The Depth of Invasion and Level IV Cervical Node Metastasis in Patients with Clinically N0 Tongue Cancer.

BACKGROUND: The accurate indication for level IV dissection is crucial for preventing complications such as phrenic nerve damage and chylous fistulas in clinically N0 tongue cancer. Although the depth of invasion is an established independent risk factor for occult lymph node metastasis in tongue cancer, its relationship with level IV metastasis has not been evaluated. This study investigated the relationship between the depth of invasion and level IV nodal metastasis in clinically N0 tongue cancer. METHODS: We retrospectively investigated clinical N0 patients who underwent glossectomy and level I-IV neck dissection. We examined lymph node metastasis, risk factors, and the relationship between depth of invasion and metastasis. RESULTS: Our study included 58 patients, and no patient had isolated level IV metastasis. Additionally, there was no level IV metastasis in well-differentiated tumors. Tumor size, depth of invasion, differentiation, and perineural invasion were significantly associated with level IV neck metastasis. We found a critical tumor size of 2.5 cm and depth of invasion of 8 mm for level IV neck metastasis. CONCLUSION: Based on our findings, we recommend that level IV dissection should be considered for poorly differentiated tumors, tumors greater than 2.5 cm in size, and those deeper than 8 mm. This study highlights the importance of depth of invasion as a prognostic factor for predicting level IV metastasis and suggests that our findings can be used to prevent unnecessary level IV dissections that may lead to complications in tongue cancer surgery.

The role of CT angiography and endovascular treatment in acute-massive head and neck bleeding.

PURPOSE: To report the results of the endovascular treatment of acute-massive head and neck bleeding in a single center and underline the value of computerized tomography-angiography and endovascular treatment of this desperate patient group. METHODS: Forty-eight patients who suffered from acute-massive head and neck bleeding and in whom conservative treatment options had failed were included in the study. To localize the site of the bleeding, computerized tomography-angiography was obtained above the supra-aortic level. Depending on the type and site of bleeding, an urgent angiographic evaluation and appropriate endovascular treatment procedure were performed in the same session immediately. Complete control of all active bleeding was determined as "technical success" at the end of the procedure. RESULTS: The majority of the endovascular treatment indications were tumoral mass bleedings in this study. Eight patients, all of which had head and neck tumors as the cause of the bleeding underwent repeated interventional procedures due to acute re-bleeding. All patients left the angiography unit with technical success and dramatic clinical improvement. Two patients had procedure-related severe complications, such as contrast-induced nephropathy and acute cerebrovascular accident. One patient died due to massive re-bleeding during the follow-up period. CONCLUSION: Computerized tomography-angiography is a successful imaging method to reveal the location and cause of bleeding. Endovascular treatment of acute-massive head and neck bleeding is an effective and life-saver treatment option that can be used successfully with relatively low-risk potential.

The role of CD133 expression of cancer stem cells on radiotherapy response in early stage glottic cancers.

PURPOSE: To investigate the relationship between CD133 positivity and radiotherapy (RT) response in early stage glottic laryngeal cancers. METHODS: Thirty seven patients with early-stage glottic laryngeal carcinoma who were treated with primary RT were evaluated. Patients with regular follow-up of at least 3 years were included in the study. Patients who had previously received chemotherapy for laryngeal surgery or underwent surgery were excluded. The patients were divided into two groups as recurrent and non-recurrent. These two groups were compared in terms of CD133 expression by immunohistochemical method. RESULTS: There were 37 patients in the study. Ten patients had recurrence and seven (70%) had CD133 positive and three had CD133 negative. Of 27 patients who had no recurrence, 16 (59%) had CD133 positive and 11 (41%) had CD133 negative. 7 (70%) of ten patients with recurrence were found to be positive for CD133; There was no statistically significant difference between recurrent and non-recurrent patient groups in terms of CD133 positivity (p > 0.05). There was no correlation between the final CD133 score and recurrence status as well (p > 0.05). CONCLUSION: There was no relationship between radiotherapy response and CD133 staining in early-stage glottic laryngeal cancers. It is the largest study about CD133 and RT sensitivity in early stage glottic carcinomas.

Bilateral Laryngocele Causing Epiglottic Deformity and Upper Airway Obstruction.

Laryngocele is the cystic dilatation of laryngeal ventricle. Most cases are asymptomatic and incidentally diagnosed in radiologic examinations. Although the etiology is unclear, obstruction, laryngeal pressure, congenital defects are possible risk factors. Computed tomography is the best method for diagnosis. Endoscopic, external or combined approaches have been described in the surgical treatment. Laryngocele should be kept in mind in patients with acute upper airway obstruction. Such patients may require tracheostomy. Some patients with laryngocele can also have laryngeal cancer, in which case direct laryngoscopy must be performed. This report presents a case with respiratory distress associated with bilateral laryngocele, and his management in the light of the literature.

The effect of FoxP3 on tumour stage, treatment response, recurrence and survivalability in nasopharynx cancer patients.

OBJECTIVES: To investigate the relationship between the cell percentage of T regulator (Treg) cells of patients' specimens and disease severity, survivability, recurrence and metastasis in patients who were diagnosed with nasopharyngeal carcinoma (NPC). DESIGN, SETTING AND PARTICIPANTS: Sixty patients who were diagnosed as NPC and treated by the same protocol were enrolled to the study. Patient files were reviewed retrospectively and their clinical and pathological results were recorded. Deparaffinized samples of nasopharyngeal carcinoma patients were stained immunohistochemically with anti-FoxP3 monoclonal antibody. All patients's Anti-FoxP3 stained slides were evaluated by the same pathologist. Stained Treg lymphocytes around the tumoral foci were investigated. Patients were divided into two groups according to the total anti-FoxP3-stained Treg cell counts of the specimens; that is, less than 20% of the total or more than 20% of the total. These groups were compared statistically. MAIN OUTCOME MEASURES: Intensity of FoxP3 which is related to negative tumor response was the main outcome measure. It was evaluated in terms of stage, survival, recurrence and metastasis. RESULTS: The study group consisted of 42 male patients (70%) and 18 female patients (30%). The mean age was 47 ± 14.9. NPC subtypes among the patients were undifferentiated non-keratinized type in 54 patients (90%), differentiated non-keratinized type in 4 patients (6.66%) and keratinized type squamous cell carcinoma (SCC) in 2 patients (3.33%). When the two groups were compared in terms of pathological subtype, there was no significant variation between the two groups. There was also no significant variation between the two groups when compared on the basis of tumor stage (P = 0.36 for T phase, P = 0.122 for N phase), early stage, late phase (P = 0.15), survival rate (P = 0.69 for general survival), recurrence (P = 0.2 for local recurrence, P = 0.37 for regional recurrence) and distant metastasis (P = 0.3). CONCLUSION: There was no significant relationship between the concentration of these cells in the stained specimens and the disease stage, survival rate, recurrence and distant metastasis discovered.

Thyroid leiomyosarcoma: presentation of two cases and review of the literature.

INTRODUCTION: Leiomyosarcoma is a tumor which is rarely seen in the thyroid gland. The diagnosis may be difficult and the treatment is controversial. OBJECTIVE: The objective of the study is to review the literature about a rare malignant disease of the thyroid gland which has high mortality. METHODS: Two cases of thyroid leiomyosarcoma are presented and the previous 23 cases in the current literature are reviewed. RESULTS: A total of 25 cases of thyroid leiomyosarcoma are reviewed; the most common complaint was rapidly growing anterior neck mass, and ten of the 25 patients had distant metastasis at the initial admission. Fifteen of the 25 patients died with the disease in the first 12 months after the diagnosis. CONCLUSION: The differential diagnosis of thyroid leiomyosarcoma is important and should be performed with other malignancies of the gland, especially with anaplastic carcinoma. The prognosis is poor and there is no consensus regarding the treatment.

Cytogenetic damage of radiotherapy in long-term head and neck cancer survivors.

PURPOSE: To evaluate cytogenetic damage of radiotherapy (RT) and chemoradiotherapy (CRT) in long-term head and neck cancer survivors. MATERIALS AND METHODS: This study included 20 patients treated with RT (10 patients) or CRT (10 patients) for head and neck cancer. Nine healthy volunteers were included as control subjects. Cytochalasin B-blocked micronucleus (CBMN) assay was used to evaluate cytogenetic damage. To evaluate micronucleus (MN) by CBMN, the venous blood samples were drawn median 68 months (range 60-239 months) after the completion of treatment (RT or CRT) for head and neck cancer. RESULTS: Nuclear division index (NDI) and number of MN in mononuclear and binuclear lymphocytes were significantly higher in patients with head and neck cancer than in control subjects [1.19 (1.08-1.47) vs. 1.07 (1.04-1.14), p < 0.001; 11.0 (2.0-22.0) vs. 1.0 (0-3.0), p < 0.001 and 15.0 (5.0-45.0) vs. 9.0 (2.0-15.0), p = 0.020, respectively]. NDI and number of MN in mononuclear lymphocytes were significantly lower in control subjects compared patients received CRT and those received only RT, but there was no significant difference between patients received CRT and those received only RT. Number of MN in binuclear lymphocytes was significantly lower in control subjects compared to patients received CRT, but there was no significant difference between control subjects and those received only RT. Also there was no significant difference between patients received CRT and those received only RT in terms of number of MN in binuclear lymphocytes. CONCLUSIONS: MN frequency of mononuclear and binuclear lymphocytes in medical follow-up of patients with head and neck cancer after RT could be important in evaluating cytogenetic damage of RT. However, further investigations are needed to provide quantitative correlations between MN yields and the clinical features in post-radiotherapy period.

An Unusual Case of Laryngeal Paraganglioma in a Patient with Carotid Body Paraganglioma: Multimodality Imaging Findings.

Multiple paragangliomas of the head and neck are rare conditions. Carotid paragangliomas are most common multiple paragangliomas. Laryngeal paragangliomas are very rare neuroendocrine tumors and usually are seen as symptomatic solitary lesions. We present multimodality imaging findings of incidentally detected laryngeal paraganglioma in a woman with synchronous carotid body paraganglioma and positive family history. To the best of our knowledge, this is the first case of laryngeal and carotid body paragangliomas in a patient with positive family history. Radiologists should keep in mind that paragangliomas may occur in various locations as multiple tumors.

Predictive value of E-cadherin and Ep-CAM in cervical lymph node metastasis of supraglottic larynx carcinoma.

OBJECTIVE: To evaluate the value of E-cadherin and epithelial cell adhesion molecule (Ep-CAM) expression in laryngeal biopsy materials for predicting cervical lymph node metastasis in patients with supraglottic laryngeal carcinoma. METHODS: All patients participating in the study were selected from among the surgically treated patients at the department of Otolaryngology, Head and Neck Surgery, Erciyes University School of Medicine between 1991 and 2005. The study consisted of thirty patients who had pathologically metastatic lymph nodes (pN+ group) and 30 age-, sex-, T value- and differentiation matched patients without pathologically metastatic lymph nodes (pN0 group). Immunohistochemical studies were performed with E-cadherin and Ep-CAM antibodies on representative tumor sections collected from paraffin sections of laryngeal biopsy materials. The expression of E-cadherin and Ep-CAM was compared between the pN0 and pN+ groups. The association between immunostaining of E-cadherin and Ep-CAM was also evaluated. RESULTS: There was no significant difference between the two groups in terms of E-cadherin and Ep-CAM expression. There was also a very poor agreement between the expression of E-cadherin and Ep-CAM. CONCLUSION: Multi-institutional and multidisciplinary immunohistochemical studies conducted with standardized methodology and also with more patient participation may help to obtain more specific results.

Experimental autotransplantation and cryopreservation of the thyroid gland.

BACKGROUND: The purpose of this study was to investigate the functionality of autotransplanted thyroid tissues immediately or after cryopreservation in rabbits. METHODS: The study was completed with 12 rabbits randomized in 2 groups. Preoperative scintigraphies were performed for all subjects. The rabbits underwent total thyroidectomy. The first group underwent immediate thyroid autotransplantation. Thyroid tissues of the second group were cryopreserved and autoimplanted at the eighth postoperative week. The free triiodothyronine (fT3) and thyroxine (fT4) levels were monitored for 8 weeks. Postoperative scintigraphies were performed at the eigth week after autoimplantation. RESULTS: The subjects in the first group reached euthyroid levels at the eighth week while none of the second group reached that level, but all showed continuous increase. Although implanted thyroid tissues of 5 of the 6 rabbits in the first group were demonstrated during the first scintigraphy, the number was only 1 in the second group. CONCLUSION: Thyroid autografts were found to be functional and thought to have a potential preventing postoperative hypothyroidism.

Survivin expression correlates with nodal metastasis in T1-T2 squamous cell carcinoma of the tongue.

In this study, the correlation between neck metastasis and recurrence was investigated by studying specimens of tongue squamous cell carcinoma patients immunohistochemical with survivin antibodies in the primary biopsy. A retrospective review was conducted at the Academic University Hospital. 46 patients who had squamous cell carcinoma of the tongue, who underwent various types of glossectomy and neck dissections between 1991 and 2008, were evaluated. The patient's sex, TNM staging, differentiation and recurrence rates were analyzed. There were 20 T1 patients and 26 T2 patients; 27 of the patients were N0 and 19 had metastatic lymph nodes in the neck. Survivin antibodies were applied with streptavidin-biotin method to the sections that were prepared from the primary tumor biopsy specimens of the patients. The correlation between neck metastasis and recurrence and survivins' immunohistochemical staining was analyzed with statistical methods. There were no significant differences between the patient's age, sex, tumor's T stage, tumor differentiation and survivin staining density. Survivin staining was positive in 15 (79 %) of 19 patients with neck metastasis, while it was positive in 16 (59 %) of 27 patients without neck metastasis. Eleven (79 %) of the 14 patients who had recurrence and all 6 patients who had neck recurrence only were stained by survivin. Expression of nuclear and cytoplasmic survivin can be a useful marker for predicting cervical lymph node metastasis in T1-T2 tumors in tongue SCC.

Laryngeal chondrosarcoma as a rare cause of subglottic stenosis.

Laryngeal chondrosarcoma (CS) is a very rare entity. It is usually seen in 50-80-year olds. It is developed from cricoid cartilage largely. Patients have laryngeal CS complaint of respiratuvar distress, dysphonia, and dysphagia generally. A submucous mass is usually seen in physical examination with an intact mucosa. Distant metastasis is rare in CSs. Main treatment is surgical excision. An 82-year-old patient who has respiratuvar distress is presented in this paper and laryngeal CS is reviewed in the light of the literature.

Comparison of effects on voice of diode laser and cold knife microlaryngology techniques for vocal fold polyps.

AIM: To compare the effects on voice of endolaryngeal microsurgery (EMS) with cold instruments and a new method, "diode laser," for vocal fold polyps. PATIENTS AND METHODS: Fifty-one patients with vocal fold polyps suffering from dysphonia who were treated in the Erciyes University Department of Otolaryngology were included in the study. Voice analysis was performed in a soundproof room, holding the microphone 15 cm away from the patients' mouth and by recording a sustained [a] vowel for at least 10 seconds. Fundamental frequency (F0), Jitter, Shimmer, and noise-to-harmonic ratio (NHR) parameters were evaluated in terms of vocal analysis. All patients were asked for to fill in a questionnaire, after being informed about the voice handicap index (VHI). EMS was performed with a diode laser and cold knife on 26 and 25 patients, respectively. Patient follow-up was performed 8 weeks after surgery. Changes in F0, Jitter, Shimmer, and NHR values were measured and recorded. VHI was also completed and reassessed. RESULTS: There was a significant difference in each technique's VHI score between the preoperative and postoperative questionnaire (P < 0.001). Postoperatively, there was no significant difference in VHI scores between two groups (P > 0.05). There was a significant difference in voice analysis values measured preoperatively and at the postoperative controls for both groups (P < 0.05). Postoperatively, there was no significant difference in voice analysis values between two groups (P > 0.05). CONCLUSION: In the treatment of vocal polyps, EMS with both diode laser and traditional cold knife is effective.

The role of H. pylori in the development of laryngeal squamous cell carcinoma.

AIM: This study aims to investigate the possible role of H. pylori as a cause of laryngeal squamous cell carcinoma. METHOD: This controlled study was performed with 31 consecutive laryngeal cancer and 28 cancer-free patients who underwent direct laryngoscopy and biopsy of laryngeal lesions. To document the previous H. pylori infection, serological analysis of the antibody titers was done. Immunohistochemical analyses were applied to the tissue samples. RESULTS: Serology was found positive at the 90.3% of the laryngeal cancer patients and 96.4% of the benign group. There were no statistically significant differences between the two groups (P > 0.05). Immunohistochemical analysis results were determined as negative at all of the specimens of laryngeal cancer patients and patients with benign lesions. CONCLUSION: There were no signs of colonization of H. pylori in laryngeal tissues of both groups' patients. It is thought that no relationship exists between the H. pylori infection and laryngeal squamous cell carcinoma.

Tularemia: a rare cause of neck mass, evaluation of 33 patients.

The objective of the study is to report 33 cases presenting with neck masses later diagnosed with tularemia and to raise attention to this rare zoonotic infection. A retrospective analysis of 33 patients, who were diagnosed with tularemia and treated at Erciyes University Department of Otorhinolaryngology between January 2010 and December 2010 was conducted. In conclusion, because tularemia is a rare infection, its diagnosis is frequently delayed and the symptoms of the patients may last for months without any appropriate treatment. The diagnosis of tularemia rests on clinical suspicion. For the patients, who carry risk factors for tularemia and having cervical lymphadenopathies with or without oropharyngeal symptoms and who do not response to treatment with beta-lactam antibiotics, tularemia must be kept in mind.

The role of CD44 and matrix metalloproteinase-9 expression in predicting neck metastasis of supraglottic laryngeal carcinoma.

AIM: The aim of this study is to evaluate the role of CD44 and matrix metalloproteinase (MMP)-9 expression in predicting neck metastasis of supraglottic laryngeal carcinoma. MATERIALS AND METHODS: Two hundred ninety-four supraglottic laryngeal cancers were treated surgically from 1991 to 2005. Ninety-four of the 294 patients had pathologically metastatic lymph node (pN+). Among the 94 patients, 30 pN+ patients were selected via random sampling. Sex-, T value-, and differentiation-matched 30 patients who had pathologically negative neck were also selected. CD44 and MMP-9 antibodies were applied to the tumor representative sections that were derived from paraffin sections by using the streptavidin-biotin method. The association between immunohistochemical results and histopathologic lymph node metastasis was analyzed statistically. The association between immunostaining of CD44 and MMP-9 was also analyzed. RESULTS: Overexpression of CD44 and MMP-9 was found to be significantly higher in pN+ patients. There was fair concordance between immunostaining of CD44 and MMP-9. CONCLUSION: Although wider multiinstitutional and multidisciplinary studies are needed to draw specific conclusions, CD44 and MMP-9 can be useful in the prediction of neck metastasis in the supraglottic laryngeal carcinoma.

Effect of nasal packing and haemostatic septal suture on mucociliary activity after septoplasty: an assessment by rhinoscintigraphy.

Nasal packing may influence the mucociliary clearance of the nose in the postoperative healing phase. In an attempt to overcome some of this problem, a haemostatic septal suturing technique was conceived. In this prospective study, we aimed to investigate the effects of nasal packing and septal suturing technique on mucociliary clearance by rhinoscintigraphy. Forty-eight adult patients who had undergone septoplasty were included in the investigation. Preoperatively, the patients were allocated into three groups: group 1, fingerstall packs filled with gauze and smeared with vaseline were used (11 male, 4 female); group 2, silicon septal splint packs were used (11 male, 4 female); group 3, haemostatic septal sutures were used (14 male, 4 female). Mucociliary clearance was measured by rhinoscintigraphy in all patients before surgery and 6 weeks after surgery. The nasal mucociliary clearance was presented as the velocity (mm/min) of nasal mucociliary transport of the (99m)Tc-MAA droplet. The mean velocity of nasal mucociliary clearances before and after surgery for group 1, group 2 and group 3 were 1.85 +/- 0.67 versus 2.43 +/- 0.78 mm/min, 2.36 +/- 0.80 versus 2.92 +/- 0.96 mm/min and 2.03 +/- 0.58 versus 2.62 +/- 0.65 mm/min, respectively. A significant difference in nasal mucociliary clearance was observed after surgery in all groups (p < 0.001). No significant differences were found between the groups regarding mucociliary clearance before and after surgery. Patients with septal deviation have a prolonged mucociliary transit time as compared with postoperative. Nasal packing did not significantly influence the mucociliary clearance in the postoperative healing phase.

Tongue metastasis mimicking an abscess.

Primary tumors metastasizing to the oral cavity are extremely rare. Lung is one of the most common primary sources of metastases to the tongue. Although the incidence of lung cancer is increasing, tongue metastasis as the initial presentation of the tumor remains uncommon. Due to the rarity of tongue metastasis, little is known about its imaging findings. Herein we report the magnetic resonance imaging and clinical findings of a lingual metastasis, mimicking an abscess, from a primary lung cancer.

Regional metastatic pattern of papillary thyroid carcinoma.

The objective of the present study was to determine the pattern of lymphatic spread in papillary thyroid carcinoma with clinically positive nodes. Between 1999 and 2008, a total of 48 consecutive patients with clinical evidence of cervical lymph node metastasis of papillary thyroid carcinoma underwent 61 modified radical neck dissections (13 being bilateral) including levels II-VI. All neck dissection specimens were separated during surgery into levels and analysis was done with respect to the levels of neck. T value of tumor and demographic parameters were compared with the number of metastatic nodes with univariate analysis. The median number of pathologic nodes in neck dissection specimen was 7.0. The predominant site of metastasis was level VI (77%), followed by level III (69%), level IV (66%), and level II (46%). Level V showed 34% of nodal metastasis. Seven patients had level VII, and five patients had parapharyngeal lymph node dissections because of lymphatic involvement at these sites. There was no statistically significant correlation between T value, age, sex and the number of histologically positive lymph nodes (P = 0.39, P = 0.91 and P = 0.84, respectively). It was concluded that the high incidence of metastatic disease in levels II through VI supports the recommendation for level II through level VI neck dissection in patient with clinically positive neck disease.