Basal Cell Adenoma and Basal Cell Adenocarcinoma: a 50-year Experience From a Single Institution.

BACKGROUND: Basal cell adenoma (BCA) and adenocarcinoma (BCAd) are two of the least frequent salivary gland tumors. We describe the largest series of these neoplasms, spanning over a period of 50 years (1970-2020), diagnosed and treated in a single Institution. METHODS: Sixty-eight cases were identified. Clinical and pathological data were collected and correlated with outcome. RESULTS: Forty-one BCA and 27 BCAd were identified. BCA cases had almost pristine prognosis, with only a relapse in a tumor inadequately excised. Ten patients with BCAd developed metastases, and 14 died from the disease. The 2-year and 5-year survival was of 76% and 42%. CONCLUSIONS: The importance of adequate excision is reinforced in BCA, with no recurrences occurring when margins were negative. Contrary to previous reports, BCAd was not associated with a good prognosis. A better understanding of the genetics of these neoplasms may identify therapeutic options when dealing with inoperable or metastatic disease.

["Immunotherapy in head and neck squamous cell carcinoma"]. / Traitement des tumeurs de la vessie par les inhibiteurs du contrôle immunitaire.

"Immunotherapy in head and neck squamous cell carcinoma.Immune checkpoint inhibitors became recently the standard of care for recurrent and/or metastatic head and neck squamous cell carcinoma not amenable to surgery and/or radiotherapy. Nivolumab as single agent is approved regardless of PD-L1 expression for recurrent and/or metastatic patients following progression within 6 months of platinum therapy administered either in the first line recurrent setting, or concomitantly with radiotherapy. Pembrolizumab in combination with platinum and 5-FU and pembrolizumab a single agent are two approved regimens in the first line recurrent and/or metastatic setting, provided: PD-L1 expression on tumour cells and/or inflammatory cells, and lack of disease progression within 6 months of platinum therapy given concomitantly with radiotherapy."

"Traitement des cancers orl par les inhibiteurs du contrôle immunitaire.Les inhibiteurs du contrôle immunitaire ciblant PD1 font partie du traitement de référence pour les patients atteints de carcinome épidermoïde de la tête et du cou en situation de récidive et/ou métastatique lorsqu'il n'y a plus de place pour les traitements locaux comme la chirurgie et la radiothérapie. Le nivolumab est approuvé en monothérapie sans sélection sur l'expression de PD-L1 chez les patients qui ont eu une progression après traitement par platine, que ce soit en première ligne de récidive ou dans les 6 mois suivant une radiochimiothérapie concomitante avec cisplatine, alors que le pembrolizumab est approuvé en première ligne de récidive en monothérapie ou en association à une chimiothérapie par platine et 5-fluoro-uracile aux conditions suivantes: expression de PD-L1 sur les cellules tumorales ou immunitaires, et absence de progression dans les 6 mois suivant une radiochimiothérapie avec platine."

Opium use and the risk of head and neck squamous cell carcinoma.

Scant evidence exists to support the association of opium use with head and neck cancer, limited to the larynx and oral cavity. In a multicenter case-control study-Iran Opium and Cancer study, we recruited 633 cases of head and neck squamous cell carcinoma (HNSCC) (254 lip and oral cavity, 54 pharynx, 327 larynx and 28 other subsites within the head and neck) and 3065 frequency-matched controls from April 2016 to April 2019. Odds ratios (ORs) for opium use and 95% confidence intervals (95% CIs) were obtained using mixed-effects logistic regression because of heterogeneity among centers. The adjusted OR (95% CI) for regular opium use was 3.76 (2.96-4.79) for all HNSCC combined. Strong dose-response effects were observed by frequency or amount of use, and duration of use. Regular opium uses significantly increased the risk of HNSCC of the pharynx, larynx and other subsites within the head and neck with OR (95% CI) of 2.90 (1.40-6.02), 6.55 (4.69-9.13) and 5.95 (2.41-14.71), respectively. The observed associations were significant even among never tobacco smokers (including cigarette and water-pipe smoking). Moreover, by the multiplicative interaction scale, the effect of opium use could be varied by cigarette smoking on HNSCC, 8.16 (6.20-10.74). For the first time, the current study showed opium users have an increased risk of several anatomic subsites of HNSCC.

[Vaccination against papillomavirus : outstanding issues]. / Vaccination contre les papillomavirus : les questions en suspens.

Vaccination against papillomavirus: outstanding issues. Human papillomavirus or HPV are oncogenic viruses involved in many cancers. It is estimated that around 5% of cancers worldwide are linked to HPV infection. Cancers of the cervix, vagina, vulva, anus, penis and throat (tonsil) are virally induced in proportions ranging from 35 to almost 100%. These cancers are not all easily detected and the detection of lesions is not always simple and effective. Prophylactic anti-HPV vaccination is recognized for its effectiveness in the prevention of cervical cancers, its place in the prevention of other induced HPV cancers remains debated.

Vaccination contre les papillomavirus : les questions en suspens. Les papillomavirus humains sont des virus oncogènes impliqués dans de nombreux cancers. On considère qu'environ 5 % des cancers dans le monde sont liés à une infection par un papillomavirus. Les cancers du col de l'utérus, du vagin, de la vulve, de l'anus, du pénis et de la gorge (amygdale) sont viro-induits selon des proportions variant de 35 à presque 100 %. Ces cancers ne sont pas tous facilement détectés, et les dépistages de lésions ne sont pas toujours simples et efficaces. La vaccination prophylactique contre les papillomavirus est reconnue pour son efficacité dans la prévention des cancers du col de l'utérus ; sa place dans la prévention des autres cancers induits par les papillomavirus reste débattue.

A solitary supraglottic neurofibroma presenting with obstructive sleep apnea in an adolescent.

None: Obstructive sleep apnea (OSA) is commonly encountered in the pediatric population and has a large differential diagnosis. As clinicians, we must determine who needs to undergo flexible laryngoscopy to rule out potential obstructing lesions causing OSA. This report presents a 16-year-old female who presented with snoring, "asthma," dysphagia, and OSA. Flexible laryngoscopy and computed tomography revealed a neurofibroma of the aryepiglottic fold without associated neurofibromatosis type 1. The patient underwent microlaryngoscopy and the lesion was excised using cold steel and a carbon dioxide laser. At 6 months' follow-up, the patient was breathing without difficulty and had no evidence of recurrence. Solitary laryngeal neurofibromas are extremely rare, and this is the first case of an adolescent with OSA caused by a solitary supraglottic neurofibroma. A supraglottic mass needs to be considered in the differential diagnosis of patients with OSA who fail conservative treatment, even a diagnosis as rare as a solitary laryngeal neurofibroma.

Investigation of correlation between quantitative parameters derived from dual?energy CT and the differentiation degree of laryngeal and hypopharyngeal squamous cell carcinoma / 中华放射学杂志

Objective To investigate the correlation between quantitative parameters derived from iodine overlay images and the monochromatic images of dual‐energy CT and the differentiation degree of laryngeal and hypopharyngeal squamous cell carcinoma(LHSCC). Methods Retrospective analysis of clinical and imaging data of eighty patients with different differentiation degree of LHSCC who underwent dual‐energy CT enhanced scan in the arterial and venous phase from March 2016 to January 2017 (20, 42 and 18 patients with well, moderately and poorly differentiation, respectively) was performed.Among them, twenty‐eight cases were stage T1, twenty‐four cases were stage T2, twenty cases were stage T3 and eight cases were stage T4. All patients were not treated with radiotherapy and chemotherapy before operation. Iodine overlay images and the monochromatic images of arterial and venous phases were acquired from Syngo MultiModality Workplace dual‐energy post‐processing software of Siemens, respectively. The mean iodine concentration (IC), standardized iodine concentration (SIC), and the slope of spectral curve(λ) of different differentiation degrees of LHSCC were calculated and compared. The correlation between quantitative parameters of LHSCC and its differentiation degree was performed by Spearman rank sum test. One‐way analysis of variance was used to compare the quantitative parameters of different differentiation degree of LHSCC. Receiver operating characteristic (ROC) curve was used for analyzing diagnostic efficiency. Results The IC, SIC, and λ in the arterial phase, and IC in the venous phase correlated positively with differentiation degree in LHSCC (r=0.258, 0.350, 0.262 and 0.275, respectively; P<0.05) in this group. The IC, SIC, and λ of poorly differentiated LHSCC in the arterial phase [(3.13 ± 0.54) mg/ml, (0.38±0.10), (5.40±0.92)] were higher than those of well differentiated LHSCC [(2.38±1.02) mg/ml, (0.25± 0.09) and (4.19 ± 1.18); t=2.73, 3.36 and 2.75 respectively; P<0.05] and moderately differentiated LHSCC [(2.56±0.85) mg/ml, (0.28±0.16) and (4.56±1.41); t=2.38, 3.06 and 2.21, P<0.05]. IC of poorly differentiated LHSCC in the venous phase [(2.59 ± 0.62) mg/ml] was significantly higher than that of well differentiated LHSCC [(1.96±0.56) mg/ml,t=2.45,P<0.05] and moderately differentiated [(2.02±0.93) mg/ml,t=2.56,P<0.05] LHSCC. There was no significant difference in the SIC and λ between different differentiation degrees of LHSCC (P>0.05) in the venous phase. The standardized iodine concentration in the arterial phase was the best in distinguishing poorly and moderately differentiated LHSCC, and poorly and well differentiated LHSCC with the area under the receiver operating curve 0.77 and 0.81, respectively, the sensitivity 88.2% and 70.0%, respectively, and the specificity 69.0% and 70.0%, respectively. Conclusions Quantitative parameters derived from dual‐energy CT might be useful in the evaluation of different differentiated degrees of LHSCC. In addition, the standardized iodine concentration of LHSCC in the arterial phase was the best in the estimation of different differentiated degrees of LHSCC.

[Exploration of feasibility and safety of transoral robotic surgery in pharyngolaryngeal tumors].

Objective: To investigate the indication, feasibility, and safety of da Vinci robotic surgical system in pharyngolaryngeal tumor resection. Methods: Thirty patients were diagnosed with pharyngolaryngeal tumors and treated with a transoral robotic surgery (TORS) in Beijing Anzhen Hospital from June 1, 2016 through November 30, 2017. Inclusion criteria included lesions of the oropharynx (n=13), parapharyngeal space (n=7), larynx (n=6) and hypopharynx (n=4). Twenty cases were males and ten cases were females. The median age was 56 years old (ranging from 30 to 81 years). Results: The robotic surgeries were performed successfully on 30 patients. One patient (3.3%) underwent TORS combined with a neck incision. The mean operative time was 40.7 min. The mean blood loss was 15.8 ml. The mean recovery time for oral intake was 5.3 days. The mean hospital stay was 9 days. None of the patients underwent tracheotomy or mandible split. Postoperative pathological examination showed that 18 cases (60.0%) were malignant and 1 case (5.6%) had positive surgical margin. Sixteen cases received neck dissection. No serious complications occurred during or after the operation. There was no local recurrence, metastasis or death except for regional recurrences in 2 cases (11.1%) with a follow-up of 1 to 18 months(median 13 months). Conclusion: Transoral robotic surgery is a feasible, safe and effective surgical procedure with clear operation field, rapid surgical access, minimally invasive surgery, lesser hemorrhage, good cosmetic effect and fast recovery.

Nasal-type extranodal T-cell/NK lymphoma in association with hemophagocytic syndrome

Abstract: Extranodal NK/T-cell lymphoma nasal type is a rare disease that mainly affects the nasal cavity and paranasal sinuses of males in the fifth decade of life. It has aggressive and locally destructive behaviour, and can be complicated by the hemophagocytic syndrome, conferring high lethality to the disease. This article describes a case of NK/T-cell lymphoma nasal type in a previously healthy patient, exemplifying its rapid and fulminant course.

Exploration of feasibility and safety of transoral robotic surgery in pharyngolaryngeal tumors / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the indication, feasibility, and safety of da Vinci robotic surgical system in pharyngolaryngeal tumor resection. @*Methods@#Thirty patients were diagnosed with pharyngolaryngeal tumors and treated with a transoral robotic surgery (TORS) in Beijing Anzhen Hospital from June 1, 2016 through November 30, 2017. Inclusion criteria included lesions of the oropharynx (n=13), parapharyngeal space (n=7), larynx (n=6) and hypopharynx (n=4). Twenty cases were males and ten cases were females. The median age was 56 years old (ranging from 30 to 81 years). @*Results@#The robotic surgeries were performed successfully on 30 patients. One patient (3.3%) underwent TORS combined with a neck incision. The mean operative time was 40.7 min. The mean blood loss was 15.8 ml. The mean recovery time for oral intake was 5.3 days. The mean hospital stay was 9 days. None of the patients underwent tracheotomy or mandible split. Postoperative pathological examination showed that 18 cases (60.0%) were malignant and 1 case (5.6%) had positive surgical margin. Sixteen cases received neck dissection. No serious complications occurred during or after the operation. There was no local recurrence, metastasis or death except for regional recurrences in 2 cases (11.1%) with a follow-up of 1 to 18 months(median 13 months). @*Conclusion@#Transoral robotic surgery is a feasible, safe and effective surgical procedure with clear operation field, rapid surgical access, minimally invasive surgery, lesser hemorrhage, good cosmetic effect and fast recovery.

[Fluorescence imaging in laryngology: Physical principles, clinical applications and study results]. / Fluoreszenzbildgebung in der Laryngologie: Physikalische Grundlagen, klinische Anwendung und Studienergebnisse.

BACKGROUND: Early detection and adequate preoperative assessment of neoplastic lesions of the larynx allow for voice-preserving therapy concepts. OBJECTIVE: The physical principles, clinical applications and most important study results of fluorescence imaging are presented. MATERIALS AND METHODS: The entire literature on autofluorescence endoscopy of the larynx was analysed and compared to induced fluorescence endoscopy. RESULTS: In detecting malignant and premalignant lesions of the larynx, autofluorescence endoscopy shows a significantly higher sensitivity, specificity and accuracy than white light endoscopy alone. Induced fluorescence endoscopy achieved an even higher sensitivity, albeit at the expense of specificity. CONCLUSION: Autofluorescence endoscopy represents a simple screening procedure for early detection of laryngeal cancer and its precursor lesions, whereas induced fluorescence endoscopy is more suited for the identification of recurrent disease.

[Noninvasive imaging using autofluorescence endoscopy: Value for the early detection of laryngeal cancer]. / Nichtinvasive Bildgebung mittels Autofluoreszenzendoskopie: Stellenwert bei der Früherfassung des Kehlkopfkarzinoms.

BACKGROUND: Autofluorescence endoscopy is able to delineate malignancy from normal tissue by color change. The objective of the present study was to assess the value of this noninvasive imaging method for the early detection of laryngeal cancer and its precursor lesions. PATIENTS AND METHODS: In a prospective study, 152 patients with a laryngeal lesion who were undergoing microlaryngoscopy were investigated. Autofluorescence endoscopy was performed after conventional white light endoscopy, just before excisional biopsy was carried out for histologic verification. RESULTS: In the early detection of laryngeal cancer and its precursor lesions, autofluorescence endoscopy showed a significantly higher sensitivity (98 vs. 88%) and accuracy (97 vs. 90%) than white light endoscopy alone, whereas the specificity (97 vs. 93%) was essentially equal in both methods. CONCLUSION: Autofluorescence endoscopy qualifies as a simple screening procedure for rapid detection of suspicious lesions and assessment of their horizontal extension. This allows for guided biopsy or tumor resection, and can also be used in oncological follow-up.

The diagnostic value of MR perfusion weighted imaging on complications and tumor recurrence in hypopharyngeal and laryngeal cancer after operation and radiotherapy / 中华放射学杂志

Objective To explore diagnostic value of MR perfusion weighted imaging(PWI)on complications and tumor recurrence in hypopharyngeal and laryngeal cancer after operation and radiotherapy. Methods MR PWI was performed in 31 patients with hypopharyngeal and laryngeal cancer who suffer from tumor recurrence, granulation or infection after operation and radiotherapy. Blood flow (BF), blood volume(BV), mean transit time(MTT) and time to peak (TTP) values were measured in the lesions. Analysis of variance and pair-wise comparison of q test were used for statistical analysis. Results Eleven cases with tumor recurrence,11 case with granulation tissues, 9 cases with infection were confirmed by pathological examinations. Average BF, BV, MTT and TTP values of recurrent tumors were (145.1 ± 29.3)ml · 100 g-1 · min-1,(14.2 ± 3.2)ml · 100 g-1,(5.4 ± 0.6)s,(13.7 ± 1.3)s respectively;Average BF, BV MTT and TTP values of granulation tissues were(109.1±27.4)ml·100 g-1·min-1,(11.1±1.7)ml·100 g-1,(7.7±1.0)s, (19.8 ± 2.1)s respectively;Average BF, BV, MTT and TTP values of infectious tissues were(86.9 ± 7.7)ml · 100 g-1·min-1,(8.8±1.0)ml·100 g-1,(8.0±0.9)s,(19.7±1.3)s respectively. Average BF and BV values of the recurrent tumors group were higher than those of the granulation(q=4.89, 4.64 respectively,P<0.01)and infection group(q=7.52,7.71 respectively,P<0.01)respectively. Average BV values of granulation group was higher than that of the infection group(q=3.31,P<0.05), Average MTT and TTP values of recurrent tumor group were lower than those of the granulation (q=9.38, 12.48 respectively,P<0.01)and infection group(q=9.77, 11.53 respectively,P<0.05). There were no significant difference in average BF, MTT and TTP between the granulation and infection group. Conclusion MR PWI can be helpful in the diagnosis of complications and tumor recurrence in hypopharyngeal and laryngeal cancer after operation and radiotherapy.

Rhinosinusal polyposis and inverted papilloma: a morphometric comparative study

Introduction Nasal obstruction is one of the main rhinologic complaints, and two diseases must be investigated as differential diagnosis: rhinosinusal polyposis and inverted papilloma. Using traditionalmethods, the differential diagnosis between these diseases may be difficult. The morphometric study may be a useful tool for differential diagnosis and to define prognosis. Objective Calculate the morphometric values of rhinosinusal polyposis and inverted papilloma and compare the average of variables obtained between the groups. Methods The nasal mucus of 10 patients who had surgery in the Department of Otorhinolaryngology and Surgery of Head and Neck was studied; 5 had rhinosinusal polyposis and 5 had inverted papilloma. After the capture and print of corresponding data of each slide, the largest and smallest diameters of the nuclei were measured and the morphometric variables were calculated: average diameter, perimeter, ratio between largest and smallest diameter, volume, area, ratio of volume to area, form coefficient, contour index, and eccentricity. Results We found a significant difference (p < 0.05) between the two groups in the following morphometric variables: largest diameter, smallest diameter, average diameter, volume, area, perimeter, and ratio of volume to area, indicating that these parameters can be useful in diagnostic differentiation between these diseases. Conclusion We founded morphometric variables higher in patients with inverted papilloma, which can be related to the neoplastic origin of the inverted papilloma. The analysis of nuclear parameters is an instrument of great value in the differential diagnosis between rhinosinusal polyposis and inverted papilloma.

Rhinosinusal Polyposis and Inverted Papilloma: A Morphometric Comparative Study.

Introduction Nasal obstruction is one of the main rhinologic complaints, and two diseases must be investigated as differential diagnosis: rhinosinusal polyposis and inverted papilloma. Using traditional methods, the differential diagnosis between these diseases may be difficult. The morphometric study may be a useful tool for differential diagnosis and to define prognosis. Objective Calculate the morphometric values of rhinosinusal polyposis and inverted papilloma and compare the average of variables obtained between the groups. Methods The nasal mucus of 10 patients who had surgery in the Department of Otorhinolaryngology and Surgery of Head and Neck was studied; 5 had rhinosinusal polyposis and 5 had inverted papilloma. After the capture and print of corresponding data of each slide, the largest and smallest diameters of the nuclei were measured and the morphometric variables were calculated: average diameter, perimeter, ratio between largest and smallest diameter, volume, area, ratio of volume to area, form coefficient, contour index, and eccentricity. Results We found a significant difference (p < 0.05) between the two groups in the following morphometric variables: largest diameter, smallest diameter, average diameter, volume, area, perimeter, and ratio of volume to area, indicating that these parameters can be useful in diagnostic differentiation between these diseases. Conclusion We founded morphometric variables higher in patients with inverted papilloma, which can be related to the neoplastic origin of the inverted papilloma. The analysis of nuclear parameters is an instrument of great value in the differential diagnosis between rhinosinusal polyposis and inverted papilloma.

Evidenced-based management of haemoptysis by otolaryngologists.

BACKGROUND: Haemoptysis is an uncommon presenting symptom to the ENT clinic and ward, but has potentially sinister aetiology. This article aims to provide a systematic and evidence-based method of managing patients with haemoptysis. METHODS: The data in this article are based on a literature search performed using PubMed in August 2013. The keywords used included 'haemoptysis' in combination with 'otolaryngology', 'ENT', 'head & neck', 'diagnosis', 'management', 'investigations' and 'treatment'. RESULTS: The majority of published literature on the subject is level IV evidence. However, this can guide ENT specialists in assessing, investigating and managing presentations of haemoptysis. CONCLUSION: Understanding the different causes of haemoptysis is important for the otolaryngologist. The main concern is the detection of a malignant lesion in the upper aerodigestive tract or tracheobronchial tree. A thorough history and systematic examination can aid diagnosis.

Linfoma de células T/Natural Killer extranodal, tipo nasal / Extranodal Natural Killer /T-cell lymphoma, nasal type

Introducción: El linfoma de células T/Natural Killer (T/NK) extranodal, tipo nasal, es un linfoma extra-ganglionar poco frecuente, con extensión a lo largo de la línea media facial, rápidamente progresivo, catastrófico y de mal pronóstico, por lo que también se le conoce como "granuloma letal de la línea media". Objetivo: El propósito de este artículo es revisar la literatura disponible y actualizada sobre el linfoma de células T/NK extranodal, tipo nasal: manifestaciones clínicas, estándares de enfoque, diagnóstico, pronóstico y tratamiento. Diseño: Revisión Narrativa de la literatura. Metodología: Revisión de la literatura mediante búsqueda selectiva por términos MeSH: Extranodal Natural Killer /T cell lymphoma, nasal type, lethal midline granuloma, de las bases de datos: MEDLINE, Current Contents, Cochrane, Pubmed y Scielo, entre los años 2000 y 2014. Resultados: Se revisaron 36 artículos según los requerimientos de los objetivos. El linfoma de células T/NK es una neoplasia rápidamente progresiva, destructiva y de mal pronóstico excepto en los casos donde el diagnóstico ha sido oportuno. Conclusiones: El diagnóstico y tratamiento tempranos del linfoma de células T/NK extranodal, tipo nasal, son las únicas herramientas para mejorar el mal pronóstico y gran afectación en la calidad de vida de los pacientes con esta enfermedad.

"Introduction: Extranodal nasal Natural Killer (NK) /T-cell lymphoma, nasal type, is an extranodal lymphoma, infrequent, with extension along facial midline, rapidly progressive, catastrophic and with poor prognosis, also known as "lethal midline granuloma". Objectives: The purpose of this article is to review the current literature available about Extranodal nasal NK/T-cell lymphoma, nasal type: Clinical manifestations, approach standards, diagnosis, prognosis and treatment. Methodology: Literature review by selective MeSH search terms: Extranodal Natural Killer / T cell lymphoma, nasal type, lethal midline granuloma of databases: MEDLINE, Current Contents, Cochrane, PubMed and SciELO, between 2000 and 2014. Results: 36 articles were reviewed according to the requirements of the objectives. Extranodal NK/T cell lymphoma, nasal type, is a rapidly progressive neoplasia, destructive and with poor prognosis except in cases where diagnosis has been timely. Conclusions: Early diagnosis and treatment of Extranodal NK/T cell lymphoma, nasal type, are the only tools to improve the poor prognosis and high impairment in quality of life of patients with this disease.