Comments on "Alveolar sarcoma of the parapharyngeal space: A case report" / Comentario sobre "Sarcoma alveolar del espacio parafaríngeo: caso clínico"

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[Grading of head and neck neoplasms]. / Grading von Tumoren der Kopf­Hals­Region.

Tumors of the head and neck form a heterogeneous group of benign and malignant neoplasms with significant differences in biological behavior and therapeutic strategies. Squamous cell carcinomas (SCC) of the larynx, pharynx and oral cavity represent the most frequent and, thus, clinically most important malignant neoplasms in this anatomical region. Similar to other neoplasms, grading of head and neck malignancies is based on evaluation of the tumor histology usually including both architectural and cytological features; however, the current consensus grading for head and neck SCC is of limited prognostic and therapeutic value and the reproducibility is low. Therefore, novel grading criteria have been proposed that are based on additional parameters, such as the type of tumor growth pattern at the invasive front (so-called tumor budding). These novel algorithms, however, have not yet been officially endorsed into guidelines. Salivary gland (SG) neoplasms, although less frequent, constitute a second important pathologically and clinically complex group of tumors at this location. In contrast to SCC, grading of these tumors is of high clinical importance. Based on the large variety of carcinoma entities of the SG, both entity-specific (e. g. mucoepidermoid carcinoma) algorithms but also algorithms, which are solely based on the recognition of a specific carcinoma variant with subsequent automatic assignment of the tumor grade (e. g. acinic cell carcinoma and salivary duct carcinoma) are in use. In the sinonasal tract, grading is important for non-intestinal type adenocarcinoma and esthesioneuroblastoma. In this article the most important grading schemes and criteria for head and neck malignancies are presented and their prognostic and therapeutic implications are discussed.

[Assessment of functioning in patients with head and neck cancer based on the international classification of functioning, disability and health (ICF)]. / Beurteilung von Funktionsfähigkeit bei Patienten mit Kopf-Hals-Tumoren, auf Basis der Internationalen Klassifikation für Funktionsfähigkeit, Behinderung und Gesundheit (ICF).

The article approaches with the question how preservation of function after treatment of head and neck cancer (HNC) can be defined and measured across treatment approaches. On the basis of the "International Classification of Functioning, Disability and Health (ICF)" a series of efforts are summarized how all relevant aspects of the interdisciplinary team can be integrated into a common concept.Different efforts on the development, validation and implementation of ICF Core Sets for head and neck cancer (ICF-HNC) are discussed. The ICF-HNC covers organ-based problems with food ingestion, breathing, and speech, as well as psychosocial difficulties.Relationships between the ICF-HNC and well-established outcome measures are illustrated. This enables the user to integrate different aspects of functional outcome into a consolidated approach towards preservation/rehabilitation of functioning after HNC - applicable for a variety of treatment-approaches and health-professions.

[Hodgkin's lymphoma in otorhinolaryngology]. / Enfermedad de Hodgkin en otorrinolaringología.

OBJECTIVES: To evaluate the implication of Hodgkin's lymphoma (HL) in Otorhinolaryngology. PATIENTS AND METHODS: A longitudinal retrospective study on patients with HL diagnosed, treated and followed-up in our Centre from 1996 to 2010. RESULTS: From 413 individuals having lymphoma, 120 were labelled as HL (29%). Patients were males in 76% and greater incidence was observed in ages between 15 and 30 years old, as well as between 45 and 60. Samples for biopsy from adenopathies were obtained in 84 cases (61 from the neck), and in 15 its origin was extranodal. The most usual finding at physical exploration was the presence of cervical (86%) and axillary nodes (68%), followed by B symptoms (37%). Waldeyer's ring was affected in 4%. The most frequent histopathological variety was classic HL with nodular sclerosis (50%) and mixed cellularity (28%). Patients were usually diagnosed at stages I (28%) and II (47%). Recurrence of disease in the neck after conventional oncologic therapies was detected in 17 patients, in 7 of which the pathologic study had varied. Mortality was 8%. The main unfavourable prognostic factors for neoplasm recurrence were lymphocyte depletion variety, lymphadenopathy larger than 10 cm and B symptoms. CONCLUSIONS: Clinical HL findings are strongly associated with the head and neck area, making its suspicion obligatory in differential diagnosis on cervical nodes.

ICF Core Set for head and neck cancer: do the categories discriminate among clinically relevant subgroups of patients?

The multidisciplinary assessment of functioning in patients with head and neck cancer (HNC) according to the ICF Core Set for Head and Neck Cancer (ICF-HNC) was developed in an international and multi-disciplinary approach. The ICF-HNC is an application of the ICF that was adopted by the World Health Organization. The objective of this study was to test whether categories of the ICF-HNC can discriminate among clinically relevant differences in patients. This was a cross-sectional multicentre study in which 267 patients with HNC from 11 different countries participated. All categories were tested within a cumulative logit model to identify which ICF-categories show differences in tumour location, staging, treatment modalities and time since treatment. In the comprehensive ICF-HNC, 84 of the tested categories (76%) reflect differences in at least one of the given parameters. In the Brief ICF Core Sets for HNC (ICF-HNC), all 19 categories (100%) reflect differences. Two categories (social relationships and economic self-sufficiency) showed significant differences among all tested criteria. Most categories of the ICF-HNC are sensitive to clinically relevant differences in the study population. Especially, the ICF component 'activities and participation' holds categories with high discriminative ability for clinically relevant differences. These aspects should be carefully included into rehabilitation plans for HNC.

[Changes in the TNM classification of head and neck tumors]. / Neuerungen der TNM-Klassifikation der Kopf-Hals-Tumoren.

Only minor modifications were introduced in the classification of squamous cell carcinomas of the oro- and hypopharynx, namely in the definition of some T and N categories. A new TNM classification has been introduced for mucosal melanoma of the head and neck. Some proposals for ramification of the T1 categories of thyroid tumours have been adopted from the TNM Supplement, unfortunately not those proposed for the T3 categories. The new TNM classification of Merkel cell carcinomas, which frequently occur in the head and neck region, is also discussed.

[Differential diagnosis of vascular malformations of the upper aerodigestive tract]. / Zur Differenzialdiagnostik vaskulärer Malformationen im oberen Aerodigestivtrakt.

The differential diagnosis of vascular malformations of the upper aero-digestive tract may represent a diagnostic challenge and become a hindrance for therapy planning. The terminus "extracranial vascular anomalies" of the Head and Neck integrates hemangiomas and vascular malformations. The differential diagnosis contains benign and malign neoplasms, naevi, pigmentations and purpura.

Prognostic subgroup distribution in diffuse large B-cell lymphoma of the upper aerodigestive tract.

AIMS: To stratify upper aerodigestive tract (UAT) diffuse large B-cell lymphoma (DLBCL) into prognostic subgroups by immunohistochemical staining (IHC) method, and to evaluate the association rate of UAT DLBCL with Epstein-Barr virus (EBV). METHODS: Using a panel of antibodies to CD10, Bcl-6, MUM1 and CD138, consecutive cases of primary UAT DLBCL were stratified into subgroups of germinal centre B-cell-like (GCB) and non-GCB, phenotype profile patterns A, B and C, as proposed by Hans et al. and Chang et al., respectively. EBER in situ hybridisation technique was applied for the detection of EBV in the tumours. RESULTS: In this series of 32 cases of UAT DLBCL, 34% (11/32) were GCB, and 66% (21/32) were non-GCB types; 59% (19/32) had combined patterns A and B, and 41% (13/32) had pattern C. Statistical analysis revealed no significant difference in the occurrence of these prognostic subgroups in the UAT when compared with series of de novo DLBCL from all sites. There was also no site difference in phenotype protein expressions, with the exception of MUM1. EBER in situ hybridisation stain demonstrated only one EBV infected case. CONCLUSIONS: Prognostic subgroup distribution of UAT DLBCL is similar to de novo DLBCL from all sites, and EBV association is very infrequent.

Updated definition of level VI lymph node classification in the neck.

CONCLUSION: This update will enable us to precisely address the involvement pattern of level VI and to standardize treatment procedures in order to refine their indications and eventually improve their results and avoid treatment morbidity. BACKGROUND: The neck level classification is being used worldwide to describe the lymph nodes status of the neck. It provides standardized data to properly evaluate and then improve our protocols for the management of neck metastasis in an evidence-based medical manner. Although level VI treatment is challenging in cancer of the larynx, pharynx, trachea, esophagus, and thyroid, our knowledge about its involvement relies on few non-standardized data, due to the inadequate definition of this region. METHOD: We propose an updated radiological and surgical definition of level VI, with the introduction of two sublevels which fulfill surgical, radiotherapy, radiological, and pathological concerns. RESULTS: Level VIa encompasses prelaryngeal, intercricothyroidal, pretracheal, and perithyroidal nodes. Level VIb encompasses inferior laryngeal nodes. Within the traditional limits of level VI, all lymph nodes lying between the inferior border of the hyoid bone and the inferior border of the cricoid cartilage belong to level VIa. Between the inferior border of the cricoid cartilage and the top of the suprasternal notch, lymph nodes lying in front of the posterior face of the thyroid gland belong to level VIa; those lying behind this boundary belong to level VIb. We also discuss the definition of the superior mediastinal lymph nodes, which should not be mistaken for level VI.

[The German DRG system and its effect on imaging quality in ENT, and head and neck surgery]. / Das G-DRG-System 2006 und seine Auswirkungen auf die Abbildungsqualität der HNO-Heilkunde und Kopf- und Hals-Chirurgie.

BACKGROUND: The new G-DRG system for 2006 was published in September 2005. This article presents, analyses, and comments essential changes in the G-DRG system for 2006 and their consequences for ENT-Medicine. RESULTS: The complexity of the G-DRG system has increased significantly. In 2006, the case allocation will be more differentiated for common surgical procedures on the middle ear, nose, paranasal sinuses, salivary glands, and for head and neck cancer. Furthermore, the patient's age and the clinical and complexity level (PCCL) will be of increased relevance in selected case constellations. However, diagnostic endoscopies with rigid instruments will still not be regarded as OR procedures. CONCLUSION: Essential adjustments proposed by the German Association for ENT Medicine (DGHNOKHC) and the ENT Medical Professional Association (HNO-Berufsverband) have been made, and the quality of case allocation of ENT-patients within the G-DRG system improved. Nevertheless, further adjustments to the G-DRG system are necessary.

Current concepts in the classification, diagnosis and treatment of hemangiomas and vascular malformations of the head and neck.

There are many different classifications of vascular anomalies. As the correct classification of the vascular lesion has a direct influence on therapy it is difficult to decide which treatment should be considered as the treatment of choice. Based on an extensive review of the literature and personal experience of the treatment of more than 200 patients with hemangiomas or vascular malformations of the head and neck, a clinical classification is described that allows vascular lesions to be categorized in order to plan purposeful treatment. In general, hemangiomas represent the main group of vascular lesions in infancy and childhood. They are usually apparent a few weeks after birth and are characterized by an initially rapid growth of epithelial cells, followed by spontaneous involution. Hemangiomas should be differentiated from vascular malformations that are present at birth but may not be evident clinically. Spontaneous involution of vascular malformations has never been reported, whereas laser therapy can induce involution of hemangiomas at an early stage in a majority of cases. In certain situations steroids or surgical removal may seem to be the appropriate therapy of choice. In contrast, vascular malformations have to be treated according to their histopathology and location, as well as their hemodynamic features as shown radiographically with angiography. The accurate diagnosis of vascular anomalies is essential for further treatment, as shown by clinical experience at the University of Marburg.

[Cytologic analysis of benign neoplasms and some pseudotumors of otorhinolaryngologic organs]. / O tsitologicheskom issledovanii pri dobrokachestvennykh opikholiakh i nekotorykh opukholepodobnykh zabolevaniiakh LOR-organov.

The authors detail cytological picture of some benign tumors and pseudotumors encountered in otorhinolaryngological practice: oncocytoma, angioma, lipoma, soft fibroma, mixoma, paraganglioma, chondroma, angiogranuloma, cholesteatoma of the ear, protein pseudotumors (early-stage fibrinoid-hyaline nodes), polyps of the nose and ear, sarcoidosis. Cytological techniques made it possible to establish accurate diagnosis in 90% and 82% of cases with benign tumors and pseudotumors, respectively.

The World Health Organization histological classification of tumours of the upper respiratory tract and ear. A commentary on the second edition.

The second edition of Histological Typing of Tumours of the Upper Respiratory Tract and Ear, in the World Health Organization series International Histological Classification of Tumours, provides a comprehensive classification of tumors and tumor-like lesions occurring in (1) the nasal cavity and paranasal sinuses; (2) the nasopharynx; (3) the larynx, hypopharynx, and trachea; (4) the external ear; and (5) the middle and inner ear. The classification includes several newly recognized entities and many that were omitted from the first edition on account of their rarity. The terminology and definitions of several tumor types have been revised in the light of experience gained during the past 12 years. This article discusses the revised classification with special reference to some of the major changes in the listings, terminology, and definitions.

[The clinical manifestations of histologically classified malignant lymphomas in the ENT area]. / Klinische Manifestation von histologisch klassifizierten malignen Lymphomen im HNO-Bereich.

For an optimum therapy of malignant lymphomas in the ENT region an extensive analysis of the interrelations of exact histological classification, clinical manifestation and prognosis is desirable. We therefore classified, according to various criteria, 57 patients (34 male, 23 female) aged between 17 and 88, in whom the first diagnosis of a malignant lymphoma was established at our department between 1970 and April 1989. Histologically, in 52 cases (91%) this concerned a non-Hodgkin lymphoma (NHL), in the other 5 cases Hodgkin's disease (HL). According to the "Kiel classification", 60% of the NHL displayed a high degree of malignancy, 36% a low one, while 4% could not be exactly classified histologically. Clinically (Ann Arbor classification), 27 patients with NHL were at stage I (with 21 at stage IE), 16 patients at stage II (with 14 at stage II E), and 9 patients at stage IV. The first manifestation was often extranodular (9 patients tonsil, 8 parotid gland, 8 base of tongue, 7 nasopharynx). A cervical lymph node enlargement was the first sign in 12 patients only. Four patients with NHL additionally developed a second malignancy (squamous cell carcinoma) of another localization. The 5-year survival rate was 81% at stage I, but there were no meaningful differences between stage II (51%) and stage IV (40%). Our study demonstrated that malignant lymphomas of the head and neck are primarily NHL which frequently affect an extranodular organ as a first manifestation. Moreover, malignant lymphomas in the ENT region seem to have a relatively good survival prognosis even in an advanced stage.