The development and design of the European Board of Otorhinolaryngology-Head and Neck Surgery Examination (EBEORL-HNS).

The UEMS Otorhinolaryngology-Head and Neck Surgery section is a dedicated body formed to promote the standardisation and harmonisation of European Otorhinolaryngology (ORL). The European Examination Board of Otorhinolaryngology and Head and Neck Surgery was created to establish a supranational final exam and accreditation for ORL Surgeons. It is open to candidates both from the European Union and outside the EU. The exam is composed of a written examination to assess mainly the theoretical knowledge of Otorhinolaryngological diseases. The second part, a viva voce examination, is designed to test the clinical application of knowledge based on case scenarios and clinical conditions presented to the candidates. The inaugural examination written component took place in Mannheim/Germany in 2009 and the inaugural Viva Voce examination in Vienna/Austria in 2010. Up to and including the year 2013, 858 participants have attempted one of the two exam components. Of the 858 participants, 305 were successful in both examinations and obtained the accreditation of the European Diploma (European Board Certification). The historical origins, development of the examination, its formal arrangements and the format of the examination are presented in this article.

[Epidemiological and clinical characteristics of 705 salivary glands neoplasms]. / Charakterystyka epidemiologiczno-kliniczna 705 nowotworów gruczolów slinowych.

UNLABELLED: The epidemiological data concerning the rare group of tumors derived from salivary glands recorded in the National Cancer Registry is insufficient because it records only malignant salivary glands tumors. AIMS OF THE STUDY: The epidemiological and clinical characteristics of 699 patients with salivary glands tumors (n=705). MATERIAL: The data were retrieved from ENT Department District Hospital in Kielce (01.09.1989-28.02.2001) and from Department of Otolaryngology Head and Neck Surgery Holy Cross Cancer Centre in Kielce (01.03.2001-31.12.2008). RESULTS AND CONCLUSIONS: In the analyzed group of 699 patients with 705 salivary glands tumors women predominated, consisting 54,2% of all group. The average age in group of malignant tumors was higher than in nonmalignant group. The risk of malignant neoplasms development increased with patient age. In the analyzed group of 705 salivary glands tumors the nonmalignant neoplasms dominated-78,3%. Out of all cases, 547 (77,6%) were localized in the parotid gland, 80 (11,3%) in submandibular gland and 78 (11,1%) in minor salivary glands. Nonmalignant tumors were more frequent in the parotid gland (82,8%) and submandibular gland (71,3%), whereas in minor salivary glands nonmalignant and malignant neoplasms the occurrence was nearly the same. In general-the smaller the salivary gland, the risk of development malignant tumors was higher. In group of nonmalignant salivary gland tumors two histopathological types dominated - pleomorphic adenoma and Warthin's tumor, which comprised 91,8% of the whole group. In the group of 153 malignant salivary gland tumors the most common histopathology were - adenoid cystic carcinoma, mucoepidermoid carcinoma and adenocarcinoma. In the analyzed period of 20 years' time, the incidence of salivary glands tumors increased with high siginificance, both for nonmalignant, as well malignant tumors.

[Recurrence of cancer of the paranasal sinuses after primary treatment--analysis of conditions and results of salvage treatment]. / Wznowy po leczeniu raka masywu szczekowo-sitowego--ocena uwarunkowan i wyników leczenia ratunkowego.

THE AIM OF THIS STUDY: is to demonstrate epidemiological and clinical parameters of the group of patients with sinonasal malignancies and to analyze its impact on development of recurrences after primary surgical treatment conducted in Head and Neck Surgery Department of Holly Cross Cancer Center Kielce during 7-years period 2001-2007. The retrospective analysis of the group of 42 patients with sinonasal malignancies was made, based on medical record and outpatient follow-up, considering: age, sex, primary focus, histological outcome, local and clinical stage and methods of the therapy. In the group of patients with at least 3-years period of follow-up (n=42) the dependence the rate of oncological failures such as local recurrence, nodal metastases, distant metastases or the second primary focus on clinical and epidemiological factors was analyzed. The probability of survival rate was also estimated. The studied group consists of 42 patients (27M, 15K, M:K = 1.8:1). Age ranged from 28 to 87. The most common localization was maxillary sinus--59.5%. Patients with high local (T3, T4) and clinical (III, IV) stage constitute 77.5% of the studied group. In 66.7% cases the radiation therapy had to follow the surgery. In the group of 42 patients with at least 3-years period of follow-up the oncological failure appeared in 17 cases (40.5%): local recurrence (8), nodal metastases (7), distant metastases (1) and all of them in 1 case. The treatment was performed through: local recurrence (surgery in 2 cases, CHTH--3, symptomatic treatment--3), nodal metastases (RND--3, SND--4, supplementary radiotherapy--7), distant metastases--CHTH--2 cases. Thanks to these procedures the 5-year survival rate is 23.1% and the 3-year survival rate is 29.4%. CONCLUSIONS: (1) The oncological failure after primary surgical treatment in the group of patients with sinonasal malignancies developed in 40.5% cases, mainly as local recurrence or nodal metastases. (2) Primary localization and sex have no impact on the rate of the recurrence. (3) The oncological failures significantly more often relate to young patients with high local, clinical stage and low grade of malignancies. (4) The recurrence after primary surgical treatment in the group of patients with sinonasal malignancies substantially reduces 3- and 5-year survival rate (29.4%; 23.1%) compared with the entire studied group--54.8%; 40.0%.

Comorbidity in head and neck cancer: a critical appraisal and recommendations for practice.

Comorbidity, the presence of additional illnesses unrelated to the tumor, has a significant impact on the prognosis of patients with head and neck cancer. In these patients, tobacco and alcohol abuse contributes greatly to comorbidity. Several instruments have been used to quantify comorbidity including Adult Comorbidity Evaluation 27 (ACE 27), Charlson Index (CI) and Cumulative Illness Rating Scale. The ACE 27 and CI are the most frequently used indices. Information on comorbidity at the time of diagnosis can be abstracted from patient records. Self-reporting is less reliable than record review. Functional status is not a reliable substitute for comorbidity evaluation as a prognostic measure. Severity as well as the presence of a condition is required for a good predictive instrument. Comorbidity increases mortality in patients with head and neck cancer, and this effect is greater in the early years following treatment. In addition to reducing overall survival, many studies have shown that comorbidity influences disease-specific survival negatively, most likely because patients with high comorbidity tend to have delay in diagnosis, often presenting with advanced stage tumors, and the comorbidity may also prompt less aggressive treatment. The impact of comorbidity on survival is greater in younger than in older patients, although it affects both. For specific tumor sites, comorbidity has been shown to negatively influence prognosis in oral, oropharyngeal, laryngeal and salivary gland tumors. Several studies have reported higher incidence and increased severity of treatment complications in patients with high comorbidity burden. Studies have demonstrated a negative impact of comorbidity on quality of life, and increased cost of treatment with higher degree of comorbidity. Our review of the literature suggests that routine collection of comorbidity data will be important in the analysis of survival, quality of life and functional outcomes after treatment as comorbidity has an impact on all of the above. These data should be integrated with tumor-specific staging systems in order to develop better instruments for prognostication, as well as comparing results of different treatment regimens and institutions.

[Pharyngeal constrictor muscles closure after total laryngectomy is that really beneficial?]. / Czy zszywanie zwieracza gardla dolnego po laryngektomii calkowitej jest korzystne?

UNLABELLED: High pressure of pharyngo-esophageal segment is the most important factor of impaired development of alaryngeal speech (esophageal speech, tracheoesophageal speech) after total laryngectomy. To prevent pharyngo-esophageal spasm in Department of Otolaryngology in Szczecin are used: pharyngoesophageal plastic surgery with interposition of vascular thyroid flap, two-layer (only mucosa) non-muscular pharyngeal closure and tree-layer closure (mucosa and muscle layer leaving inferior pharyngeal constrictor unsutured). AIM OF STUDY: The aim of this study was to compare the pharyngo-esophageal pressure between patients after pharyngo-esophageal plastic surgery and following the non-muscular pharyngeal closure. MATERIAL AND METHODS: One hundred eighty two subjects after total laryngectomy were enrolled in this study, and included 108 patients subjected to the pharyngo-esophageal plastic surgery, 44 patients who underwent the two-layer pharyngeal closure, and 30 patients with the tree-layer closure. To evaluate the pharyngo-esophageal pressures manometric tests were performed, and to asses the pharynx morphology videopharyngoscopy was used. RESULTS: The average pharyngo-esophageal pressure in the group after the pharyngo-esophageal plastic surgery was 32 (min.-5, max. 50) mmHg. After the two-layer non-muscular pharyngeal closure mean pressure was 35 (min.-17, max.-40) mmHg, and after the tree-layer non-muscular pharyngeal closure the average pressure was 22,42 (min. 5, max. 40) mmHg. The average pharyngo-esophageal pressure was significantly lower (p < 0.01) among patients after the tree-layer non-muscular closure. CONCLUSION: The study suggests that the tree-layer non-muscular pharyngeal closure with inferior pharyngeal constrictor unsutured is the preferable method to prevent pharyngo-esophageal spasm after total laryngectomy. However, the efficacy and safety of this surgical procedure should be explored in further multicenter studies.

The effect of a Heat and Moisture Exchanger (Provox HME) on pulmonary protection after total laryngectomy: a randomized controlled study.

The goal of this randomized controlled study was to investigate the effect of Heat and Moisture Exchanger use on pulmonary symptoms and quality of life aspects in laryngectomized patients. Eighty laryngectomized patients were included and randomized into an HME and Control group. The effect of the HME was evaluated by means of Tally Sheets and Structured Questionnaires. The results showed a significant decrease in the frequency of coughing, forced expectoration, and stoma cleaning in the HME group. There were trends for the prosthetic speakers to report more fluent speech with the HME and for the HME group to report fewer sleeping problems. In conclusion, this study, performed in Poland, confirms the results of previous studies performed in other countries, showing that pulmonary symptoms decrease significantly with HME use and that related aspects such as speech and sleeping tend to improve, regardless of country or climate.

[The metastases to the head and neck region from distant primary localization]. / Przerzuty do regionu glowy i szyi z odleglych nowotworów zlosliwych.

INTRODUCTION: Distant metastases to the head and neck region, with primary tumor located outside the head and neck, presents often a diagnostic problems, especially when metastases are an exclusive signs and symptoms of the disease. In most of this cases there is no chance for curative therapy, and optimum palliation is the goal of the treatment. AIM: The description and analysis of clinical and prognostic factors, which could establish the optimum diagnostic formula, and predict the prognosis in distant metastases to the head and neck region. MATERIAL AND METHODS: The study of 44 cases diagnoses and treated in 2001-2006 in Dept. ORL H&N Surgery. The analysis was based on current observations and case records documentation. RESULTS/CONCLUSIONS: In the most of cases (39/44) the distant metastases to the head and neck regions presented a part of generalized malignant neoplastic disease, but in 14/44 cases that was a first warning symptom. All of this 14/44 cases presented as a metastases to the IV and V lymph nodes region. The most common primary sides were found in the lung. The average survival within the analyzed group was only 7,2 months.

[Plasmocytoma in the nasal cavity and paranasal sinuses]. / Szpiczak plazmocytowy w obrebie jam nosa i zatok przynosowych.

INTRODUCTION: Plasma cell myeloma is a monoclonal neoplastic growth of plasmocytes--classified to a large group of B cell lymphomas. In the majority of cases plasma cell myeloma manifest as a generalized neoplastic disease localized in the bones. Only ca 10% of cases represent a isolated growth within the lymph nodes, skin or mucosa. The most common localization of extramedullary plasmocytoma is a mucosa of the nasal cavity and paranasal sinuses. The rest of myelomas within the nose and sinuses are in fact only one of mulitiple focuses, within a bone frame of the nose and sinuses. MATERIAL: Case reports of three cases of plasma cell myeloma localised within the nose and paranasal sinuses; diagnosed and treated in Holy Cross Cancer Center- Kielce, Poland, from 2001 to 2008. METHODS: The retrospective analysis and current follow up of cases presented. CASES PRESENTATION: Case I-- Male 49 years old--Extramedullary plasmocytoma localized in mucosa of the floor of nasal cavity. Treated with radical Rtg-therapy. Alive 57 months with symptoms of the disease. Case II--Male 42 years old--Multiple myeloma with one of focuses in anterior wall of maxillary sinus. Treated with radical Rtg-therapy and Chemotherapy. Died due to the primary disease in 2 months. Case III--Male 29 years old--Multiple myeloma with one of the focuses in posterior wall of maxillary sinus. Treated with radical Rtg-therapy and Chemotherapy. Died due to the primary diseases in 16 months. CONCLUSIONS: (1) Plasma cell myelomas in the nose and paranasal sinuses region are a rare tumors. They may manifest as an isolated form of plasmocytoma, or a generalized disease as a one of focuses in the bone frame of the nose and sinuses or one of the focuses outside the bone. (2) The complex diagnosis and treatment of plasma cell myelomas require a multispecialistic approach, and should be conducted in oncological centers. (3) The ceases presented confirm, that a generalized myelomas usually have a bad prognosis. In isolated form of plasmocytoma the long remissions or cure may be expected.

[Metastases to the parotid gland and parotid region]. / Przerzuty nowotworów zlosliwych do slinianki przyusznej i regionu przyusznicy.

INTRODUCTION: Among the malignant tumors found within the parotid gland, the primary tumors, as well as a metastatic tumors may be found. AIM: Epidemiological and clinical characteristic, and preliminary assessment of treatment results of metastatic tumors to the parotid gland and the parotid region. MATERIAL AND METHODS: The retrospective analysis of 60 cases with metastatic tumors to the parotid gland and parotid region, selected from the material of Dept. ORL H&N Surg. Holy Cross Cancer Center in Kielce - Poland (2001-2008), with the analysis of age, sex, localization and histopathology of primary tumor, stage according to O'Brien classification, diagnostic methods and treatment modalities, and analysis of 3 and 5 years survival. RESULTS: In the analyzed group of 60 patients (35M + 25F), in the age ranging from 31 to 92 years (mean age 73,5), the most common primary localization of metastatic tumor was skin of the head and neck (Squamous Cell Ca - 41,6%; Malignant Melanoma 25,0%). The therapy with radical intention was applied in 75,0% of patients treated, mostly combined surgery and radiotherapy. 25,0% of patients received symptomatic and palliative treatment only. In the group with 3 (17 cases) and 5 years (6 cases) of observation accordingly, 53,1% and 33,3% total survival was achieved. CONCLUSIONS: The most common primary localization of metastases to the parotid region are Squamous Cell Carcinoma and Malignant Melanoma of the head and neck skin. Metastases to the parotid gland and region are usually diagnosed in the advanced local stage of the disease. The treatment of choice in mentioned above metastases are surgery followed by radiotherapy. The unfavorable prognosis of metastatic tumors to the parotid gland and parotid region may be improved, with systematic follow up of the patients with the skin cancer.

Pleomorphic adenoma of salivary glands does not appear to be a BRCA-1-dependent tumour in a Polish cohort.

BACKGROUND: The aim of the study was to examine whether pleomorphic adenoma of salivary glands can occur on the basis of constitutional BRCA-1 mutations. MATERIALS AND METHODS: Two hundred and sixty-eight patients affected by mixed tumour of salivary glands were examined for occurrence of three BRCA-1 mutations dominating in Poland. RESULTS: BRCA-1 mutation was detected in only one of the patients, a female affected by breast cancer and pleomorphic adenoma of parotid gland. Parotid gland tumour showed clinical and histopathological features of typical pleomorphic adenoma with no morphological features of high-grade malignancy, which are characteristic of BRCA-1-dependent tumours. CONCLUSION: Considering the low frequency of BRCA-1 mutation in the examined group and also the absence of features characterizing BRCA-1-dependent tumours in the only BRCA-1-positive case, pleomorphic adenoma of salivary glands should not be recognized as a BRCA-1 dependent tumour.

[Distant metastases to nasal cavities and paranasal sinuses, from the organs outside the head and neck]. / Przerzuty nowotworowe do jam nosa i zatok przynosowych z narzadów odleglych.

INTRODUCTION: The metastases from below the clavicles, to the head and neck region, are relatively uncommon, and usually demonstrate during the progression of the primary disease. At that time, the correct diagnosis requires only to compare the pathology report from the primary biopsy, with the biopsy from the lump in the head and neck. The majority of distant metastases to the head and neck region are localized within the lymph nodes. The metastases to nasal cavity and paranasal sinuses are very rare and usually localized within the maxillary sinus. MATERIAL: 4 cases, out of 46 all distant metastases to the head and neck region, localized in the nasal cavity and paranasal sinuses, diagnosed and treated in Dept. of ORL H&N surgery, Holy Cross Cancer Centre, from 2001 to 2007. METHODS: Case presentation, based on clinical documentation, and current follow up. Case I. F. 71 years; the metastasis of colonic carcinoma to the sphenoid sinus as a first symptom of the disease). The palliative Rtg-therapy was applied, and patient died in 2 months after diagnosis was established. Case II. M. 69 y with metastasis of kidney cancer (Ca clarocellulare) to the nasal cavity, during a palliative stage of the disease due to multiple lung metastases. Patient was treated with multiple courses of chemotherapy due to generalization of the disease. The nasal cavity metastasis was treated with repeated local resections. At present with no metastasis within the head and neck region--alive, in relatively good condition, with 23 months of observation. Cases III. F. 50 years in palliative stage of the breast cancer, with metastases to the bones and hepar and with metastasis to the maxillary sinus. Received palliative Rtg. therapy on the region of metastasis. Died in 5 months after diagnosis of maxillary sinus metastasis. Case IV. F. 54 years in palliative stage of the colonic cancer, with multiple metastases to the lungs and hepar; with metastasis to the maxillary sinus. During hemotherapy a symptoms of tumor of the maxillary sinus appeared, confirmed as a metastasis. The palliative Rtg-therapy on the region of metastasis. Died in 18 months, after diagnosis of maxillary sinus metastasis. CONCLUSIONS: The prognosis of metastases from distant organs, to the nasal cavity and paranasal sinuses is miserable. In the majority of distant metastases to the nose and paranasal sinuses, the palliative therapy is the only possible option of treatment.

[Epidemiology and clinical characteristics of the sinonasal malignancies]. / Nowotwory zlosliwe jam nosa i zatok przynosowych w materiale wlasnym--charakterystyka epidemiologiczna i kliniczna.

INTRODUCTION: Sinonasal malignances (SNM) usually present as a difficult diagnostic and therapeutic problem. In the paper presented, the epidemiological and clinical characteristics of SNM, diagnosed in Holy Cross Cancer Center in Kielce (Dept. of Otolaryngology, Head and Neck Surgery), from 2001 to 2007, as well as a calculated survival rates are discussed. MATERIAL AND METHODS: From the hospital data and current clinical observations of 87 patients with SNM the age, sex, localization, stage of the disease, pathology and treatment applied, was taken for analysis. In cases with at least 3 year observation, the Kaplan-Meier survival curves were calculated. Results. In the analyzed group of 87 cases, ranging from 8 to 82 years of age (average 62.3 years), there was 48 male, and 39 female patients (M:F = 1.2:1). 59.8% of all group was in the age above 60 years, with the most common age group 71-80 years (33.3%). The most common defined localization was a maxillary sinus (33.3%), but due to very advanced stage at time of diagnosis in 37.9% of cases, the precise localization within the region was not possible to define. The primary epithelial tumors were diagnosed in 52.9% (n=46), of all SNM, the non epithelial malignant tumors in 42.5% (n=37), and metastatic tumors to the nose and paranasal sinuses in 4.6% (n=4). In the group of epithelial SNM the Squamous cell carcinoma dominated (26/46-56.5%), and in the non epithelial SNM the most common group was a malignant lymphoma (10/37-27.0%). At time of diagnosis the majority of patients with epithelial SNM (80.4%) presented with advanced local stage of the disease (T3+T4a+T4b). The combined modality treatment was applied in the most of patients in the analyzed group (79.3%). The probability of 3 years disease free survival, calculated with Kaplan-Meier method was 64.0%, and 5-years survival--45.0%. CONCLUSIONS: (1) The SNM present as a very heterogeneous group of tumors. (2) The most common SNM are a Squamous cell carcinoma, and malignant lymphoma. (3) The majority of SNM are diagnosed at then advanced stage of local disease. (4) The calculated probability of 3-years survival was 64.0%, and 5-years survival 45.0%. (5) The diagnostic, as well as therapeutic approach to SNM requires a multidisciplinary cooperation.

[The epidemiology and clinical characteristics of malignant melanoma localized in nasal cavity and paranasal sinuses--analysis of 6 cases]. / Obraz epidemiologiczny i kliniczny czerniaka zlosliwego jam nosa i zatok przynosowych--analiza 6 przypadków.

INTRODUCTION: The mucosal malignant melanoma (MM), represent a rare group of tumors (0.2%--8% of all MM), with predominant localization on the mucosal surface of head and neck region, where the localization on the mucosa of nasal cavity, paranasal sinuses and oral cavity are the most common. The mucosal MM within the nose and paranasal sinuses represent approximately 4% of all malignant tumors in these localizations, affecting predominantly the age group over 60-es, equally in both sexes. The treatment of choice in mucosal MM is surgery followed by Rtg-therapy in cases of small or doubtful margins of resection. The prognosis of mucosal MM is poor with 8% to 30% of 5-years survival. MATERIALS AND METHODS: 6 cases of mucosal MM, selected from 72 of all MM in the head and neck region, diagnosed and treated from 2001 to 2007 in Dept. of ORL H&N Surgery, Holy Cross Cancer Center in Kielce. RESULTS: In group of mucosal MM which was taken to analysis there was 5 female and 1 male patient, with range of age from 55 to 80 (mean--69.4) with following localization: nasal septum--2 cases; lateral wall of nasal cavity--2; and paranasal sinuses--2. In 1 case an extremely rare pathologic form of amelanotic MM was diagnosed. The surgical resection of tumor followed by Rtg-therapy was performer in 4 cases. In 1 case, the radical surgery was the only method of treatment, and in 1 case the palliative Rtg-therapy was only applied. Within the observation period (4-96 months) 3 patients died, all due to the fatal progression of the MM. CONCLUSIONS: (1) Mucosal MM localized in the nasal cavity and paranasal sinuses, present a very rare, but highly diversified group of malignant tumors. (2) The surgery, followed by Rtg-therapy is still the treatment method of choice. (3) The prognosis of mucosal MM in the nose and paranasal sinuses is bad.

History of voice rehabilitation following laryngectomy.

INTRODUCTION: The history of voice rehabilitation following laryngectomy is as long as the history of laryngectomy itself. The multitude of methods which have been employed to reduce the disability associated with the loss of the larynx, illustrate the difficulty of finding an optimal method of reestablishing verbal communication while preserving the ability to breathe and swallow. MATERIAL AND METHODS: The world literature was reviewed using various Internet and medical search engines and library facilities. Landmark articles were identified and summarized. RESULTS: A coherent history of voice rehabilitation following laryngectomy was constructed. DISCUSSION: The methods employed to reestablish voice after extirpation of the larynx may be grouped into the categories of: esophageal speech, surgical methods of creating competent tracheo-pharyngeal shunts to create lung powered voice with and without the use of prosthetic devices to prevent aspiration, "near-total" resection of the larynx with dynamic phonatory shunt, and the use of external pneumatic or electrical devices to create sound which is then transmitted through the oral cavity and pharynx. CONCLUSION: For the past two decades, simple shunt devices inserted either primarily, at the time of laryngectomy, or later as a secondary procedure, have mainly supplanted the other methods of voice rehabilitation, with the exception of an occasional patient who has acquired good esophageal speech, or for whom external devices may be the only practical method of voice production.

Evolution of the epidemiology and clinical characteristics of larynx and hypopharynx carcinoma in Poland from 1991 to 2001.

A retrospective analysis was performed of 12,888 cases of larynx and hypopharynx carcinoma diagnosed in 19 ENT Departments in Poland during an 11-year period from 1991 to 2001. An assessment of basic epidemiological data, including also tumor site and disease stage at the time of diagnosis, was conducted. Epidemiological trends over the 11-year period of the analysis were examined. The average M:F proportion was 8:1, with a significant increase in the number of female patients during the analyzed period. The predominant localization of carcinoma was in the glottis (47.2%), followed by the supraglottis (40.3%) and pyriform sinus (7.8%). A significant increase in pyriform sinus tumors was observed in the analyzed period. Majority of cases (57.4%) presented with local advanced stage (T3+T4) carcinoma of the larynx and hypopharynx, with the highest rate (81.0%) for the pyriform sinus carcinomas, and with the lowest rate for glottic tumors (41.8%). Regional lymph node metastases were diagnosed in 47.7% of the analyzed cases, with the highest rate (82.2%) in cases of pyriform sinus carcinomas, and the lowest (31.7%) in glottic carcinomas. In the 11-year period, a significant drop in N0 cases and a tendency toward increased rates of N2 and N3 lymph nodes metastases cases of supraglottic carcinoma were observed. Distant metastases at the time of diagnosis were registered in 2.2% of the analyzed cases, with the highest percentage in the posterior pharyngeal wall (7.6%) and pyriform sinus (7.4%) carcinomas.

Immunohistochemical expression of androgen receptor in salivary gland cancers.

Accidental discovery of androgen receptor (AR) expression in high-grade salivary gland cancer led to evaluation of that finding. In this study we evaluated the immunohistochemical expression of AR in a series of 37 formalin-fixed, paraffin-embedded malignant salivary gland tumors using two commercially available antibodies. Nuclear immunoreactivity for AR was demonstrated in 3 of 4 salivary duct carcinomas, 2 of 7 adenocarcinomas NOS and 1 of 2 carcinoma ex pleomorphic adenoma for both antibodies. Expression of AR was evaluated semiquantatively according to Dako ER/PR pharmDx scoring guidelines. All positive cases came from male patients. There was no immunoreactivity seen in 13 adenoid cystic carcinomas, 7 mucoepidermoid carcinomas and 4 acinic cell carcinomas. The expression of AR in high-grade salivary gland cancers suggests a possible role for AR in the clinical management of these neoplasms.

[Salivary duct carcinoma--a clinicopathological analysis of five cases]. / Rak przewodowy gruczolów slinowych (salivary duct carcinoma) - charakterystyka kliniczna i patologiczna 5 przypadków.

The 5 cases of salivary duct carcinoma (SDC); very rare, but distinct group of highly malignant salivary gland tumor are presented, and difficulties with pathological and clinical diagnosis is discussed. The SDC developed in single cases in parotid salivary gland, submandibular salivary and in mucosa of maxillary sinus, pyriform fossa and oral cavity (check). In 3 cases the second malignant tumor was present--synchronously (SDC + pleomorphic adenoma in parotid gland; SDC + squamous cell carcinoma in hypopharynx) or metachroneously (squamous cell carcinoma of upper lip followed by SDC). In one case the high levels of PSA suggesting of metastases from unknown primary within the prostate gland, or PSA expression related to SDC was observed. The four patients received radical treatment - surgical resection followed by radiotherapy; in one case only palliative treatment was applied, due to patient's poor general condition and high advancement of the primary disease. The observation ranged from 10 to 77 months (average time--31 months). The one patient died 13 months after diagnosis and palliative treatment. The three patients are alive with distant metastases to the lung and bones (77, 38 and 18 months after primary treatment was completed). Only one patient with 10 months observation after treatment is living without symptoms of recurrence or metastases.

European surgeons were the first to perform neck dissection.

The history of the surgical treatment of cervical lymph node metastases began in the 19th century, and, unfortunately, the initial attempts at surgical treatment of neck metastases were disastrous. Although some European surgeons reported few cases of radical en bloc dissection, the first successful surgical procedure was performed and described in detail by Franciszek Jawdynski, a Polish surgeon, in 1888. George Washington Crile popularized and illustrated radical en bloc neck dissection in the early 20th century.