垂直斜方肌肌皮瓣修复头颈部肿瘤切除术后软组织缺损

目的介绍应用垂直斜方肌肌皮瓣同期修复头颈部肿瘤切除术后软组织缺损的临床经验。方法 2008年6月-2010年2月,采用垂直斜方肌肌皮瓣同期修复头颈部肿瘤切除术后软组织缺损12例。其中男9例,女3例;年龄32～76岁,中位年龄54岁。眼眶区基底细胞癌2例,腮腺鳞状细胞癌侵及皮肤2例,颌下腺恶性混合瘤2例,鼻咽癌放疗后颈部淋巴结转移2例,舌鳞状细胞癌1例,枕部皮肤鳞状细胞癌3例。患者肿瘤TNM分期均为T3或T4病变。肿瘤切除术后软组织缺损范围13 cm×6 cm～25 cm×13 cm,采用大小为14 cm×7 cm～26 cm×14 cm的垂直斜方肌肌皮瓣修复缺损。供区直接拉拢缝合。结果术后切口均Ⅰ期愈合,无感染等并发症发生。11例肌皮瓣全部成活,1例术后10 d肌皮瓣边缘坏死,经换药后延期愈合。2例术后7 d拔除引流后1周内背部供区出现少量皮下积血、积液,经抽吸加压包扎后皮瓣愈合。11例患者术后获随访,随访时间1～3年,平均2年。9例患者随访期内未见肿瘤复发,肌皮瓣外形满意,双肩外展功能良好;术后3个月1例眼眶区基底细胞癌复发;1例鼻咽癌患者术后12个月死于脑转移。结论垂直斜方肌肌皮瓣手术操作简便,组织瓣有足够长度,血供丰富,可满足头颈部软组织缺损的修复。     

Ectopic Thyroid Presenting as a Submandibular Mass

Although extremely rare, the presence of ectopic thyroid tissue in the submandibular region should be considered in the differential diagnosis of tissue masses in the cervical region. Diagnosis is confirmed by fine-needle aspiration biopsy and exclusion of malignancy should be confirmed by histopathologic analysis of the lesion. In general, surgery is the treatment of choice. A rare case of ectopic thyroid in the right submandibular region is reported; it was diagnosed after total thyroidectomy and successfully treated through surgery.     

Rhabdomyosarcoma Presenting as an Anterior Cervical Mass in an Adult: Report of a Case

We report herein the case of a 61-year-old man who was referred to our hospital for treatment of a rapidly growing tumor in the right anterior cervical region. A 13 × 14 × 15 cm mass was palpated on physical examination. Computed tomography (CT) findings indicated a thyroid tumor, but cytology results suggested rhabdomyosarcoma. A tumor, measuring 9.3 × 7.2 × 5.2 cm and weighing 220 g, was resected and histopathological examination confirmed a diagnosis of rhabdomyosarcoma. Cervical rhabdomyosarcoma is rarely found in adults. Received: September 13, 1999 / Accepted: July 25, 2000     

Kaposiform Hemangioendothelioma of the Oral Cavity: A Rare Tumor with an Unusual Location

Kaposiform hemangioendothelioma is a rare neoplasm with intermediate malignant behavior, mainly affecting infants and children. Involvement head and neck is uncommon, and there are only four cases reported in the oral cavity and oropharynx. Microscopically, it is characterized by a vascular proliferation permeated by spindle-to-ovoid cells resembling Kaposi sarcoma. Immunohistochemically, the tumor is positive for CD31, CD34 and negative for D2-40. Herein we present a rare case of intraoral Kaposiform hemangioendothelioma in a 10-year-old boy.     

Surgical resection of carotid body paragangliomas: 10 years of experience

Background

Carotid body tumors (CBTs) are relatively rare neoplasms, and even if they are considered predominantly benign, there is an indication for early surgical removal. The objective of this study was to conduct a review of the surgical management of CBTs.

Methods

A retrospective study identified 34 cases (12 men and 19 women) of tumors in patients who had undergone surgical resection of pathologically confirmed CBTs over a period of 10 years from 2001 to 2011 in 2 academic departments of general surgery in Italy.

Results

In our series, 10 CBTs (31%) were Shamblin class I, 13 (41%) were class II, and 9 tumors (27%) were class III. Two patients (6%) had transient cerebral ischemia immediately after operation. One patient (3%) died of postoperative cerebral ischemia after surgery for internal carotid artery thrombosis.

Conclusions

The experience of this casuistry shows that the procedure is relatively low risk for Shamblin I and II classes, whereas there is an increasing risk of neurovascular complications for Shamblin III class.     

Living Donor Liver Transplantation for Epithelioid Hemangioendothelioma: Report of a Case

Epithelioid hemangioendothelioma (EH) of the liver is a rare tumor, generally considered to have low-grade malignancy. Little is known about its clinical behavior and the therapeutic strategy is not established. We report the case of a 36-year-old woman who underwent living donor liver transplantation for EH with splenic metastases and died of recurrence 8 months later. To determine if transplantation improves the prognosis of patients with EH, we must re-evaluate its indications.     

Myoepithelioma of the soft tissue of the head and neck: a case report and review of the literature

BACKGROUND: Extraglandular myoepitheliomas are neoplasms that seldom occur in the soft tissue of the head and neck region. Misdiagnosis of these neoplasms as more aggressive tumors can lead to unnecessary treatment. METHODS: We describe a myoepithelioma of cervical soft tissue. The histopathology of the tumor, its immunophenotype, its differential diagnosis, and a review of the literature are presented. RESULTS: Histopathologically, the tumor was composed of epithelioid cells with eosinophilic cytoplasm and eccentric nuclei arranged in cords and files. On immunohistochemical analysis, the cells expressed cytokeratin 14, calponin, glial fibrillary acid protein, and p63 and showed focal positivity for S-100 protein. Together, these markers identified the cells as myoepithelial type. A literature review identified only five cases of myoepithelioma in the soft tissue of the head and neck region in which detailed clinical information was provided. CONCLUSIONS: Myoepitheliomas can have cells with variable morphology arranged in different histologic patterns. Immunohistochemical analysis is crucial for unequivocal diagnosis when myoepitheliomas occur in extraglandular locations.     

Epithelioid Hemangioendothelioma of the Head and Neck: Role of Podoplanin in the Differential Diagnosis

Epithelioid hemangioendothelioma is an uncommon vascular tumor of soft tissue and bone that may rarely occur in the liver, lung and the head and neck. We present five new cases of epithelioid hemangioendothelioma of the head and neck region diagnosed and managed in one institution in order to define the phenotypic characteristics, podoplanin immunohistochemical staining and the biological outcome. Podoplanin is a transmembrane mucoprotein selectively expressed in lymphatic endothelium and recently in some vascular neoplasms. The patients were comprised of two male and three female patients ranging in age from 4 to 71 years. The lesions were found in the gingiva, submandibular region soft tissue, nasal cavity and tongue, and ranged in size from 0.7 to 2.5 cm. All tumors manifested infiltrative cords and nests of epithelioid cells with occasional spindle morphology in a myxoid stroma. Immunohistochemical analysis of vascular and epithelial markers showed strong and uniform cytoplasmic reactivity for podoplanin and variable intensity and staining of CD31 and lack of cytokeratin staining in tumor cells. Surgical treatment included simple and wide local excisions. Of the three patients with follow-up, one developed lymph node metastasis and one had no evidence of disease 10 months after surgery. The patient with multiple recurrences and LN metastases was additionally treated with chemotherapy and is under consideration for radiation therapy. Hemangioendothelioma of the head and neck is: (1) a low-grade malignancy with a tendency for local recurrence and regional lymph node metastasis, (2) complete excision with negative margins is the treatment of choice for localized disease and (3) podoplanin may be useful in differentiating epithelioid hemangioendothelioma from non-vascular tumors.     

增殖期血管瘤和卡波西样血管内皮瘤的病理比较研究

目的正确鉴别体表软组织深部的增殖期婴幼儿血管瘤(Infantile hemangioma,IH)和卡波西样血管内皮瘤(Kaporsiform Hemangioendothelioma,KHE)是选择合适治疗方案的重要条件。从多方面比较增殖期IH和KHE的病理特征,为更准确地鉴别诊断这两种疾病提供依据。方法在2001年1月至2009年6月期间,收集21例增殖期IH和12例KHE标本。采用HE染色、透射电镜和免疫组化染色等方法,比较增殖期IH和KHE的病理结构和抗原标记(D2-40和Glut1)的表达。结果 HE染色显示,增殖期IH有众多毛细血管丛,新生毛细血管壁内可见扁平状周细胞;KHE由肿瘤结节组成,结节中心是大量狭缝状管腔,结节边缘可见毛细血管。在电镜下观察,增殖期IH的毛细血管壁基底膜呈多层板状结构,基底膜内有周细胞;KHE的狭缝状管腔和毛细血管壁基底膜仅有数层,且不连续,基底膜内也可见周细胞。增殖期IH肿瘤内皮细胞不表达D2-40,强烈表达Glut1;而KHE仅表达D2-40,不表达Glut1。结论增殖期IH的病理结构与KHE有明显差别。D2-40和Glut1可以作为鉴别增殖期IH和KHE的可靠抗原标记。     

Metastases to the Head and Neck: An Overview

This paper provides a review of the more common tumors to metastasize to 12 anatomic subsites of the head and neck, exclusive of cervical lymph nodes. Emphasis is placed on clinical rather than subclinical metastases discovered at autopsy.     

A case of symptomatic tumoral calcinosis on the great toe and review of the literature

A 67-year-old woman with no specific medical history showed a hard mass on her great toe for several years. The lesion was elastic, round, and had good mobility. An X-ray showed the lesion to be a calcified “chicken wire” lesion; CT and MRI findings indicated it as a benign subcutaneous calcified tumor. Therefore, a resection biopsy was performed. The mass was a 20 × 20 mm calcified tumor diagnosed as tumoral calcinosis. Pathological findings showed that the calcified lesion lay in fibrous connective tissue and characteristic cells were seen around the calcification site. In this case, the lesion was mature and surgical resection was successful. The patient showed no symptoms or recurrence 3 years after the surgery.     

Cryopreservation of Composite Tissue Transplants

Composite tissue allotransplantation holds great promise for upper extremity reconstruction but is limited by donor part availability. Cryopreservation may increase the availability of donor parts and even reduce antigenicity. The purpose of the study was to evaluate the viability of cryopreserved composite tissues and to demonstrate the feasibility of microvascular isotransplantation of cryopreserved composite flaps. Twenty epigastric flaps were harvested from Lewis rats. Ten flaps were analyzed fresh. Ten flaps were perfused with dimethyl sulfoxide (DMSO)/trehelose cryoprotectant agent (CPA), frozen by controlled cooling to −140°C, and stored for 2 weeks. Flaps were evaluated by factor VIII endothelial staining and MTT tetrazolium salt assay. For the in vivo phase, 30 flaps were harvested. Ten were transplanted fresh to isogenetic recipient animals, ten were perfused with CPA and transplanted, and ten were cryopreserved for 2 weeks, thawed, and transplanted. All cryopreserved samples displayed intact vascular endothelia on factor VIII staining. On MTT analysis, the epithelial viability index for the cryopreserved samples was not significantly different from fresh controls (p = 0.12). All freshly transplanted flaps (10/10) were viable at 60 days. Nine of ten flaps in the perfused/transplanted group were viable at 60 days. Survival of cryopreserved/transplanted flaps ranged from 5 to 60 days. The skin and vascular endothelial components of composite tissue flaps appear to retain their viability after cryopreservation. The in vivo studies demonstrate that the long-term survival of cryopreserved composite tissue transplants is feasible and support an indirect injury, rather than direct injury from freezing or cryoprotectant agents, as the mechanism of flap loss. Presented at the Annual Meeting of the American Association for Hand Surgery, Rio Grande, Puerto Rico, January, 2007.     

下斜方肌肌皮瓣在修复头颈部严重电击伤中的应用

目的 探讨下斜方肌肌皮瓣修复头颈部深度电烧伤创面的效果。方法 2007年起,应用下斜方肌肌皮瓣转移修复5例头颈部严重电烧伤患者创面。结果 5例下斜方肌肌皮瓣全部成活。术后随访3~24个月,头颈部外形和功能恢复满意,无肩胛下垂畸形。结论 下斜方肌肌皮瓣血运可靠,手术切取简便安全,抗感染能力强,对肩关节影响小,是修复头颈部深度电烧伤创面的有效方法。     

Composite adeno-endocrine carcinoma of the gallbladder with long-term survival

INTRODUCTIONPrimary endocrine cell tumors in the gallbladder are uncommon, and the coexistence of an endocrine cell tumor and adenocarcinoma, squamous cell carcinoma, and sarcomatoid components is extremely rare.PRESENTATION OF CASEA rare case of adeno-endocrine cell carcinoma of the gallbladder in an 81-year-old woman is reported. Abdominal ultrasonography (US) revealed a hypo-echoic, solid tumor, 2.0 cm × 1.8 cm in size, at the fundus of the gallbladder. On computed tomography (CT), the tumor was well-enhanced, well-demarcated, and homogeneous. The tumor, which was papillary, protruded into the gallbladder with no direct invasion to the liver. The tumor was diagnosed as gallbladder carcinoma; its depth appeared not to pass the subserosa layer. A cholecystectomy and hepatic bed resection with regional lymph node dissection were performed. Histologically, the tumor consisted of several components, including well to poorly differentiated papillary and tubular adenocarcinoma with squamous and sarcomatoid differentiations, and endocrine cell carcinoma. Histochemical studies of these tumor cells were positive for chromogranin A, synaptophysin, and cluster of differentiation 56 (CD56). The lymph node consisted of metastatic adeno-endocrine carcinoma. The patient survived and has remained disease-free for 4 years without adjuvant chemotherapy.DISCUSSIONAdeno-endocrine cell carcinoma of the gallbladder generally has a poor prognosis.CONCLUSIONThe present case suggests that adeno-endocrine cell carcinoma with various components may be derived from a common precursor cell. This observation would require further investigation.     

Large liposarcoma developing in the ischiorectal fossa: Report of a rare case

INTRODUCTIONWe herein report an extremely rare case of a liposarcoma developing in the ischiorectal fossa that was completely resected using a transsacral approach.PRESENTATION OF CASEA 74-year-old man was admitted to our institute because of a large perianal tumor. A pelvic magnetic resonance imaging (MRI) revealed an 8 cm × 7 cm × 5 cm sized encapsulated heterogeneous tumor on the right side of the ischiorectal fossa. Transsacral excision was performed under a diagnosis of liposarcoma. The tumor was partially fixed to the external sphincter and puborectalis. Therefore, the muscles were partially resected to ensure sufficient margins. Histopathological examination revealed a well differentiated liposarcoma and negative surgical margins.DISCUSSIONThe basic treatment strategy of liposarcoma is surgical resection, whereas the effects of chemotherapy or radiotherapy remain limited. Although no postoperative adjuvant therapy has been performed in our case, no recurrences have occurred for 1 year after surgery.CONCLUSIONAlthough the curative resection of large tumors located in the ischiorectal fossa is usually difficult, the complete resection of liposarcoma is the main potentially curative treatment. A transsacral approach is useful for a complete resection.     

Hydatid Cystic Disease of the Soft Tissues with Pulmonary and Hepatic Involvement: Report of a Case

Hydatid disease, which is caused by the Echinococcus granulosis parasite, is endemic in certain parts of the world where close contact between humans and sheep exists. The disease most commonly involves the liver and other solid organs. This report describes the case of a teenage girl with hydatid disease involving the right axilla and various other sites concomitantly. The patient was admitted to hospital with a mass in the right axillary region, and further examinations revealed that the liver and right lung were also involved. We report this case to emphasize that hydatid disease should be considered in the differential diagnosis of patients from endemic areas who present with soft tissue masses. Received: September 25, 2001 / Accepted: May 7, 2002 Reprint requests to: Ş. Dilege     

~(125)I粒子组织间植入治疗头颈部复发和转移恶性肿瘤

目的探讨125I植入治疗复发和转移头颈部恶性肿瘤的可行性。方法2003年1月~2007年7月,对29例头颈部癌术后或放化疗后复发或转移,在局部浸润麻醉下,CT、B超或腔内镜引导125I粒子植入术,粒子间距0.5~1.0cm。肿瘤周边匹配剂量(matched peripheral dose,MPD)90~160Gy,粒子活度29.6MBq。结果29例均顺利完成手术,每例植入粒子12~67颗,中位数23颗。术后未发生出血、感染、粒子移位等严重并发症。29例随访3~24个月,平均16个月,局部控制率术后3个月为55%(16/29),6个月71%(20/28),12个月45%(10/22),2年36%(5/14)。结论放射性125I粒子植入治疗复发和转移头颈部肿瘤可行,近期疗效可靠。