Rationale for Increasing Oncological Vigilance in Relation to Clinical Findings in Accessory Parotid Gland-Observations Based on 2192 Cases of the Polish Salivary Network Database.

The accessory parotid gland (APG, Vth level) differs in histological structure from main parotid tissue. This gives rise to the hypothesis, mirrored in clinical observations, that the representation of tumours is different than in the rest of the gland. The aim of the study was to analyse the epidemiological and histological differences of parotid tumours located in regions I-V, with particular emphasis on the distinctiveness of region V. To define the epidemiological factors that will indicate the risk of histological malignancy from clinically benign appearance, multicentre prospective studies conducted between 2017-2021 by five Head and Neck Surgery University Departments, cooperating within the Polish Salivary Network Database 1929 patients (1048 women and 881 men), were included. The age, gender, patient occupation, place of inhabitation, tumour size, clinical features of malignancy, histology, and facial nerve (FN) paresis were analysed for superficial (I_II) and deep (III_IV) lobes and with special regard to the tumours affecting region V. Twenty eight tumours were located exclusively in region V (1.45% total) and seventy-two tumours were found in region V exhibiting extensions to neighbouring regions (3.7% total), characterised as significantly younger and less frequent in retirees. In I-IV regions, approximately 90% of tumours were benign, with pleomorphic adenoma (PA) and Whartin tumour (WT) predominance. In region V, PA exceeded 75% but WT were casuistic (2/28). Incidences of malignancies in region V was 40% but clinical signs of malignancy were evident only in tumours > 4 cm or in the presence of FN paresis. In 19% of patients with a benign appearance, imaging revealed malignancy; however, 38% of patients showed false negative results both in terms of clinical and radiological features of malignancy. Logistic regression models in 28 patients with tumours located exclusively in region V vs. 1901 other patients and in 100 patients with V extension vs. 1829 other patients showed no clinical symptoms of malignancy binding with final malignant tumour histology as a single variable or in combination with other variables. The logistic regression models obtained in this study show strong linkage between tumour location and predictors (age, male gender, and tumour diameter) and also aimed to function as a good classifier. Our conclusion is that, despite the very clear image of the mid-cheek tumour which is easily accessible in palpation and ultrasound examination, it is necessary to improve oncological vigilance and preoperative patient preparation.

Jejunal and ileocolic free flaps for digestive tract reconstruction following pharyngo-laryngo-oesophagectomy - 30 years of single-centre experience.

INTRODUCTION: Hypopharyngeal cancer accounts for 3-5% of all squamous-cell carcinoma (SCC) of the head and neck and has one of the worst prognoses. The aim of the study was to evaluate oncologic and functional treatment outcomes in patients with T3-T4a squamous cell hypopharyngeal and laryngeal cancer. MATERIAL AND METHODS: Retrospective analysis of the material from one treatment site included 90 patients (81 male, 9 female) who had undergone surgery between 1986 and 2010. Their mean age was 55.06 years (range 36-75). RESULTS: TNM (T - tumour, N - node, M - metastasis) staging assessment was feasible in 70 treatment-naïve patients (77.78%): 57 (63.33%) were classified to stage T4a, and 13 were classified to T3 (14.44%). Cervical lymphadenopathy was observed in 53 (63.3%) patients; in 44 patients (48.89%) postoperative histopathology confirmed metastatic disease. G2 or G3 SCC was detected in 80% of patients. All patients underwent laryngopharyngoesophagectomy (LPE). Digestive tract reconstruction was performed using one of two methods: jejunal autograft (JA) in 79 patients (87.78 %) - Group A or ileocolic autograft (IA) in 11 patients (12.22%) - Group B. Comparative statistical analysis of both groups showed statistically significant differences only for substitute speech production. The mean survival time of patients from both groups was 2.21 years after reconstruction surgery. CONCLUSIONS: JA or IA for digestive tract reconstruction in patients after LPE are burdened with high risk of complications but offer patients the chance of a normal oral diet shortly after surgery. Ileocolic autograft enables rapid production of substitute speech.

Simultaneous Malignant and Benign Nonepithelial Neoplasms of the Larynx-A Case Report and Literature Review.

Nonepithelial tumors of the larynx are relatively rare neoplasms of the head and neck. The chondrosarcoma, which develops commonly from cricoid and thyroid cartilage, stands for 0.2% of the laryngeal malignant neoplasms. The rhabdomyoma is even more uncommon benign tumor developing from the laryngeal striated muscles. The clinical manifestation and the treatment options depend on the histopathological evaluation, tumor localization, and its size. In presented case, the simultaneous occurrence of benign and malignant tumors of mesenchymal origin in the patient's larynx was provoking hoarseness, globus sensation, and dysphagia. To the best of authors' knowledge, no other case of the concomitance of rhabdomyoma and chondrosarcoma of the larynx have been reported in the literature.

The influence of age and comorbidities on the outcomes of surgical treatment with free tissue transfer: a retrospective study.

<b>Introduction:</b> Microvascular free tissue transfer enables the reconstruction of complex head and neck defects. The aim of the study was to assess the results of treatment of patients undergoing reconstructive surgery and to identify factors affecting these results, with particular reference to patient's age. <br><b>Materials and Methods:</b> All patients who underwent free-flap head and neck reconstruction in our institution between 2010 and 2017 were included in this retrospective study. A series of 66 patients met the inclusion criteria and were divided into 2 age groups: group G1 aged <65 years (n = 41) and group G2 aged ≥65 years (n = 25). Minor local complications and general complications as well as comorbidities were analyzed. <br> <b>Results:</b> No correlation was found between advanced age and the risk of free flap failure as well as the incidence of local minor complications. General complications were more frequent in the G2 group (32%) than in the G1 group (19.5%), although this is not a statistically significant difference. A statistically significant difference was found between the age and the patient's health status according to ASA (P = 0.010). In the younger low-risk group, 12 patients (29.3%) had general and local complications, while in the older low-risk group only 1 (4%). General and local complications were found in 5 (12.2%) high-risk G1 patients and in 7 (28%) high-risk G2 patients. <br><b>Conclusion(s):</b> Patients with advanced head and neck malignant tumors should undergo reconstructive microsurgery regardless of age.

Oncological outcomes of CO2 laser cordectomies for glottic squamous cell carcinoma with respect to anterior commissure involvement and margin status.

BACKGROUND AND OBJECTIVES: Controversial prognostic factors of primary CO2 laser cordectomy are anterior commissure involvement (ACI) and status of margin. STUDY DESIGN/MATERIALS AND METHODS: Retrospective analysis of oncological outcomes in 102 patients with early glottic cancer undergoing laser cordectomy between 2013 and 2015. RESULTS: The T stages distribution included: 72.6% T1a, 14.7% T1b, and 12.7% T2. The ACI was diagnosed in 26 patients. The primary cordectomy was radical in 72 patients. The 2- and 5-year disease free survival (DFS) for all patients were, respectively, 83.3% and 77.3%.The 2-year DFS rates for T1a, T1b, T2 were, respectively, 91.7%, 66.7%, and 53.9% and the differences were statistically significant (P < 0.001). The 2-year DFS rates according to the ACI and free anterior commissure tumors were, respectively, 65.4% and 89.2%, and the ACI indicated worse prognosis (P = 0.057). The 2-year DFS rates according to margins status were higher for patients with close or positive margins, who had second resection (88.9%) compared with those of negative margins (80.9%) (P = 0.340). Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Gender-related incidence, risk factors exposure and survival rates of laryngeal cancers - the 10-years analysis of trends from one institution.

OBJECTIVES: The aim of the study was the analysis of the epidemiology of laryngeal cancer over 10 years in relation to known risk factors and to assess the current survival rates in this group of patients. METHODS: The data were retrospectively collected from patients' medical records, then entered in the database using dedicated software and a statistical analysis was performed. RESULTS: 512 subjects - 443 men (86.5%) and 69 women (13.5%) were enrolled into the study. The male-to-female ratio was 6.4:1. There were 97.1% smoking women and 98% smoking men, however the history of more than 20 cigarettes per day smoking admitted 81.1 % of women and 94.6% of men. Heavy alcohol consumption was the case in 14 (20.3%) women and in 307 (69.3%) men. For both the size of heavy alcohol consumption and the size of excessive tobacco use, there was found statistically significant difference between women and men with laryngeal cancer (p<0.05). In the majority of male and female subjects, the tumour was located in the supraglottis/glottis area. Apparently this tumour location was much more common among women, accounting for 60.9% of cases , while in men was confirmed in 39.3% of cases. The stages of the laryngeal cancer were similarly of high advancement for both the men and women - stages III and IV were confirmed in 82.6% of women and in 77.6% of men. The over 5-year survival rate was 39.1% among women and 37.2% among men. Conclusions Contradictory to decreased exposure to risk factors and the shorter period for diagnosis, the higher stages of cancer were observed in women. Although in women the advancement was higher and the majority of cases were located in unfavourable supraglottic area, the survival rates were higher. Key words: laryngeal cancer, epidemiology, men and women, risk factors.

Altered Expression of miRNAs Is Related to Larynx Cancer TNM Stage and Patients' Smoking Status.

It has been reported that microRNAs (miRNAs) are responsible for acquiring all the hallmarks of cancer cells, as well as have a significant impact on the clinical management of cancers at every stage, including prognosis, remission, relapse, and metastasis. In this study, we investigated the association of miR-29a-3p, miR-202-3p, miR-3713, miR-4768-3p, and miR-548aa expression with clinicopathologic features in patients suffering from laryngeal cancer (LC) and determined the potential role of studied miRNAs in the progression of LC. The study group consisted of 48 patients with untreated primary tumors of head and neck cancer localized in the larynx. Expression of the selected miRNAs was verified by the qRT-PCR technique. We showed that the expression of miR-29a as well as miR-548aa was positively correlated with tumor stage and lymph node metastasis, whereas the expression of miR-4768-3p was negatively correlated with lymph node metastasis. Furthermore, we investigated that exposure to cigarette smoke altered miRNA expression profile in LC. The expression level of miR-202-3p was significantly increased in smoking patients compared with nonsmokers, whereas the miR-4768-3p, miR-548aa, and miR-3713 were markedly decreased. Our research contributed toward better elucidating the mechanisms underlying the progression of LC as well as the use of miRNAs inhibitors as novel agents against progression and metastasis of LC.

Multicenter experiences in temporal bone cancer surgery based on 89 cases.

OBJECTIVE: To present outcomes of extensive surgery: lateral, subtotal, total petrosectomies in patients with temporal bone invasion resulting from specific primary cancers. STUDY DESIGN: Retrospective case review. SETTING: Four tertiary referral centers. MATERIAL: 89 patients with cancer of the temporal bone treated between January 2006 and December 2010. INTERVENTION: Multidisciplinary team approach including surgical resection, reconstruction, and postoperative radiotherapy. MAIN OUTCOME MEASURE: Disease-specific survival, overall survival. RESULTS: In 27.0% of the patients, relapse was reported, with an average of 6.3 months after surgery; 31 patients (34.8%) died during the follow-up. The average mortality was 22.1 months. Fifty-four patients (58.7%) stayed alive during the time of observation. The average survival time was 42.0 months. The median time of survival with relapse was 12 months (range: 1-51 months). The three-year disease-free rate was 38.0% and the overall survival rate was 58.7%. CONCLUSIONS: Petrosectomy is an effective treatment for malignant temporal bone invasion. The probability of a good outcome was statistically decreased with a high T grade, positive margins, and salvage surgery. Younger age is connected with better prognosis. One of the major tasks remains to improve detection and to shorten the time to diagnosis, keeping in mind that symptoms are insidious and in younger people, the time before diagnosis was longer.

Evaluation of polymorphisms in microRNA biosynthesis genes and risk of laryngeal cancer in the Polish population.

MicroRNAs are the largest group of short regulatory RNAs. They regulate genes participating in many physiological and pathological processes. The role of micro RNAs in cancer development is also considerable. Therefore, the aim of this study was to evaluate the relationship between DROSHA (rs6877842) and DGCR8 (rs417309, rs1640299) gene polymorphisms with risk of occurrence of laryngeal cancer. The study included 100 patients and 100 healthy subjects. Genomic DNA was extracted from formalin-fixed, paraffin-embedded tissues. Analysis of the gene polymorphisms was performed using TaqMan SNP Genotyping Assay. The rs417309 AA genotype was found to be correlated with increased risk of larynx cancer. The rs1640299 TG and rs6877842 CG heterozygotes were significantly inversely associated with the presence of larynx cancer. Additionally, rs417309 AA genotype increased the risk of larynx cancer in the T1 stage, and the rs1640299 TG heterozygote occurred more frequently in the control group than those in the T3 and T4 stage. The rs417309 and rs1640299 polymorphisms of the DGCR8 gene as well as rs6877842 of the DROSHA gene might be associated with a risk of laryngeal cancer occurrence in the Polish population.

Association of Polymorphic Variants of miRNA Processing Genes with Larynx Cancer Risk in a Polish Population.

Laryngeal cancer (LC) is one of the most prevalent types of head and neck cancer. An increasing interest has been focused on the role of microRNA (miRNAs) in LC development. The study group consisted of 135 larynx cancer patients and 170 cancer-free individuals. Nine polymorphisms of pre-miRNA processing genes, DROSHA (rs6877842), DGCR8 (rs3757, rs417309, and rs1640299), RAN (rs14035), XPO5 (rs11077), DICER1 (rs13078 and rs3742330) and TARBP2 (rs784567), were performed by TaqMan SNP Genotyping Assay. It was found that the frequency of the GT and the TT polymorphic variants of XPO5 gene were higher in LC patients than in controls (p < 0.0001 and p = 0.000183, resp.). In turn, the frequency of the CT genotype of RAN gene was higher in controls than in LC patients (p < 0.0001). The TT and the AG of DICER1 gene (p = 0.034697 for rs13078 and p = 0.0004 for rs3742330) as well as the AG and the GG genotypes of TARBP2 gene (p = 0.008335 and p < 0.0001, resp.) were associated with higher risk of LC occurrence. Our data suggested that polymorphisms of miRNA processing genes might be useful as predictive factors for the LC development.

Non-epithelial neoplasms of the larynx and hypopharynx - 12 - years of experience.

OBJECTIVE: The non-epithelial neoplasms of larynx and hypopharynx are of rare incidence but may originate from various histological tissues. These effect in the difficulty of final diagnosis and often delay the proper treatment. MATERIAL AND METHODS: There was performed retrospective analysis of patients with histopathologicaly confirmed non-epithelial neoplasms of larynx or hypopharynx between 2001 and 2013, that included the evaluation of epidemiology, diagnostic methods and treatment. RESULTS: Non-epithelial neoplasms of larynx and hypopharynx were established in 18 patients (9 women, 9 men), mean age - 60,3 years. The malignant neoplasms were diagnosed in 10 patients and benign - in 8. The soft tissue neoplasms were the most common - 8 patients. There were also 4 lymphomas, 4 chondrosarcomas, 1 paraganglioma and 1 malignant melanoma. Tumors manifested clinically as covered by unchanged mucosa. Characteristic features were observed on computed tomography for certain cases of these neoplasms. The results of the tumor biopsy were in most of the cases not diagnostic. Intralaryngeal microsurgery was applied in benign neoplasms, chemiotherapy - for lymphomas and total laryngectomy for chondrosarcomas and malignant melanoma.

How useful is ultrasound in the assessment of local advancement of laryngeal cancer?

AIM: The aim of the presented study was to examine the possibility of assessing the advancement of laryngeal cancer by ultrasound (USG) in patients qualified for laryngectomy. MATERIAL AND METHODS: Ultrasound examination of the larynx was performed in 25 patients before the planned surgery. The staging of larynx tumor was evaluated according to the guidelines of the American Joint Committee on Cancer (AJCC). Laryngectomy was performed eventually in 22 patients. The results of histopathological examination of the excised larynx and lymph nodes were compared with the results obtained by ultrasound examination performed prior to surgery using McNemar test to estimate the accuracy, sensitivity, and specificity of the method. RESULTS: The evaluation of tumor location with ultrasound was appropriate in all patients in the presented study. The accuracy of staging tumor advancement was 81% for USG (18/22). The sensitivity and specificity of ultrasound in detecting infiltration of paraglottic space was 91.7% and 83.3%, respectively, and in detecting subglottic infiltration - 100% and 95.2%, respectively. The sensitivity of ultrasound in the assessment of preepiglotic space infiltration and invasion of the laryngeal cartilage was 75% and specificity - 100% and 88.9%, respectively. The sensitivity of ultrasound in the assessment of extralaryngeal infiltration was 50% and the specificity 100%. CONCLUSIONS: Ultrasound can provide a valuable complement to laryngoscopy and tomography in patients with laryngeal cancer. It enables the real-time evaluation of cancer advancement before planned surgery. Moreover, it can also be used in screening.

Kimura's Disease in a Caucasian Female: A Very Rare Cause of Lymphadenopathy.

Introduction. Kimura's disease is a rare chronic inflammatory disorder characterized by the head and neck lymphadenopathy often accompanied by eosinophilia and elevated serum IgE. It is benign condition with unknown etiology usually affecting young men of Asian race. Affected Caucasians are very rare. Case Presentation. We report a clinically and histopathologically typical case of this disease in a 40-year-old Caucasian female. In differential diagnosis particular attention has been paid to angiolymphoid hyperplasia with eosinophilia and neoplasms. Conclusion. The diagnosis of Kimura's disease can be very difficult and misleading; it is important not to ignore histopathological features. The presented patient has been under follow-up with no more symptoms of the disease for the last 1.5 years.

[Tuberculoma mimicking the tumor of ponto-cerebellum angle as complication after postvaccinated tuberculous otitis media]. / Poszczepienne gruzlicze zapalenie ucha srodkowego i jego powiklania - opis przypadku.

INTRODUCTION: Tuberculosis is a major problem of constant importance all over the world. Notably, in the developed countries it is due to immunosuppressive therapy and AIDS. Primary otological tuberculosis constitutes a very small share of cases of this disease. Moreover, the appearance of tuberculomas remains unique to even greater extent. CASE REPORT: Clinical history of a patient who has already been infected tuberculosis for 60 years in result of the BCG vaccination. Ponto-cerebellum angle tumour appeared in his brain as complication ensuing the disease. The first therapeutic method used was based on antituberculous drugs, subsequent surgical intervention (cerebello-pontine angle tumor removal via translabirynthin approche) was necessary however. We suspected another cause of this lesion - cholesteatoma or facial nerve neurinoma. Correct diagnosis give only histopatological examination. Because of facial nerve palsy, facial nerve reconstruction was necessary (connection of n. VII and n. XII) CONCLUSION: This case reminds us that correct diagnosis of tuberculosis remains a serious problem despite the long experience and the development of diagnostics and treatment methods. Nowadays we observe the unusual clinical manifestations of the disease (e.g. such as ear pain, tinnitus, rapid hearing loss) more frequently.

Tuberculosis of the head and neck - epidemiological and clinical presentation.

INTRODUCTION: The aim of our retrospective study was to review the clinical and epidemiological presentation of head and neck tuberculosis. MATERIAL AND METHODS: We analyzed the history of 73 patients with head and neck tuberculosis hospitalized in the Department of Otolaryngology, Medical University of Warsaw, between 1983 and 2009. RESULTS: We found that 26 (35.6%) patients presented with lymph node tuberculosis, 20 (27.4%) with laryngeal tuberculosis, 10 (13.7%) with oropharyngeal tuberculosis, 9 (12.3%) with salivary gland tuberculosis, 3 (4.1%) with tuberculosis of paranasal sinuses, 3 (4.1%) with aural tuberculosis, and 2 (2.7%) with skin tuberculosis in the head and neck region. Within the group of patients with lymph node tuberculosis in 15 cases there were infected lymph nodes of the 2(nd) and 3(rd) cervical region and in 11 infected lymph nodes of the 1(st) cervical region. In 5 cases of laryngeal tuberculosis there was detected coexistence of cancer. Oropharyngeal tuberculosis in 7 cases was localized in tonsils, where in 1 case coexisting cancer was diagnosed. Chest X-ray was performed in all cases and pulmonary tuberculosis was identified in 26 (35.6%) cases. CONCLUSIONS: We conclude that tuberculosis still remains a problem and must be taken into consideration in the diagnostic process. The coincidence of tuberculosis and cancer is remarkable in the head and neck region.

[Malignant mixed tumors of the parotid gland: a review of the Department of Otolaryngology Medical University of Warsaw experience]. / Zlosliwe gruczolaki wielopostaciowe slinianki przyusznej w materiale Kliniki Otolaryngologii Warszawskiego Uniwersytetu Medycznego.

OBJECTIVES: Pleomorphic adenoma (PA), or benign mixed tumor, is the most common salivary gland neoplasm. One of the factors influencing the management strategy in parotid PA is the risk of malignant transformation of this tumor. The objective of this study was the clinical and pathological analysis of malignant mixed tumors treated surgically at the Department of Otolaryngology, Medical University of Warsaw. MATERIALS AND METHODS: Retrospectively analysed clinical material included 12 patients with malignant mixed tumors selected from the group of 423 patients who underwent surgical treatment for parotid pleomorphic adenoma at the Department of Otolaryngology, Medical University of Warsaw, between January 1988 and June 2010. There were 7 women and 5 men; age ranged from 39 to 67 years, with a mean of 56 years. The following parameters were analysed: demographic data, symptoms and disease duration, results of diagnostic tests, intraoperative data, results of histopathological examination, and adjunctive therapy. Four patients with a follow-up shorter than 5 years were excluded from the analysis of treatment results. RESULTS: A group of 12 patients with malignant mixed tumours included 10 (83.3%) cases of a primary tumor and 2 (16.7%) cases of a recurrent tumor. In the complete study sample (n=423), patients with malignant mixed tumor comprised: 2.8% of all patients, 2.5% of patients with primary PA and 5.1% of patients with recurrent PA. Patients with malignant mixed tumor were significantly older than patients with benign PA (an average patient age was 56.0 and 43.2 years, respectively p<0.001). 83.3% (n=10) patients were older than 50 years. An average disease duration was longer in patients with malignant tumors. Considering all data from preoperative patient assessment (medical history, physical examination, FNAB, imaging studies), a preliminary diagnosis of malignant disease was made in 6 (50%) patients. All patients were treated surgically and 10 also had radiation therapy. The group of patients (n=8), subjected to evaluation of treatment results, included three patients with non-invasive carcinoma and five patients with invasive carcinoma. All patients with non-invasive carcinoma were free from disease symptoms during the follow-up of 9 to 21 years after the treatment. Five-year survival was 80% (4 of 5 patients) in a group of patients with invasive carcinoma. The rate of death for the underlying disease was the same (80%). An overall 5-year survival in patients with malignant mixed tumor was 87.5%. CONCLUSIONS: 1. Malignant transformation of pleomorphic adenoma more frequently occurs in recurrent tumors and in older patients. 2. Uncharacteristic clinical picture of malignant mixed tumors allows to make an accurate initial diagnosis only in half of the patients. 3. Extracapsular cancer invasion is a vital prognostic factor. Overall 5-year survival for invasive and noninvasive carcinoma was 80 % and 100 % respectively.

[The methodology of measurements of ossicular chain movability during tympanoplasty using Laser Doppler vibrometry]. / Metodologia pomiarów ruchomosci elementów ucha srodkowego za pomoca laserowej wibrometrii dopplerowskiej.

INTRODUCTION: Laser Doppler vibrometry can potentially be applied in the measurement of the acoustic conductivity of the middle ear during tympanoplasty. Its usefulness in estimating the accuracy of ossiculoplasty requires experimentally verified. AIM: The article presents the test procedure developed at the Department of Otolaryngology, Medical University of Warsaw for the displacement measurement of the conductive elements of the middle ear. MATERIALS AND METHOD: In the study were used 14 fresh-frozen temporal bones. In the initial stage was performed antrotomy with posterior tympanotomy. During the measurements, ER-2 speakers generated a signal with a frequency of 1000 Hz, 2000 Hz, 4000 Hz, 8000 Hz. Acoustic conductivity of the middle ear was measured on the back branch of the stapes, round window. Laser Doppler Vibrometer was used to measure velocity of each selected elements of the ear. In four experiments were assessed the intraoperative availability of measurement points, the impact of laser beam angle changes and the presence of reflective tape on the amplitude of vibration measured point, intra- and interindividual variability of the method. RESULTS: For all measured frequencies intra-individual differences were no statistically significant. There were observed large differences between the velocity values in various temporal bones. Changing the angle of the laser beam does not significantly affect the results. Mucosal surface of the tympanic cavity does not reflect the laser beam. CONCLUSION: Laser Doppler vibrometry can be used to measure motion of the middle ear sound conductivity with very good repeatability of measurements. Changing the angle of the laser beam should not vary amplitude of measurement during surgery. To maintain the sensitivity of response, it is necessary to use part of reflective tape.