Prognostic factors after transoral resection of early hypopharyngeal cancer.

OBJECTIVE: This study aimed to investigate risk factors predictive of local recurrence and/or lymph node metastasis after transoral resection of early hypopharyngeal cancer. METHODS: Forty-nine consecutive patients who underwent transoral videolaryngoscopic surgery (TOVS) as an initial treatment for hypopharyngeal cancer were evaluated. On univariate and multivariate analysis, local recurrence rates were assessed respectively using log-rank test and cox regression analysis according to the following parameters: subsite, pT, mucosal margin, lymphatic invasion, vessel invasion, tumor thickness (> 4 mm vs ≤4 mm), history of esophageal cancer, and multiple Lugol-voiding lesions (LVLs) in the esophagus. Categorical variables were evaluated for their associations with lymph node metastasis using chi-squared test or Fisher's exact test. RESULT: The subsites of primary lesions were piriform sinus in 24 patients, posterior wall in 15 patients, and postcricoid in 10 patients. Thirty patients had esophageal cancer. Local recurrence occurred in 14 patients. Three patients had lymph node metastasis at the time of diagnosis and four patients developed lymph node metastasis after the initial treatment, resulting a total of seven patients having lymph node metastasis. While mucosal margin and LVLs showed significant associations with local recurrence on univariate analysis, only LVLs remained as a significant risk factor on multivariate analysis (P = .0395; hazard ratio = 8.897; 95% confidence interval, 1.113-71.15). Most cases of local recurrence were satisfactorily controlled by repeated TOVS. While multivariate analysis could not be performed due to the small number of the patients with lymph node metastases, venous invasion (P = .0166) and tumor thickness (P = .0092) were significantly associated with lymph node metastasis on univariate analysis. CONCLUSIONS: Local recurrence was more frequent in patients with LVLs, but most of them were salvaged by repeated TOVS. Patients with venous invasion and/or tumor thickness greater than 4 mm should be followed up with special attention to lymph node metastasis.Level of Evidence: 3.

Oncologic and functional outcomes of transoral CO2 laser cordectomy for early glottic cancer.

OBJECTIVE: To investigate the oncological and functional outcomes of the patients treated with transoral CO2 laser cordectomy for early glottic cancer. PATIENTS AND METHODS: Fifty-five consecutive patients who underwent CO2 laser cordectomy for early glottic cancer were retrospectively reviewed. RESULTS: Overall survival, larynx preservation, and relapse free local control rates were 96%, 100%, and 91%, respectively. Five patients with local recurrences were salvaged with re-cordectomy and/or radiotherapy. In type I cordectomy, VHI-10 consistently improved during postoperative course and VHI-10 at postoperative 12months was significantly better than preoperative value (2.3 vs. 9.4, p=0.02). Perceptual grading, MPT, MFR and AC/DC also improved and were better than preoperative values. In type III cordectomy, shimmer at 12months after cordectomy was significantly better than preoperative value (14.7 vs. 9.3, p=0.007). CONCLUSIONS: These results further support the rationale of CO2 cordectomy as initial and salvage surgery for early glottic cancer.

Sinonasal ameloblastic carcinoma in a 50-year-old Filipino female: Continuing tale of the unexpected

@#<p style="text-align: justify;"><strong>OBJECTIVE: </strong>To report the possible malignant transformation of primary sinonasal ameloblastoma into sinonasal ameloblastic carcinoma.<br /><br /><strong>METHODS</strong><br /><strong>Design:</strong> Case Report<br /><br /><strong>Setting:</strong> Tertiary Public University Hospital<br /><br /><strong>Patient:</strong> One<br /><br /><strong>RESULT:</strong> A 50-year-old woman with a previous diagnosis of sinonasal ameloblastoma reported recurrence of symptoms of right-sided nasal obstruction and epistaxis two years after endoscopic sinus surgery. Clinical examination, CT scans and subsequent total maxillectomy with orbital exenteration revealed a left intranasal mass with maxillary, ethmoid and orbital floor extension and pulmonary and hepatic metastases.  Histopathologic findings of palisading columnar epithelium with reverse polarity with malignant features were consistent with ameloblastic carcinoma. Despite subsequent cycles of chemotherapy, the patient died two years after surgery. To the best of our knowledge, there have been no published reports of a primary sinonasal ameloblastoma with malignant transformation in the English literature.<br /><br /><strong>CONCLUSION:</strong> Ameloblastic carcinoma is a rare neoplasm which may arise de novo or from malignant transformation of an ameloblastoma. Because ameloblastoma is commonly encountered in our setting, clinicians should be aware of this possibility and closely follow their patients accordingly.</p>