Etiology and Differential Diagnoses of Nuchal Tumors: A Study of 61 Cases.

BACKGROUND/AIM: Compared to other cervical localizations, masses of the nuchal region are rare in the clinical practice of otolaryngologists. This study presents the relevant etiologies of nuchal tumors. PATIENTS AND METHODS: This study included 61 cases (5.3%) from 1,150 consecutive cervical biopsies/neck tumor excisions between 2010 and 2022. Lipomatosis or Madelung fat neck diagnoses were excluded. RESULTS: Seventy-seven percent of the biopsies included lymph node tissue. Among the patients, 26 were female and 35 were male. The average diameter of the tumors was 3.5 cm (1.5-9 cm). Of the 33 non-malignant formations (54%, 42.3 years), lymphadenopathy (e.g., toxoplasmosis and tuberculosis) was found in 58% of cases. Lipomas were most common among benign tumors (8 out of 14). Malignant tumors (46%, 63.4 years) included lymphomas (10 cases, 6 recurrences) and metastases (18 cases). The metastases were predominantly squamous cell carcinomas of the pharynx (9 cases, 5 recurrences) and the skin (7 cases, 4 recurrences), as well as two cases of adenocarcinomas from the lung and pancreas. CONCLUSION: Indications of the malignant genesis of a nuchal mass include older patient age and a history of carcinomas in the head and neck region. In carcinomas of the posterior and parietal scalp and neck skin, the nuchal region should be included in the staging and follow-up examinations.

[Contemporary use of instruments during clinical examination in German ENT departments and private practices]. / Einsatz von Instrumenten bei der klinischen Untersuchung in deutschen HNO-Abteilungen und Privatpraxen heutzutage.

BACKGROUND: The classical forehead reflector as traditionally used by ear, nose, and throat (ENT) physicians for the ENT examination is now iconic for doctors in general. It is unknown which instruments are currently used in Germany to clinically examine ENT patients. Therefore, this study aims to present results of a survey about commonly used instruments. MATERIALS AND METHODS: An evaluation of 321 questionnaires from ENT doctors working in general and university hospitals (172) and in private practices (149) was performed. RESULTS: The ENT mirror examination is nowadays carried out with a self-illuminating headlamp with battery and/or light guide cable. Approximately 20% of respondents also use a forehead mirror. The microscope is used by 90% of doctors to examine the ears; a rigid endoscope was used in 53.3% to examine the larynx, epipharynx (41.1%), and the nose/sinuses (34.6%). Flexible endoscopes and otoscopes are used only rarely. CONCLUSION: The self-illuminating headlamp, which is more often wireless in eastern Germany, has largely replaced the classical forehead reflector, with which doctors younger than 40 years were no longer trained. At least some organs are also examined very regularly with the microscope or rigid endoscope. The flexible endoscope and otoscope are used much less frequently overall, mainly by younger physicians and ENT doctors working in hospitals. The diagnostic potential of flexible endoscopy may be compromised by the outpatient remuneration structures in Germany.

Tonsillectomy as a Prevention Strategy in the Light of Increasing Incidence of Oropharyngeal Cancer - a Research of Current Literature.

BACKGROUND/AIM: While in many Western countries the number of tonsillectomies decreases significantly, there is an increasing incidence of oropharyngeal carcinomas. For, obviously, removal of the tonsils will reduce individual risk for tonsil cancer, the question of tonsillectomy as a prevention strategy is suggested. This study focused on this question by carrying out a literature research. MATERIALS AND METHODS: A literature research was performed (www.pubmed.gov; Search words: tonsillectomy, oropharyngeal cancer, tonsil cancer, prevention) without applying additional filters. RESULTS: Out of the 16 identified studies, three population-based studies were evaluated. Individual incidence of tonsil cancer is significantly lower after removal of tonsils; however, risk elimination by tonsillectomy has not been proven. One of the studies revealed increasing numbers of base of the tongue cancer after previous tonsillectomy. CONCLUSION: The increase in oropharynx carcinomas can currently be attributed not to the decreasing tonsillectomy rates, but to the increase in HPV infections. A previous tonsillectomy reduces the individual risk of developing tonsil carcer. Tonsillectomy as prevention for oropharyngeal cancer cannot be recommended and may even be a disadvantage concerning base of the tongue cancers.

[Second opinion process for tonsillectomy and tonsillotomy: analysis of the quantitative and qualitative justifying conditions]. / Zweitmeinungsverfahren für die Tonsillektomie und Tonsillotomie: eine Analyse der rechtfertigenden quantitativen und qualitativen Voraussetzungen.

BACKGROUND: In 2017, the Federal Joint Committee determined tonsillectomy and hysterectomy in non-oncologic diseases as well as tonsillotomy for second opinion procedure. We discuss the suitability of tonsillectomy and tonsillotomy for the second opinion procedure on its quantitative and qualitative characteristics. MATERIALS AND METHODS: Data from the Federal Statistical Office concerning numbers of cases were evaluated. Numbers and regional distribution of ENT-specialists providing second opinion were analyzed by websites of Associations of SHI Physicians. RESULTS: Between 2005 and 2018a significant decrease in tonsillectomy cases from 119 808 to 42 548 is observable that is by far not compensated by increasing tonsillotomy numbers from 4659 (2007) to 18 369. At the same time, surgical procedure rates at regional levels remain volatile. 218 ENT-specialists in 142 towns provide second opinion. On basic of case numbers in 2018a relationship of 1(ENT-specialist): 280 (tonsillectomy/tonsillotomy patients) results (range from 1:90 to 1:800). CONCLUSIONS: On the background of decreasing surgical rates tonsil surgery does not comply with the requirements of second opinion procedure. Reachability of second opinion providers is difficult in many regions, such compromising a compensation of different levels of surgery. As a result of our investigation we recommend scientific supervision of currently second opinion procedures and a survey of actual demand from the patient's viewpoint.

Correction to: Increased incidence of Warthin tumours of the parotid gland: a 42-year evaluation.

In the original publication, in Table 2, the last value of third column, referring to `Number of cases' has been misprint. It should read "265" instead of the "235". The corrected table 2 is given below.

Increased incidence of Warthin tumours of the parotid gland: a 42-year evaluation.

AIM: To evaluate the frequency of Warthin tumours among parotid neoplasms over the past 42 years in a population in rural Germany and to identify potential risk factors. METHODS: We conducted a retrospective case note evaluation from all patients who underwent parotid surgery between 1975 and 2017. The 42-year time period was evenly split into four quartiles. RESULTS: A Warthin tumour was diagnosed in 265 out of 806 patients (32.9%). The frequency of Warthin tumour increased steadily from 20.6% in the first decade between 1975 and 1986 to 44.9% in the fourth decade between 2008 and 2017. The age of the patients decreased from 68 years in the first to 62 years in the fourth decade. The male-to-female ratio in Warthin tumour was reduced from 1:5.3 in the first to 1:2.1 in the fourth decade. CONCLUSION: A Warthin tumour was the most common histological tumour type in the period from 1997 to 2017. We also found a high incidence of multiple tumours, a growing incidence in women and a decreasing age of patients. We propose a re-evaluation of the existing view of the epidemiology of benign parotid tumours, which proposes that pleomorphic adenoma is the most common benign parotid tumour.

[Altered indication for parotidectomy in north-western Brandenburg: A longitudinal study]. / Veränderte Indikation zur Parotidektomie im nordwestlichen Brandenburg: Eine Longitudinaluntersuchung.

OBJECTIVE: Knowledge about parotoidectomy indications is based on notifications to ENT departments and tumor databases. The study investigates the hypothesis that the surgical indication for parotoidectomy has changed over recent years. MATERIAL AND METHODS: We performed a retrospective observation study of patients who underwent parotidectomy between 1975 and 2016 (subdivided into 4 quartiles) in a teaching hospital of a medical university. RESULTS: 405 men and 366 women underwent operation for benign tumors (600/78 %), malignant tumors (116/15 %) or parotitis (55/7 %). The proportion of benign tumors remained unchanged (78 %), whereas malignant tumors increased (7 % - 23 %) and parotitides decreased (17 % - < 1 %). In benign tumors, the proportion of pleomorphic adenomas decreased (60 % - 24 %), whereas Warthin tumors increased (23 % - 58 %). Among malignant tumors, the proportion of metastases increased from 2/13 to 31/49 (in particular squamous cell carcinomas of the skin). CONCLUSIONS: The present the study shows the decreasing importance of parotitis as an indication for parotidectomy due to improved non-surgical procedures. The increasing prevalence of Warthin tumors was associated with an increasing proportion of smokers. Increased number of malignant tumors was caused by an increased prevalence of intraparotidial matastases of cutaneous squamous cell carcinoma. The presented results are based on the evaluation of patient charts. Due to their ICD or DRG reference, histological findings cannot be generated by evaluating databases. For this purpose, a special salivary gland tumor database should be established.

Metastases to Both Parotid Glands Six and Twelve Years after Resection of Renal Cell Carcinoma.

Metastases of renal cell carcinoma (RCC) involving the parotid gland are very rare. We present to our knowledge the first case of a 74-year-old woman with metastases of an RCC which affected both parotid glands six and twelve years following curative therapy.

Are Multiple Tumors of the Parotid Gland Uncommon or Underestimated?

BACKGROUND/AIM: Parotid gland tumors are mostly solitary tumors of the salivary gland tissue. There is limited evidence about multifocal tumor growth of the parotid gland. PATIENTS AND METHODS: We reviewed medical records of 796 consecutive parotidectomies in 758 patients over the last 40 years in our department, and investigated the incidence and histological type of synchronous and metachronous parotid tumors. Multifocal recurrent tumors and hybrid tumors were excluded. RESULTS: We identified 93 (13%) patients with multiple parotid lesions. Their mean age was 63 (range=15-93) years. Multiple parotid tumors were found unilaterally in 59% and bilaterally in 41% of cases. The contralateral tumor was diagnosed synchronously in 13 of 38 (34%) cases and in 25 of 38 (66%) cases metachronously. The time separating the diagnoses of both contralateral tumors ranged between one and eleven years. The same histological type was found in 95% of the tumors, and 96% of the parotid tumors had lymphatic origin. Warthin tumors (65%) were the most frequent histological type. CONCLUSION: Every sixth patient with a parotid tumor has multifocal tumor lesions. The majority of multifocal parotid tumors have a lymphoid element, while multifocal growth is uncommon in other histological types.

Parotid gland metastases of distant primary tumours: A diagnostic challenge.

OBJECTIVE: Metastatic disease is common among parotid malignancies. The majority of primary tumours are located in the head and neck, but primary tumours below the clavicle must also be considered, especially in histological types not usually found in primary parotid or skin tumours. METHODS: We performed 644 consecutive parotidectomies between 1980 and 2012. Benign tumours were found in 555 patients (86%) and malignant tumours in 89 patients (14%). RESULTS: Of 89 malignant tumours, 39 were metastases (44%). In 5 cases, the primary tumour was located below the clavicle (6% of malignant tumours). A carcinoma of the bronchus was subsequently diagnosed in three patients: one patient had breast carcinoma and one renal cell carcinoma. CONCLUSION: The majority of metastases in the parotid gland arise from primary tumours of the head and neck. In 10-20% of metastases, the primary tumour arises below the clavicle. Parotid metastases can be the first clinical manifestation of a malignant tumour, and can also occur years after curative intent treatment. Histopathology and immunohistochemistry will offer clues to a possible metastatic process and to primary tumour location. Parotidectomy with complete excision of the tumour can be a curative measure or form an essential part of symptom control and should be considered in all but the most moribund patients.