Adenosquamous Carcinoma of Hypopharynx with Intestinal-Phenotype

Adenosquamous carcinomas of the head and neck (ADSCs) are rare locally aggressive malignancies characterized by the presence of two distinctive components, a squamous cell carcinoma and an adenocarcinoma. The immunophenotype of the glandular component of ADSCs has only been rarely studied but has been reported as being positive for keratin 7 (CK7) and carcinoembryonic antigen (CEA) and negative for keratin 20 (CK20). Herein, we report a case of an ADSCs of the hypopharynx composed of a superficial squamous cell carcinoma and an adenocarcinoma with an intestinal phenotype. The patient was a 62 year-old male with a T2 N0 M0 squamous cell carcinoma (SCC) of uvula and palate and a T1 N0 M0 of right hypopharynx. The ADSCs of the hypopharynx was composed of a minimally invasive SCC and an adenocarcinoma with tubulo-glandular and cribriform architecture. The neoplastic glands were positive for CK7, CK20, CDX2, CEA and Villin. The patient underwent radiotherapy to both tumors and remains well with no evidence of recurrent disease 19 months after treatment. To the best of our knowledge, this is the first report of an ADSCs of the head and neck with an intestinal phenotype in its glandular component.     

Sclerosing Paraganglioma of the Carotid Body: A Potential Pitfall of Malignancy

Paragangliomas (PGs) of the head and neck region are typically benign, slow-growing neuroendocrine tumours. At times, they may exhibit unusual histological features, such as prominent stromal sclerosis (sclerosing PG), which may raise concerns of malignancy. We describe a case of sclerosing PG of the carotid body, emphasizing the value of immunohistochemical stains for differential diagnosis. A 43-year-old woman presented with a painless lump on the neck. A magnetic resonance imaging scan demonstrated a hypervascular lesion of the carotid body, which was surgically excised. Grossly, the lesion measured 1.8 cm at maximum diameter. On microscopic examination, irregular nests and tiny bundles of neoplastic cells were found between thick bands of fibrous tissue. Focal nuclear cytomegaly and marked pleomorphism were noted. Neoplastic cells proved to be immunoreactive for chromogranin, synaptophysin and neuron specific enolase, but negative for cytokeratins, smooth muscle actin and CD34. Ultrastructurally, numerous mitochondria, rough endoplasmic reticulum structures and endocrine granules were seen in the cytoplasm of the tumour cells. On consideration of the above-mentioned clinico-pathological and ultrastructural findings a diagnosis of sclerosing PG was established. Sclerosing PG is a rare entity which may mimic a malignant neoplasm. The recognition of this unusual morphological variant of PG, together with appropriate immunostains, leads to the correct diagnosis.     

Spontaneous regression of Merkel cell carcinoma: A case report and review of the literature

INTRODUCTIONMerkel cell carcinoma (MCC) is a rare and highly aggressive primary cutaneous neuroendocrine carcinoma, most often occurring in the elderly. Recurrence is frequent and in 40% of cases regional and distant metastases develop. Despite this, there have been reports of spontaneous regression. We report the first case of MCC with primary complete spontaneous regression of the nose in an 86-year-old woman following an incisional biopsy.PRESENTATION OF CASEAn 86-year-old woman presented with a violaceous lump on the left side of the nose measuring 25 × 25 mm. Incisional biopsy of the lesion showed MCC and immunohistochemistry confirmed diagnosis. Following an 8-week period the lesion completely disappeared and histology did not show any residual MCC but immunohistochemistry demonstrated a mixture of T and B cells.DISCUSSIONComplete spontaneous regression (CSR) is rare. The literature documents 22 similar cases of CSR of MCC. From this case report and previous literature the most likely reason for regression is a T-cell mediated immune response.CONCLUSIONTo the best of our knowledge, this is the first described case of MCC with primary CSR of the nose. Exact mechanism of regression remains unclear. Further research is needed in identifying pathway of immune response and possible immunotherapy as a cure.     

发育性髋关节发育不良儿童股骨头覆盖率三维CT测量及远期评价

目的探讨应用CT技术对发育性髋关节发育不良（developmental dysplasia of the hip,DDH）儿童的股骨头覆盖率进行三维测量的方法及其远期随访的意义。方法通过CT的原始数据结合计算机技术,测量DDH儿童术前、术后髋臼对股骨头的覆盖率。结果手术时年龄3岁或3岁以下的DDH患儿,随访时间超过4年时,股骨头覆盖率明显降低,但与对照组相比无明显差异。手术时年龄大于3岁,随访时间超过4年的DDH患儿股骨头覆盖率较正常对照组高。结论DDH患儿骨盆截骨术和股骨近端内翻截骨术后近期股骨头覆盖率最大,通常高于正常对照组;手术时年龄小于3岁的患儿,远期随访中股骨头覆盖率会有所降低;年龄超过3岁的患儿股骨头覆盖率的变化较小。CT测量股骨头覆盖率具有一定的可行性和可重复性,可用于指导DDH患儿的治疗与随访。     

Nuevas curvas poblacionales de crecimiento en recién nacidos extremadamente prematuros españoles

IntroductionMost anthropometric reference data for extremely preterm infants used in Spain are outdated and based on non-Spanish populations, or are derived from small hospital-based samples that failed to include neonates of borderline viability.ObjectivesTo develop gender-specific, population-based curves for birth weight, length, and head circumference in extremely preterm Caucasian infants, using a large contemporary sample size of Spanish singletons.Patients and methodsAnthropometric data from neonates ≤ 28 weeks of gestational age were collected between January 2002 and December 2010 using the Spanish database SEN1500. Gestational age was estimated according to obstetric data (early pregnancy ultrasound). The data were analyzed with the SPSS.20 package, and centile tables were created for males and females using the Cole and Green LMS method.ResultsThis study presents the first population-based growth curves for extremely preterm infants, including those of borderline viability, in Spain. A sexual dimorphism is evident for all of the studied parameters, starting at early gestation.ConclusionsThese new gender-specific and population-based data could be useful for the improvement of growth assessments of extremely preterm infants in our country, for the development of epidemiological studies, for the evaluation of temporal trends, and for clinical or public health interventions seeking to optimize fetal growth.     

上颈部淋巴结恶性肿瘤影响颈鞘的CT评价

目的：评价上颈部淋巴结恶性肿瘤影响颈鞘的CT表现。方法：收集经手术和活检病理证实的上颈部淋巴结恶性肿瘤病例77例(83例病变)，并对其在CT上显示的影响颈鞘及其内部血管的形式进行分类和评价。结果：CT上，病变对颈鞘及其内部血管影响的表现主要有：①颈鞘内血管受压变形者52例病变(颈内动脉1例；颈内静脉51例)；②颈鞘内血管受压“消失”者13例病变(均为颈内静脉)；③颈鞘内血管受压移位者67例(颈内动脉22例，颈内静脉50例)；④淋巴结恶性肿瘤围绕颈鞘血管者15例。结论：上颈部淋巴结恶性肿瘤对颈鞘内部血管的影响主要表现为推移和受压变形。判断病变是否侵犯颈鞘及其内部血管，应综合考虑其CT影像表现。     

The pharyngeal mucosal, parapharyngeal, and retropharyngeal spaces

Mass lesions in the deep neck spaces cannot be examined directly but instead require sectional imaging examinations. This pictorial essay reviews cases of mass and/or mass-like lesions in the oral cavity and/or the pharyngeal region that were radiologically diagnosed at our department. The purpose of this paper is to introduce to oral radiologists several key points in the sectional imaging diagnosis of a variety of lesions of the pharyngeal mucosal space, parapharyngeal space, and retropharyngeal spaces. To help readers make full use of CT or MR image findings of lesions in these spaces, we provide actual images of common diseases that occur in either the oral cavity or the neck. By focusing on displacements of fat, vessels, muscles, and bony structures in each space, oral radiologists can narrow the range of possible differential diagnoses. Familiarity with not only the anatomy of these spaces but also with the diseases specific to them and, in turn, their radiological manifestations, can help oral radiologists reach an accurate diagnosis.     

CT angiography of the head and neck: A report of 5 cases

We report on five cases in which patients were examined with CT angiography (CTA). In two cases of facial arteriovenous malformation (AVM), the dilated vascular structure was clearly visible. Moreover, three-dimensional reconstruction allowed observation of the relationship to the bone and comparison with the skin surface. The maximum intensity projection (MIP) image was useful for understanding the spatial relationship between the embolic material and the residual AVM. We also constructed three-dimensional subtraction images. In these images, only the blood vessels and lesion site were visible as bright areas, making it easy to determine the volume of the lesion. CT angiography can be used as a screening method for observing blood vessels and is useful for detailed examination of the relationship between lesions and blood vessels, and for examination of hypervascular lesions.     

A synopsis of head and neck oncology and related papers published in the British Journal of Oral and Maxillofacial Surgery in 2009/10

This review summarises all head and neck oncology and related papers published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) during the period 2009-2010. A similar review, covering the years 2007-2008 was published in the Journal in 2009 and was well received by readers, as evidenced by the high number of downloads from the BJOMS website. In this article, we include all head and neck oncology-related articles published in the print version of the journal during 2009/10 and concentrate on summarising the full length article papers. Compared to the previous 2-year period, there has been a 25% increase in number of articles published in this sub-specialty.