Collision metastasis of squamous carcinoma of the oral tongue and incidental thyroid papillary carcinoma to a single cervical lymph node

The incidence of collision tumor is exceedingly rare. There are only four published case reports. This is the first report of a case of collision metastasis of squamous cell carcinoma (SCC) of the oral tongue and incidental thyroid papillary carcinoma to the same cervical lymph node. A 47-year-old man with SCC of the oral tongue at clinical stage T4N1M0 was treated with total glossectomy and bilateral neck dissection. During neck dissection, concomitant secondary foci of thyroid papillary carcinoma were identified in the same cervical lymph node as SCC (collisional metastasis). The patient subsequently underwent total thyroidectomy and was alive without any recurrences at 25 months after the operation.     

Prediction of delayed neck metastasis in patients with stage I/II squamous cell carcinoma of the tongue

BACKGROUND: The incidence of delayed neck metastasis (DNM) in patients with squamous cell carcinoma (SCC) of the tongue is reported to be 20% to 50%. Although clinically negative cervical lymph nodes (N0) are associated with a good outcome, the prognosis is poor in patients with DNM. The aim of this study was to evaluate the clinicopathological and immunohistochemical parameters associated with DNM in patients with stage I/II SCC. METHODS: Fifty nine patients, with previously untreated stage I/II carcinoma, underwent examination of clinicopathological and immunohistochemical parameters and incidence of DNM. A linear discriminant analysis was used to analyze prognostic factors and to determine the probability of DNM occurring. RESULTS: DNM occurred in 14 (24%) subjects of the 59 study patients, level I to level III, within 5 years. Parameters such as gender and age, disease stage, tumor size and histological grade, tumor location, degree of tumor invasion and expression of VEGF, E-cadherin or Ki-67 showed no significant correlation with the occurrence of DNM; however, factors such as tumor morphology, tumor thickness greater than 4 mm, and Flt-4 expression were significantly associated with development of DNM. CONCLUSIONS: Such factors provide useful information with regard to DNM and the prognosis. We concluded that patients with early SCC whose tumors are > 4 mm in thickness and immunopositive for Flt-4 are particularly at risk of developing DNM.     

Sublingual lymph node metastasis of early tongue cancer: report of two cases and review of the literature

Sublingual lymph node metastasis of early stage squamous cell carcinoma of the tongue (SCCT) is seldom reported. Lymphatic tissue in the floor of mouth, which intervenes between the tongue and neck, will be left behind by a primary tumour resection with discontinuous neck dissection. The authors present two cases of early stage SCCT with sublingual lymph node metastasis, review the literature, and discuss the management of the floor of mouth for early stage SCCT. The authors suggest that more attention should be paid to possible sublingual lymph node metastasis for T1/T2 SCC of the ventral tongue with deeply endophytic infiltration.     

美蓝在口腔鳞状细胞癌前哨淋巴结活检中的应用

目的：探讨美蓝在口腔鳞状细胞癌前哨淋巴结（sentinel lymphnode,SLN）活检中的应用,为临床N0患者是否作颈部淋巴结清扫提供依据。方法：用美蓝对30例口腔鳞状细胞癌临床N0患者行前哨淋巴结定位活检,通过与区域淋巴结清扫标本的比较来评价前哨淋巴结活检的准确性。结果：前哨淋巴结定位活检总成功率为93.3%（28/30）,准确率92.9%（26/28）,假阴性率为11.1%（2/18）,灵敏度为83.3%（10/12）,特异性100%（16/16）。结论：前哨淋巴结活检在口腔鳞状细胞癌中能很好地反映淋巴结的转移情况,对指导淋巴结清扫的合理性和必要性有一定的临床应用价值。     

Expression of complement restriction factors (CD46, CD55 & CD59) in head and neck squamous cell carcinomas

BACKGROUND: Tumor cells can escape complement-dependent cytotoxicity (CDC) by expressing complement restriction factors (CRFs), CD46, CD55 and CD59. CRF-expression in non-neoplastic mucosa of the head and neck was compared with biopsies of the head and neck squamous cell carcinoma (HNSCC) and cell lines derived from oral squamous cell carcinomas (OSCC). METHODS: Normal mucosa and HNSCC tumor tissue (poor, moderate, or well differentiated) specimens were immunostained with anti-CRF monoclonal antibodies. Immunostaining of the OSCC cell lines (SCC12 and SCC71) was examined under laser scan fluorescence microscopy. RESULTS: CD46, CD55 and CD59 were highly expressed in HNSCC cells including T1/T2N0M0 stages. The CRF expression was much lower or absent in non-neoplastic squamous epithelia or in the submucosa of both normal and tumor tissues. CONCLUSIONS: Enhanced staining of tumor tissues at stages T1/T2 indicates that the CRFs are overexpressed by primary tumors before metastasis to either lymph nodes or organs (N0M0 stage) suggesting that CRFs are formed early during tumorigenesis.     

口腔癌对侧颈淋巴结转移的临床研究

目的:探讨原发灶未过中线口腔癌的对侧颈淋巴结转移的相关临床病理因素,为口腔癌手术方法的选择提供依据。方法:收集2010年6月~2012年12月口腔癌238例,对年龄、性别、病程、原发灶部位、CT分期、颈清术式、病理分级、淋巴结转移等情况进行统计学分析。结果:单因素Logistic回归分析显示口腔癌对侧颈淋巴结转移在T3/T4期、中低分化、同侧淋巴结转移的患者中明显增加;多因素Logistic回归分析表明病理分级为口腔癌对侧颈淋巴结转移的高危因素。结论:在肿瘤未过中线时,如果T3/T4期、同侧颈淋巴结明确有转移、病理分级为中低分化等因素中出现两者或以上,为改善预后及提高患者治愈率,则有必要考虑同期行对侧颈清。     

cN0期舌鳞癌患者颈淋巴结转移的相关因素及预后分析

目的: 探讨cN0期舌鳞癌患者颈淋巴结转移的相关因素及术后生存质量,为临床预测颈部隐匿性转移及提高生存率提供理论依据。方法: 收集南京医科大学附属淮安第一医院cN0期舌鳞癌患者283例,通过卡方检验及Logistic回归分析颈淋巴结转移与患者临床病理参数之间的相关性,通过单因素及多因素Cox回归分析探讨舌鳞癌患者预后的独立危险因素,通过生存分析研究颈淋巴结转移与患者预后之间的相关性。采用SPSS 21.0软件包对数据进行统计学分析。结果: 卡方检验及Logistic回归分析表明,浸润深度、T分期、病理学分级与颈淋巴结转移密切相关（P<0.05）,而浸润深度是导致术后颈淋巴结转移的主要因素（OR=2.175）;浸润深度、病理分级及颈淋巴结转移与舌鳞癌患者预后密切相关（P<0.05）。结论: 浸润深度、T分期、病理学分级可作为预测cN0期舌鳞癌隐匿性颈淋巴结转移的指标,浸润深度、病理分级及颈淋巴结转移可作为预测cN0期舌鳞癌患者预后的指标。     

舌鳞癌淋巴管生成与颈淋巴结转移的关系

目的：研究舌鳞癌淋巴管生成及淋巴管密度／淋巴管相对面积（LVD／LVA）与颈淋巴结转移的关系，为术前准确判断颈淋巴结状况提供参考。方法：口腔颌面外科接受舌癌切除及颈淋巴清扫术的标本63例：对HE染色阴性的淋巴结，应用细胞角蛋白CK（AE1／AE3）标记检测微转移，以免疫组织化学检测结果判断淋巴结转移；以LYVE—1作为淋巴管内皮标志物，研究舌癌淋巴管生成参数——淋巴管密度（LVD）和淋巴管面积（LVA）与颈淋巴结转移及其他临床病理变量（年龄、性别、T分类、病理分级、浸润方式）之间的关系。应用SPSS10．0统计软件包对所得数据进行Mann-whitney U检验。结果：应用细胞角蛋白CK（AE1／AE3）标记免疫组化法检测微转移，提高了淋巴结转移的检出率；舌癌实质内未见到LYVE—1^＋的脉管结构，LYVE—1^＋脉管多位于癌周，癌周LVD、LVA与颈淋巴结转移及其他临床病理变量均无关。结论：舌癌癌周淋巴管密度（LVD）、淋巴管面积（LVA）与颈淋巴结转移及其他临床病理变量均无关，不宜作为术前评估淋巴结状况的指标。     

cN0舌鳞癌颈部Ⅲ区、Ⅳ区淋巴结的微小转移分析

目的 分析临床颈部阴性（cN0）舌鳞癌患者的颈部Ⅲ区、Ⅳ区淋巴结微小转移情况。方法 采用角蛋白免疫组化染色结合半连续切片技术,对25例cN0舌鳞癌颈部Ⅲ区、Ⅳ区的471个淋巴结进行复查。结果 常规病理检查证实有转移的11个位于Ⅲ区的阳性淋巴结,角蛋白免疫组化染色均能检出;在常规病理检查为阴性的460个淋巴结中,角蛋白免疫组化染色结合半连续切片技术,仅在1个Ⅲ区淋巴结中检出一个2.0 mm×1.5 mm的微转移灶,在Ⅳ区淋巴结中未检出微转移灶。结论 cN0舌鳞癌Ⅳ区淋巴结转移率很低,对所有的cN0舌鳞癌患者均清扫Ⅳ区似无必要。     

口腔鳞状细胞癌患者颈部淋巴结特征与预后的关系

目的： 探讨口腔鳞状细胞癌（oral squamous cell carcinoma,OSCC）患者颈部阴性淋巴结临床、病理形态特征,并研究其与颈淋巴结转移、复发及总生存期的关系。方法： 回顾分析2017年1月—2021年1月新疆医科大学第一附属医院收治的100例OSCC患者的临床病理资料,研究终点事件为颈淋巴结转移、复发和死亡,采用Kaplan-Meier法绘制生存曲线,Cox生存分析法探讨不同因素与患者预后的关系。采用SPSS 21.0软件包对数据进行统计学分析。结果： 100例患者平均随访时间为30个月,失访10例。90例患者中,出现颈淋巴结转移、复发11例（12.2%）、死亡28例（31.1%）,阴性淋巴结出现窦组织细胞增生（sinus histiocytosis, SH）27例（30%）,3年无颈淋巴结转移复发率为89.4%,3年总生存率为67.3%。90例患者的Cox回归生存分析结果显示,分化程度、N分期、临床分期对总生存期有显著影响（P<0.05）;吸烟、初次颈淋巴结转移（N≠0）、SH、行双侧颈淋巴清扫术对颈淋巴结转移、复发有显著影响（P<0.05）,且吸烟、初次颈淋巴结转移、SH、行双侧颈淋巴清扫术患者的颈淋巴结转移、复发概率较高。结论： SH、初次颈淋巴结转移是导致OSCC患者颈淋巴结转移、复发的独立危险因素,N分期是导致患者死亡的独立危险因素。     

Management of the N0 neck in oral squamous cell carcinoma

Oral squamous cell carcinoma (SCC) has an unpredictable capacity to metastasize to the neck, an event that dramatically worsens prognosis. Metastasis occurs even in earlier stages when no neck lymph node involvement is clinically detectable (N0). Management of the N0 neck, namely when and how to electively treat, has been debated extensively. This article presents the controversies surrounding management of the N0 neck, and the benefits and pitfalls of different approaches used in evaluation and treatment. As current methods of assessing the risk for occult metastasis are insufficiently accurate and prone to underestimation of actual risk, and because selective neck dissection (SND) is an effective treatment and has minimal long-term detriment to quality of life, the authors believe that all patients who have oral SCC, excluding lip SCC, should be prescribed elective treatment of the neck lymphatics. However, this opinion remains controversial. Because of the morbidity of radiation therapy and because treatment of the primary tumor is surgical, elective neck dissection is the preferred treatment. In deciding the extent of the neck dissection, several retrospective studies and one randomized clinical trial have shown SND of levels I through III to be highly efficacious.     

合理的根治性颈淋巴清扫术的临床应用评价

目的:评价保留颈外静脉、耳大神经和颈神经丛深支的新型改良根治性颈淋巴清扫术(或称合理的根治性颈淋巴清扫术)在治疗口腔癌颈淋巴转移灶中的临床应用价值。方法:TNM分期在T2N1M0~T4N3M0之间的口腔鳞癌初诊患者45例,随机分为2组(RND组和RRND组),RND组行传统根治性颈淋巴清扫术(22例),RRND组行合理的根治性颈淋巴清扫术(23例),比较2种手术方式的颈淋巴结术后复发率和并发症。结果:RRND组术后患者面部水肿及头晕、头痛症状显著低于RND组(P<0.05);术后6个月复查,RRND组患者耳廓和肩部麻木感显著低于RND组,耳廓皮肤感觉功能和肩运动功能显著高于RND组(P<0.05);随访3年,RRND组和RND组术后颈淋巴结复发率分别为8.70%、4.55%,差别无统计学意义(P>0.05)。结论:合理的根治性颈淋巴清扫术与传统根治性颈淋巴清扫术相比,不会增加术后颈淋巴结复发率,但极大地提高了患者术后的生存质量。     

Management of patients with squamous cell carcinoma of the lower lip and N0-neck.

AIM: For lower lip carcinoma, an incidence of 15% of cervical lymph node metastasis at presentation is generally accepted. This is an argument in favour of an expectant approach. The purpose of this study was to compare the results of the different approaches to the clinically negative neck: prophylactic neck dissection, prophylactic neck irradiation and follow-up. MATERIAL AND METHOD: The retrospective study included 200 patients with lower lip carcinoma. The following data were evaluated: (1) the incidence of cervical lymph node metastasis in patients with a clinically negative neck; and (2) pathological confirmation of cervical lymph node metastasis. RESULTS: In the group undergoing prophylactic neck dissection, lymph node metastasis was found microscopically in 20% of the cases. More than half of the patients receiving prophylactic radiotherapy developed bulky neck lymph node metastases. Out of the patients attending the 2-year follow-up 64% developed a clinically positive neck. Cervical lymph node metastases in these patients was proven microscopically in 88% of cases. CONCLUSION: The high incidence of a clinically positive neck, along with the high incidence of neck node metastasis found in neck dissection specimens suggest that elective neck dissection is the treatment of choice for the neck in patients with lower lip carcinoma.     

功能性与根治性颈淋巴清扫术在早期口腔鳞状细胞癌治疗中的疗效比较

目的:探讨功能性颈淋巴清扫术(functional neck dissection,FND)与根治性颈淋巴清扫术(radical neckdissection,RND)在口腔鳞状细胞癌中的临床疗效.方法:63例口腔鳞状细胞癌患者,分为FND组(n=30)和RND组(n=33),FND组保留胸锁乳突肌、副神经、颈内静脉及耳大神经,术后随访2组患者的肩外展功能、耳大神经功能、颈部是否明显凹陷及颈部复发率.应用SPSS 18.0软件包对数据进行单因素x2检验、两独立样本均数t检验,以及Fisher确切概率检验.结果:FND与RND组之间在年龄、性别、肿瘤部位、T分期、N分期、组织学分化程度、病理学类型、术前化疗及术后化疗等方面无显著差异(P＞0.05).所有患者均为N0或N1期,FND组术后肩关节活动度、耳垂感觉麻木及颈部凹陷改善程度显著优于RND组(P＜0.05);术后随访2年,FND组的颈部复发率与RND组无显著差异(P=1.000).结论:对于N0或N1期口腔鳞状细胞癌患者,FND与RND相比,患者颈部复发率无显著差异,但其并发症显著减少,可明显提高患者术后的生活质量.     

活性碳吸附卡铂在口腔癌及其颈淋巴结转移中的初步临床应用

目的：评价亲淋巴化疗制剂卡铂－活性碳（CP－CH）的亲淋巴性和化疗效果。方法：利用经特殊制备粒径小于2um活性碳微粒吸附化疗药物卡铂。形成卡铂－活性碳释药系统,将卡铂－活性碳注射于6例有颈淋巴结转移的口腔癌原发灶周围的粘膜下,72小时后行口腔癌联合根治术,清理原发灶和淋巴结,并采血进行检查,分别光镜,电镜检查,淋巴结和血中药物含量用等离子发射光谱分析法测定,结果：使用卡铂－活性碳的患者口腔癌原发灶四周粘膜无糜烂和坏死。颈淋巴结黑染率为83．33％（60／70）,淋巴结转移灶内的肿瘤细胞明显变性和坏死,而全身化疗的患者颈淋巴结转移灶内的肿瘤细胞没有变化,接爱卡铂－活性碳的患者淋巴结内铂的含量是血中的11．56倍。结论：卡铂被活性碳吸附后癌周注射能靶向性的进入淋巴结,在淋巴结内持续缓慢释放,维持淋巴结内化疗药物高浓度,而血注中药物浓度低,是较为有效针对淋巴结转移的化疗策略。     

Sentinel lymph node biopsy for early oral cancer – accuracy and considerations in patient selection

Sentinel lymph node biopsy (SLNB) for staging oral squamous cell carcinoma (OSCC) patients presenting with early (T1 and T2 N0) disease in preference to elective neck dissection (END) remains controversial worldwide. A retrospective analysis of 145 patients who underwent sentinel lymph node biopsy for a previously untreated early oral cancer between 2010 and 2020 was performed. The primary outcome measures were predictors of occult metastases, accuracy of SLNB and disease specific plus overall survival. The negative predictive value, the false negative rate, and sensitivity for SLNB were 97%, 7.8%, and 92%, respectively. Depth of invasion (DOI) was a significant predictor of N status, overall survival, and disease specific survival. There was a significant difference in the incidence of the neck node metastasis in patients with DOI <5mm compared to those with DOI >5mm. For tumours >5mm there was a moderate to good correlation between radiological depth on contrast enhanced computed tomography (CECT) and histopathological DOI. Preoperative estimation of DOI may be a useful tool in the counselling of patients in the selection of either SLNB or END for N staging purposes in early OSCC.     

手术联合放射治疗伴有淋巴样间质的未分化癌的疗效分析

目的：分析涎腺伴有淋巴样间质的未分化癌（恶性淋巴上皮病Malignant lymphoepithelial lesions,MLEL)的临床特点、发展规律治疗方法及转归。方法：收集自1989年－1997年来收治的涎腺伴有淋巴样间质的未分化癌患者共21例，其中原发于腮腺18例。对腮腺Ⅱ，Ⅲ期患者行肿专人切除＋腮腺浅叶或全叶切除＋面部神经保留术。对Ⅳ期患者根据情况，行腮颌颈联合根治术或腮颈联合根治术。术后2－9周内行原发灶或加同侧颈部照射，肿瘤剂量平均为52．03Gy。以寿命表法对生存率进行分析。结果；全组病例中，3／21有良性淋巴上皮病复发史，其中，第2次复发至确诊为伴有淋巴样间质的未分化癌最长2a，最短0.5a。Ⅱ，Ⅲ，Ⅳ期患者分别为8（42．9％）、3（14．3％）、10（47．6％）例。Ⅱ，Ⅲ期者均为NO。全组5年生存率达70．66％，Ⅱ，Ⅲ，Ⅳ期的5年生存率分别为86．68％、66．67％、33．3％。本组死亡5例，均为Ⅳ期，死于肿瘤复发；其中4／5例颈上、中淋巴结有转移。复发者7／21，其中5／7为Ⅳ期，N2、N3患者。复发后经治疗死亡者，最短存活7个月，最长7a。4／21有远处转移，均为T4N2MO。结论：对复发性良性淋巴上皮病患者应高度警惕其恶变。Ⅳ期患者应行腮腺全叶切除，面神经未受累者可考虑保留面神经，因同侧下颌下、颈淋巴结转移多见，建议行根治性或功能性颈清，术后放疗范围应包括原发灶和同侧锁骨上颈淋巴区。     

Patients with unilateral squamous cell carcinoma of the tongue and ipsilateral lymph node metastasis do not profit from bilateral neck dissection

Objectives

The purpose of this study was to evaluate the necessity of elective bilateral neck dissection for treating strict unilateral squamous cell carcinoma (SCC) of the tongue.

Methods

A cohort of 169 patients with unilateral non-midline crossing SCCs of the tongue treated by local resection and neck dissection was investigated. Study endpoints were nodal relapse and overall survival. The mean follow-up was 7.4 years.

Results

A total of 146 (88.1%) patients were treated by neck dissection. Lymph node metastases were diagnosed in 50 (34.2%) patients. Only two (1.1%) had contralateral lymph node metastases. Risk factors for developing a primary lymph node metastasis were size of tumor (T2/T3, p =?0.03; OR?=?2.2), lymphangiosis (p =?0.003; OR?=?4.7), and higher-grade differentiation (p =?0.051; OR?=?2.43). Metachronous lymph node metastases were detected in 23 (13.6%) patients (19 ipsilateral, one contralateral and three bilateral). The main risk factor for developing a metachronous lymph node metastasis was the presence of a primary lymph node metastasis (p =?0.004; HR?=?4.65). Patients with initial neck dissection came up with lower 5-year recurrence rates (13.6%) compared to patients without neck dissection (27.3%; p =?0.014). Bilateral neck dissection showed no advantage regarding nodal relapse free and overall survival (p =?0.606) compared to unilateral neck dissection irrespective of initial N or T stage.

Conclusion

Patients with unilateral SCC of the tongue benefit from an ipsilateral neck dissection regarding nodal relapse. The value of elective bilateral neck dissection as standard treatment seems questionable even if positive lymph nodes were diagnosed ipsilateral at primary therapy.

     

SPECT/CT同机融合显像在口腔鳞癌前哨淋巴结定位中的应用

目的　探索一种准确、实用的口腔鳞癌前哨淋巴结定位方法。方法　术前运用SPECT/CT同机融合显像技术对30例cN0期口腔鳞癌患者的SLN进行定位,术中对定位的SLN活检,术后比较SLN与颈淋巴清扫的病理结果。结果　全组病例中,SPECT/CT同机融合图像对SLN定位的准确度为100%, 8例患者的前哨淋巴结和颈清扫淋巴结病理结果证实有癌转移,前哨淋巴结活检对颈部淋巴结转移状况评价的敏感度、特异度和准确度均为100%。结论　SPECT/CT同机融合显像技术可以在术前准确定位前哨淋巴结,客观评价cN0期口腔鳞癌患者颈部淋巴结的真实状况。     

淋巴显像技术在口腔鳞癌哨位淋巴结活检中的应用

目的:评价淋巴显像技术在口腔鳞癌哨位淋巴结活检中的价值。方法:应用颈淋巴显像技术结合蓝染法及SPECT/CT同机融合技术,对21例临床NO(cNO)口腔鳞癌患者的哨位淋巴结(sentinel lymph node,SLN)进行研究。结果:全组患者SLN检出率为100％,21例中有7例SLN活检阳性,颈清术后标本同样证实有颈淋巴结转移,无假阴性结果,SLN活检对全组病例颈淋巴结转移状况预测的准确性为100％。结论:颈淋巴显像技术结合蓝染法及SPECT/CT同机融合技术能有效地对口腔鳞癌SLN进行定位,从而准确预测颈淋巴结转移状况。