An algorithm-for local non-surgical management of complicated wounds in head and neck cancer patients.

This review paper introduces an algorithm for non-surgical local wound care in head and neck cancer patients who have delayed and complicated wound healing. Wound complications are common in patients undergoing head and neck cancer treatment, regardless of whether their primary treatment modality is surgery or chemoradiation. The risk for complications is compounded by the vital structures in the regional anatomy of these tumors and by the toxicities and long-term consequences of the cancer treatments employed. There is limited empirical and clinical evidence to specifically guide and improve local wound healing outcomes in head and neck cancer patients. The algorithm, based on an analysis of the medical literature, begins with the assessment of five simple wound environment characteristics: exudate volume; slough and eschar; large vessel exposure; proliferation; and systemic nutrition and perfusion. Assessing these wound characteristics is the basis for planning local care. The wound characteristics are discussed in relation to the pertinent literature, product categories, and other known interventions presented herein.     

Head and neck paragangliomas: an overview

Paragangliomas of the head and neck are unique tumors. Their pathology, tissue of origin, location, genetics, potential for bio-chemical activity, multicentricity, and growth pattern are unusual compared with more common head and neck tumors. Because these tumors are widespread and can appear in the ear, neck, larynx, nose, orbit, and chest, they cross subspecialties of otolaryngology.     

Animal Models of Cancer in the Head and Neck Region

Animal models that resemble the cancers of the head and neck region are of paramount importance in studying the carcinogenesis of these diseases. Although several methods for modeling cancer in the head and neck are available, none are fully satisfactory. Subcutaneous xenograft models of cancer in nude mice are often used in preclinical studies. However, these models are problematic in several aspects as they lack the specific interactions that exist between the tumor cells and their native environment. Establishment of tumors at the orthotopic sites restore these distinct patterns of interactions between the tumor and the host organs that are lost or altered when the tumors are established in ectopic sites. With regard to the transgenic model of cancer in the head and neck region, it should be kept in mind that the transgene used to drive the malignant transformation may not be representative of the carcinogenic process found in human tumors. Low penetrance of tumor formation also translates into high cost and time commitment in performing studies with transgenic models. In this review, we will discuss some of the commonly used methods for modeling cancer in the head and neck region including squamous cell carcinoma of the head and neck as well as thyroid carcinoma.     

Simultaneous (non-epidermoid) neoplasms involving the head and neck

The phenomenon of multiple primary malignant neoplasms involving the head and neck is well documented. Epidermoid carcinomas constitute the majority of these neoplasms. Case reports are made of two patients with simultaneously occurring chronic reticuloendothelial malignancies and non-epidermoid tumors involving the head and neck. The first case is one of chronic lymphocytic leukemia (CLL) and metastatic primary retro-peritoneal extragonadal seminoma, while the second is one of lymphocytic lymphoma (LL) and a carotid body tumor (CBT). The head and neck manifestations of metastatic seminoma, CBT, and CLL and LL are discussed. A review of the literature of the association of each of these entities to other tumors is presented. Also presented is the evidence for an increased incidence of malignancies associated with CLL and LL and the complicating factors introduced when reticuloendothelial malignancies occur simultaneously with head and neck neoplasms.     

Neurilemmoma of the head and neck--report of 3 cases

BACKGROUND: Neurilemmoma are benign tumors of the nerve-sheath, also known as schwannoma. Beside intracranial manifestation, neurilemmoma are found at other peripheral nerves of the head and neck. CASE REPORT: We present three cases of patients with seldom manifestation of neurilemmoma of the supraglottis, the retropharyngeal space and a neurilemmoma of the hypoglossal nerve. The histological examination showed two types of Antoni-A-neurilemmoma, whereas one tumor was found with mixed type A and B-neurilemmoma. CONCLUSION: Although extracranial neurilemmoma of retropharygeal space, neck or supraglottic larynx are rare tumors, neurilemmoma should be involved in differential diagnosis of tumors in these areas. The therapy of choice consists of complete surgical removal and histological examination.     

Small cell carcinoma of the submandibular gland: a rare small round blue cell tumor

The presence of small cell carcinoma within the submandibular gland is an uncommon clinical entity. However, other small round blue cell tumors are encountered in the head and neck with greater frequency. These include lymphoma, Ewing's sarcoma, melanoma, esthesioneuroblastoma, and neuroblastoma. A basic knowledge of the immunohistochemical studies available to distinguish each these tumors from one another significantly improves the frequency of accurate and timely initial diagnosis. We report a case of small cell carcinoma of the submandibular gland and review the other common small round blue cell tumors that occur within the head and neck. We utilize an acronym, LEMONS, to organize our review and facilitate improved retention of the differential diagnosis for small round blue cell tumors of the head and neck.     

Hypernephroma as second neoplasm simultaneous in a patient whith larynx carcinoma

The presence of two or more different histologic types of neoplasms in patients treated for head and neck cancer is well known. It is provided the clinical case of a woman of 48 years old who developed two primary tumors, a squamous carcinoma of larynx and a clear cell carcinoma of kidney (hypernephroma). The diagnosis of second primary tumor was a casual find when an abdominal TC was being carried out. The more frequent association of a head and neck cancer is with a malignant tumors of lung, being unusual the malignant tumors of kidney association.     

转移相关蛋白2在头颈部恶性肿瘤中的作用

转移相关蛋白2(MTA2)是近年来被发现的与肿瘤侵袭进展、转移相关的转录调控家族成员,在肿瘤的增殖、侵袭以及远处转移中起着非常重要的作用。其在多种头颈部恶性肿瘤如鼻咽癌、口腔癌、喉癌、食管癌、甲状腺癌中呈高表达,并且MTA2的高表达与这些恶性肿瘤的不良预后相关。MTA2与头颈部恶性肿瘤的侵袭、进展及预后的关系研究成为了头颈肿瘤研究中的新热点。本文对MTA2的结构与功能、其在不同头颈肿瘤中的表达以及意义、其可能的调节机制以及其研究展望作一个小结,希望对MTA2的后续研究以及头颈肿瘤的综合诊治提供帮助。     

Distant metastasis of parotid gland tumors

The incidence of distant metastasis in head and neck cancer and especially in salivary gland cancer is relatively low in comparison to other malignancies. However, the presence of distant metastasis heralds a poor prognosis in head and neck cancer, with a median survival of 4.3–7.3 months. Treatment of these patients is usually performed in a palliative setting. Patients with malignant salivary gland tumors should have an X-ray or CT scan of the chest at their initial assessment to exclude the possibility of distant metastasis. The likelihood of developing distant metastasis is associated with high-grade tumors, such as adenoid cystic carcinoma, salivary duct carcinoma, high-grade mucoepidermoid carcinoma and tumors located in the submandibular gland, posterior tongue and pharyngeal tumors. A lower risk of developing distant metastasis is known for all other histological entities of salivary gland tumors. Nevertheless all patients who have a histologically confirmed malignant salivary gland tumor should have lifelong follow-up. On the basis of a clinical case regarding a patient with metastatic parotid gland cancer we present a review of the literature.     

Distant metastasis of parotid gland tumors

The incidence of distant metastasis in head and neck cancer and especially in salivary gland cancer is relatively low in comparison to other malignancies. However, the presence of distant metastasis heralds a poor prognosis in head and neck cancer, with a median survival of 4.3-7.3 months. Treatment of these patients is usually performed in a palliative setting. Patients with malignant salivary gland tumors should have an X-ray or CT scan of the chest at their initial assessment to exclude the possibility of distant metastasis. The likelihood of developing distant metastasis is associated with high-grade tumors, such as adenoid cystic carcinoma, salivary duct carcinoma, high-grade mucoepidermoid carcinoma and tumors located in the submandibular gland, posterior tongue and pharyngeal tumors. A lower risk of developing distant metastasis is known for all other histological entities of salivary gland tumors. Nevertheless all patients who have a histologically confirmed malignant salivary gland tumor should have lifelong follow-up. On the basis of a clinical case regarding a patient with metastatic parotid gland cancer we present a review of the literature.     

Psychological states and personality as factors in the morbidity of head and neck malignant tumors

Many publications have repeatedly indicated that there seems to be a correlation between neoplastic disease and certain types of psychological situations. However, such studies subjected malignant tumors in head and neck region are scanty so far. We applied Cornell Medical Index Health Questionnaire (CMI) and Maudsley Personality Inventory (MPI) to collect medical and psychiatric data from 86 patients (56 males and 30 females) with head and neck malignant tumors and 115 control patients (73 males and 42 females) with head and neck diseases other than malignant tumors. Analysis of CMI data using Diagnostic Sheet, Fukamachi's method and Modification of Abe's method, and analysis of each of Extroversion-Introversion scale scores, Neuroticism scale scores and Lie scale scores of MPI led the following conclusion. 1) Both male and female patients with head and neck malignant tumors showed to be more depressive than their control patients were. Especially, between the two patient groups in males, there was a statistically significant (p less than 0.05) difference. 2) Regarding neurosis, autonomic nerve dysfunctioning and extroversion-introversion, none of these factors seemed to be related with the morbidity of head and neck malignant tumors. Further exploration of this issue, with a special attention to the relationship between depression and head and neck malignancy should be conducted, if possibly, from a prospective point of view.     

Synovial sarcoma of the head and neck: two cases report

Synovial sarcomas are soft tissue tumors that rarely occur in the head and neck The purpose of this report is to accrue data on this sarcoma at a rare site, and to highlight the histopathological differential diagnosis with other cervical tumors. MATERIALS AND METHODS: Two cases of cervico-facial tumors were reported in 26 and 27 year old women. RESULTS: Histologically, these tumors were classified into monophasic and biphasic variants. Immunohistochemistry plays a major part in the differential diagnosis, enabling the demonstration of epithelial differentiation. Radical surgery was the mainstay of treatment with post-operative radiotherapy for residual disease in one case. Local recurrence was developed in the patient who had only surgical treatment. DISCUSSION: Synovial sarcomas are a rare soft tissue malignancies and the head and neck region location accounts for 3-5% of them. The rarity of this tumor in the head and neck and its multitude of his histopathologic features are responsible for frequent initial misdiagnosis. Histologic, immunohistochemic and characteristic chromosomal translocation findings are necessary for diagnosis. The poor prognosis of this sarcoma justified a radical surgery with post-operative radiotherapy.     

Multiple Primary Malignant Tumors in Patients With Head and Neck Cancer

Multiple primary tumors are a known phenomenon in head and neck cancer. They are partially responsible for the limited improvement in survival of head and neck cancer during the past 20 years. Only a few prospective data have been published about the incidence of metachronous tumors. The authors prospectively studied 127 patients with squamous cell carcinoma of the head and neck. The overall incidence of second primary tumors was 13.5% (simultaneously, 3%; synchronously, 5.5%; and metachronously, 8%). More than 90% of the recurrences of the first primary tumor occurred within the first 2 years following primary treatment, but the second primary tumors continued to occur gradually in the course of follow-up. Most of the second primary tumors were discovered because the patients developed symptoms (14/17). Survival after detection of the second primary tumor was poor. The development of a second primary tumor was of equivalent prognosis to a recurrence of the primary tumor. Future directives include the development of more adequate screening methods. Identification of potential early markers for the development of a squamous cell carcinoma at the level of the mucosa at risk and in serum could be of value for the early detection of individuals at risk.     

Tumor deposition of laminin-5 and the relationship with perineural invasion.

OBJECTIVES/HYPOTHESIS: Perineural invasion (PNI) is increasingly being recognized as an important indicator of aggressiveness in head and neck squamous cell carcinoma. The mechanisms of PNI are poorly understood. Laminin-5, an important basement membrane constituent, has been shown to be essential in head and neck squamous cell carcinoma invasion and motility. We hypothesized that tumors exhibiting increased expression of laminin-5 are more likely to be neurotropic. STUDY DESIGN: Analysis of archived surgical specimens with and without PNI for presence and intensity of laminin-5 tumor staining. METHODS: Immunohistochemistry of archived head and neck squamous cell carcinoma specimens with known PNI was performed with anti-laminin-5 antibodies and appropriate positive and negative control specimens. The staining patterns were characterized as follows: A, few to no tumor cells positive; B, some peripheral cells positive; C, all peripheral cells positive; and D, almost all tumor cells positive. Statistical analysis was by chi2 analysis. RESULTS: Forty-six PNI-positive and 18 PNI-negative specimens were analyzed. The staining distribution for the PNI-positive specimens was as follows: 2% for A, 41% for B, 46% for C, and 11% for D. For tumors without PNI, the distribution was 28% for A, 50% for B, 22% for C, and 0% for D (P = .005). In PNI-positive tumors, no significant difference in staining was seen between areas with and without PNI. CONCLUSIONS: We found a significant correlation between laminin-5 staining and the presence of PNI in head and neck squamous cell carcinoma. Expression of laminin-5 by tumors is, possibly, an important step in the process of PNI. These preliminary findings support the concept that deposition of basement membrane constituents are required in the multistep process of nerve invasion.     

Enhancement of cytarabine sensitivity in squamous cell carcinoma cell line transfected with deoxycytidine kinase

BACKGROUND: Cytarabine is the most effective agent known for the treatment of acute myeloid leukemia. Its antitumor effect is expressed by combining with DNA during replication and then destroying the DNA chain. However, cytarabine has only limited activity against most solid tumors, including squamous cell carcinoma of the head and neck. The reason for this is thought to be that in cell lines of solid tumors the expression of cytidine deaminase, an enzyme that degrades cytarabine, is high, whereas the expression of deoxycytidine kinase (dCK), which phosphorylates cytarabine (a prodrug), is weak. OBJECTIVE: To determine whether head and neck squamous cell carcinomas can be made more sensitive to the cytotoxic effects of cytarabine by shifting the balance from the degradative to the activation pathway. METHODS: Human SCC-25 squamous carcinoma cells were transfected by either retroviral vector or adenoviral vector containing DCK gene and were identified for dCK expression by Northern blot analysis. In vitro cytotoxic assay after cytarabine exposure was performed using these cells. RESULTS: Both retroviral and adenoviral vector-mediated transduction of the dCK complementary DNA resulted in marked sensitization of tongue squamous carcinoma cell lines to the cytotoxic effects of cytarabine in vitro. CONCLUSION: The dCK-cytarabine system may be a useful approach for gene therapy of squamous cell carcinomas of the head and neck.     

Simultaneously presenting head and neck and lung cancer: a diagnostic and treatment dilemma.

OBJECTIVES/HYPOTHESIS: Synchronous tumors are defined as malignancies presenting within 6 months of the index tumors. A significant subset of patients present at initial evaluation with malignant tumors of both the head and neck (head and neck squamous cell carcinoma) and the lung, which are termed simultaneous primaries. The management and treatment outcomes in this cohort of patients have not been clearly defined and are the subject of the present review. STUDY DESIGN: Retrospective chart review of previously untreated patients. METHODS: From January 1974 to December 1997, a total of 2964 patients were treated for mucosal squamous cell carcinoma of the head and neck. Forty-two patients fulfilled the criteria for synchronous head and neck and lung malignancy. Of these, 27 patients had simultaneous tumors of the head and neck and the lung. This cohort of patients (n = 27) was stratified into three treatment groups. Patients in group A (n = 10) had resectable head and neck and lung primaries treated with curative intent. Group B (n = 8) was composed of patients who could have been treated with curative intent but declined and were given only palliative therapy. Patients in group C (n = 9) were candidates for only palliative treatment. RESULTS: The estimated 5-year disease-specific survival in group A was 47%, whereas patients in group B had a 5-year disease-specific survival of only 13% (P =.05). There were no survivors beyond 1 year in group C. The presence of mediastinal adenopathy in patients in group A portended poor clinical outcome. There was an estimated 5-year disease-specific survival of 51% in patients with no preoperative evidence of mediastinal adenopathy (n = 7), whereas 67% of patients with radiological evidence of mediastinal adenopathy died (two of three patients). CONCLUSION: The presence of simultaneous head and neck squamous cell carcinoma and pulmonary malignancies should not be a deterrent to aggressive surgical therapy because a potentially satisfactory outcome can be expected in these patients.     

Circulating tumor cells in head and neck cancer: clinical impact in diagnosis and follow-up

Metastasis and the associated loss of function of vital organs in the course of the disease is one of the main causes of death in head and neck cancer patients. An earlier and more reliable determination of metastasis and recurrence than currently obtained by common imaging methods could improve therapy and therefore the prognosis of head and neck cancer patients. The detection of tumor cells, which circulate in the blood of cancer patients, known as circulating tumor cells and those that can be found in the bone marrow, called disseminated tumor cells (DTC) provides a diagnostic source especially for those patients at high risk of locoregional recurrence or distant failure. Circulating tumor cells (CTC) have been identified as a prognostic factor in different solid tumors. In head and neck squamous cell carcinoma, there are data for a similar prognostic relevance. The methods of detection of CTC/DTC, the role in diagnosis and follow-up in head and neck cancer are summarized in this review. Furthermore, the future technical and clinical challenges to be addressed to establish CTC/DTC in clinical routine are being critically discussed.     

Secreting vagal paraganglioma

Paragangliomas are rare tumors that derive from neural crest tissue. Vagal paragangliomas account for only 3% of all head and neck paragangliomas. Patients with vagal paragangliomas typically present with an asymptomatic neck mass and, less frequently, with cranial neuropathies. It is estimated that only 1% to 3% of all head and neck paragangliomas secrete catecholamines. The incidence of secreting vagal paragangliomas is even smaller. The diagnosis of a secreting paraganglioma involves the use of a screening test for serum catecholamines and a 24-hour urinary test for catecholamine metabolites. The identification and staging of these tumors can be performed through the use of MRI and/or CT scans and an octreotide scintigraphy. The mainstay treatment is surgical extirpation; however, preoperative medical blockade is critical to avoid a hypertensive crisis intra-operatively. We present two illustrative cases of secreting vagal paragangliomas involving a complex diagnostic and therapeutic algorithm.