Optimizing the Ovarian Tissue Cryopreservation in the 'Oncofertility' Institutional Program at an Italian National Cancer Institute.

BACKGROUND: The majority of female cancer patients undergoing anticancer treatments are at risk of experiencing 'cancer treatment-related infertility', which can result in permanent damage to their reproductive prospects. Among the fertility preservation methods, ovarian tissue cryopreservation (OTC) has emerged as an alternative for these patients. The Cancer Institute of Bari initiated a research program to assess the feasibility of OTC. This study compares the viability of ovarian cortical fragments cryopreserved using slow freezing (SF) and ultra-rapid freezing (URF) methods. METHODS: Ovarian cortex biopsies were obtained from 11 fertile women enrolled in our oncofertility service between June 2022 and January 2023. After tissue collection, a histological assessment was performed before cryopreservation. OTC was carried out using both SF and URF methods. Six months later, thawed samples were evaluated for follicle counts and histological integrity. RESULTS: No statistically significant difference was observed in the proportion of intact follicles (means of 31.5% and 73.0% in the SF and URF groups, respectively; p = 0.064). However, there was a significant difference in the number of follicles between the SF group (n = 149) and the URF group (n = 37) (p = 0.046). CONCLUSIONS: We assessed the viability of ovarian cortex after freezing and thawing, focusing on the structural integrity of follicles. Our findings suggest that there are no significant differences between the SF and URF methods.

Incidental metastases of well-differentiated thyroid carcinoma in lymph nodes of patients with squamous cell head and neck cancer: eight cases with a review of the literature.

The examination of a large series of cervical lymph nodes in patients with head and neck cancer revealed the presence of incidental metastases of occult thyroid carcinoma in eight patients, of which six cases were squamous cell carcinoma of glottic and supraglottic sites of the larynx and two cases were pyriform sinus and tongue carcinomas. Three patients had two lymph nodes and the remaining patients had one lymph node each involved. The nodal chains affected were the jugular (n=5; level IV), Kuttner (level II), supraomohyoid (level III) and supraclavicular (level VI). In four cases, a subtotal thyroidectomy or unilateral lobectomy was performed during laryngectomy (for surgical reasons) or after histologic nodal examination; a minimal focus of thyroid papillary carcinoma was detected in one patient. Three of eight patients died from recurrence of the squamous cell carcinoma; no case presented clinical evidence of thyroid malignancy. The differential diagnosis from benign thyroid heterotopia was based on the presence of minimal nuclear atypia. The choice of treatment of patients with a coexisting neoplasm characterized by poor prognosis is difficult, and contrasting opinions exist regarding the use of radical thyroidectomy and the subsequent management. As reported in the literature (66 cases), the more aggressive squamous cell carcinoma will determine the prognosis of these patients; in fact, only one of the referred cases died of cerebellar metastases of the thyroid cancer. Our results emphasize the importance of an accurate re-evaluation and follow-up of patients with incidental occult metastases for detection of a primary thyroid tumor. In the general population, this incidental nodal involvement may be related to a minimal occult thyroid carcinoma.

Localización del ganglio centinela “natural“ en el carcinoma de laringe e hipofaringe / Localization of "natural" sentinel node in laryngeal and hypopharyngeal cancer

La técnica del ganglio linfático centinela localiza el ganglio que drena primariamente el territorio neoplásico anatómico. Más tarde, este procedimiento ha sido aplicado a pacientes con carcinoma epidermoide (CE) de cabeza y cuello. Nuestra experiencia de veinte años con las disecciones cervicales funcionales en el cáncer de laringe e hipofaringe nos permite asegurar que existe un ganglio linfático centinela natural en estos órganos. En nuestro estudio, examinamos una serie de 170 pacientes con disecciones funcionales del cuello con metástasis mediante el uso de un procedimiento quirúrgico de acuerdo con la anatomía topográfica clásica. En los casos con metástasis ganglionares únicas, resultaban afectados en alto porcentaje los ganglios de Küttner, supraomohioideo y prelaríngeo (46%, 38% y 6%, respectivamente), lo que representa una prueba in vivo de ganglio linfático centinela. En los casos con más de tres metástasis ganglionares, los ganglios de Küttner y supraomohioideo siempre estaban afectados primariamente. En cambio, en las metástasis detectadas en otros ganglios, podría suponerse la aparición de un drenaje linfático inconstante del pedúnculo laríngeo superior o un cambio patológico del flujo linfático. Por lo tanto, el examen histopatológico intraoperatorio simple de estos ganglios permitiría a los cirujanos controlar la difusión locorregional de la neoplasia y reducir la disección cervical total. Esta acción no es predecible cuando se emplea la división de los ganglios cervicales por niveles que se utiliza actualmente.

Sentinel lymph node technique locates that node whichprimarily drains anatomic neoplastic territory. Lately, thisprocedure has been applied to patients with head andneck squamous cell carcinoma. Our twenty-yearexperience in functional neck dissections for larynx andhypo pharynx cancer let us to assert that there exists anatural sentinel lymph node in these organs. In our study,we examined a series of 170 patients with metastasized functional neck dissections using a surgical procedure according to classic topographic anatomy. In the cases with single nodal metastasis, Küttner, Supraomohyoid, Pre-laryngeal nodes were involved with a high percentage(46%, 38%, 6% respectively) representing an “in vivo”evidence of sentinel lymph node. In cases with more thanthree nodal metastases, Küttner and supraomohyoid werealways primarily interested. Instead, for the metastasesdetected in other nodes, it might be supposed theoccurrence of an unsteady lymphatic drainage of thesuperior laryngeal peduncle or a pathological change ofthe lymphatic flow. Therefore, the simple intraoperative histopathological examination of these nodes would allow surgeons to control locoregional diffusion of neoplasia and to reduce total neck dissection. This acting is not predictable using the division of cervical nodes bylevels currently used.