Multicentre study on resection margins in carcinoma of the oral cavity, oro-hypopharynx and larynx.

Objective: The prognostic significance of the resection margins is still subject of conflicting opinions. The purpose of this paper is to report the results of a study on the margins in carcinoma of the oral cavity, oro-hypopharynx and larynx. Methods: A multicentre prospective study was carried out between 2015 and 2018 with the participation of 10 Italian reference hospitals. The primary objective was to evaluate local control in patients with well-defined clinical characteristics and comprehensive histopathological information. Results: During the study period, 455 patients were enrolled; the minimum follow-up was 2 years. Previous treatment, grading and fresh specimen examination were identified as risk factors for local control in multivariate analysis. On the basis of these results, it seems possible to delineate "risk profiles" for different oncological outcomes. Discussion: The prognostic significance of the margins is reduced, and other risk factors emerge, which require diversified treatment and follow-up. Conclusions: Multidisciplinary treatment with adjuvant therapy, if indicated, reduces the prognostic importance of margins. Collaboration with a pathologist is an additional favourable prognostic factor and quality indicator.An appendix with literature review is present in the online version.

Conservative cricoid surgery for chondrosarcoma: a case report.

We present the case of a 39-year-old man who presented with hoarseness and progressively worsening dyspnea. Findings on laryngoscopy and computed tomography strongly suggested the presence of a chondrosarcoma. The patient underwent open surgery for removal of the lesion with wide margins. Reconstruction was carried out with two segments of costal cartilage. Laryngeal chondrosarcomas are rare, malignant, usually well-differentiated neoplasms that should be treated with conservative surgery. Recurrences should be treated more aggressively.

Staphylococcus aureus and Zygosaccharomyces bailii as primary microbial contaminants of a spoiled herbal food supplement and evaluation of their survival during shelf life.

This investigation was carried out to identify the microbiota in a spoiled commercial food supplement consisting of a syrup suspension of a mixture of dried herbs and herb extracts. The product did not contain alkyl-p-hydroxybenzoates (parabens) as preservatives, was kept at room temperature and showed abundant gas formation. Colonies of distinct morphology were recovered on bacteria- and yeast-specific media, and tested for their ability to grow in the product. Genetic differentiation and identification of the microbial contaminants were achieved by RAPD-PCR and rDNA sequence analysis. The bacteria Bacillus megaterium, Bacillus subtilis, Paenibacillus humicus, Paenibacillus glycanilyticus, Staphylococcus aureus, Staphylococcus epidermidis and the yeasts Zygosaccharomyces rouxii and Zygosaccharomyces bailii were detected. Of the two S. aureus strains isolated, one was enterotoxigenic, as indicated by the presence of five SE genes. Quantitative Real-Time PCR tests, specific for this pathogen and for Z. bailii, a microbial agent causing fermentation processes and consequent food spoilage, were carried out to quantify these microorganisms in the product and identify their source among the herbal ingredients and the fructose syrup used as sweetener. Most components appeared to be contaminated by both S. aureus and Z. bailii. These findings indicate the need to improve hygienic practices in the industrial manufacturing of the food supplement, starting with herbal ingredients, to ensure a high quality of the product.

Bilateral myoepithelioma of the nasopharynx: a case report.

Myoepithelioma is a rare salivary tumour which is usually encountered in the parotid gland. Outside the parotid, myoepithelioma may arise from minor salivary glands of the hard palate and less frequently in bronchi or breast. In this report we describe the unique case of a metachronous bilateral nasopharyngeal myoepithelioma arising from the tubaric regions. Its microscopic features, immunophenotype, and the differential diagnosis together with a review of literature are discussed.

MASPIN's prognostic role in patients with advanced head and neck carcinoma treated with primary chemotherapy (carboplatin plus vinorelbine) and radiotherapy: preliminary evidence.

CONCLUSIONS: Our very preliminary results support the hypothesis that MASPIN expression in primary head and neck squamous cell carcinoma (HNSCC) may be a valuable parameter for predicting patients' responses to a treatment based on carboplatin plus vinorelbine combined with radiotherapy. OBJECTIVES: The roles of induction chemotherapy and combined chemoradiotherapy in the treatment of locally advanced unresectable HNSCCs have evolved rapidly. MASPIN has a unique tumour-suppressing activity. Experimental evidence has shown that MASPIN suppresses tumour growth, angiogenesis, invasion and metastasis. We investigated the potential prognostic roles of MASPIN and p53 in a series of HNSCCs treated with carboplatin plus vinorelbine combined with radiotherapy. PATIENTS AND METHODS: Nineteen consecutive stage III or IV HNSCC patients were recruited. The treatment plan consisted of the administration of carboplatin on day 1 and vinorelbine on days 1 and 8. Four weeks later, carboplatin was administered concomitantly with radiation therapy. Expression of MASPIN and p53 was determined immunohistochemically in HNSCC diagnostic biopsies. RESULTS: A significant inverse relation was found between MASPIN expression and cN staging (p = 0.003). From a prognostic viewpoint, MASPIN expression was directly correlated with chemoradiotherapy response (p = 0.041). Moreover, the log-rank test showed a significant relationship between higher MASPIN expression and longer disease-free survival (p = 0.03), overall survival (p = 0.006) and disease-specific survival (p = 0.007).

MASPIN subcellular localization and expression in oral cavity squamous cell carcinoma.

MASPIN, a member of serpin superfamily, has multifaceted biological functions and an unique tumour suppressing activity. Experimental evidences showed that MASPIN suppresses tumour growth, angiogenesis, invasion and metastasis. Only a very limited number of studies considered MASPIN expression in the upper aero-digestive tract carcinomas. It was recently found that nuclear localization of MASPIN was significantly associated with lower recurrence rate and longer disease-free interval in laryngeal carcinoma. The present study investigated the biological and prognostic role of MASPIN in relation to its subcellular localization in oral carcinoma. Sub-cellular pattern of distribution of MASPIN, nuclear and cytoplasmic MASPIN expressions were immunohistochemically determined in 56 consecutive cases of oral carcinoma. Statistical analysis found a significant association between pN-stage and recurrence of disease (P=0.032) and a significantly longer disease-free interval in pN0 patients than in pN+ ones (P=0.038). None of the subcellular expressions of MASPIN was significantly correlated with recurrence of disease and disease-free interval in our series of oral carcinomas. Sixty-one percent of pN0 cases was strongly MASPIN-positive in the cytoplasm of primary carcinoma cells, 33% of the pN+ cases was MASPIN-positive in the cytoplasm. Statistical analysis found a significant association between MASPIN cytoplasmic expression and pN-stage (P=0.032). Negative MASPIN immunoreactivity in carcinoma cells cytoplasm may be useful to identify patients at risk of disease disseminating to neck lymph nodes. Further investigations are necessary to understand the biological role of cytoplasmic MASPIN localization in oral carcinoma.

Pediatric sudden sensorineural hearing loss after diving.

OBJECTIVE: Sensorineural hearing loss after diving from a low height has been rarely reported especially in children. METHODS: We present and discuss a new case of pediatric sudden sensorineural hearing loss after diving. RESULTS AND CONCLUSION: Medical and surgical approaches (indications and timing of explorative tympanotomy) to this occurrence are still controversial.

Endoglin (CD105) expression in head and neck basaloid squamous cell carcinoma.

CONCLUSIONS: This comparison of neo-angiogenesis performed by analysing CD105 expression seems to suggest that the biological behaviour of head and neck BSCCs is similar to that of site- and stage-matched conventional SCCs. OBJECTIVE: Basaloid squamous cell carcinoma (BSCC) is an uncommon, high-grade biomorphic variant of SCC with a predilection for the head and neck region. It is a matter of controversy whether the biological and clinical behaviour of BSCC is more aggressive than that of SCC. Angiogenesis is essential for tumour growth. It has been established that endothelial cells of tumour-associated neovasculature proliferate more rapidly than endothelial cells of normal tissue. Endoglin (CD105) has been shown to be a useful marker for identifying proliferating endothelium involved in tumour angiogenesis. The aim of this study was to investigate the expression of CD105 in head and neck BSCCs and to compare it with that in SCCs. MATERIAL AND METHODS: Nine head and neck BSCCs (five cases in the larynx, three in the tongue and one in the tonsil) were considered. A group of nine site- and stage-matched SCCs was examined simultaneously. For each sample, CD105 reactivity was evaluated immunohistochemically. The mean area fraction (percentage of fields occupied by vessels), the percentage of vessel-presenting fields and the vessel density were considered. RESULTS: The median values of the mean area fraction were 1.01% and 0.9% in BSCCs and SCCs, respectively. The median values of the percentage of vessel-presenting fields were 57.5% and 46.67% in BSCCs and SCCs, respectively. The median values of vessel density were 2.07% and 1.58% in BSCCs and SCCs, respectively. Statistical analysis did not disclose any significant differences between BSCCs and SCCs for any of the above-mentioned parameters.

Inverted papilloma involving the temporal bone and its association with squamous cell carcinoma: critical analysis of the literature.

Inverted papilloma is a rare, benign neoplasm, which usually originates from the lateral nasal wall and can be locally aggressive, extending into surrounding structures. Unusually, this disease involves temporal bone. There have been only 18 reported cases in the literature. The available data regarding inverted papilloma of the temporal bone are reviewed, and its etiopathogenesis, recurrence rate and association with squamous cell carcinoma are discussed.

A case of simultaneous retroauricular traumatic neuroma and arteriovenous aneurysm.

Traumatic neuroma is a well-defined clinicopathologic entity that is seldom associated with vascular neoformations. We describe the case of a patient with a postsurgical retroauricular neuroma that was associated with a coexisting arteriovenous aneurysm. We also performed an extensive immunohistologic characterization of the traumatic neuroma.

Uncommon metastatic site of renal adenocarcinoma: the oral tongue.

Primary tumours metastasizing to the tongue are very unusual and only anecdotal cases have been reported. An exhaustive literature review covering the period from 1970 onwards disclosed only 22 cases of renal adenocarcinoma metastasizing to the tongue. We report the case of an 87-year-old female patient with oral tongue, lung, liver, thyroid gland, pancreas and renal adenocarcinoma metastases. She had undergone contralateral nephrectomy for clear cell carcinoma 10 years before diagnosis of the metastases. The tongue lesion was surgically removed under local anaesthesia. Tongue metastasis of renal adenocarcinoma is usually a manifestation of widespread disease. The prognosis for patients with lingual metastasis of renal adenocarcinoma is poor, the mean interval from diagnosis of tongue metastasis to death being 5.8 months. In our patient, metastatic involvement of the tongue was detected approximately 5 months before death. Treatment of renal adenocarcinoma metastasis to the tongue is usually palliative and aims to provide patient comfort by means of pain relief and prevention of bleeding and infection. Surgical excision is recommended as the primary treatment, with emphasis on preservation of tongue structure and function. Recent data regarding immunotherapy or immunochemotherapy for metastatic renal adenocarcinoma are encouraging.

Candidal abscess of the parotid gland associated with facial nerve paralysis.

Facial nerve paralysis associated with parotid gland mass is usually caused by malignant neoplasms and facial nerve dysfunction due to parotid infection is exceedingly rare. A review of the literature revealed approximately 15 cases of facial nerve palsy associated with suppurative parotitis or parotid abscess. We report the first case of candidal abscess of the parotid gland associated with facial nerve paralysis in a 74-year-old insulin-dependent diabetic patient. The differential diagnosis in these unusual cases occurring in diabetic, immunodeficient patients should include Candida albicans infection.

Facial nerve paralysis secondary to Warthin's tumour of the parotid gland.

Facial nerve paralysis associated with a parotid gland tumour classically denotes malignancy. Only a few case reports have indicated benign parotid tumours as a cause of facial nerve palsy. We present a new case of facial nerve paralysis secondary to Warthin's tumour of the parotid gland. It is important for clinicians to be aware that, on rare occasions, facial nerve dysfunction may result from benign parotid disease.

Primary inverted papilloma of the middle ear and mastoid.

OBJECTIVE: Inverted papilloma (Schneiderian-type papilloma), involving the middle ear and mastoid as a primary lesion or as an extension of a sinonasal papilloma, is an extremely rare occurrence. STUDY DESIGN: The study design was a case report format with a review of the literature. Epidemiologic, diagnostic, therapeutic and follow-up problems are discussed. SETTING: Academic, tertiary referral hospital. PATIENT AND METHODS: The patient underwent Wullstein type I tympanoplasty and complete mastoidectomy, revealing obliteration of the pneumatic cells by polypoid tissue. The middle ear was completely filled by polypoid tissue. Histopathologic examination revealed an inverted papilloma of the middle ear and mastoid. CONCLUSION: Literature reports indicate that inverted papillomas of the middle ear and mastoid differ pathogenically and epidemiologically from sinonasal inverted papillomas. Recurrence rates and association with squamous cell carcinoma are higher in Schneiderian-type papillomas of the middle ear than in inverted papillomas of the nose and paranasal sinuses. Long-term follow-up after removal of inverted papilloma of the middle ear and mastoid is mandatory. Magnetic resonance imaging is the first follow-up examination to perform.

Lymphoepithelial carcinoma of the larynx.

Lymphoepithelial carcinoma is a very rare tumour of the larynx, with an exhaustive review of the literature having disclosed only 33 documented cases. The relationship between lymphoepithelial carcinoma of the larynx and Epstein-Barr virus is still controversial. We describe one new case of this tumour involving the supraglottis. The patient was treated with supraglottic laryngectomy and left modified neck dissection. Three years and 4 months later, the right side of the neck was found positive for metastatic disease and a right modified neck dissection was performed. No evidence of disease was exhibited 4 years after the diagnosis of metastatic disease. The diagnostic problems and therapy associated with this rare tumour are discussed.

Delayed facial nerve palsy following uneventful stapedectomy.

Facial nerve palsy is a rare complication of stapedectomy. Its onset may be immediate or delayed by several days. The authors present a case of a 59-year-old man who developed right delayed peripheral facial nerve palsy occurring after uncomplicated ipsilateral stapedectomy. The incidence, treatment and prognosis of this complication are discussed.