Management of the Neck in Well-Differentiated Thyroid Cancer.

PURPOSE OF REVIEW: In this narrative review, we discuss the indications for elective and therapeutic neck dissections and the postoperative surveillance and treatment options for recurrent nodal disease in patients with well-differentiated thyroid cancer. RECENT FINDINGS: Increased availability of advanced imaging modalities has led to an increased detection rate of previously occult nodal disease in thyroid cancer. Nodal metastases are more common in young patients, large primary tumors, specific genotypes, and certain histological types. While clinically evident nodal disease in the lateral neck compartments has a significant oncological impact, particularly in the older age group, microscopic metastases to the central or the lateral neck in well-differentiated thyroid cancer do not significantly affect outcome. As patients with clinically evident nodal disease are associated with worse outcomes, they should be treated surgically in order to reduce rates of regional recurrence and improve survival. The benefit of elective neck dissection remains unverified as the impact of microscopic disease on outcomes is not significant.

Periorbital emphysema after dive barotrauma without radiological evidence of paranasal sinus injury.

BACKGROUND: Scuba diving has increased in popularity since its invention in 1943, with over 21 million PADI registered members worldwide. Injuries to the paranasal sinuses caused by barotrauma are the second most common after injury to the middle ear. CASE REPORT: In this paper we present a case of unilateral periorbital surgical emphysema in a 23-yr-old male commercial scuba diver with minimal symptoms following an uneventful 13-ft (4-m) dive. The only symptoms experienced were pain and pressure over the right maxillary sinus and retrorbitally. Imaging with computed tomography showed no fracture of his paranasal sinuses. DISCUSSION: The authors recommend that a high index of suspicion for paranasal sinus barotrauma should be maintained in all patients reporting minor symptoms after diving (even to shallow depths) to facilitate rapid clinical diagnosis and prompt medical management.

Parotid gland keratocystoma: a rare diagnosis of a neck lump.

Keratocystoma of the parotid gland is a rare benign tumour, with only a handful of case reports in literature. We report a case of a man in his 70s who presented to the head and neck clinic with a 2-month history of a gradually increasing left neck swelling. Fine-needle aspiration showed contents of an epidermal cyst; however, an MRI showed a solid/cystic mass with a low T2 signal, suggesting increased risk of malignancy. The patient went on to have a left superficial parotidectomy and level IIa supraselective neck dissection. The lesion contained laminated keratin and was lined by squamous epithelium, with nodal extension. Features were those of a keratocystoma; metastatic cystic well-differentiated squamous cell carcinoma was not favoured. This is the first reported case of a parotid keratocystoma with nodal extension of the lesion. This case report demonstrates that surgical excision and clinical monitoring can be a safe management strategy for these benign tumours.

Anterior Skull Base Sarcomas: Report of Characteristics and Outcomes at a Tertiary Care Cancer Center.

Objective This study was aimed to describe our institutional experience on characteristics and treatment outcomes of sinonasal sarcomas invading the anterior skull base. Design Present study is a retrospective review. Setting The study was conducted at an academic cancer care center. Participants Thirty-one patients with skull base sarcomas treated with primary surgery from 1979 to 2015 were identified for this study from a preexisting database. Main Outcome Measures Survival and recurrence outcomes using the Kaplan-Meier method were the focus areas of the study. Results The median age was 44 years (range: 13-69 years). Twenty patients were male (64.5%). Twenty-nine patients underwent open craniofacial resection (93.5%) and two patients underwent endoscopic resection (6.5%). The majority of tumors were staged pT4 (77.4%). The most common pathologies were leiomyosarcoma (19.4%), osteosarcoma (16.1%), and chondrosarcoma (12.9%). Of those with known margin status, 10 patients had positive/close margins (32.2%) and 16 patients had negative margins (51.6%). Most tumors were high grade (74.2%). Twenty-three patients (74.2%) received adjuvant radiation and four patients (12.9%) received adjuvant chemotherapy. There were nine postoperative complications (29%) including one mortality and three cerebrospinal fluid leaks. There were 10 local, 2 regional, and 5 distant recurrences over a median follow-up of 74 months (range: 1-300 months). The 5-year disease-specific survival (DSS) was 69.8%. The 5-year locoregional recurrence-free probability (RFP) was 63.2% and the 10-year distant RFP was 71.7%. The 5-year DSS for high grade tumors was 64.2 and 85.7% for low grade tumors ( p = 0.117). Conclusion This study contributes an updated analysis of anterior skull base sarcomas. Five-year DSS is approximately 70%. Analysis of survival outcomes based on grade, tumor size, and other factors is limited by small sample size and the rarity of these tumors.

Mumps presenting with unilateral, synchronous parotid and submandibular gland swelling.

A previously healthy 22-year-old woman presented with acute, unilateral facial and neck swelling, associated with fever and malaise. She was initially treated with intravenous antibiotics; however, CT imaging showed unilateral, synchronous swelling and inflammation of the parotid and submandibular glands, and a PCR swab from the parotid duct was positive for mumps. She was fully immunised and had no contact in the preceding period with anyone diagnosed with mumps. She responded to supportive management and her symptoms resolved over the course of her admission. Unilateral, synchronous swelling and severe inflammation of both the parotid and submandibular glands in mumps is a very unusual presentation, and not one previously reported in the literature.

When dizziness becomes sinister: oropharyngeal carcinoma presenting as a paraneoplastic neurological disorder.

Paraneoplastic neurological disorders are uncommon presentations of head and neck cancers. We present a case of a 68-year-old male patient who presented with dizziness, nausea and memory problems. MRI of his brain showed bilateral cerebellar leptomeningeal enhancing signal abnormality with cervical lymphadenopathy. CT imaging of his neck raised the suspicion of a tonsillar primary, which was later confirmed on biopsy. His poorly differentiated HPV positive squamous cell carcinoma was treated with chemoradiotherapy. Subsequent MRI imaging showed progressive cerebellar atrophy and his presenting symptoms persisted, but he remained disease free 6 months post-treatment for his primary malignancy.

Ultrasonographic assessment of tonsillar volume in children.

OBJECTIVES: Adenotonsillar hypertrophy in children is the most common anatomical abnormality associated with obstructive sleep apnoea. Perioperative complications associated with adenotonsillectomy are more common in children with severe obstructive sleep apnoea. An objective preoperative method to determine the size of tonsils is missing. This study assessed the validity of ultrasound as a tool for measuring tonsillar size in children. METHODS: Single-institution prospective study of twenty-six children aged 2-6 years who underwent elective bilateral tonsillectomy. Trans-cervical ultrasonographic assessment of tonsillar size prior to tonsillectomy operation was performed. We assessed correlation of ultrasonographic and actual tonsillar volume. RESULTS: A total of 52 tonsils from 26 patients were measured. Actual and ultrasonographic mean tonsillar volume (±SD) was 3.9 (±2.1) ml and 3.6 (±2.5) ml, respectively (P = 0.24). Ultrasonographic and actual measurements correlated well (r = 0.89). CONCLUSIONS: This is the first study to show that ultrasound is a suitable objective method for determining tonsillar volume in paediatric patients. Preoperative ultrasound assessment of tonsillar anatomy and size may be an additional and suitable, objective method in the development of a risk stratification system in children with obstructive sleep apnoea undergoing tonsillar surgery.

Sinonasal glomangiopericytoma: Is anything new?

More than 100 cases of sinonasal hemangiopericytoma have been reported in the literature, but only a handful of cases of nasal glomangiopericytoma. In this article, we report a case of a nasal glomangiopericytoma that was treated with endonasal surgical excision. We also attempt to clarify the confusion that attends to the nomenclature surrounding the terms glomangiopericytoma and hemangiopericytoma, which are often used interchangeably. Although glomangiopericytomas are histologically similar to sinonasal hemangiopericytomas, they sometimes behave in a different clinical manner. To further enhance our understanding of nasal glomangiopericytomas, more cases need to be reported. This may improve our ability to establish specific treatment modalities for this type of neoplasm and to predict clinical outcomes.

Idiopathic pseudoaneurysm: a rare cause of parotid mass.

A 77-year-old woman presented with a pulsatile blue-tinged mass over the left parotid, present for 5 years, and slowly enlarging. The size of the mass fluctuated during this period and there was no associated pain. The patient reported no history of surgery or trauma. Vascular lesions are rarely encountered within parotid glands in adults. MRI with contrast demonstrated a soft tissue lesion; despite the presence of feeding vessels it was thought unlikely to be an arterial venous malformation or aneurysmal change. The appearance was thought to be in keeping with an enlarged lymph node or sebaceous cyst. Fine-needle aspiration was obtained using ultrasound guidance and yielded bloody fluid. The lesion was closely related to the superficial temporal artery and a diagnosis of a thrombosed pseudoaneurysm was made. The vessel had thrombosed and the decision was made to enact a watchful waiting policy. The patient will be monitored in the outpatient setting.

Validity and reliability of the Greek version of the Quebec Back Pain Disability Scale.

OBJECTIVES: Low back pain is related to functional status and possible resulting disability. The Quebec Back Pain Disability Scale (QBPDS) has been used widely to evaluate functional disability in patients with low back pain. The purpose of this study was to assess: (a) the face and content validity, (b) the factor structure, (c) the concurrent validity, (d) the discriminant validity, (e) the internal consistency and the test-retest reliability (ICC) of the Greek version of the QBPDS. METHODS: One hundred and sixty patients with low back pain participated in the study. Face and content validity of the translated QBPDS were first investigated and afterwards exploratory factor analysis (EFA) was chosen to examine the factor structure of it. The concurrent and discriminant validity of the QBPDS was also assessed by a number of valid constructs. Finally, Cronbach α and Pearson r (ICC) were used to investigate the reliability of the instrument. RESULTS: The face and content validity of the QBPDS were supported and the EFA confirmed the sixth initial factor structure of the instrument. The concurrent and discriminant validity of it was confirmed by examining correlations between the QBPDS with other constructs. The Cronbach a and the ICCs indices of the instrument were acceptable. CONCLUSION: The Greek translation of the QBPDS provided reliable and valid instrument for the evaluation of Greek patients with low back pain.