Tongue Metastasis From Renal Cell Carcinoma: A Rare Case Presentation.

Renal cell carcinoma (RCC) is characterized by a marked metastatic potential and is the third most common cancer of metastasis to the head and neck, following breast and lung cancer. We report a rare case of a patient with RCC with metastasis to the tongue. A 72-year-old man visited our otorhinolaryngology clinic complaining of tongue pain and ulcerative lesions which occurred 3 weeks before. The patient had been diagnosed with RCC and received a right radical nephrectomy 3 years previously. Because the lesion was suspected to be malignant, a hemiglossectomy was planned. However, metastatic lesions were suspected on the left upper lung and the left 10th ribs in imaging studies and the result of an incisional biopsy revealed tongue metastasis of RCC. RCC metastasis to the tongue is extremely rare. Only 51 cases were reported worldwide from 1911 to 2017. According to the literature, no case of RCC metastasis to the tongue has been reported to date in Korea. Therefore, we report this case along with a review of the literature.

Guidelines for the Use of Botulinum Toxin in Otolaryngology From the Korean Society of Laryngology, Phoniatrics and Logopedics Guideline Task Force.

The Korean Society of Laryngology, Phoniatrics and Logopedics created a task force to establish clinical practice guidelines for the use of botulinum toxin (BT) in otolaryngology. We selected 10 disease categories: spasmodic dysphonia, essential vocal tremor, vocal fold granuloma, bilateral vocal fold paralysis, Frey's syndrome, sialocele, sialorrhea, cricopharyngeal dysfunction, chronic sialadenitis, and first bite syndrome. To retrieve all relevant papers, we searched the CORE databases with predefined search strategies, including Medline (PubMed), Embase, the Cochrane Library, and KoreaMed. The committee reported 13 final recommendations with detailed evidence profiles. The guidelines are primarily aimed at all clinicians applying BT to the head and neck area. In addition, the guidelines aim to promote an improved understanding of the safe and effective use of BT by policymakers and counselors, as well as in patients scheduled to receive BT injections.

Primary small cell thyroid carcinoma combined with poorly differentiated thyroid carcinoma, evidence for a common origin: A case report.

Primary small cell thyroid carcinomas are extremely rare and there is still debate about their classification as a distinct disease entity. The present case report reports a small cell carcinoma (SCC) combined with poorly differentiated thyroid carcinoma (PDTC) in a 34 year old man. The tumor consisted of ~80% PDTC and ~20% SCC. The PDTC component was positive for cytokeratin and thyroid transcription factor-1 (TTF-1), and negative for calcitonin, chromogranin and synaptophysin. The SCC component was positive for synaptophysin and CD56, and negative for calcitonin, chromogranin and TTF-1. Seven months after thyroid surgery, two new lung nodules were detected. Histologically and immunohistochemically, the lung tumors were similar to the SCC component of the thyroid carcinoma. The mutational status of cancer-related genes was assessed using targeted next-generation sequencing in both the thyroid and lung, which identified similar genetic alterations. The histogenesis of SCC was evaluated through NGS analysis of the two cancer components.

Granular cell tumor of the neck treated using a local flap: A case report.

RATIONALE: Granular cell tumors are rare soft tissue neoplasms derived from nerve that can arise in the oral cavity, skin, or gastrointestinal tract. Various hypotheses have proposed that granular cell tumors originate from the nervous system, skeletal muscle, and Schwann cells. PATIENT CONCERNS: A 47-year-old male patient presented with a 5 cm cervical mass. DIAGNOSES: Computed tomography showed a 4 cm-sized homogeneous enhancing mass infiltrating the sternocleidomastoid muscle and even the surrounding skin. INTERVENTIONS: Extensive surgical resection of the tumor including the skin was performed. A submental transposition local flap was used for the wide skin defect. OUTCOMES: Histologic finding showed polygonal granular cells with rich eosinophilic coarse granular cytoplasm without interstitial tissue without mitosis or necrosis. Immunohistochemically, the tumor cells were positive for S100 and CD68, which is consistent with classic granular cell tumors. LESSONS: In microscopic observations, granular cell tumors do not have a defined boundary with surrounding tissues, and they display an infiltrating pattern that can expand to adjacent tissue. As a result, the tumor should be removed with a sufficient margin, including the normal tissues surrounding it. The authors experienced granular cell tumor in the muscle layer of the head and neck. It could be treated without recurrence through extensive surgical resection and local flap.

Phonetic features of patients with transoral endoscopic thyroidectomy.

OBJECTIVE: The objective of this study was to compare phonetic outcomes of TOETVA with those of conventional transcervical thyroidectomy(OPEN). METHODS: Retrospective chart review of total 61 patients who received thyroidectomy through OPEN (n = 34) or TOETVA (n = 27) approach in single tertiary center were enrolled. RESULTS: There were significant differences in F0 between the two groups and there were significant changes from different time points within each group in jitter for vowel /i/. Aerodynamically, there were significant differences in mean sound pressure level for vowel /a/ and mean sound pressure level, mean air pressure, and aerodynamic resistance for syllable /pa/ between the two groups. In subjective VHI evaluations, there were no significant differences between the two groups. CONCLUSION: This study is significant in that it has investigated voices of patients with TOETVA. Results of this study are expected to be useful for voice evaluation, treatment, and prevention in the future.

Guideline for the Surgical Management of Locally Invasive Differentiated Thyroid Cancer From the Korean Society of Head and Neck Surgery.

The aim of this study was to develop evidence-based recommendations for determining the surgical extent in patients with locally invasive differentiated thyroid cancer (DTC). Locally invasive DTC with gross extrathyroidal extension invading surrounding anatomical structures may lead to several functional deficits and poor oncological outcomes. At present, the optimal extent of surgery in locally invasive DTC remains a matter of debate, and there are no adequate guidelines. On October 8, 2021, four experts searched the PubMed, Embase, and Cochrane Library databases; the identified papers were reviewed by 39 experts in thyroid and head and neck surgery. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence, and to develop and report recommendations. The strength of a recommendation reflects the confidence of a guideline panel that the desirable effects of an intervention outweigh any undesirable effects, across all patients for whom the recommendation is applicable. After completing the draft guidelines, Delphi questionnaires were completed by members of the Korean Society of Head and Neck Surgery. Twenty-seven evidence-based recommendations were made for several factors, including the preoperative workup; surgical extent of thyroidectomy; surgery for cancer invading the strap muscles, recurrent laryngeal nerve, laryngeal framework, trachea, or esophagus; and surgery for patients with central and lateral cervical lymph node involvement. Evidence-based guidelines were devised to help clinicians make safer and more efficient clinical decisions for the optimal surgical treatment of patients with locally invasive DTC.

Malignant Solitary Fibrous Tumor of the Nasal Cavity and Orbit: A Case Report.

Solitary fibrous tumors are well-recognized in the pleura and their occurrence in the nasal cavity is uncommon. They show a hemangiopericytoma-like vasculature, a "patternless pattern" of growth, and lesions characterized by both hypercellularity and hypocellularity. As a malignant form of SFT, mesenchymal neoplasm is extremely uncommon and poorly understood, although there are no established standards for making this diagnosis, it is nonetheless accepted. It can develop either de novo or within an already-existing benign SFT, and there are few published accounts of the cytopathologic characteristics of these tumors.In this case, a patient complained of tenderness on the right nasal root and diplopia for six months. Here, we report on a case of malignant solitary fibrous tumors in the nasal cavity, which extended into the orbit, and review the radiologic and pathologic features.

Immunological characteristics of IgG4-related Kuttner tumors.

Immunoglobulin G4-related disease (IgG4-RD) has recently been well recognized and Kuttner tumor is known to be a chronic sclerosing sialadenitis, representing the focal manifestation of IgG4-RD, in the submandibular gland (SMG). This study is to evaluate the immunologic features of IgG4-related Kuttner tumor in the SMG. We retrospectively chose 13 patients who were confirmed as having Kuttner tumor by surgical biopsy between May 2012 and January 2019. The fine-needle aspiration cytology, serum antibody levels (anti-Ro antibodies, anti-La antibodies), IgG serum levels (total IgG and IgG4), and immunohistochemical findings for IgG and IgG4-positive plasma cells were reviewed. The cytologic results found that 7 of the 9 cases were reported as chronic sialoadenitis, and the other 3 as benign lymphoproliferative lesion. The serum levels of autoantibodies, Sjögren-syndrome-related antigen A/Ro-Ab and Sjögren-syndrome-related antigen A/Ro-La, showed all normal values of serum level. The serum level of IgG was increased in only 4 among the cases. However, the IgG4 levels were significantly increased in 11 among the cases. In all the patients who received resection of SMG, immunohistochemical findings showed all positive for IgG4-RD, with elevated numbers of IgG and IgG4-positive plasma cells. The evaluation of IgG4 serum level should be very informative for the diagnosis of this tumor before surgery. Fine-needle aspiration cytology with ultrasound guidance are not conclusive in this study. The immunological study including IgG4 serum level should be required for proper diagnosis and treatment, with clinical features of the Kuttner tumor. The level of evidence was IV.

A case report of primary myxoid liposarcoma mimicking as a parotid cystic lesion.

RATIONALE: Myxoid liposarcoma (MLS) is an extremely rare tumor of the salivary gland and it arises from undifferentiated pluripotent mesenchymal cells. We report a rare case of a primary MLS in the parotid gland. PATIENT CONCERNS: The patient was a 49-year-old female who presented with a hard fixed mass in the left parotid region. DIAGNOSIS: On computed tomography and MR images, this tumor has a low attenuation center with a thick enhancing wall and ill-defined margins. The absence of high-signal-intensity foci on T1-weighted images makes a MLS indistinguishable from most other soft-tissue masses. Pathologically, the tumor was diagnosed as MLS. INTERVENTIONS: The patient received total parotidectomy with facial nerve preservation and selective neck dissection. OUTCOMES: Immediate facial nerve function was House Brackmann Grade III and recovered within 3 months after the surgery. Follow-up period is 57 months and there was no recurrence until now. LESSONS: In this report, we report a rare case of primary MLS mimicking a cystic lesion of the parotid gland.

Intraoral Approach for Parapharyngeal Branchial Cleft Cysts.

Branchial cleft cyst (BCC) most frequently arises from the second branchial cleft and is located anterior to the sternocleidomastoid muscle at the mandibular angle. However, very rarely, this may occur in the parapharyngeal space. Interestingly, the parapharyngeal BCC is frequently misdiagnosed as a peritonsillar abscess. In this study, we reported 2 cases of parapharyngeal BCC misdiagnosed as peritonsillar abscess.

Care and Management of Voice Change in Thyroid Surgery: Korean Society of Laryngology, Phoniatrics and Logopedics Clinical Practice Guideline.

Voice change is a common complaint after thyroid surgery and has a significant impact on quality of life. The Korean Society of Laryngology, Phoniatrics and Logopedics assembled a task force to establish guideline recommendations on education, care, and management related to thyroid surgery. The guideline recommendations encompass preoperative voice education, management of anticipated voice change during surgery, and comprehensive voice care after thyroid surgery, and include in-depth information and up-to-date knowledge based on validated literature. The committee constructed 14 key questions (KQs) in three categories-preoperative (KQ 1-2), intraoperative (KQ 3-8), and postoperative (KQ 9-14) management-and developed 18 evidence-based recommendations. The Delphi survey reached an agreement on each recommendation. A detailed evidence profile is presented for each recommendation. The level of evidence for each recommendation was classified as high-quality, moderate-quality, or low-quality. The strength of each recommendation was designated as strong or weak considering the level of evidence supporting the recommendation. The guidelines are primarily targeted toward physicians who treat thyroid surgery patients and speech-language pathologists participating in patient care. These guidelines will also help primary care physicians, nurses, healthcare policymakers, and patients improve their understanding of voice changes and voice care after thyroid surgery.

A nodular type of mantle cell lymphoma in the nasopharynx.

Mantle cell lymphoma (MCL) is a subtype of B-cell lymphoma derived from CD5-positive antigen-naïve pre-germinal center B-cells within the mantle zone that surrounds normal germinal center follicles. MCL comprises approximately 5 to 10% of all lymphomas. Tonsil is the most common location of MCL in the head and neck region, followed by the nasopharynx. Primary MCL involving the nasopharynx is extremely rare. Its clinical course is very aggressive with frequent relapses after conventional chemotherapy. It always presents as a protruding mass on the mucosal lining of the pharyngeal cavity. Here, we report a new nodular type of MCL in the nasopharynx. Endoscopically, this case showed multiple nodular lesions of primary MCL on the nasopharyngeal mucosa. This unique finding has not been reported yet in the English literature. These lesions should be differentiated from simple pharyngeal infections or benign lymphoid hyperplasia in the nasopharynx.

Delayed pseudoaneurysm formation of the carotid artery following the oral cavity injury in a child: A case report.

BACKGROUND: An impalement injury of the oral cavity is a common traumatic injury in children. In most cases, it is not accompanied by sequelae, but if foreign body residues are not found due to a minor injury, they may result in inflammatory responses and delayed vascular injuries in the surrounding tissues. Without early diagnosis and appropriate initial management, residual foreign bodies can cause serious complications and even mortality in some cases. CASE SUMMARY: A 9-year-old boy suffered an intra-oral injury by a wooden chopstick, and the patient was discharged from the hospital after receiving conservative treatment for the injury. However, the patient was readmitted to the hospital due to intra-oral bleeding, and since neck hematoma and right internal carotid artery pseudoaneurysm formation were detected on computed tomography, emergency surgery was performed. A remnant fragment of a wooden chopstick was found during the operation, and a delayed rupture of the internal carotid artery caused by the foreign body was also found. CONCLUSION: The failure of early detection and diagnosis of a residual foreign body may result in delayed vascular rupture.

Voice Outcome of Total Thyroidectomy in Comparison With Administration of Recombinant Human TSH.

BACKGROUND AND OBJECTIVES: The larynx is an end-organ target for hormones, and thyroid hormone may act on the larynx. We objectively compared and analyzed the phonetic characteristics of patients who underwent total thyroidectomy before and after radioiodine therapy (RIT) according to administration of recombinant human TSH (rh-TSH). SUBJECTS AND METHODS: Ninety-one patients who had undergone a total thyroidectomy participated (50 patients without rh-TSH, 41 patients with rh-TSH). Voice samples were obtained postoperatively (Post-OP), before high-dose RIT (Pre-RIT), and after high-dose RIT (Post-RIT). Frequency-, perturbation-, and noise-related parameters were evaluated for acoustic analysis, and the voice handicap index (VHI) was used for the subjective evaluation. RESULTS: Frequency-related parameters decreased significantly in patients without rh-TSH administration, but not changed at three periods in patients with rh-TSH administration. Pitch perturbation parameters were not changed at each period in two groups, but amplitude perturbation parameters were changed significantly in two groups. The functional scores of the VHI increased significantly at Pre-RIT in two groups and physical scores increased in patients without rh-TSH at Pre-RIT. CONCLUSION: The hypothyroidism after total thyroidectomy affects phonation significantly. Our results suggest that rh-TSH administration during RIT resulted in improving voice results during RIT in the patients with total thyroidectomy.

Initial Experience With Robotic Modified Radical Neck Dissection Using the da Vinci Xi System Through the Bilateral Axillo-Breast Approach.

OBJECTIVES: The bilateral axillo-breast approach (BABA) to robotic thyroidectomy has been extended to modified radical neck dissection (MRND). This study assessed outcomes in patients who underwent robotic MRND through BABA using the da Vinci Xi system. METHODS: The medical records of 40 patients who underwent total thyroidectomy, bilateral central neck dissection, and MRND from September 2018 to March 2020 were reviewed retrospectively, including 12 who underwent robotic surgery and 28 who underwent open surgery. All operations were performed by a single endocrine surgeon. RESULTS: The operation time was significantly longer in the robotic group than in the open group (277.08±32.64 vs. 191.43± 60.43 minutes, respectively, P<0.01), but the number of retrieved lymph nodes did not differ significantly (32.58± 9.31 vs. 34.54±10.90, respectively, P=0.569). The incidence of transient hypoparathyroidism was significantly lower in the robotic group (16.7% [2/12] vs. 53.6% [15/28], P=0.041). The mean hospital stay was shorter (3.92±0.90 vs. 4.71±1.63 days) and the pain score on the first postoperative day was lower (2.92±0.29 vs. 3.18±0.67) in the robotic group. Six of the 12 patients (50%) in the robotic group had stimulated thyroglobulin levels <1.0 ng/mL. CONCLUSION: Robotic MRND through BABA has several advantages, including excellent cosmetic outcomes and a lower incidence of transient hypoparathyroidism than is the case for open MRND. Robotic MRND through BABA may be a promising surgical approach compared with conventional open MRND.

Survival Benefits From Surgery for Stage IVa Head and Neck Squamous Cell Carcinoma: A Multi-institutional Analysis of 1,033 Cases.

OBJECTIVES: Head and neck squamous cell carcinomas (HNSCs) are frequently diagnosed at the locoregional advanced stage (stage IVa), but controversy remains regarding whether stage IVa HSNCs should be treated with upfront surgery or definitive chemoradiation therapy (CRT). The purpose of this study was to compare overall survival (OS) and disease-free survival (DFS) in patients with stage IVa HNSC treated primarily by surgery with curative intent with/without (neo)adjuvant treatment (surgery group) versus those treated primarily with CRT (CRT group). METHODS: We reviewed data of 1,033 patients with stage IVa HNSC treated with curative intent at 17 cancer centers between 2010 and 2016. RESULTS: Among 1,033 patients, 765 (74.1%) received upfront surgery and 268 (25.9%) received CRT. The 5-year OS and DFS rates were 64.4% and 62.0% in the surgery group and 49.5% and 45.4% in the CRT group, respectively. In multivariate analyses, OS and DFS were better in the surgery group than in the CRT group (odds ratio [OR] for death, 0.762; 95% confidence interval [CI], 0.592-0.981; OR for recurrence, 0.628; 95% CI, 0.492-0.802). In subgroup analyses, the OS and DFS of patients with oropharyngeal cancer were better in the surgery group (OR for death, 0.548; 95% CI, 0.341-0.879; OR for recurrence, 0.598; 95% CI, 0.377-0.948). In the surgery group, patients with laryngeal cancer showed better OS (OR for death, 0.432; 95% CI, 0.211-0.882), while those with hypopharyngeal cancer DFS was improved (OR for recurrence, 0.506; 95% CI, 0.328-0.780). CONCLUSION: A survival benefit from surgery may be achieved even in patients with stage IVa HNSC, particularly those with oropharyngeal and laryngeal cancer. Surgery led to a reduction in the recurrence rate in patients with hypopharyngeal cancer.

Smart needle to diagnose metastatic lymph node using electrical impedance spectroscopy.

OBJECTIVES: The cause of cervical lymphadenopathy varies from inflammation to malignancy. Accurate and prompt diagnosis is crucial as delayed detection of malignant lymph node can lead to a worse prognosis. To improve the diagnostic accuracy of metastatic lymph node, electrical spectroscopy was employed to study human normal and metastatic lymph nodes using a hypodermic needle with fine interdigitated electrodes on its tip (EoN). SUBJECTS AND METHODS: The electrical impedance of samples collected from 8 patients were analyzed in the sweeping frequency range from 1 Hz to 1 MHz. To align the impedance level data of the patients, normalized impedance was employed. RESULTS: The optimal frequency exhibiting the best discrimination results between the normal and cancerous tissues was introduced based on a discrimination index. A high sensitivity (86.2%) and specificity (88.9%) were obtained, which implied that the EoN holds the potential to improve the in vivo diagnostic accuracy of metastatic lymph node during biopsy and surgery. CONCLUSION: EoN has a promising potential to be utilized in real-time in actual clinical trials without a need for any pre/post-treatment during FNA or surgery. We believe that the EoN could reduce unnecessary operations with its associated morbidity.

Bi-institutional experience of transoral endoscopic thyroidectomy: Challenges and outcomes.

BACKGROUND: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel remote-access endoscopic approach. In this study, we compared the surgical outcomes of TOETVA with those of conventional transcervical approach (TCA) in two tertiary hospitals. METHODS: A total of 82 patients were done by TOETVA and 233 patients received TCA between January 2018 and April 2019. Propensity score matching was used to reduce selection bias. RESULTS: Operation time of the TOETVA group was longer than that of the TCA group. The mean number or retrieved lymph nodes were significantly higher in the TOETVA group. No significant difference was observed in the overall perioperative complications. CONCLUSION: TOETVA is technically acceptable when compared to TCA in terms of equal baseline characteristics of patients. Although future large-scale multicenter studies with longer follow-up periods are needed, we expect this novel technique can be performed not only for cosmetic purposes but also for patients with papillary thyroid carcinoma.