18F-FDG-PET/CT Imaging in Advanced Glottic Cancer: A Tool for Clinical Decision in Comparison with Conventional Imaging.

This study assessed the role of 18F-FDG PET-CT (PET/CT) to detect the cartilage and paraglottic infiltration in advanced glottic cancer comparing the results with those of conventional imaging (CI) (contrast-enhanced computed tomography and/or magnetic resonance). In addition, we assessed the prognostic value of quantitative parameters, measured on baseline PET/CT, in terms of event-free survival (EFS) and overall survival (OS). We retrospectively analyzed 27 patients with glottic squamous cell carcinoma stage III and IVA, treated in our institute between 2010 and 2016, comparing PET/CT, performed for staging and radiotherapy planning, and CI findings. Cohen's K was used to compare concordance between PET/CT and CI. Imaging findings were correlated with endoscopic evaluation and histological reports (gold standard (GS)). All lesions shown by CI were also detected by PET/CT imaging, and in 5 cases, a better definition of local infiltration was achieved with PET/CT than CI (5 CT). Sensitivity, specificity, and accuracy of PET/CT and CT were 95%, 86%, and 93% and 70%, 86%, and 74% for, respectively. MRI showed sensitivity and specificity of 100%. One false-negative (FN) cases and 1 false-positive (FP) case were observed with PET/CT with no difference compared to MRI (10 cases). Six FN cases and 1 FP case were observed with CT. Cohen's K was 0.60 (PET vs. CI) and 0.80 (PET vs. GS). Patients were followed-up for at least 24 months to calculate EFS and OS. 13 local recurrence and 7 deaths were recorded. Among quantitative PET parameters, baseline MTV was the most powerful predictor of outcome. Our data suggest a reliable sensitivity and accuracy of PET/CT in the evaluation of local extension, proving a useful method for initial local staging in addition to the well-established role in lymph-node and distant sites assessment. Furthermore, pretreatment MTV provides better prognostic information than other PET/CT parameters.

[Castleman disease with lateral neck outset. Report of a clinical case]. / Malattia di Castleman ad esordio laterocervicale. Descrizione di un caso clinico.

This work presents the case of a young woman with Castleman's disease, manifest as an isolated, asymptomatic swelling in the supraclavear fossae. A fine needle biopsy was performed on the swelling and cytology on this material proved insignificant (blood cells), while CT and MRI did not show any significant vascular components nor did they provide any elements decisive for diagnosis, the neoformation being similar to a reactive lymph node. To determine the nature of the mass, the lesion was removed by cervicotomy. Histology then led to a definitive diagnosis of a hyaline vascular variant of Castleman's disease. The literature on the topic was then reviewed with an eye to otorhinolaryngological manifestations and the histological aspects and clinical-diagnostic approach are discussed in detail.

Laryngeal long-term morbidity after supraglottic laryngectomy and postoperative radiation therapy.

PURPOSE: This study was performed to investigate factors associated with laryngeal morbidity when postoperative radiation therapy (RT) is added to supraglottic laryngectomy. MATERIALS AND METHODS: From 1980 to 1994, 56 patients affected with T1 to 4 N0 to 2c supraglottic squamous cell carcinoma selected for standard (59%) or extended (41%) supraglottic laryngectomy at 2 different institutions were retrospectively analyzed. Most of the patients (91%) also underwent neck dissection. Approximately 80% of the patients had stage T4 primary lesions or N2 neck disease. Postoperative RT was added for presumed microscopic disease at the primary site (13 patients), regional nodes (23 patients), or both (20 patients). Median delivered doses to the larynx and to the neck were 50 Gy (range, 40 to 64 Gy) and 46 Gy (range, 40 to 64 Gy), respectively. Median follow-up for living patients is 11 years (range, 2.8 to 16.9 years). Laryngeal complication was defined as the appearance of grade 2 or higher toxicity according to the European Organization for Research and Treatment of Cancer (EORTC) and the Radiation Therapy Oncology Group (RTOG) scoring systems. RESULTS: Two- and 5-year actuarial locoregional control rates were 85+/-5% and 83+/-5%, respectively. Thirty patients (54%) developed laryngeal complications. However, just one patient experienced grade 4 laryngeal oedema requiring permanent tracheostomy. Estimated actuarial survival without laryngeal complications were 50+/-7%, 43+/-7%, and 39+/-7% at 2, 5, and 10 years, respectively. At univariate analysis, treated volumes (P = .03) and total dose to the larynx (P = .03) were significantly associated with local toxicity. A trend was observed also for the maximum dose to the neck (P = .06) and dose per fraction (P = .09). A multivariate Cox proportional hazards model showed total dose to the larynx to be the only independent predictor of toxicity (P = .03). The hazard ratio of laryngeal toxicity was 2.2 (95% confidence interval: 1.1/4.6), for a total dose to the larynx greater than 50 Gy. CONCLUSION: After supraglottic laryngectomy, postoperative RT to the neck does not affect local morbidity, but careful RT treatment planning is necessary to avoid delivering a total dose to the larynx greater than 50 Gy.

[Palatine tonsillar metastasis from small cell carcinoma of the lung]. / Metastasi alla tonsilla palatina da carcinoma a piccole cellule del polmone.

With regard to the rarity of metastatic tumor of the oropharyngeal region, we report a case of tonsillar metastases from the small cell carcinoma of the lung with controlateral cervical lymphadenopathy. The review of literature and the our clinic experience confirms the opportunity for an exclusively palliative treatment as then one no survivors in such events.

[Radiation treatment of early stage supraglottic cancer]. / Le traitement radiothérapique des tumeurs sus-glottiques au stade initial.

The management of early-stage squamous cell carcinoma (SCC) of the supraglottic larynx is still controversial. Supraglottic laryngectomy as well as irradiation alone is correlated with good oncological and functional results. In order to evaluate the results and prognostic factors influencing the successful using radiotherapy (RT), the authors performed a retrospective study of 100 consecutive T1-T2 N0 M0 cases of SCC of the supraglottic larynx, treated at a single institution between 1983 and 1992. RT was delivered with 60Co or 6 MeV photons through two lateral parallel opposed portals encompassing the primary laryngeal tumor and the upper and mid-neck nodes (Robbins' levels II, III and V). Supraclavicular nodes (level IV) were electively irradiated in 54 patients with T2 N0 tumors only, using an anterior field with midline block. Sixty-three patients received conventional fractionation (2 Gy/fraction, once-a-day, five times a week), while 37 patients were irradiated according to a twice-a-day fractionation regimen (1.5 Gy/fraction, twice a day with six-hour interval, five days a week). The median total tumor dose delivered was 67 Gy. A multivariate analysis showed that performance status, tumor grade and fractionation modality were the only statistically significant variables influencing disease-free survival. Acute and late radiation reactions were relatively low. This retrospective study confirms that conservative management of T1-T2 N0 supraglottic cancer using RT can achieve good cure rates with the possibility of larynx preservation for the majority of the patients. The decision between different conservative treatment modalities may be influenced by several factors correlated to the patient's conditions, tumor characteristics, but especially treatment modalities.

Reconstruction of major orbital-maxillary defects with free latissimus dorsi myocutaneous flap.

Reconstruction following excision of tumors of the orbital-maxillary region represents a challenge to the head and neck surgeons. Microvascular techniques have significantly improved the possibilities of an adequate three-dimensional repair. Among the different available options, the latissimus dorsi myocutaneous flap (LDMF) has been considered, as it seems to fulfill the requirements for a functional obliterations of the orbital-maxillary cavity and to restore the facial contour. Two cases of large orbital-maxillary defects repaired with a LDMF are reported; in one of them the intraoral palatal competence and lining were achieved through a temporalis muscle flap. Technical remarks are presented and discussed as well as the indications and possibilities for more sophisticated reconstructions, aimed at a better cosmetic outcome.

[Basaloid-squamous cell carcinoma of the larynx: a new morphologic entity. Case report]. / Il carcinoma squamoso basaloide della laringe: una nuova entità morfologica. Presentazione di un caso.

Basaloid-Squamous Cell Carcinoma (BSCC) is considered a biologically aggressive variation of squamous cell carcinoma (SCC). Wain et al. first reported BSCC as an independent neoplasm in 1986. In the past, it was most likely misinterpreted as atypical SCC. To date approximately one hundred cases have been reported in the literature. The pathognomonic characteristic of BSCC is an intimate association between basaloid and squamous patterns: for this reason a small biopsy specimen may be insufficient for correct diagnosis. In such cases, knowledge of the biological behavior of these tumors (i.e. local aggressiveness and tendency to spread both regionally and at a distance) may prove useful. Prognosis and survival rates are certainly worse than in SCC. Within the upper aero-digestive tract, BSCC is most likely to arise in the supraglottic larynx, the pyriform sinus and the base of the tongue. Treatment should include surgery of the primary tumor and of the neck lymph nodes, followed by radiotherapy. The authors present a new case report indicating the typical feature of this tumor (aggressiveness, synchronous basaloid and squamous histology, supraglottic involvement.

Conservative management of T1-T2N0 supraglottic cancer: a retrospective study.

PURPOSE: Evaluate the results of conservative management of early-stage supraglottic cancer. PATIENTS AND METHODS: A retrospective analysis of 166 consecutive T1-T2N0 cases of squamous cell carcinoma of the supraglottic larynx, treated conservatively between 1983 and 1992, was performed. Sixty-six patients received conservative surgery (CS), whereas 100 patients received definitive radiation therapy (RT). Surgical procedures included horizontal supraglottic laryngectomy in 38 patients, extended supraglottic laryngectomy in 16 patients, and reconstructive laryngectomy with cricohyoidopexy in 12 patients. Elective bilateral neck dissection was always performed. Radiotherapy was delivered with 60Co or 6 MV photons to the primary laryngeal tumor and the upper and mid neck nodes (level II and III), whereas supraclavicular nodes (level IV) were electively irradiated only in 54 patients with T2N0 tumors. Fifty-two patients received conventional fractionation, whereas 31 patients were irradiated according to a twice-a-day fractionation regimen. The median total tumor dose was 67 Gy (range, 64 to 72 Gy). RESULTS: The 5-year overall survival of the whole series was 72.7% +/- 4.5. In patients treated with CS, the 5-year disease-free survival was 88.4% +/- 4.5 versus 76.4% +/- 6.1 for patients who received RT. Salvage surgery was effective in rescuing 2 of 3 CS failures and 12 of 25 RT failures. The overall incidence of secondary tumors (11%) and distant metastases (5%) was relatively low, although together they account for 15% of all deaths. Complications of CS were significantly correlated to the extent of surgical procedure. A multivariate analysis performed in the RT group showed that performance status, tumor grade, and fractionation regimen significantly influenced disease-free survival. CONCLUSION: Conservative management of T1-T2N0 supraglottic cancer, either by CS or RT, can achieve good cure rates with larynx preservation for the majority of the patients (82% overall; 95% in the CS group and 72% in the RT group). The decision between different conservative treatment modalities may be influenced by the patient's conditions, tumor characteristics, treatment modalities, and also economic costs.

[A free radial forearm flap in oral cavity reconstruction]. / Il lembo libero radiale per la ricostruzione del cavo orale.

A relatively recent method for reconstruction of the oral cavity after tumor removal employs the use of revascularized free flaps. In particular, the Radial Forearm Flap has gained significant international recognition. After a review of the history of this procedure, the authors describe the essential aspects of the technique including what is involved in removal as well as in microanastomosis and reconstruction. In addition, the paper also deals with operative patient monitoring, prevention and treatment of any complications. Finally, a series of 10 cases is presented all of which underwent surgery at the E.N.T. Division of the Varese Hospital. The case study presents the oncological and functional results and emphasizes the technical details of the entire sampling. The purpose of this work has been to demonstrate that this procedure can be used by an E.N.T. surgical staff without requiring input from an outside team of specialists. Although this technique is difficult and somewhat limited, it must be considered one of the most innovative proposals in the field of plastic, reconstructive surgery of the head and neck.

Immunoassay of neuron-specific enolase (NSE) and serum fragments of cytokeratin 19 (CYFRA 21.1) as tumor markers in small cell lung cancer: clinical evaluation and biological hypothesis.

NSE is a biochemical marker for small cell lung cancer (SCLC) diagnosis and management. CYFRA 21.1 is a newly developed immunoassay to detect the serum fragments of cytokeratin 19 which are also expressed in SCLC with or without neurofilaments. The aim of this study was to evaluate the diagnostic performance and prognostic role of the two markers in SCLC and their contribution to chemotherapy monitoring and patient follow-up. We studied 62 patients with pathologically proven SCLC: 28 with limited disease (LD) and 34 with extensive disease (ED), and 100 patients with non-malignant pulmonary disease. Immunoradiometric assays (IRMA) were employed to test NSE and CYFRA 21.1 in patients and control subjects. For each patient subset results were expressed as median and interquartile distribution range. NSE and CYFRA 21.1 sensitivity was 0.52 (33/62) and 0.56 (35/62), respectively. In the group of patients with LD, NSE and CYFRA 21.1 sensitivity was 0.42 (12/28) and 0.54 (15/28) and in patients with ED, NSE and CYFRA 21.1 were positive in 0.62 (21/34) and 0.59 (20/34) of cases, respectively. Combining the two markers, a sensitivity of 0.78 (22/28) in LD, 0.82 (28/34) in ED and a global sensitivity of 0.80 (50/62) was obtained. Only NSE was significantly linked to the extension of disease (Mann-Whitney U test p = 0.002) while CYFRA 21.1 did not correlate. The analysis of survival and the evaluation of the two markers at diagnosis showed CYFRA 21.1 to be strongly linked to the patients' outcome, independently of both clinical prognostic factors and NSE levels (log rank and Cox's model). The markers' performance during chemotherapy was tested in a group of 33 patients with at least one marker above cut-off. NSE can be considered a reliable marker of tumor mass modifications under chemotherapy, while CYFRA 21.1 expression seems to be relatively independent of tumor volume modifications. An applicable model of biomarkers in SCLC could be the concurrent assay of NSE and CYFRA 21.1 in pre-therapeutic assessment and therapy planning. CYFRA 21.1 does not play an important role during therapy monitoring and follow-up; in these phases NSE alone may be employed.

[Solitary fibrous tumor of the nasopharynx. Apropos of a case]. / Tumeur fibreuse solitaire du nasopharynx. A propos d'un cas.

Solitary fibrous tumor (SFT) is a rare neoplasm, arising in the adult and more commonly in the pleura. For many years it has been referred to the serous surfaces of the body, namely pleura, peritoneum and pericardium; recently cases arising in mesenchymal organs such as lung, mediastinum, liver and paranasal sinuses were reported. We present a SFT of the nasopharynx, observed in a 41 year-old patient complaining a 6 months history of aural fullness at the right ear. Clinical examination revealed the presence of secretory otitis media and swelling of the lateral wall of the nasopharynx. CT scan and MR showed the presence of a solid mass, with scarce vascularization, extending from the right side of the nasopharynx to the infratemporal and pterigoid fossae. The surgical approach consisted in a facial translocation by the rotation of a maxillary-check flap through different osteotomies; a firm whitish mass not invading the surrounding tissues was identified and enucleated. A definitive diagnosis cannot be made at frozen sections, requiring more accurate processing and immunohistochemical staining. Literature reports fourteen cases of SFT of the upper aero-digestive tracts (nasopharynx, paranasal sinuses, larynx) and some 8 more cases in the head and neck area (thyroid, salivary glands and parapharyngeal spaces). This case report adds a further contribution to support the mesenchymal origin of the SFT.

[Idiopathic thrombosis of the internal jugular vein]. / Thrombose idiopathique de la veine jugulaire interne.

The venous thrombosis represents a vascular disorder usually involving the low limbs. The manifestation at the level of the upper limbs and the neck is much more rare, particularly as a consequence of a central venous catheterization of an infectious disease or of a trauma. The authors report an unusual case of spontaneous thrombosis of the internal jugular vein and analyze the most salient nosologic, diagnostic and therapeutic aspects.

[Surgical treatment of otosclerosis in the aged. Results of retrospective analysis]. / Il trattamento chirurgico dell'otosclerosi nell'anziano. Risultati di un'analisi retrospettiva.

Otosclerosis is, per se, a disease which rarely occurs after the age of 50. This is why stapes surgery is seldom performed in advanced age and there are few reports on the topic in the literature. The authors have performed a retrospective analysis of patients over the age of 65 who had undergone surgery for otosclerosis in the last 27 years. Out of a total of 3585 surgical procedures, 106 patients were analyzed. Most of the cases were in the advanced stages. Assessment of the outcome included pre- and post-operative audiometry, one year after surgery. Inner ear performance was established by evaluating air and bone conduction at 0.5, 1, 2, 3 and 4 kHz. The results showed that performing otosclerosis surgery is worthwhile even in the elderly with mixed auditory impairment, as long as the air-bone gap is limited to 20-30 dB and the surgical procedure is through. In this light, stapedotomy appears to be the most adequate technique. When evaluating the results the possibility of adopting a less powerful hearing aid should also be considered a success.

[Cutaneous head and neck carcinomas: biological characteristics, natural history and clinical classification]. / I carcinomi cutanei della testa e del collo: caratterizzazione biologica, storia naturale e classificazioni cliniche.

In cutaneous carcinoma of the Head and Neck there is a 7% of cases that often suffer substantial morbidity and even mortality. The identification of the "high-risk patient" may derive from the study of the prognostic factors which have been published in Literature. The problem has to be differentiated between the basal cells carcinoma (BCC) and the squamous cells carcinoma (SCC) due to the locally limited aggressiveness of the first and the potential for metastatization of the latter. The evaluation of the different variables confirms the inadequacy of the present TNM Classification for Cutaneous carcinoma; nevertheless the opportunity of a new and omni-comprehensive proposal is questionable.

[Primary lymphoma of the sphenoid sinus. Report of a case and review of the literature]. / Lymphome primitif du sinus sphénoïdal. Présentation d'un cas et révision de la littérature.

The Authors describe a case of primary isolated non-Hodgkin lymphoma with sphenoidal presentation. According to literature, this is the third specification quoted in the whole world. The diagnostic approach for this clinical entity is emphasized, stressing the importance of the complete radiological and endoscopic work-up.

Hypopharyngeal reconstruction using a pectoralis major myofascial flap / Reconstrucción de hipofaringe con un colgajo músculo aponeurótico del pectoral mayor

Se describe una técnica para reconstrucción hipofaríngea usando un colgajo músculo-aponeurótico y se comunican los resultados en tres pacientes. Las ventajas de la técnica son que, gracias a que es un injerto delgado y versátil, ofrece una menor posibilidad de que haya dehiscencia de la herida y, a la vez, una mayor probabilidad de desarrollar mejor voz esofágica. Deja una buena apariencia cosmética en el pecho y no crece cabello en el colgajo.

[Prospective, cohort, epidemiologic studies of laryngeal neoplasms in Italy]. / Studio prospettico probabilistico per effetto coorte sull'incidenza del cancro della laringe in Italia.

Recent epidemiological studies show, quite surprisingly, a regression in mortality rates for lung cancer in some of the most industrialized countries of the world. Aetiopathogenetic analogies are made by the Authors in order to verify future trends concerning the incidence of laryngeal cancer in Italy. In this study a particular study model, which furnishes incidence rate expectations for the disease, is elaborated. Comparison of relative risks according to birth dates demonstrates that people born around 1930 are in the higher risk range while younger generations seem to show an effective incidence reduction. Evaluations include that of estimating the period in which the world-wide incidence of the disease will be maximum. With the addition of 70 years (main incidence in the seventh decade) to the year 1930 (the worst year) the study predicts that the end of this century will see the most consistent accumulation of new cases. After the year 2010 a trend towards a gradual regression in incidence will appear. The reasons are probably related to the social and cultural transformations of the last twenty years, particularly the progressive abandoning of the smoking habit.

[Temporal bone metastasis of adenocarcinoma of the breast: personal observations and a review of the literature]. / Metastasi temporale da adenocarcinoma mammario: osservazione personale e revisione della letteratura.

A single case of temporal bone metastases from breast carcinoma is reported and its clinical features and main instrumental diagnostic characteristics are described. Although this is quite rare the possibility cannot be neglected when making diagnosis should the clinical features and test results suggest such an expansive process of the temporal bone. In fact, although extremely limited, treatment is strictly linked to proper and early diagnosis.