Update on hemangiomas and vascular malformations of the head and neck

Although the current classification systems of vascular malformations and hemangiomas are increasingly accepted, there are nonetheless several aspects that show us how special and at the same time difficult it is to diagnose, evaluate, and treat some of those diseases. Close interdisciplinary cooperation of all involved disciplines is essential; the discussion of the adequate individual procedure must be performed in angioma boards, as it is already well established in the context of tumor boards. The interface of angioma therapy and tumor therapy seems to be very close, which is certainly true for the aspect of angiogenesis and of course for the inhibited proliferation as promising therapeutic approach of complex vascular malformations. This leads to another obvious necessity of intensifying experimental scientific research on vascular malformations and hemangiomas, which is a precondition for optimizing or elimination of different current problems and deficits in the mentioned field.     

正电子发射断层摄影术在头颈部恶性肿瘤诊断中的应用

目的 :探讨18F FDG正电子发射断层摄影术 (PET)在头颈部恶性肿瘤诊断中的价值。方法 :回顾性分析应用18F FDGPET检查的 75例头颈部肿瘤患者 (鼻咽癌 36例 ,食管癌 18例 ,甲状腺癌 13例 ,喉癌 6例 ,下咽癌 2例 )的临床资料 ,其18F FDGPET显像结果与病理结果进行比较 ,部分与CT、MRI比较。结果 :18F FDGPET显像结果与病理结果相符率极高 ,鼻咽癌的灵敏度为 91.30 % ,特异度为 76 .92 % ,准确率为 86 .11% ;食管癌的灵敏度为 10 0 .0 0 % ,特异度为 83.33% ,准确率为 94 .4 4 % ;甲状腺癌、喉癌和下咽癌的灵敏度、特异度及准确率均为 10 0 %。结论 :18F FDGPET在头颈部恶性肿瘤的诊断中具有明显的优势。     

重视头颈恶性肿瘤的个体化治疗

头颈肿瘤的治疗主要有手术、放疗和化疗3种方法,手术包括传统的开放手术和镜下激光、射频、微波等微创手术。近10年来分子靶向治疗和免疫治疗在某些肿瘤中获得了辅助治疗效果。如何根据患者的全身和局部情况在众多的治疗方法中选择最合理的治疗手段是头颈肿瘤外科医师一直在探讨的问题。本文通过文献回顾和个案剖析谈谈个人对头颈肿瘤个体化治疗的看法,希望引起同行的重视,以推动头颈肿瘤从外科向多学科模式的转化。     

头颈部横纹肌肉瘤8例报告

目的 :提高临床对头颈部横纹肌肉瘤 (RMS)的诊疗水平。方法 :报告经病理确诊的 8例头颈部 RMS的临床资料。 8例均经手术治疗 ,其中手术加放疗 5例 ,加化疗 1例。结果 :7例获随访 ,3例分别于术后 4个月、16个月、2年死亡 ,4例生存≥ 5年。结论 :对发生在耳鼻咽喉 -头颈部的无痛性或痛性肿块 ,应注意 RMS的可能。根据影像学检查、病理活检及免疫组化标志等确诊 ;采用手术加化疗或放疗 ,可以提高 RMS患者的生存率。     

头颈部淋巴水肿的诊治进展

头颈部淋巴水肿(HNL)多继发于头颈肿瘤治疗后,症状、体征缺乏特异性,相较于乳腺癌、宫颈癌治疗后继发性淋巴水肿的肿胀程度稍轻。然而,由于头颈部解剖位置的特殊性,其对患者外观、感觉、运动,乃至心理的长期影响较为严重。目前,临床医生对HNL关注较少,缺乏足够的认识,诊治手段及流程尚不规范,且没有完善的诊疗指南用于指导医疗工作,有待学界进一步探究。本文就近年国内外对HNL的诊治进展进行综述,旨在进一步明确HNL的诊治方式。     

Clinical analysis of surgical treatment for head and neck lymphatic malformations in children: a series of 128 cases

Background: Lymphatic malformations (LMs) are caused due to abnormal lymphatic development, and mainly occur in neonates or young children. At present, the role of surgery in the treatment of head and neck LMs is still controversial, focusing mainly on surgical efficacy and indications.

Objective: This study aimed to explore the effect and influential factors of surgical treatment in children with head and neck LMs, hoping to provide a basis for rational selection of surgical indications.

Methods: This retrospective study enrolled 128 children with head and neck LMs and underwent surgical treatment in Beijing Children’s Hospital from May 2007 to June 2016. They were classified into three morphological groups: macrocystic, microcystic, and mixed. Based on de Serres staging, they were divided into five groups: stage I to V. The local lesion control rate, complication rate, and recurrence rate were summarized and analyzed.

Results: The rate of completely controlled and almost completely controlled in cases with head and neck LMs was 71.1%. The postoperative complication rate was 13.3%, and the postoperative recurrence rate was 11.9%. Statistically significant difference was found for local lesion control and postoperative recurrence rates between different morphological and clinical staging groups. Furthermore, the complication rate showed a significant difference between different morphological groups, but not between clinical staging groups.

Conclusions: Surgical resection in children with macrocystic, low-stage, or neck-limited LMs demonstrated better therapeutic effect, with fewer complications. However, the effect remained poor and had more complications for microcystic, diffused and high-stage patients. High stage and incomplete resection are considered as the main factors for postoperative recurrence. Current staging system for LMs has important predictive value in the prognosis of head and neck LMs. For LMs in posterior pharyngeal space, plasma ablation has certain advantages.     

头颈部髓外浆细胞瘤临床分析

目的:总结头颈部髓外浆细胞瘤(EMP)的临床特征、诊断和治疗经验,提高治疗效果。方法:回顾性分析8例头颈部髓外浆细胞瘤的临床资料。发生于鼻腔3例、上颌窦2例、鼻咽部2例、口咽后壁1例。结果:8例均病理学确诊为浆细胞瘤,全部接受手术治疗,其中4例术后追行放疗。4例无瘤生存者分别已超过1年、5年、10年、12年;3例死亡,其中1例在出院2年后死于局部复发,1例3年后死于多发性骨髓瘤,1例2年后死于心脏病;失访1例。结论:头颈部髓外浆细胞瘤属于低度恶性肿瘤,诊断主要依靠临床表现和病理,手术和放疗是其主要治疗手段。     

头颈部异位脑膜瘤(附10例报告)

目的：提高临床对头颈部异位脑膜瘤的诊治水平。方法：回顾性分析了１０例头颈异位脑膜瘤的资料其中内皮型脑膜瘤２例,砂粒体型脑膜瘤２例,过渡型脑膜瘤２例,过渡型脑膜瘤１例,恶性脑膜瘤１例,余者为分型。所有病例均行手术治疗。结果：４例复发后再次手术后随访多年未再复发。结论：头颈部异位脑膜瘤的治疗应以手术为主。     

Factors that influence treatment decision in older patients with resectable head and neck cancer

OBJECTIVES: To find clinical factors related to administration of substandard treatment in older patients with head and neck cancer. STUDY DESIGN: Historic cohort. METHODS: Patients of 70 years of age of older with diagnosis of resectable head and neck cancer were included. Treatment offered to patients was classified as standard or substandard by experienced surgeons. Relation of age, clinical stage, comorbidities, performance status, and treatment with substandard treatment was explored. The effect of substandard treatment on survival was assessed. RESULTS: Three hundred twelve patients were included. Substandard treatment was offered to 19.9% of patients. Associated factors related to selection of substandard treatment were higher age, oro/hypopharynx tumor site, severe comorbidity, advanced clinical stage, and low Karnofsky Index. Patients submitted to substandard treatment had lower overall and cancer-specific survival (45.9% vs. 19.9% and 63.0% vs. 33.1%, respectively). CONCLUSION: Selection of substandard treatment decreases overall and cancer-specific survival. Selecting substandard treatment for reasons such as chronologic age, tumor site, or moderate or mild comorbidities worsen patient prognosis.     

12例头颈部髓外浆细胞瘤的病理与免疫组化研究

目的 :探讨头颈部髓外浆细胞瘤 ( EMP)的组织学特点、临床行为、免疫球蛋白分泌功能与预后的关系。方法 :对 12例头颈部 EMP患者的手术蜡块进行病理观察与免疫组化检测。结果 :12例中 ,低度恶性 ( 级 ) 3例 ,中度恶性 ( 级 ) 3例 ,高度恶性 ( 级 ) 6例 ;免疫组化显示肿瘤均为单克隆性 ,Ig Gκ、Ig Gλ阳性各 6例。除鼻咽部 2例外 ,均接受手术切除加放疗。 、 、 级 EMP 5年生存率分别为 75 .0 %、6 2 .0 %、37.6 % ;Ig Gκ阳性者6 8.5 % ,Ig Gλ阳性者 37.5 % ,两者有显著性差异 ( P <0 .0 1)。结论 :免疫组化检测对头颈部 EMP鉴别诊断有重要作用 ,手术加放疗为有效的治疗手段 ,组织学分级、免疫球蛋白分泌功能对判断其预后有一定价值     

Treatment for extracranial arteriovenous malformations of the head and neck

Conclusions. For extracranial arteriovenous malformations of the head and neck (HNAVMs), in which the nidus was accessible via the percutaneous route, ethanol sclerotherapy was a feasible and safe first-line treatment, although successful outcomes were obtained for only about half of the subjects. For other HNAVMs, surgical excision with embolization may be the best choice of treatment. Objective. To suggest a treatment protocol for patients with HNAVMs by comparing the treatment outcomes and complications of ethanol sclerotherapy with those of surgical excision combined with embolization. Material and methods. Twenty patients who had been diagnosed with HNAVM and treated between 1995 and 2002 were retrospectively reviewed. Ethanol sclerotherapy, surgical excision and embolization were used as treatments, either alone or in various combinations. The treatment outcomes and complications with the different modalities were analyzed. Results. Ethanol sclerotherapy was used for 12 cases, with a success rate of 50.0% and a permanent complication rate of 8.3%. Surgical excision combined with embolization was used for 13 patients. Although all patients achieved successful resolution of their HNAVM after surgical excision, 15.4% suffered from permanent complications. In total, 16/20 patients (80.0%) eventually achieved a ≥75% reduction in the size of their lesions.     

Vascular malformations of the head and neck

Objective

Vascular malformations may appear anywhere in the body; 14–65% are in the head and neck. There are several treatments (sclerotherapy, surgery, laser treatment, and embolization, etc.), but standardized guidelines for these treatments are lacking. We conducted a retrospective review of venous or capillary malformations of the head and neck, and analyzed the epidemiology, pathology and treatment.

Methods

We retrospectively reviewed 67 patients with pathologically diagnosed venous or capillary malformations of the head and neck; we analyzed the location, pathology and treatment, as well as recurrent/residual cases.

Results

The oral cavity (59%) and nasal cavity (35%) were the most common locations. The frequency of each pathological type depended upon location. Surgery was undertaken in 65 cases, and sclerotherapy done in one patient. Sixty-one cases (92%) had resectable lesions. However polycystic masses (≥3 cysts) and large masses (diameter, ≥5 cm) were significantly difficult to cure by single treatment.

Conclusions

Surgery is indicated for localized small vascular malformations. However if the lesions ≥5 cm or polycystic lesions were more likely to recur after surgery alone in our study population.     

头颈部恶性肿瘤治疗后大出血成功救治体会

目的 探讨不同头颈部恶性肿瘤治疗后大出血有效的急救方法 .方法 对18例成功抢救的不同头颈部恶性肿瘤手术和(或)放射治疗后大出血的病例进行回顾性分析.9例鼻咽部大出血病例中,1例大出血引起窒息进行紧急手术抢救,6例颌内动脉破裂行数字减影血管造影术(DSA)栓塞颌内动脉止血,2例鼻咽部溃疡者行溃疡切除,采用帽状腱膜鼻咽缺损修复止血.9例颈部大出血中,皆先行指压暂时止血,或立即在床旁用三角针、7号或10号丝线经皮行颈动脉破裂口上下结扎,再到手术室行规范的手术.结果 1例由鼻咽癌放疗后引起的颅底颈内动脉破裂出血行颈总动脉结扎术;6例鼻咽大出血病例行CT和DSA检查证实颌内动脉破裂引起,行DSA介入栓塞颌内动脉止血成功;2例鼻咽部深部溃疡出血帽状腱膜修复缺损止血成功.3例鼻咽癌、3例喉癌和1例下咽癌颈动脉破裂口结扎止血后,颈部溃疡用胸大肌皮瓣修复6例,下斜方肌修复1例.6例肌皮瓣修复成功,1例喉癌修复颈部创而的胸大肌肌皮瓣部分坏死,颈动脉再次破裂出血后成功止血.1例甲状腺癌多次手术放疗后无法修复缺损创面;1例颈部淋巴瘤全身状况极差,未修复缺损创面.所有患者出血抢救后无偏瘫,1例鼻咽癌放疗后出血行颈总动脉结扎术后部分脑梗死,6个月后死于肺部感染;2例鼻咽癌出血抢救成功后在11个月后死于局部复发;其余病例在12～36个月内死于再复发(7例)、远处转移或(和)全身衰竭(8例).结论 针对不同头颈部恶性肿瘤治疗后大出血时的具体情况选择不同的治疗方法 ,DSA介入栓塞治疗和指压止血经皮颈动脉结扎分别是鼻咽癌放疗后鼻咽大出血和颈动脉破裂出血救治的有效方法 .     

头颈部隆突性皮肤纤维肉瘤诊治分析

目的探讨头颈部隆突性皮肤纤维肉瘤（dermatofibrosarcoma protuberans，DFSP）的不同治疗方式对患者预后的影响。方法对1982年至2005年中国医学科学院肿瘤医院头颈外科收治的28例头颈部DFSP进行回顾性分析，其中11例行扩大切除（切除边界≥2．0cm），17例行局部切除（切除边界〈2．0cm）；24例行单纯手术切除，4例行术前或术后放疗，放疗剂量为40—65Gy，同期行缺损修复的共18例。结果总体局部复发率为21．4％（6／28），11例行扩大切除的术后局部复发率为0（0／11），17例行局部切除的术后复发率35．3％（6／17），二者差异有统计学意义（P：0．033）；行术前或术后放疗的局部复发率为0（0／4），单纯手术的局部复发率25．0％（6／24），二者差异无统计学意义（P=0．357）。总体5年生存率为88．9％；行扩大切除的5年无复发生存率为100％，行局部切除的5年无复发生存率为59．6％，二者差异有统计学意义（X2=3．933，P：0．047）。结论扩大切除可以降低头颈部DFSP术后的复发率，对于切缘不充分或切缘不净的DFSP，行局部放疗可能有效。手术缺损较大时应行同期修复。     

Serum levels of vascular endothelial growth factor in patients with head and neck cancer

Angiogenesis is now considered to be crucial for tumor growth and metastasis. In several tumors, microvascular density has been shown to be correlated with metastasis and aggressiveness. Vascular endothelial growth factor (VEGF) is a secreted endothelial cell-specific mitogen, which is induced by hypoxia and is angiogenic in vivo. VEGF has been identified in a wide variety of malignancies including head and neck squamous cell carcinomas (HNSCC). We investigated the circulating level of VEGF in sera from patients with various head and neck squamous cell carcinomas (n = 71) as well as from healthy normal controls (n = 47). Serum VEGF concentrations were determined as serum immunoreactivity by using a quantitative sandwich enzyme immunoassay technique. For statistical analysis, the Wilcoxon 2-sample test and Kruskal-Wallis test were performed. The majority of the patients with HNSCC were found to have high concentrations of serum VEGF. The levels of VEGF in the sera of patients with cancer ranged from below the detection limit to 937.1 pg/ml (mean, 144.5 pg/ml). In contrast, the VEGF serum levels in 47 healthy individuals ranged from below the detection limit to 168.1 pg/ml (mean, 32.7 pg/ml), VEGF serum concentration being significantly higher in HNSCC patients (P = < 0.001). These findings indicate that a positive angiogenesis regulator such as VEGF might function as an endocrine growth factor, particularly for solid HNSCC tumors and may be a useful marker for clinical monitoring. Received: 12 April 1999 / Accepted: 30 September 1999     

Low power radiofrequency ablation for symptomatic microcystic lymphatic malformation of the tongue

Although many head and neck surgeons agree that complete surgical excision is the treatment of choice for lymphatic malformation, the infiltrating nature of microcystic lymphatic malformations and the involvement of vital structures of the head and neck make total removal nearly impossible in most cases. Recently radiofrequency ablation was introduced for the treatment of microcystic lymphatic malformations of the oral cavity; it destroys lesion tissues at low temperature (40-70 degrees C) with minimal damage to adjacent structures. However, high energy (800-1200 J) and general anesthesia for radiofrequency ablation can hinder the easy and repetitive application of radiofrequency to patients. To overcome this limitation of radiofrequency ablation for microcystic lymphatic malformations, we used the same technique with a lower power (6 W, less than 100 J per site) radiofrequency ablation in an office-based setting under local anesthesia in a child with a microcystic lymphatic malformation of the whole tongue, that was associated with recurrent bleeding and swelling. The repetitive low power energy radiofrequency ablation of the microcystic lymphatic malformation of the tongue was safe and effective; it provided the patient with symptomatic relief without recurrence at follow-up. Therefore, our modification of radiofrequency ablation of the microcystic lymphatic malformations could be technically feasible and easily applicable; our result suggests that it can be a useful alternative treatment option to relieve symptoms from microcystic lymphatic malformation of the oral cavity.     

头颈肿瘤术后并发肺栓塞

目的　提高对头颈肿瘤术后并发肺栓塞的诊断意识。方法　回顾性分析中国医学科学院中国协和医科大学肿瘤医院头颈外科 1993～ 1999年头颈肿瘤手术后发生的 5例严重急性肺栓塞患者的临床资料。结果　同期共行头颈肿瘤手术 5 80 1例 ,手术后死亡 39例 ,发生严重急性肺栓塞 5例 ,其中 4例因漏诊、误诊未能给予及时正确的治疗 ,于 2h内死亡 ,占同期术后死亡的 10 3% (4/39) ;仅 1例得到正确诊断 ,经积极溶栓治疗存活。结论　急性肺栓塞是头颈肿瘤术后导致死亡的严重并发症 ;及时正确诊断与治疗可以挽救患者生命     

原发性头颈部非霍奇金淋巴瘤62例临床分析

目的 :探讨原发性头颈部非霍奇金淋巴瘤 (NHL)的临床特征。方法 :分析 6 2例头颈部NHL的临床资料。结果 :腭扁桃体 (2 5 .8% )、颈淋巴结 (19.4 % )、鼻腔及鼻窦 (12 .9% )为NHL的好发部位 ;临床分期ⅠE期和ⅡE期分别为 38.7%、2 4 .2 %。病理分型高度恶性为 75 .8%。CR率 75 .8% ,PR率 14 .5 % ,有效率 90 .3% ;部分患者无瘤长期生存。结论 :头颈部NHL一般恶性度高 ,多发于结外组织且易发生淋巴结转移 ,准确的取材活检结合免疫组化有利于早期确诊 ,治疗上应采用化疗、放疗或结合手术的综合治疗方案。     

Current applications of microarrays in head and neck cancer research

OBJECTIVES/HYPOTHESIS: The objective was to introduce microarray technology and its applications in cancer research to the head and neck clinician. STUDY DESIGN: Literature review combined with methodology and examples from the authors' experiences with microarray analysis of tumors of the head and neck. METHODS: Search of literature and the authors' experience was made for technical details, alternative methods of data analysis, available bioinformatics tools, and applications of microarrays in cancer research. RESULTS: Microarrays allow the simultaneous analysis of the expression of thousands of genes. The use of a well-developed microarray study design leads to informative results. There are various bioinformatics resources widely available to aid in the analysis of microarray data. However, there is not yet a gold standard for analysis because this methodology is still evolving. CONCLUSION: Microarray studies may allow researchers to identify genetic changes relevant to diagnosis and prognosis in patients with head and neck cancer. Although still relatively new, this powerful methodology has immense potential to aid in understanding of the genetic changes that are important in head and neck cancer.