Lymph node metastases in the lower neck

Current knowledge suggests that lymph node metastases in the lower neck (supraclavicular fossa and posterior triangle) are associated with a poor survival. Very little systematic work has been published on this subject. This was a retrospective study carried out on a database where all patients were entered in a prospective manner over a 35-year period using a standard pro-forma. Data on 168 patients presenting with a lower neck node metastasis were retrieved. The main outcome measures were: association between variables and tumour-specific survival. Data were displayed in contingency tables and analysed by chi-square and categorical modelling. Recurrence and survival were plotted in a cause-specific manner using the Kaplan Meir method. Differences in curves were analysed using the log rank test. Multivariate analysis was carried out using Cox's proportional hazard model. The only association was between site and node level and histology. Head and neck tumours were associated with squamous histology (P = 0.0004) and supraclavicular nodes (P = 0.0047). Survival time was not significantly different when lower-neck lymph node metastasis from the head and neck was compared to non-head and neck metastasis: 5-year survival 30% and 10% respectively (P = 0.1363). Survival with posterior triangle metastases was significantly better than supraclavicular metastases (P = 0. 0059), confirmed on multivariate analysis. Laterality of metastasis had no effect on survival (P < 0.0001). There was no significant difference in survival between squamous and non-squamous metastases on Cox regression (P = not significant). There were 85 head and neck primaries including lymphomas, 53 infraclavicular primaries and 30 unknown primaries. There were 73 squamous cell carcinomas, 27 adenocarcinomas, 34 lymphomas, 28 undifferentiated tumours and six other tumours. Nearly half the primary tumours were below the clavicle. Survival was unaffected by laterality, primary site or histology, but was better for posterior triangle nodes.     

Neuroendocrine carcinoma of the head and neck: a 20-year case series

Neuroendocrine carcinoma (NEC) can be an aggressive disease with locoregional and distant metastasis. We present this article (1) to highlight the typical presentation of NEC in head and neck primary sites such as the parotid gland, paranasal sinuses, and supraglottis and (2) to discuss the prognosis of these tumors based on their histologic subtype and stage. We base our comments on the findings of our retrospective review of the cases of 16 adults-10 men and 6 women, aged 43 to 88 years (mean: 65.8)-who had been diagnosed with pathologically confirmed NEC of the head and neck. Analysis of subtypes revealed that 11 of these patients (68.8%) had presented with poorly differentiated NEC, 4 (25.0%) with moderately differentiated NEC, and 1 (6.3%) with well-differentiated NEC. The most common primary sites were the salivary glands (n = 5; 31.3%), paranasal sinuses (n = 4, 25.0%), and larynx (n = 4). There was no statistically significant difference in survival at 24 months between the patients with moderately differentiated NEC and those with poorly differentiated NEC (37.5 vs. 35.4%; p = 0.86); at the end of the study period, the patient with well-differentiated NEC was still living, 129 months after diagnosis. Taken together, patients with stage I, II, and III disease had a combined survival of 77.8% at 12 months, which was significantly higher (p = 0.023) than the 57.1% survival at 12 months for patients with stage IV disease.     

The controversy in the management of the N0 neck for squamous cell carcinoma of the maxillary sinus

Squamous cell carcinoma (SCC) of the maxillary sinus is a relatively rare disease. As the reported incidence of regional metastasis varies widely, controversy exists as to whether or not the N0 classified neck should be treated electively. In this review, the data from published series are analyzed to decide on a recommendation of elective treatment of the neck in maxillary SCC. The published series consist of heterogeneous populations of different subsites of the paranasal sinuses, different histological types, different staging and treatment modalities used and different ways of reporting the results. These factors do not allow for recommendations based on high levels of evidence. Given this fact, the relatively high incidence rate of regional metastasis at presentation or in follow-up in the untreated N0 neck, and the relatively low toxicity of elective neck irradiation, such irradiation in SCC of the maxillary sinus should be considered.     

Survival in sinonasal and middle ear malignancies: a population-based study using the SEER 1973–2015 database

Background

The sinuses, nasal cavity, and middle ear represent a rarer location of head and neck malignancy than more common sites such as the larynx and oral cavity. Population-based studies are a useful tool to study the demographic and treatment factors affecting survival in these malignancies.

Methods

Population-based database search of the Survival, Epidemiology, and End Results (SEER) database from 1973 to 2015 for malignancies involving the nasal cavity, paranasal sinuses, and middle ear. Data were analyzed for demographics, treatment type, stage, primary site and histopathologic type. Kaplan-Meier analysis was used to assess and compare survival.

Results

A total of 13,992 cases of sinonasal or middle ear malignancy were identified and analyzed. The majority of patients were between ages 50 and 80 at the time of diagnosis. Overall 5-, 10-, and 20-year survival was 45.7%, 32.2%, and 16.4%, respectively. Lymph node metastasis was reported in 4.4% of patients, while distant metastasis was present in 1.5% of cases. On univariate analysis surgical vs. nonsurgical treatment, sex, race, age at diagnosis, T stage, N stage, M stage, AJCC overall stage, primary site, tumor grade, and histopathologic subtype significantly affected survival. On multivariate analysis age, race, sex, primary site, overall AJCC stage, surgical vs. nonsurgical treatment, and T, N, and M stage remained significant predictors of overall survival.

Conclusions

Malignancies of the nasal cavity, paranasal sinuses, and middle ear account for a minority of overall head and neck cancers. The overall 5-, 10-, and 20-year survival for these malignancies is relatively low. Higher T, N, M, and overall stage and higher tumor grade is associated with lower survival. Patients treated with surgery as part of the treatment regimen had higher overall survival. Demographics and primary site also significantly affect survival. Certain histopathologic subtypes were associated with poorer survival.

     

Unilateral opacification of the paranasal sinuses in CT or MRI: an indication of an uncommon histological finding

BACKGROUND: Clinical and radiological differentiation between subacute or chronic sinusitis and differential pathologies such as malignoma, inverted papilloma or mycosis can be very difficult. In some cases the CT- or MRI-scan shows a unilateral opacification of the paranasal sinuses. Which histological results can be found in patients with persisting sinusitis related problems and a unilateral opacification of the paranasal sinuses in the CT- or MRI-scan? There are only a few publications on this topic. PATIENTS: In a prospective study between June 1998 and November 1999 all patients who underwent surgery in our Department for subacute or chronic sinusitis problems were included into our study group if they had a unilateral opacification of the paranasal sinuses. Thereafter, the same neuroradiologist verified the unilateral radiological findings on CT or MRI, unaware of the clinical and histological findings. Cases with a pre-existing histological examination, previous operation or injury to the paranasal system were excluded from this study. Data on clinical symptoms, radiological and histological findings were analysed. RESULTS: 43 cases with unilateral opacified paranasal sinuses were diagnosed by means of CT or MRI. These were comprised of 24 males and 19 females with an average age of 43.6 years (range 6 to 88 years). The major findings of our study were as follows: Firstly unilateral opacification of the paranasal sinuses is often (19/43 cases or 43%) associated with diseases othe than simple chronic sinusitis (8 inverted papilloma, 5 malignoma, 3 mycoses and one brown tumor, one osteoidosteoma and one haemangioma). Secondly the incidence of significant pathology other than simple chronic sinusitis rises strikingly with increasing age of the patient. For instance pathologies other than simple chronic sinusitis were found in 14% (1/7) of cases in the under 16 years group, 27% (6/22) of cases in the 16-60 years group and in 86% (10/12) of cases in the over 60 years group. Concerning clinical signs of our patients with unilateral sinus opacity 7 of 11 patients (63%) with epistaxis and 3/5 with diplopia had histological findings other than simple chronic sinusitis. In contrast unilateral rhinorrhea, unilateral nasal congestion and cephalgia were not of predictive value. CONCLUSION: Unilateral opacification of paranasal sinuses in the CT or MRI is--especially at a higher age--an indice for a neoplasm or mycotic sinusitis and therefore an early histological diagnosis or operative treatment is always suggested.     

Second radical neck dissection

We report a series of 96 patients (62 men and 34 women) undergoing a second radical neck dissection for enlarged contralateral cervical nodes after primary treatment of a squamous cell carcinoma of the head and neck, including an ipsilateral radical neck dissection. The proportion of patients requiring a second later neck dissection varied from 0% for tumours of the nasopharynx, nasal cavity and paranasal sinuses, to 5% for tumours of the hypopharynx. The incidence of second neck dissection was not determined by the original T stage of the primary tumour, but patients with enlarged nodes at presentation were 5 times more likely to need a second neck dissection than those with no palpable nodes at presentation. Also, patients with a poorly differentiated tumour were twice as likely to need a second neck dissection as those with a well differentiated tumour. The overall 5-year survival after second neck dissection was 35% and the perioperative mortality 1.92%. Significant factors predicting survival after a second neck dissection were the time to recurrence, the clinical neck node status at recurrence, the number of histologically invaded nodes in the neck and the presence of extra-nodal disease.     

Epidemiologic analysis of 72 carcinomas of the nasal cavity and paranasal sinuses

ObjectiveThe aim of this study is to define the epidemiological aspects of carcinoma of the nasal cavity and paranasal sinusesMaterial and methodsWe performed a retrospective study of 72 carcinomas of the nasal cavity and paranasal sinuses. Various sites, age and sex distribution, drug consumption, TNM stage grouping and treatment were reported.ResultsThe average age was 63. Seventy- five percent of patients (54/72) were male and 25% (18/72) female. The site of origin was paranasal sinuses in 46 patients (64%), 30 in ethmoid sinus, 15 in maxillary sinus and 1 in sphenoid sinus. Twenty-six patients (36%) were located in nasal cavity.Squamous cell carcinoma was the most frequent histological type in both localizations. The 5-yea adjusted survival rate for all patients was 60% (IC: 54-66), 36% (IC: 28-44) for paranasal sinus carcinoma and 86% (IC: 79-93) for nasal cavity carcinoma. The 5-year adjusted survival rate according to the T distribution in 46 carcinomas paranasal sinus was 80% T2, 71% T3, 19% T4a and 6% T4b.(p=0.0002).ConclusionsCarcinoma of nasal cavity and paranasal sinuses represent a group of tumors that differ from the rest of carcinomas of the head and neck.     

甲状腺乳头状癌Ⅵ区淋巴结清扫非劣性研究

目的：了解未行含Ⅵ区的择区性淋巴结清扫术的分化良好的甲状腺乳头状癌患者的复发情况;探讨分化良好的甲状腺乳头状癌是否要常规行含Ⅵ区的择区性颈淋巴结清扫术。方法：不同时期处理的甲状腺乳头状癌患者267例,按时间分成2组：A组为近期行含Ⅵ区的择区性淋巴结清扫的甲状腺乳头状癌151例;B组为早期未行Ⅵ区择区性淋巴结清扫的甲状腺乳头状癌116例。原发灶处理2组均一致：肿瘤发生侧行甲状腺全切除,甲状腺峡部全切,健侧甲状腺次全切除;若肿瘤两侧同时发生,则行双侧甲状腺全切术。统计第1组中Ⅵ区淋巴结转移发生率;随访第2组患者,观察头颈部淋巴结复发情况以及生存情况。结果：A组151例患者中59例仅行Ⅵ区淋巴结清扫,其中发生转移者22例,其余92例同时行Ⅱ、Ⅲ、Ⅳ、Ⅵ区颈淋巴结清扫,其中各区都没有转移者31例,Ⅵ区和其他区均转移者33例（35．8％）,只有Ⅵ区颈淋巴结转移者17例（18．4％）,除Ⅵ区外其他区域淋巴结有转移者11例（11．9％）。即甲状腺乳头状癌病例中Ⅵ区淋巴结转移率为47．7％（72／151）。B组116例甲状腺乳头状癌伴有颈淋巴结转移者47例,占40．5％;5年生存率为99．3％;复发率为6．0％（7／116）。A组颈淋巴结转移率（54．9％）高于B组（40．5％）。结论：分化良好的甲状腺乳头状癌患者较多的转移到气管前和喉返神经周围淋巴结,Ⅵ区淋巴清扫可成为常规。     

Clinical aspects and prognosis of paranasal sinus tumors with special reference to their etiology

Sixty-one patients operated on for malignant paranasal sinus tumours were investigated to elucidate the incidence and route of metastasis; survival rate, incidence of recurrent tumours, sex distribution etc. as well as possible exogenous causative factors. Adenocarcinomas have a better prognosis in women than in men and sometimes show local recurrences even 10 years and more after primary operation. Tumours of the paranasal sinuses often produce primarily hematogeneous distant metastases, with a fatal outcome. Occupational carcinogenic influence of wood dust seems very likely.     

The paranasal sinuses as metastatic site of renal cell carcinoma]

BACKGROUND: Malignant tumors very seldom establish metastasis in the paranasal sinuses. Renal cell carcinomas (RCC) are one of the possible primary tumors displaying metastases in this location. The incidence of metastasis from the renal cell carcinoma in the paranasal sinuses is higher as would be expected by the incidence of this tumor. PATIENTS: We report here about 3 patients from the ENT clinic with metastasis in the paranasal sinus derived from primary RCC. Two of them showed metastases in the maxillary sinus and the third patient had a metastasis in the sphenoid sinus. RESULTS AND CONCLUSIONS: Further progression of the patients disease exhibited the paranasal sinuses being only a localisation of the generalised tumor disease. 2 of 3 patients developed the metastasis many years after nephrectomy and the third patient displayed a renal cell carcinoma by the diagnosis of a paralysis of the abducens nerve. All patients were treated with radiation of the tumor, but in one case with a metastasis in the maxillary sinus the tumor was also treated surgically. 2 of the 3 patients (one with a metastasis in the maxillary sinus and the other in the sphenoidal sinus) were inoperable due to the expanded tumor size. Nowadays surgical resection of the tumor seems to be the only therapy. In the follow-up all patients developed multiple distant metastasis. With respect to the quality of life of the patients the indication of a radical operation should be discussed very critically. Palliative methods, like interferon-therapy or selective embolisation of tumor, may also reduce the symptoms of the tumor and increase the quality of life for the patients.     

New aspects in parotid gland surgery

We present our results of current research on parotid gland surgery at our clinic. a) Histopathological characteristics of pleomorphic adenomas, especially of capsular alterations like thin capsule areas, capsule-free regions, satellite nodules, and pseudopodia in the different subtypes were analyzed in 100 consecutive patients. 51 pleomorphic adenomas were classified as stroma-rich type, 35 as cell-rich-type, and 14 as classical subtype. 97% of all tumors showed areas with very thin (< 20 mm) capsules. Stroma-rich tumors showed the absolute greatest regions of very thin capsules and exhibited focal absence of encapsulation in 71% of the tumors. 11% of the cell-rich and 43% of the classical subtype tumors also presented capsule-free areas. Satellite nodules and pseudopodia were present in 33% of the stroma-rich tumors, respectively 23% in cell-rich, and 21% in classical subtype tumors. Therefore, enucleation or local dissection of the pleomorphic adenoma can not be a sufficient surgical treatment of this special tumor entity. We recommend lateral or total parotidectomy as the treatment of choice. b) To ascertain the incidence of clinically apparent and occult lymph node metastases in patients with major salivary gland cancers we analyzed 160 consecutive patients that underwent parotidectomy and neck dissection. Histologically confirmed positive neck was found in 53% of all cases. The histology of the primary tumor had a significant influence on the incidence of lymph node metastasis: Highest incidence of 89% (16/18) was found in undifferentiated carcinomas, however also so-called low-risk tumors showed a rate from 22% to 47%. Of the 139 patients with clinical N0 neck 45% had occult neck metastasis. In conclusion neck dissection should be considered as an integral part of the surgical concept in major salivary gland cancer patients.     

原发性鼻黏膜及口腔黏膜恶性黑色素瘤患者的预后因素分析

目的:总结手术治疗的原发性鼻黏膜及口腔黏膜恶性黑色素瘤患者的临床特点及生存状况,探讨影响其预后的主要因素。方法:回顾性分析1980-01-2005-01期间66例原发性鼻黏膜及口腔黏膜的恶性黑色素瘤患者的临床资料,复习病历并进行随访。生存分析采用Kaplan-Meier法,多因素分析采用Cox模型。结果:66例患者中,37例行术后辅助治疗,包括化疗12例,生物治疗8例,化疗加生物治疗5例,放疗8例,放疗加化疗4例。15例(22.7%)首次治疗后6个月内原发灶复发或伴淋巴结转移或远处转移。10例(15.2%)出现远处转移。平均生存时间为77.9个月,中位生存时间为33.7个月,3年和5年累积生存率分别为41.4%和31.1%。多因素分析显示:肿瘤最长径、有无淋巴结转移、首次治疗效果是影响预后的独立因素。结论:原发性鼻黏膜及口腔黏膜的恶性黑色素瘤预后较差,生存率较低,局部复发率较高,且容易出现淋巴结转移及远处转移。影响预后的独立因素是肿瘤大小、有无淋巴结转移和首次治疗效果。关于术后辅助治疗的作用仍需进一步研究。     

The prevalence and significance of incidental paranasal sinus abnormalities on MRI

Morphological changes in the paranasal sinuses are regularly noted on MRI, but little is known about the incidence and significance of these changes in the general population. The purpose of this study was 1) to classify the morphological changes in the paranasal sinuses seen on MRI 2) to investigate the prevalence, site and type of paranasal abnormalities and 3) to evaluate the significance of the findings by relating them to the presence of sinusitis symptoms, allergy, smoking habits and seasonal variations. In a one-year period, 404 patients referred to MRI for suspected intracranial neurological pathology were prospectively investigated. Before undergoing the scan the patients completed a questionnaire. The observed morphological conditions were classified so that mucous thickening < 5 mm was recorded as normal; > or = 5 mm, total sinus opacification or fluid and polyps as pathological. According to this classification 31.7% of the patients had pathological findings in the sinuses. A significantly higher incidence was found in the winter period and in patients with symptoms associated to sinusitis. "Blocked nose" was the only symptom occurring significantly more often in patients with pathological changes. There was no significant relationship between paranasal sinus abnormalities and sex, age, allergy, smoking habits, previous events of sinusitis or frequent events of colds. Criteria for pathological MRI findings in the paranasal sinuses are desirable and might improve the basis for a decision on the correct medical or surgical treatment.     

Distributions of cervical lymph node metastases in oropharyngeal carcinoma: therapeutic implications for the N0 neck

OBJECTIVES: This study sought to investigate the patterns and distributions of lymph node metastases in oropharyngeal squamous cell carcinoma (SCC) and improve the rationale for elective treatment of N0 neck. MATERIALS AND METHODS: One hundred four patients with oropharyngeal SCC who underwent neck dissection between 1992 and 2003 were analyzed retrospectively. All patients had curative surgery as their initial treatment for the primary tumor and neck. A total of 161 neck dissections on both sides of the neck were performed. Therapeutic dissections were done in 71 and 5 necks and elective neck dissection was done on 33 and 52 necks on the ipsilateral and contralateral sides, respectively. Surgical treatment was followed by postoperative radiotherapy for 78 patients. The follow-up period ranged from 1 to 96 months (mean, 30 months). RESULTS: Of the 161 neck dissection specimens evaluated, 90 (56%) necks were found to have lymph node metastases found by pathologic examination. These consisted of 76 (73% of 104 necks) of the ipsilateral side and 14 (25% of 57 necks) of the contralateral side dissections. The occult metastatic rate was 24% (8 of 33) of ipsilateral neck samples and 21% (11 of 52) of contralateral neck samples. Of the 68 patients who had a therapeutic dissection on the ipsilateral side and had lymphatic metastasis, the incidence rate of level IV and level I metastasis was 37% (25 of 68) and 10% (7 of 68), respectively. Isolated metastasis to level IV occurred on the ipsilateral side in three patients. There were no cases of isolated ipsilateral level I pathologic involvement in an N-positive neck or occult metastasis to this group. The incidence rate of level IV metastasis in patients with ipsilateral nodal metastasis was significantly higher in base of tongue cancer (86% [6 of 7]) compared with tonsillar cancer (34% [20 of 59]) (P=.013). Patients with level IV metastasis had significantly worse 5-year disease-free survival rates than patients with metastasis to other neck levels (54% versus 71%; P=.04). CONCLUSION: These results suggest that elective N0 neck treatment in patients with oropharyngeal SCC, especially base of tongue cancer, should include neck levels II, III, and IV instead of levels I, II, and III.     

鼻腔鼻窦腺样囊性癌88例临床分析

目的 总结鼻腔鼻窦腺样囊性癌的临床特征和治疗方法,探讨影响鼻腔鼻窦腺样囊性癌患者预后的因素.方法 总结中山大学肿瘤防治中心头颈外科1975年11月至2003年8月收治的88例原发于鼻腔鼻窦的腺样囊性癌患者的临床及病理资料,回顾性分析单纯手术、单纯放疗与放疗结合手术、化疗等治疗方式的疗效.对其治疗与预后进行统计分析.生存分析采用Kaplan-Meier法,组间比较采用Log-rank检验,多因素分析采用Cox比例风险模型.结果 就诊时56例鼻腔鼻窦腺样囊性癌患者为Ⅲ、Ⅳ期病变,治疗多采用手术+放疗.全组患者的5年、10年、15年生存率分别为0.640、0.341、0.190;Ⅲ期患者的5年、10年生存率分别为0.833、0.221;Ⅳ期患者的5年、10年生存率分别为0.323、0.145.手术+放疗组、单纯手术组及单纯放疗组的5年、10年生存率分别为0.761、0.415,0.750、0.367,0.286、0.143.结论 鼻腔鼻窦腺样囊性癌的治疗应以综合治疗为主,临床分期及治疗方式是影响鼻腔鼻窦腺样囊性癌患者预后的独立因素.     

Clinical significance of neck node metastasis in squamous cell carcinoma of the maxillary antrum

PURPOSE: To further clarify the clinical significance of neck node metastasis in squamous cell carcinoma of the maxillary sinus (maxillary SCC). MATERIALS AND METHODS: The medical charts of the 116 patients with maxillary SCC were retrospectively reviewed. Twelve patients (10.3%) presented initially with neck node metastases, and 14 (13.5%) of 104 node-negative patients subsequently developed regional recurrence during the follow-up period. The high-risk factors for neck node metastasis, patterns of regional failure, and survival for node-positive patients were analyzed with the patient cohort that had largely been treated with radiation alone. RESULTS: Of the various factors, the tumor extension to the nasopharynx or oral cavity was the statistically significant determinants predictive of neck node metastasis at the initial diagnosis. During the follow-up period, regional failure was far less common than local failure (19.0% v 68.1%), and the majority of regional failures were accompanied by local recurrences. The oral cavity extension and control status of local disease were the high-risk factors for subsequent development of regional recurrence in node-negative patients. The overall 5-year survival rate for node-positive patients (16.7%) showed a poorer outcome compared with that for node-negative patients (31.3%), but it was similar to that of T4N0 patients (26.6%). Although patients who subsequently developed neck node recurrence during follow-up represented a dismal prognosis, uncontrolled local diseases in these patients still remained a major problem, resulting in a poor prognosis. CONCLUSIONS: Despite an unfavorable prognosis of patients with neck node metastasis, an aggressive trial to achieve maximum local control of the primary tumor was considered to be more important than elective neck treatments.     

High incidence of lymph node metastasis in major salivary gland cancer

OBJECTIVE: To analyze the incidence and risk factors for clinically apparent and occult lymph node metastases in patients with major salivary gland cancers. DESIGN: Cohort of patients with a median follow-up of 46 months (range, 1-174 months). SETTING: University-based referral center. PATIENTS: A total of 160 consecutive patients with complete clinical and pathologic data. INTERVENTION: Neck dissection was performed in all cases. Patients were treated with surgery alone (55%); surgery and radiation therapy (43%); or a combination of surgery, radiation, and chemotherapy (2%). MAIN OUTCOME MEASURE: Incidence of apparent and occult lymph node metastases. Univariate and multivariate analyses were used to evaluate the significance of clinical and pathologic data. RESULTS: Histologically confirmed positive neck was found in 53% of all cases. Histologic diagnosis was significantly related to the incidence of lymph node metastasis: 89% (16/18) for undifferentiated carcinomas. However, so-called low-risk tumors had incidence rates of 22% to 47%. Twenty-one patients (13%) presented with clinically apparent cervical lymph node metastasis. Of the 139 patients with clinical N0 neck, 45% had occult neck metastasis. Neck metastasis was found in 29% (10/34) of T1, 54% (38/70) of T2, 65% (20/31) of T3, and 54% (16/25) of T4 tumors. Assessment of survival according to nodal status revealed significant correlations for overall (P<.001) and disease-free survival (P<.001). CONCLUSIONS: We found a high incidence of lymph node metastasis from major salivary gland cancers. Neck dissections should be considered as an integral part of the surgical approach in patients with major salivary gland cancer, especially if no postoperative radiation therapy is planned.     

鼻腔鼻窦转移性肾透明细胞癌一例报道并文献综述

目的 探讨鼻腔鼻窦转移性肾透明细胞癌的临床特点及诊疗方法.方法 回顾性分析1例肾透明细胞癌转移至鼻腔鼻窦患者病历资料,并检索1993～2020年间国内外发表的相关文献,包括本例共有64篇文献76例患者纳入研究,总结其临床表现、诊断、治疗方法及预后.结果 76例中男61例,女15例.症状出现较多者为鼻出血58例、鼻塞25...     

改良性颈廓清术在声门上型喉癌患者中的应用

目的 :为提高声门上型喉癌患者的生存率和生存质量 ,总结颈廓清术中保留颈内静脉的临床经验。方法 :88例声门上型喉癌患者中 ,在原发灶切除同时 ,共进行 146侧 (双侧 116例 ,单侧 30例 )颈廓清术 ,其中改良颈廓清 (MND)10 6侧 ,根治颈廓清 (RND) 4 0侧。双颈廓清术 5 8例 ,其中同期双颈廓清 32例 ,18例保留双侧颈内静脉 ,14例保留一侧颈内静脉 ;分期双颈廓清 2 6例 ,第一次均为 RND,第二次均为 MND。 30例行一侧颈廓清术 ,术中均保留颈内静脉。结果 :患者 3年生存率同期双颈廓清 81.5 % (2 2 / 2 7) ,分期双颈廓清 6 0 .9% (14/ 2 3) ,一侧颈廓清 75 % (15 / 2 0 )。5年生存率同期双颈廓清 6 1.5 % (16 / 2 6 ) ,分期双颈廓清 40 .9% (9/ 2 2 ) ,一侧颈廓清 70 .6 % (12 / 17)。 MND最大淋巴结直径≤ 3cm,术后复发率 12 .9% (11/ 85 ) ,>3cm者复发率为 47.6 % (10 / 2 1) ,总复发率为 19.8% (2 1/ 10 6 )。 RND术后颈淋巴结复发率为2 2 .5 % (9/ 40 )。结论 :声门上型喉癌常有双颈淋巴结转移 ,需行双颈廓清术 ,并必须保留一侧颈内静脉。在淋巴结小于3cm ,肉眼观与颈内静脉无粘连时保留颈内静脉 ,不增加淋巴结复发率 ,减少并发症 ,并提高生存质量。     

Alveolar rhabdomyosarcoma of paranasal sinus with cervical metastasis-a case report

Rhabdomyosarcoma (RMS) is a rare tumour in adults and involvement of paranasal sinuses is extremely rare comprising only 1.5% of reported head and neck rhabdomyosarcomas. Alveolar type, a rarer form of RMS, mainly seen in adults, has the worst prognosis. Incidence of lymph node metastases is more common in this type, compared to the other forms. An aggressive combined modality of treatment has dramatically improved the poor survival statistics noted previously. Our experience with one such case occurring in paranasal sinus and orbit which was managed by surgery multidrug chemotherapy & radical radiotherapy is discussed and relevant literature has been reviewed.