (EBV). Until now, only 13 cases of EBV-associated T-cell PTLPDs have been reported. We describe a case of an EBV-associated T-cell PTLPD in a renal allograft recipient 2 years after transplantation. Histologic examination showed medium- to large-sized lymphoid cells with an angiocentric growth pattern and necrosis. The atypical cells showed a CD2+, CD3epsilon+, CD7+, CD43+, CD45R0+, CD56+, and CD4-, CD5-, CD8- betaF1- phenotype with expression of the latent membrane protein (LMP)-1 of EBV. In addition, EBV-specific RNAs (EBER 1/2) were identified by in situ hybridization. Molecular analysis of the T-cell receptor (TCR) gamma chain by polymerase chain reaction (PCR) showed a polyclonal pattern. The morphologic, immunohistochemical, and molecular findings were consistent with a diagnosis of an EBV-associated extranodal natural killer (NK)/T-cell non-Hodgkin lymphoma (NHL) of nasal type. To our knowledge, this is the first reported case of this rare entity in the posttransplant setting.

Surgical pathology of cancer of the larynx and hypopharynx.

A study was designed to determine the influence of certain surgical pathologic findings on tumor spread and survival in patients with cancer of the larynx and hypopharynx. All patients with primary epidermoid carcinoma of the larynx and hypopharynx, treated by either surgery or preoperative irradiation and surgery, between 1955 and 1971 were included in the study. The patient population consisted of 791 patients all of whom were eligible for three-year follow-up. Information from a retrospective study of the surgical pathology reports regarding resection margins, size and differentiation of the primary tumor, histopathologic characteristics of the primary tumor and neck dissection, number, position and size of positive lymph nodes and post treatment staging, was correlated with tumor spread and survival.

Sugarcane farming, occupational solvent exposures, and the risk of oral cancer in Puerto Rico.

The work history information from a population-based case-control study conducted in Puerto Rico was analyzed using a job exposure matrix to investigate the relationship between occupational exposures and cancers of the oral cavity or pharynx. After adjustment for age, alcohol, smoking, and residence in a logistic model, the risk for cancer of the oral cavity, but not the pharynx, was significantly elevated among farm workers in the sugarcane industry (OR = 4.4, 95% CI = 1.4-13.6). An exposure-response trend was seen for cumulative exposure to solvents, with an OR = 3.2 (95% CI = 0.8-12.6) in the highest exposure category. The overall contribution to the risk of cancer of the oral cavity or pharynx associated with occupational exposures in Puerto Rico appears to be small, however, the elevated risks were seen among sugarcane farmers and subjects with high cumulative exposure to solvents.

The World Health Organization's revised classification of tumours of the larynx, hypopharynx, and trachea.

A second edition of the Histological Typing of Upper Respiratory Tract Tumours in the WHO series International Histological Classification of Tumours was published in 1991. The new edition has been entitled Histological Typing of Tumours of the Upper Respiratory Tract and Ear. The task of revising the first edition, which was published in 1978, was undertaken at the WHO Center for Upper Respiratory Tract Tumours by K. Shanmugaratnam in collaboration with L. H. Sobin and pathologists in 8 countries. Several tumour types have been added to the classification, and some have been redefined in light of current knowledge. This presentation outlines the changes in the revised WHO classification as regards tumours of the larynx, hypopharynx, and trachea and discusses the grounds for said revisions.

Pharyngeal dermoids ("hairy polyps") as accessory auricles.

The purpose of this study is to clarify the origin and nature of so-called hairy polyps or dermoids of the pharynx, which are often thought to be a variant of pharyngeal teratoma. For this purpose, a case is reported of a dermoid polyp involving the middle ear of an infant, the features of multiple examples of pharyngeal dermoid polyps and teratomas received for consultation by the Armed Forces Institute of Pathology are examined, and selected pertinent reports from the literature are reviewed. All three means are used to support the conclusion that these lesions are choristomatous developmental anomalies arising from the first branchial cleft area and that they essentially represent heterotopic accessory "ears" (auricles) without the growth potential of a teratoma.

[Sentinel lymph node biopsy in head and neck cancer patients].

OBJECTIVE: By performing sentinel lymph node (SLN) biopsy, its detecting and predictive value to the cervical metastasis in the head and neck cancer patients was studied. METHODS: Intraoperative SLN biopsy was done in 51 untreated head and neck cancer patients who all had no metastasis before operation. The lesions were: laryngeal cancer 23, pharyngeal cancer 6, thyroid cancer 20 and cancer of the tongue 2. Fifteen minutes before taking the SLN, local 0.2 to 0.5 ml 2% isosulfan blue dye was submucously injected 0.5 cm away from the upper, lower, right and left margin of the primary tumor. The frozen sections of SLN were compared with the routine pathological sections of the cervical lymph nodes. The metastatic relation between the SLN and the cervical nodes as well as SLN's predictive value to the cervical nodes metastasis were analyzed. RESULTS: SLN was successfully revealed in 48 (94%) of these 51 patients, averaging 2.5 nodes per patient. They were: laryngeal cancer 22, pharyngeal cancer 6, thyroid cancer 18 and lingual cancer 1. Eleven of these SLNs were positive, among whom two had lymph node metastasis in addition to the SLN. Two others were false negative. The positive predictive value of SLNs to the cervical lymph node metastasis was 85%. CONCLUSION: The predictive value of sentinel lymph node to the cervical metastasis is important in head and neck cancer patients.

[Comparative morphological characteristics of adenoacanthoma of different localization]. / Sravnitel'naia morfologicheskaia kharakteristika adenoakantom nekotorykh lokalizatsii

A morphological analysis of 40 observations on adeno-acanthomas of different localizations (oesophagus, uterus, larynx, pharynx) is presented. It was established that adeno-acanthoma, which is characterized by two-component composition, distinguished itself by certain variability of the structure. The plano-epithelial component present in the tumour of the glandular structures may be of a different degree of maturation, may have the structure of planocellular cancer, or may have no signs of atypia. Basing on their own findings and data reported in the literature the authors come to the conclusion that adeno-acanthomas depending on their structures should be referred to differently: adeno-acanthoma and adenosquamous cancer. It is possible that morphological differences in the histological structure of adeno-acanthoma are of significance in the clinical course of the disease.

[New TNM classification of cancer of the upper respiratory and digestive tracts]. / Nowa klasyfikacja TNM dla raka w górnym odcinku drogi oddechowej i pokarmowej.

The modified TNM classification of cancers in oral cavity, pharynx, larynx, maxillary sinuses was described. This classification was introduced in 1987 in agreement with UICC and AJCC. The criteria of classification were discussed.

[Remarks concerning up to date TNM staging of cancer localized in lip and oral cavity, pharynx, nasal cavity and paranasal sinuses, and major salivary glands]. / Uwagi dotyczace aktualnej klasyfikacji TNM dla raka wargi i jamy ustnej, gardla, krtani, jamy nosa i zatok przynosowych oraz duzych gruczolów slinowych.

The general principles and historical background of TNM classification was briefly discussed, with advantages as well as weakness and limitations of the system. The current TNM staging of lip and oral cavity, pharynx. The currant TNM staging of carcinoma in lip and oral cavity, pharynx, larynx, nasal cavity and paranasal sinuses and major salivary glands was presented, pointing out the last changes in the classification.

Diagnostic utility of narrow-band imaging endoscopy for pharyngeal superficial carcinoma.

AIM: To investigate the endoscopic features of pharyngeal superficial carcinoma and evaluate the utility of narrow-band imaging (NBI) for this disease. METHODS: In the present prospective study, 335 patients underwent conventional white light (CWL) endoscopy and non-magnified/magnified NBI endoscopy, followed by an endoscopic biopsy, for 445 superficial lesions in the oropharynx and hypopharynx. The macroscopic appearance of superficial lesions was categorized as either elevated (< 5 mm in height), flat, or depressed (not ulcerous). Superficial carcinoma (SC) was defined as a superficial lesion showing high-grade dysplasia or squamous cell carcinoma on histology. The color, delineation, and macroscopic appearances of the lesions were evaluated by CWL endoscopy. The ratio of the brownish area/intervascular brownish epithelium (IBE), as well as microvascular proliferation, dilation, and irregularities, was determined by non-magnified/magnified NBI endoscopy. An experienced pathologist who was unaware of the endoscopic findings made the histological diagnoses. By comparing endoscopic findings with histology, we determined the endoscopic features of SC and evaluated the diagnostic utility of NBI. RESULTS: The 445 lesions were divided histologically into two groups: a non-SC group, including non-neoplasia and low-grade dysplasia cases, and an SC group. Of the 445 lesions examined, 333 were classified as non-SC and 112 were classified as SC. There were no significant differences in age, gender, or the location of the lesions between the patients in the two groups. The mean diameter of the SC lesions was significantly greater than that of non-SC lesions (11.0 ± 7.6 mm vs 4.6 ± 3.6 mm, respectively, P < 0.001). Comparisons of CWL endoscopy findings for SC and non-SC lesions by univariate analysis revealed that the incidence of redness (72% vs 41%, respectively, P < 0.001) and a flat or depressed type of lesion (58% vs 44%, respectively, P = 0.013) was significantly higher in the SC group. Using non-magnified NBI endoscopy, the incidence of a brownish area was significantly higher for SC lesions (79% vs 57%, respectively, P < 0.001). On magnified NBI endoscopy, the incidence of IBE (68% vs 33%, P < 0.001) and microvascular proliferation (82% vs 51%, P < 0.001), dilation (90% vs 76%, P = 0.002), and irregularity (82% vs 31%, P < 0.001) was also significantly higher for the SC compared with the non-SC lesions. Multivariate analysis revealed that the incidence of redness (P = 0.022) on CWL endoscopy and IBE (P < 0.001) and microvascular irregularities (P < 0.001) on magnified NBI endoscopy was significantly higher in SC than non-SC lesions. Redness alone exhibited significantly higher sensitivity and significantly lower specificity for the diagnosis of SC compared with redness plus IBE and microvascular irregularities (72% vs 52%, P = 0.002; and 59% vs 92%, P < 0.001, respectively). The accuracy of redness plus IBE and irregularities for the diagnosis of SC was significantly greater than using redness alone (82% vs 62%, respectively, P < 0.001). CONCLUSION: Redness, IBE, and microvascular irregularities appear to be closely related to SC lesions. Magnified NBI endoscopy may increase the diagnostic accuracy of CWL endoscopy for SC.