October 31, 2010 Daniel P. Nadeau, MD, LCDR, MC, USN, Paul C. Shick, CAPT, DC, USN, and Robin Lindsay, MD, LCDR, MC, USN
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Abstract
Adenosquamous carcinoma of the head and neck is a rare and aggressive tumor, with fewer than 100 cases reported in the world literature to date. We report a case of adenosquamous carcinoma of the oral pharynx arising as a second primary malignancy in a patient being treated for primary gastric MALT (mucosa-associated lymphoid tissue) lymphoma. We also review the literature to assess current treatment and long-term prognosis of this rare tumor.
October 31, 2010 Lester D.R. Thompson, MD
September 30, 2010 Florence M.F. Cheung, FRCPath, Tina W.S. Lau, MBBS, Leslie K.N. Cheung, MPh, Albert S.M. Li, MSc, Shun Kit Chow, FRCS, and Anthony W.I. Lo, PhD
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Abstract
Schneiderian papillomas are uncommon benign tumors of the sinonasal area. They are prone to local aggressiveness and recurrence, and some undergo malignant progression. We analyzed specimens obtained from 67 Chinese patients who had presented to the ENT department of a regional hospital with biopsy-proven schneiderian papilloma. Seven of these patients had either synchronous or metachronous carcinoma, 1 of whom had pure carcinoma in situ. For each case, we documented the morphology, immunohistochemical expression of tumor suppressor genes p53 and p16, and any association with human papillomavirus (HPV) infection as detected by either polymerase chain reaction or in situ hybridization techniques. We found that severe dysplasia and p53 positivity were strongly associated with malignant progression. Association with HPV was demonstrated in 22 of the 67 patients (33%); the association was strongest among patients with exophytic papillomas and carcinomas. The effect of HPV in papilloma oncogenesis probably begins during the early phase, while other factors are responsible for progression to carcinoma. We conclude that p53-positive, dysplastic schneiderian papillomas warrant aggressive surgical treatment.
August 31, 2010 Lester D.R. Thompson, MD
July 31, 2010 Rob Wormald, MRCS, Patrick Sheahan, FRCS (Oto), and Con Timon, FRCS (Oto)
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Abstract
Metastases of head and neck cancers to the axillary lymph nodes are rare. Our review of the literature found only five such reports involving 10 patients. We describe a new case that occurred in a 69-year-old man who presented with a 6-week history of right neck swelling. Positron-emission tomography/computed tomography demonstrated high F18-fluorodeoxyglucose uptake in the neck and also in the right axilla. Fine-needle aspiration cytology revealed squamous cell carcinoma (SCC) at both sites. The patient underwent right-sided radical neck dissection with pectoralis major myocutaneous flap reconstruction and axillary node block dissection. The patient was subsequently treated with chemoradiotherapy, but 6 months later he developed an SCC in the lung. The lung lesion was also treated with chemotherapy, but the patient died 5 months later. Our case is unique among similar cases in that our patient had not undergone any previous treatment of the neck primary. We discuss the mechanism of this unusual presentation.
June 30, 2010 Frederick L. Durden Jr., MD, Charles E. Moore, MD, and Susan Muller, DMD, MS
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Abstract
Verrucous carcinoma is a low-grade variant of squamous cell carcinoma reported to occur in all anatomic sites in the head and neck region, most commonly the oral cavity. The tumor grows locally invasive but is histologically benign and metastasizes rarely. To date, 22 cases of verrucous carcinoma involving the nasal cavity and/or the paranasal sinuses have been reported. We present a case of verrucous carcinoma involving the paranasal sinuses, nasal cavity, cranium, and orbit. This case highlights the difficulty of pathologic diagnosis and management options for a rare neoplastic lesion.
June 30, 2010 Lester D.R. Thompson, MD
June 30, 2010 Mahmoud Ghaderi, DO, Jeffrey Coury, DO, Jacqueline Oxenberg, DO, and Harvey Spector, MD
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Abstract
Primary Merkel cell carcinoma (MCC) is a neuroendocrine tumor that typically affects older whites. It usually originates in the dermis, but in rare instances it has arisen in other primary sites, including the oral mucosa and the parotid gland. Explanations for the presence of MCC in these atypical locations have included theories of malignant transformation and neuroendocrine migration. We describe the case of a 35-year-old white woman who had an MCC in the parotid gland and no evidence of any other primary cutaneous lesion. A left superficial parotidectomy with facial nerve preservation was performed, and a histologic diagnosis of MCC was made. Positron-emission tomography was negative for other lesions, and postoperative radiation therapy was administered for local control. To the best of our knowledge, this is only the sixth case of a primary MCC of the parotid gland to be reported in the English-language literature; of these 6 patients, ours was by far the youngest. Otolaryngologists should be familiar with this rare but potentially fatal neoplasm.
June 30, 2010 Adele Wong, MBBS, Jern L. Leong, FRCS, and Ho Bernard, FRCPath
May 31, 2010 Tolga Kandogan, MD
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Abstract
A 44-year-old man presented with squamous cell carcinoma (T1aN0M0) on the left vocal fold and was prepared for a combined laryngofissure cordectomy and type III thyroplasty. The author performed both procedures together-not only to lower the tension on the healthy vocal fold, but also to determine whether the thyroplasty would successfully close the glottic gap created by the cordectomy, resulting in relatively fast improvement in the patient's voice. Satisfactory glottic closure and a satisfactory voice result were achieved rather quickly. The patient was satisfied with his new voice, both in the early and late postoperative periods.
May 31, 2010 Kevin H. Wang, MD, Ekai Kyle Hsu, MD, MBA, and Larry J. Shemen, MD
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Abstract
A retrospective study was conducted to assess outcomes of reconstruction of the oral cavity with the platysma myocutaneous flap, in terms of flap survival, complications, and quality of life. Included were 10 patients with squamous cell carcinoma (stage T1 to T4; nodal status N0 to N2) of the oral cavity who were treated between 2002 and 2006. Each patient underwent tumor resection, modified radical neck dissection, and primary reconstruction with a platysma myocutaneous flap. Operating time, length of stay, time to swallow, and complications were assessed, and the University of Washington Quality of Life questionnaire was administered. Mean operating time was <4 hours, mean length of stay was 11 days, and mean time to swallow was 9 days. One patient had distal flap necrosis and one had wound dehiscence. No total flap failures or fistulas occurred. The authors conclude that the platysma myocutaneous flap provides thin, pliable, reliable tissue for use in the oral cavity. The additional operating room time is negligible, the surgical complications minimal, and the overall quality of life very good. This flap should be used more frequently in the reconstruction of oral cavity defects.
April 30, 2010 Jiovani M. Visaya, BA, Julie M. Wu, MD, Eugene A. Chu, MD, and Marc G. Dubin, MD
