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.     

First report of elective selective neck dissection in the management of squamous cell carcinoma of the maxillary sinus

Controversy remains about management of the neck in squamous cell carcinoma (SCC) of the maxillary sinus and we know of no reports of the use of elective selective neck dissection for management in this site. We retrospectively reviewed 18 consecutive patients with SCC of the maxillary sinus who were managed by primary operation with curative intent. A total of 13 patients had an elective selective neck dissection, which was invaded in one case 8%. Four patients had regional metastases, two with positive nodal disease confirmed after elective selective neck dissection, and two who developed regional recurrence (both after elective selective neck dissections which were negative (pN0)). A review of other published articles in the English language showed no cases of elective selective neck dissections reported. The mean regional recurrence rate was 12% (range 0–26%) and total mean regional metastases rate 21% (range 5–36%). Elective selective neck dissection did not contribute to an improved rate of neck control with regional recurrence of 11% (2/18) compared with 12% in the review. There is no evidence in this report to indicate that elective selective neck dissections for maxillary sinus SCC will result in better disease control. Future research may indicate fewer radiotherapy fields for necks with pathologically clear nodes after elective selective neck dissection.     

cN0头颈鳞癌哨位淋巴结示踪法的研究进展

颈部哨位淋巴结是头颈部鳞癌最早发生转移的淋巴结,其所在位置及有无转移或微转移,是决定是否行区域性颈淋巴清扫的一个重要指标。对于哨位淋巴结阴性的cN0患者,为减少过度治疗,精确定位哨位淋巴结十分重要。目前多采用示踪法检测哨位淋巴结,本文就其判断cN0头颈鳞癌隐匿性转移的研究进展作一综述。     

A single cervical lymph node metastasis of malignant ameloblastoma

IntroductionCervical node metastasis of malignant ameloblastoma is extremely rare. Because of its rarity, there is no standard treatment modality in a single lymph node metastasis in malignant ameloblastoma.Materials and methodsEleven patients of malignant ameloblastoma involving a single cervical lymph node metastasis and one new case were reviewed. Neck treatment was classified into neck dissection and simple excision. Local nodal recurrence, distant metastasis and follow-up periods were investigated.ResultsEight patients were treated with neck dissection (group A) and four patients underwent a simple node excision (group B). Two patients in group A experienced multiple organ metastases such as liver and lung seven months and 13 years after neck dissection respectively. The other patients showed no recurrence and metastasis. In group B, there was no report of a regional neck recurrence and distant metastasis during follow-up of 1–7 years.ConclusionMultiple nodes metastasis requires a radical neck dissection; however, simple excision with close follow-up may be used in a single node metastasis in malignant ameloblastoma.     

Histopathological and lymphangiogenic parameters in relation to lymph node metastasis in early stage oral squamous cell carcinoma.

PURPOSE: Lymph node metastasis from oral squamous cell carcinoma (SCC) correlates with a poor prognosis. Therefore, accurate assessment of lymph node status is crucial in treatment planning. Furthermore, prediction of delayed neck metastasis (DNM), especially in early stage tumors with a clinically negative (N0) neck, will determine the need for neck dissection or irradiation. In this study, we assess various clinical, histopathological and lymphangiogenic parameters in early stage oral SCC and their association with DNM. MATERIALS AND METHODS: Clinical, histological, and immunohistochemical analyses were undertaken for 29 patients with T1N0M0 or T2N0M0 oral SCC affecting the tongue or floor of mouth and correlated with the development of DNM. RESULTS: Tumor thickness, nuclear pleomorphism, pattern of invasion, and immunohistochemical expression of the lymphangiogenesis-associated molecules VEGFR-3 and VEGF-C were associated with DNM. CONCLUSIONS: Analysis of these parameters may help to identify patients who would benefit from a neck dissection or irradiation by predicting the likelihood of lymph node metastasis.     

舌根恶性多形性腺瘤双颈淋巴结转移（附病例报告）

目的：研究舌根恶性多形性腺瘤（MPA）双侧颈淋巴结内癌转移的临床表现、诊断、治疗及预后。方法：对舌根恶性多形性腺瘤双侧颈淋巴结内癌转移病例,分析其临床表现、影像学表现、诊疗过程及组织病理学特征,并进行文献回顾。结果：本文病例为老年男性,首诊症状为颈侧上部无痛肿物,鼻咽镜检查发现舌根无痛性肿物,钳取活检为中分化鳞状细胞癌,行舌根肿瘤扩大切除及双侧改良根治性颈淋巴清扫术,术后病理为舌根恶性多形性腺瘤,恶性成分为鳞状细胞癌,可见淋巴管内瘤栓,双侧Ⅰ、Ⅱ、Ⅲ区颈淋巴结内癌转移（18/42）。术后放疗50Gy,随访1年,未见肿瘤复发与转移。结论：舌根MPA极罕见,双侧颈淋巴结内癌转移病例,经文献检索未见报告。手术彻底广泛切除原发灶并行颈清扫术,辅以放疗,预后良好。     

Hyalinizing clear cell carcinoma of the base of tongue

Hyalinizing clear cell carcinoma is a rare, low-grade neoplasm of the minor salivary glands. It is composed exclusively of epithelial cells with optically clear cytoplasm. There are only a few isolated cases reported in the literature involving the base of tongue. The treatment of choice is wide excision and selective neck dissection, with or without radiotherapy. The prognosis of these tumours is good. A 57-year-old male patient presented with a lesion in the base of tongue, which was well enhanced on contrast computerized tomography scan. Once confirmed by biopsy, the hyalinizing clear cell carcinoma was resected via a transcervical approach. The patient underwent postoperative radiotherapy. There was no evidence of locoregional recurrence or distant metastasis at 18 months of follow up.     

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.     

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.     

腮腺淋巴上皮癌22例临床分析

目的探讨腮腺淋巴上皮癌的诊断方法、治疗方式及预后情况,为临床提供参考。方法 2012年至2019年期间收治的腮腺淋巴上皮癌病例22例,对患者的临床表现、影像学检查、治疗方式及随访结果进行回顾性分析。结果 22例患者中,男性8例,女性14例;年龄26~61岁,主诉病程3天~18年,单侧腮腺区多发肿块1例,其余21例均为腮腺区单侧单发肿块。所有患者均行术前螺旋CT检查,CT所示腮腺组织内软组织肿块影,其内密度影欠均匀,CT值26~81 HU,15例表现为类圆形,界限尚清晰;7例表现为结节状,界限稍不清晰或部分不清晰。所有病例诊断最终依据病理学检查,HE染色图像可见肿瘤细胞边界清楚,上皮细胞生长活跃伴有异型性,可见核分裂像,肿瘤间质可见丰富的淋巴细胞浸润。22例患者均接受手术治疗,其中9例患者未行颈淋巴清扫。20例患者术后接受辅助放疗,其中10例同时行辅助化疗;1例患者术后仅行化疗,1例患者术后未行其他任何辅助治疗。所有病例均得到回访,21例无瘤生存13个月~8年,1例患者术后16个月因肝转移死亡。结论腮腺淋巴上皮癌是临床上较为罕见的恶性肿瘤,病理仍是诊断腮腺淋巴上皮癌的金标准。根治性手术切除肿瘤是首选治疗方法,根据临床检查及影像学检查及颈部情况进行选择性颈淋巴清扫,术后辅助放化疗可获得较好的治疗效果。     

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。     

Cardiac metastasis of head and neck squamous cell carcinoma

Two patients with cardiac metastasis from head and neck cancer are reported. Cardiac metastasis located in the left atrium was detected on a follow-up computed tomography (CT) scan 15 months after partial glossectomy for a tongue carcinoma in a 60-year-old man. The diagnosis was confirmed as cardiac metastasis of squamous cell carcinoma (SCC) by surgical excision of the cardiac lesion. The patient died 3 weeks after surgery. In a 69-year-old man with a partial maxillectomy for primary soft palate cancer, a follow-up CT scan 5 months after surgery revealed a mass in the right atrium and ventricle, and multiple lung metastases. He died of heart failure 3 weeks after the diagnosis of cardiac metastasis. Information on these cases should add to knowledge about rarely encountered cardiac metastasis.     

颊黏膜鳞癌颈淋巴结隐匿性转移的临床研究

目的:探讨颊黏膜鳞癌隐匿性转移规律。方法:1992-01～2004-12月在南京大学口腔医院口腔颌面外科行颈淋巴清扫术的颊黏膜鳞癌cN0患者69例,男性31例,女性38例,年龄31～79岁,平均58.2岁。颈部的处理采用根治性颈淋巴清扫术、功能性颈淋巴清扫术或肩胛舌骨上颈淋巴清扫术。结果:颊黏膜鳞癌颈淋巴结隐匿性转移率为14.49%(10/69),转移到Ⅰ区为10.14%(7/69)、Ⅱ区为5.80%(4/69)、Ⅲ区为2.90%(2/69);T1颈部隐匿性转移率为9.52%(2/21)、T2为15.38%(6/39),T3、T4例数较少,其中4例T3中有1例转移,5例T4中有1例转移;高、中分化鳞癌颈部隐匿性转移率分别为14.89%(7/47)、10.00%(2/20),低分化鳞癌例数较少,2例中有1例转移。结论:认识颊黏膜鳞癌颈部淋巴结隐匿性转移特征,对制定颈部治疗方案具有重要意义。     

Clinicopathological study of involvement of the submandibular gland in oral squamous cell carcinoma

Our purpose was to provide a pathological basis for preservation of the submandibular glands during neck dissection for oral squamous cell carcinoma (SCC) by investigating whether intraglandular lymph nodes exist in submandibular glands, and the modes of involvement of submandibular glands in oral SCC. We studied the records of 95 patients with oral SCC (other than that in the floor of the mouth) treated at our hospital from January 2017 to June 2018. The specimens of submandibular glands discarded after neck dissection were analysed, and serially sectioned. Sections 5 μm thick were obtained at 0.5 mm intervals and stained with haematoxylin and eosin for examination under light microscopy. A total of 116 specimens were obtained from the 95 patients, and about 5000 slides were evaluated. No intraglandular lymph nodes were detected in the submandibular glands. In the subgroup of patients whose primary tumours had extended into the floor of the mouth, four submandibular glands were involved by direct spread of the primary tumour. In the subgroup with metastases to level Ib lymph nodes, four submandibular glands were involved by extranodal extension from the metastatic nodes. No intraglandular lymph nodes or micrometastases were detected. We conclude that no intraglandular lymph nodes are present in submandibular glands, which may be involved by direct extension of the primary carcinoma or metastatic cervical lymph nodes with extranodal extension. Preservation of the submandibular glands during neck dissection seems to be feasible and safe in selected patients with oral SCC.     

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.     

cN0舌癌患者颈淋巴结转移的区域分析

目的探讨cN0舌癌患者颈淋巴结转移的区域分布情况,为cN0舌癌患者颈淋巴清扫的术式选择提供参考。方法取61例cN0舌癌患者根治性颈淋巴清扫术后标本,收集各平面区域的淋巴结进行病理切片,分析其淋巴结转移情况及各区域的分布。结果 20例患者发现淋巴结转移,转移率32.8%,811颗淋巴结中62颗证实有转移,占7.6%。其中平面Ⅰ为11.0%（26/237）,平面Ⅱ为8.2%（20/243）,平面Ⅲ为6.0%（13/218）,平面Ⅳ为3.5%（3/85）,平面Ⅴ无淋巴结转移。结论 cN0舌癌患者仍有较高的颈淋巴结转移率,转移淋巴结主要分布于平面Ⅰ、Ⅱ和Ⅲ,少部分转移至平面Ⅳ,选用肩胛舌骨上颈淋巴清扫术最好扩展至平面Ⅳ。     

Cervical metastases from maxillary squamous cell carcinoma: retrospective analysis and review of the literature

The purpose of this study was to define the incidence of cervical metastasis in squamous cell carcinoma (SCC) of the maxillary alveolus, hard palate and gingiva; to identify patterns of locoregional failure and to assess survival outcomes. We retrospectively analysed 30 patients treated for SCC of the maxillary alveolus and hard palate between 2000 and 2010. Parameters assessed included the incidence of cervical metastasis at presentation and recurrence, paying particular attention to tumour staging and survival outcomes. Of our 30 patients, 25 were confirmed to have T4 SCC of the maxillary alveolus and hard palate with bone invasion. Cervical metastases had been noted in 7 (23%) patients at initial presentation. A total of 9 (36%) patients developed regional failure in the pT4 SCC group shortly after primary resection. Patients with advanced primary SCC of the hard palate and maxillary alveolus (particularly when there was bone invasion) showed high rates of regional failure, and in most cases successful salvage was not achieved. Based on our findings and a review of the existing literature we strongly recommend elective neck dissection for patients with pT4 SCC of the maxillary alveolus and hard palate.     

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。     

Relevance of level IIb neck dissection in oral squamous cell carcinoma

Background

The purpose of this study was to determine the prevalence of level IIb metastasis in patients with oral squamous cell carcinomas (OSCCs).

Material and Methods

A prospective analysis of 56 patients with OSCC who underwent surgical treatment of the primary lesion with simultaneous neck dissection was performed. During neck dissection, level IIb lymph nodes were separately removed and processed. Neck dissection was bilateral in 26 patients (46%) and unilateral in 30 patients (54%).

Results

The mean number of nodes found in the level IIb specimens was 4.7 (range: 0-8 nodes). The prevalence of metastasis at level IIb was 0% in pN0 necks and 3.4% in pN+ necks, with an overall prevalence of 1.8%. A significant association between metastasis to level IIb and type of neck dissection was observed. There were no isolated metastases to level IIb without the involvement of other nodes in the remaining neck specimen. Four regional recurrences were observed during follow-up.

Conclusions

Based on our findings, we suggest that dissection of the level IIb region in patients with OSCC may be required only in patients with multilevel neck metastasis or if level IIa metastasis is found intraoperatively. Key words: Oral squamous cell carcinoma, neck dissection, level IIb, metastasis, spinal accessory nerve.     

Development of a new invasion and metastasis model of human oral squamous cell carcinomas

A new model was devised in order to establish an in vivo model for oral carcinoma that exhibits significant local invasion and metastasis. One hundred and fifty-two nude mice had tumour cells from one of two established oral squamous cell carcinoma (SCC) cell lines (OSC-19 and OSC-20) implanted into the tongue or the oral floor via an intra-oral route and, as a control, the subcutaneous tissue of the back. The back tumours showed an expansive growth pattern, lacking significant invasion of surrounding tissues. In contrast, the tumours implanted into the tongue or the oral floor exhibited invasive growth and the histological appearance was similar to that of the original tumours. Moreover, regional neck lymph node and pulmonary metastases were observed in this model. Regional neck lymph node metastases were detected in 81.0% of mice implanted with OSC-19 cells and in 13.6% of mice implanted with OSC-20 cells. OSC-19 and OSC-20 cells showed pulmonary metastases in 9.5 and 9.1% of mice, respectively. These results suggest that this intra-oral implantation model is valuable in the study of the mechanism of invasion and metastasis of oral SCC.