A Case of Mumps Presenting With Unilateral Submandibular Sialadenitis and Laryngeal Edema.

Mumps is a viral infection that primarily affects the parotid glands. Here, we report an atypical case of mumps presenting with unilateral submandibular sialadenitis and laryngeal edema. A 20-year-old woman with unremarkable medical history was referred to our hospital for the management of left submandibular sialadenitis. Laryngeal endoscopy revealed laryngeal edema. Contrast-enhanced computed tomography of the neck revealed swelling of the left submandibular gland with surrounding fluid density and increased density of the cervical subcutaneous adipose tissue. A few days later, both anti-mumps immunoglobulin M (IgM) and IgG antibodies were positive, and she was diagnosed with mumps. To date, there have been no reports of unilateral submandibular gland mumps complicated by laryngeal edema. It is important to keep in mind that the involvement of the submandibular gland in cases of mumps is probably a risk factor for laryngeal edema.

Deep Neck Infection Complicated by Phlegmonous Esophagitis and Mediastinitis.

Descending necrotizing mediastinitis is a life-threatening disease that extends into the pretracheal, perivascular, retrovisceral, and/or prevertebral spaces, generally sparing the esophagus. We report a case of deep neck abscess complicated by phlegmonous esophagitis and mediastinitis. The patient was successfully treated with antibiotics and surgery, combining transcervical and bilateral thoracoscopic transthoracic mediastinal drainage. However, a pseudo-lumen with a large amount of pus remained in the esophagus. The septum between the true and the pseudo-lumen was cut endoscopically, after which the patient recovered well without any complications.

Prognostic factors for hypopharyngeal cancer: a univariate and multivariate study of 142 cases.

CONCLUSIONS: Reduction of distant metastases is essential for better survival. Effective adjuvant chemotherapy should be developed for patients with advanced primary disease (T>2) as well as for patients with advanced nodal status (N>0 or PLN>2). OBJECTIVES: The aim of this study was to identify prognostic factors for hypopharyngeal cancer. PATIENTS AND METHODS: In all, 142 previously untreated patients were analyzed retrospectively; 75% of the cases were stage III or IV. Surgical resection was administered as primary treatment to 116 of the patients (82%), while 26 patients (18%) underwent primary radiotherapy. RESULTS: The cause-specific 5-year actuarial survival was 46.3%. Distant metastases were the most frequent (23%) cause of failure, followed by local recurrence (15%), and regional recurrence (13%). Cox's regression analysis showed that the significant factors affecting cause-specific survival were N classification, T classification, number of pathological lymph node metastases (PLN), lymphatic invasion, and positive surgical margin. Similarly, T classification and PLN affected distant metastases.

Analysis of prognostic factors of nasopharyngeal carcinoma: impact of in situ hybridization for Epstein-Barr virus encoded small RNA 1.

OBJECTIVES: To evaluate the impact of clinical, histopathological, and molecular biological parameters on the prognosis of nasopharyngeal carcinoma (NPC). STUDY DESIGN AND SETTING: The clinical records of 48 patients with a diagnosis of NPC were retrospectively reviewed. In situ hybridization for Epstein-Barr virus encoded small RNA 1 (EBER-ISH) was applied for 30 paraffin-embedded specimens available. Prognostic factors of NPC were meticulously analyzed. RESULTS: The EBER-ISH signal was shown to be highly significant as a favorable prognostic factor (P = 0.007). Although EBV was more commonly associated with Type III NPC, EBER-ISH-positive Type I-II NPC had also significantly better survival rate than EBER-ISH-negative Type I-II NPC (P = 0.036). CONCLUSIONS: In addition to the WHO histopathological grade, the 1997 UICC staging, nodal status, and distant metastasis at presentation, the EBER-ISH signal was shown to be significant as a prognostic factor. SIGNIFICANCE: This is the first report to describe the EBER-ISH as an independent prognostic factor of NPC regardless of histopathology. EBM RATING: B-2b.

[Clinical inspection of metastasis to the mesenteric lymph nodes in patients with hypopharyngeal cancer after pharyngolaryngectomy with free jejunal graft-136 cases].

Single-stage reconstruction of the pharyngoesophagus with a free jejunal graft is considered standard surgical treatment for hypopharyngeal cancer. We reviewed postoperative cervical CTs in 72 of 136 consecutive patients (1982-2002) undergoing this therapy in our department. Of these, 29 (40%) showed mesenteric lymph node swelling (> 10mm) in grafts. Most swelling is considered reactive, but 1 patient showed pathological metastasis in fine-needle aspiration cytology (FNA). When metastasis is clinically suspected in imaging study and other examinations, FNA should be done carefully with guided ultrasound echo-imaging, to avoid damaging vascular grafts and necrosis of the jejunal graft.

Malignant melanoma of nasal cavity: report of 16 Japanese patients.

BACKGROUND: Primary malignant melanoma of the nasal cavity is a rare disease that has a poor prognosis. There are significant racial differences in the incidence of melanomas in the nasal cavity. METHODS: Sixteen Japanese patients treated at the Hospital of Tokyo University were reviewed retrospectively. RESULTS: Fourteen patients were treated with surgery. Two patients received treatment with radiotherapy alone. Seven patients had microscopically negative surgical margins and seven patients had positive surgical margins. The 2- and 5-year actuarial survival rates for all patients were 63.6 and 31.8%, respectively. No statistically significant difference could be shown in the overall survival rate between patients with positive surgical margins and those with negative surgical margins. CONCLUSIONS: Clinical features of nasal melanoma in Japanese are not different from nasal melanoma in Caucasians. The negative surgical margins were not predictive of a better prognosis.

[Clinical study of parapharyngeal space tumors].

We clinically studied 31 cases of parapharyngeal space tumor treated between 1988 and 2002, and compared histological findings and preoperative diagnosis. Pleomorphic adenoma was the predominant tumor, accounting for 35.5%. Schwannoma and paraganglioma were next at 26.6%. In determining pathological diagnosis, fine needle biopsy and imaging were useful. Important factors in imaging diagnosis are inspecting the degree of enhancement in CT or MRI, investigating the existence of flow void on MRI, and discriminating whether the origin is pre- or post-styloid.

Fibromatosis of the infratemporal fossa extending to the parapharyngeal space accompanied by trismus.

Fibromatosis is a tumor of fibroblastic origin that may arise in any musculoaponeurotic structure. Although fibromatosis is histologically benign, it has a tendency to invade surrounding tissues and often recur locally after treatment. A 34-year-old female patient was presented with pain in the left buccal region, left loss of visual acuity, and trismus. Computed tomographic scans revealed a large mass in the infratemporal fossa and parapharyngeal space. An open biopsy was performed and the pathological diagnosis was a fibromatosis. Surgical treatment for her trismus was performed simultaneously.

Detection of Epstein-Barr virus in metastatic lymph nodes of patients with nasopharyngeal carcinoma and a primary unknown carcinoma.

BACKGROUND: Nasopharyngeal carcinoma is often associated with neck lymph node (LN) metastases, which in many cases is the only manifestation of this disease. The submucosal and infiltrative characteristics of nasopharyngeal carcinoma make this type of cancer difficult to diagnose. Nasopharyngeal carcinoma has also been reported to be strongly associated with the Epstein-Barr virus. METHODS: We examined 36 nasopharyngeal carcinomas (from 30 primary sites and from 6 metastasized LNs), 13 metastasized LNs of other head and neck cancers, and 12 primary unknown neck metastases using an in situ hybridization technique. RESULTS: In the nasopharyngeal carcinomas, in situ hybridization with an Epstein-Barr virus-encoded small RNA identified the Epstein-Barr virus in 20 (67%) of the 30 primary sites and in 3 (50%) of the 6 metastasized LNs. Epstein-Barr virus was not detected in metastasized LNs of other head and neck cancers, but was detected in 1 of the primary unknown neck metastases. CONCLUSION: In situ hybridization using a digoxigenin-labeled Epstein-Barr virus-encoded small RNA probe is useful for the differential diagnosis of metastasized LNs when the primary site is unknown.

Partial laryngectomy to treat early glottic cancer after failure of radiation therapy.

OBJECTIVE: To evaluate the role of partial laryngectomy to treat glottic cancer after failure of radiation therapy. DESIGN: A 12-year retrospective outcome analysis. SETTING: University referral center. PATIENTS: A total of 19 patients who underwent partial laryngectomy to treat glottic cancer after failure of radiation therapy. RESULTS: The follow-up period in this group ranged from 31 to 144 months. After surgery, a laryngocutaneous fistula was observed in 4 cases, and flap necrosis occurred in 2, but these complications were successfully managed. Maximum phonation time after surgery ranged from 3 to 28 seconds (median phonation time, 10.2 seconds). Of these 19 patients, 3 developed local recurrence. These cases were successfully treated with total laryngectomy. A surgical margin of less than 1 mm was found to be a significant risk factor for local recurrence after partial laryngectomy. CONCLUSIONS: These results indicate that partial laryngectomy is a useful option for the treatment of irradiation failure in the treatment of stage I and stage II vocal cord carcinomas. However, careful follow-up is mandatory for patients with a small surgical margin.

Results of multimodality therapy for squamous cell carcinoma of maxillary sinus.

BACKGROUND: A wide variety of modalities, including surgery, radiation therapy, and chemotherapy, alone or in combination, have been used for the treatment of squamous cell carcinoma (SCC) of the maxillary sinus to obtain better local control and maintain functions. However, there is still much controversy with regard to the optimum treatment. METHODS: From 1987 to 1999, 33 patients with SCC of maxillary sinus were treated at the Department of Otolaryngology-Head and Neck Surgery, University of Tokyo Hospital. The treatment consisted of 30-40 grays (Gy) of preoperative radiotherapy with concomitant intraarterial infusion of 5-fluorouracil and cisplatin followed by surgery and 30-40 Gy of postoperative radiotherapy, for tumors without skull base invasion. For tumors invading the skull base, preoperative systemic chemotherapy with or without radiotherapy was performed, instead of intraarterial chemotherapy, then followed by skull base surgery. The surgical procedures varied according to the extent of tumor. Results were compared with those of the 108 patients treated in our hospital from 1976 to 1982. RESULTS: Partial maxillectomy was performed in 2 T2 patients and 12 T3 patients. Total maxillectomy was performed in 1 T2 patient, 3 T2 patients, and 7 T4 patients. Skull base surgery was performed in eight T4 patients. Orbital content and hard palate were preserved in 22 patients and 18 patients, respectively. The overall 5-year survival rates were 86% in T 3 patients and 67 % in T4 patients, respectively. CONCLUSIONS: Our multimodal treatment has provided favorable local control and survival outcome with good functional results.