Incidence of lymphomas in head and neck region

In the present study 109 cases of Heck swellings were subjectedto F.V.A.C. examination. H vases teere found to he positive for lymphomas with 62.5% eases presenting as cervical lymphade.nopathy. Median age of presentation tints 48 years with preponderance of femulr patients. 57.2% of the patients presented in stage I of the disease.     

Our experience with extranodal lymphomas of the ORL region

Head and neck extranodal lymphomas are rare. Waldeyer lymphatic ring is the most common localisation of these lymphomas, followed by oral cavity and parothoid glands. We have done a retrospective study of patients with extranodal lymphomas diagnosed in our hospital between 1991 and 1999. We have included in this study 23 patients, 15 males and 9 females. We have used the REAL classification. All of them have been non-Hodgkin lymphomas. The rhinopharynx has been the most affected region, followed by the palatine tonsils and oral cavity. Most of them were of medium degree and they were in the initial stages. The presentation symptoms varied depending on the localisation. The age, stage and histologic degree were important for the treatment election.     

Clinical features of head and neck cancer patients with methicillin-resistant Staphylococcus aureus

CONCLUSIONS. The risk factors for methicillin-resistant Staphylococcus aureus (MRSA) detection in head and neck cancer patients are the duration of hospitalization, intravenous hyperalimentation, prior antibiotic use, and the coexistence of other pathogens. OBJECTIVES. To shed light on the clinical characteristics of MRSA-positive inpatients with head and neck cancers. The secondary goal was to evaluate risk factors for MRSA detection in comparison with methicillin-sensitive S. aureus (MSSA). PATIENTS AND METHODS. Sixty-one consecutive inpatients with head and neck cancers with S. aureus detection were analyzed based on their medical records. The antimicrobial susceptibility of isolated S. aureus was tested by the broth microdilution method. RESULTS. MRSA and MSSA were detected in 46 (75.4%) and 15 (24.6%) of the 61 patients, respectively. There was no significant difference in the male/female ratio, age, primary site, comorbidity, cancer stage, cancer treatment, or 5-year survival rate between the MRSA and MSSA groups. Compared with the MSSA group, the MRSA group had significantly longer hospitalization periods and intervals between admission and MRSA detection, as well as significantly greater likelihood of intravenous hyperalimentation, prior antibiotic use, and co-isolation of other pathogens. Isolated strains of MRSA were thoroughly sensitive to vancomycin and arbekacin and moderately sensitive to minocycline.     

Inflammatory myofibroblastic tumors of the head and neck: evaluation of clinicopathologic and prognostic features

Head and neck lesions composed of spindle cells evoke a differential diagnosis which includes a host of benign and malignant entities. One of the less common spindle cell lesions in this region is the inflammatory myofibroblastic tumor (IMT). Although IMTs were originally regarded as “pseudotumors”, they are now recognized to be true neoplasms. Local recurrence, and, rarely, malignant change have been reported. Currently, the definitive means of diagnosing IMTs is the identification of a rearrangement of the anaplastic lymphoma kinase gene (at chromosome 2p23) by fluorescence in situ hybridization. The histopathologic differential diagnosis includes infectious processes, other fibro-inflammatory lesions, lymphoma, the inflammatory variant of malignant fibrous histiocytoma, and sarcomatoid (spindle cell) carcinoma. Complete surgical excision is the treatment of choice.     

18例头颈部非霍奇金淋巴瘤临床分析

目的：探讨头颈部非霍奇金淋巴瘤(NHL)的临床表现、病理分型、临床分期、治疗及预后。方法：18例头颈部NHL患者，7例行手术加放、化疗，11例行放、化疗。结果：完全缓解13例，部分缓解5例。除1例失访外，17例随访3～5年，均生存。结论：头颈部NHL早期诊断较难；治疗以放、化疗为主，早期放、化疗有利预后。     

Epidemiological features and prognostic factors of cutaneous head and neck melanoma: a population-based study

OBJECTIVES: To describe the epidemiological features of cutaneous head and neck melanoma (CHNM) and to identify factors associated with mortality from this disease. DESIGN: A population-based cohort study. SETTING: Patients treated for CHNM in Ontario between January 1, 1994, and December 31, 2002, were identified through the provincial Cancer Registry. A Cox proportional hazards regression model was used to analyze the data. PATIENTS: A total of 2218 patients with CHNM were identified, comprising 15.8% of all melanomas in Ontario. The mean age of the cohort was 66 years (SD, 16 years); 1363 patients (61.5%) were males. MAIN OUTCOME MEASURE: Patients' vital status (dead or alive). RESULTS: The incidence of CHNM increased from 2.0 per 100,000 in 1996 to 2.7 per 100,000 in 2001, while mortality remained stable. The Cox proportional hazards regression model showed that increased age (hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.04-1.06) and male sex (HR, 1.31; 95% CI, 1.03-1.66) had a significantly higher risk of death. Patients with lesions of the scalp and neck had a 53% higher risk of death than those with lesions of the face. Nodular melanoma (HR, 1.61; 95% CI, 1.17-2.24) had the worst prognosis compared with other morphological types. Increased tumor thickness (HR, 1.05; 95% CI, 1.03-1.07), ulceration (HR, 1.53; 95% CI, 1.08-2.07), and Clark level V (HR, 1.52; 95% CI, 1.01-2.22) were significantly associated with increased mortality. CONCLUSIONS: Our study demonstrated an increase in the incidence of CHNM. Advanced age, male sex, nodular morphological features, tumor thickness, ulceration, and Clark level V carried a significant risk of death, whereas facial melanomas had a favorable prognosis.     

Variability of genetic alterations in different sites of head and neck cancer

OBJECTIVE: Tumors arising from different sites of the head and neck area have different clinical behavior. However, most of the studies on genetic alterations in head and neck squamous cell carcinomas do not make a distinction between the sites within this area. The objective of this study is to compare the genetic alterations in three different sites of the head and neck (larynx, oropharynx, and hypopharynx). STUDY DESIGN: Prospective study. METHODS: Thirty-eight laryngeal, 29 oropharyngeal, and 37 hypopharyngeal carcinomas were studied. DNA from tumor and healthy tissue was evaluated for amplification of the oncogenes at 11q13 region (CCND1, FGF3, FGF4 and EMS1) and of the oncogenes MYC and ERBB1; for integration of the human papillomavirus (HPV) types 6b and 16; for loss of heterozygosity (LOH) at p53 and NAT2; and for the cellular DNA content. RESULTS: FGF3 and FGF4 showed a significantly higher frequency of amplification in hypopharyngeal tumors (P =.006 and P =.0002, respectively). CCND1 amplification had a nearly statistically significant (P =.072) higher frequency of amplification in hypopharyngeal tumors. Aneuploid tumors were found in a significantly lower proportion in the larynx (P =.03) compared with the other sites. For the other genetic alterations, no significant differences among the three sites were found. CONCLUSIONS: These results suggest that cancers originating from different sites in the head and neck may have different tumor biology. Therefore, they should be considered as different entities.     

Histologic and clinical assessment of primary extranodal non-Hodgkin malignant lymphomas of the head and neck region

The authors presented 27 cases of primary extranodal non-Hodgkin's malignant lymphomas of the head and neck area in patients treated surgically in the ENT Department in the years 1996-2001. We observed tumors in the various areas: palatine tonsil, naso-pharynx, eye socket, paranasal sinuses, parapharyngeal space and lingual base. In the course of the diagnostic process we examined the patients carefully to be sure that the cancer had not disseminated. We used some imaging techniques such as: ultrasonography, CT and MRI. We also used the needle aspiration biopsy, as a additional examination. However the material was not significant in the most cases and we were unable to make a definitive diagnosis on the basis of this method alone. After prior examinations we performed the radical operations and removed the tumours. In each case the postoperative material was examined using immunohistochemical methods. Afterwards the pathomorphological diagnosis was made by the specialists. Next the patients were observed and treated in the Haematological Department and Radiotherapy Department. In all cases pathomorphological diagnosis were performed on the base of usage postoperative histochemical examinations. All treated patients were performed as diagnostic preoperative USG, CT, MRI and fine-needle biopsy aspiration exam. All patients for further treatment were observed at Haematological Department.     

Driving performance in patients with cancer in the head and neck region: a pilot study

OBJECTIVE: To investigate actual driving performance in a group of patients with cancer in the head and neck region. DESIGN: A nonrandomized controlled trial. PARTICIPANTS: Ten patients with cancer in the head and neck region participated in a driving evaluation using a virtual reality driving simulator. Driving performance from the simulator and observer ratings on participants' driving behaviors were compared between a group of patients with cancer in the head and neck region and a group of 50 community control subjects. MAIN OUTCOME MEASURES: Average speed, mean brake reaction time, steering variability, the total number of (fatal and nonfatal) collisions during the 12-minute evaluation course on the driving simulator, and the score of the 18-item Simulator Driving Performance Scale. RESULTS: Using Mann-Whitney U tests, the brake reaction time and the steering variability in the cancer group were significantly longer and larger, respectively, than those in the control group (P = .04) and (P = .02). However, no significant differences were found between the 2 groups in the mean rank scores for average speed, total number of collisions, and Simulator Driving Performance Scale (P >.05 for all). CONCLUSIONS: This pilot study provides preliminary evidence indicating inferior driving performance in a group of patients with cancer in the head and neck region when compared with a community control group. Further study is needed to investigate factors attributing to the difference.     

Non-Hodgkin's lymphoma of the head and neck: prognostic factors

A series of 127 patients were studied, presenting with non-Hodgkin's lymphoma of the head and neck between 1962 and 1986. Clinical data on the site of tumour, stage, patient's age, sex, condition and outcome were compared with the pathological diagnosis and lymphoma type according to the Kiel classification. Pathological material was received and new preparations made, including immunohistology where appropriate. An exact pathological classification was possible in 102 patients, and most were either centroblastic or centroblastic/centrocytic, with diffuse morphology. Other types of lymphoma were too few in number to enable correlation of histological type with prognosis. The most significant factor was the pathological stage at presentation, and it was important to examine trephine specimens of bone marrow to ensure accurate staging.     

Lipoma in unusual head and neck region: Case series of 4 patients

Lipomas are fairly common in head and neck but their presentation in areas like parapharyngeal space, submandibular space and lateral cervical region are rarely seen. These are mainly asymptomatic and mostly cause aesthetic concerns. Surgical excision remains the mainstay of treatment and surgical approach depends on the site and extent of the lesion. Radiological investigations like CECT and MRI play a vital role in diagnosis and management of these lesions. Here we describe a case series of 4 patients with lipomas in unusual regions of the head and neck, and their management.     

Supraclavicular flap in head and neck reconstruction: experience in 50 consecutive patients

The supraclavicular flap (SCF) is a fasciocutaneous flap used to cover head, oral, and neck region defects after tumor resection. Its main vascular supply is the supraclavicular artery and accompanying veins and it can be harvested as a vascularised pedicled flap. The SCF serves as an excellent outer skin cover as well as a good inner mucosal lining after oral cavity and head-neck tumor resections. The flap has a wide arc of rotation and matches the skin colour and texture of the face and neck. Between March 2006 and March 2011, the pedicled supraclavicular flap was used for reconstruction in 50 consecutive patients after head and neck tumor resections and certain benign conditions in a tertiary university hospital setting. The flaps were tunnelized under the neck skin to cover the external cervicofacial defects or passed medial to the mandible to give an inner epithelial lining after the oral cavity and oropharyngeal tumor excision. Forty-four of the 50 patients had 100% flap survival with excellent wound healing. All the flaps were harvested in less than 1 h. There were four cases of distal tip desquamation and two patients had complete flap necrosis. Distal flap desquamation was observed in SCFs used for resurfacing the external skin defects after oral cavity tumor ablation and needed only conservative treatment measures. Total flap failure was encountered in two patients who had failed in previous chemoradiotherapy for squamous cell cancer of the floor of mouth and tonsil, respectively, and the SCF was used in mucosal defect closure after tumor ablation. The benefits of a pedicled fasciocutaneous supraclavicular flap are clear; it is thin, reliable, easy, and quick to harvest. In head, face and neck reconstructions, it is a good alternative to free fasciocutaneous flaps, regional pedicled myocutaneous flaps, and the deltopectoral flap.     

De novo head and neck cancer arising in solid organ transplantation recipients: The Asan Medical Center experience

Objective

De novo cancers of head and neck area in solid organ transplantation recipients show standardized incidence ratio (SIR) of 3.8. Immunosuppression following transplantation is suggested to play as a crucial factor in pathogenesis of secondary malignancy. Prognosis of head and neck cancer arising in solid organ transplantation recipients is proven to have poor prognosis. The incidence, risk, prognosis, and survival of de novo malignancy of head and neck area in solid organ transplantation recipients in single-tertiary medical center followed up for 20 years.

Unusual sites of schwannoma in the head and neck

Two cases of schwannoma originating in unusual sites in the head and neck are reported. To the best of our knowledge ours is the first case of schwannoma in the nasopharyngeal area to be described. Schwannomas in the parotid area must be kept in mind in the differential diagnosis of parotid tumours. The pertinent literature is reviewed.     

Blood transfusion and other prognostic variables in the survival of patients with cancer of the head and neck

The clinical records of 207 patients with squamous cell carcinoma of the head and neck, diagnosed and surgically treated at the Otolaryngology Division of Pordenone General Hospital and Aviano Cancer Centre, northeast of Italy, from January 1982 to December 1987, were retrospectively reviewed to gather information on blood transfusions and other characteristics potentially related to survival. The group of patients (mean age = 59 years) included 85 cases (41%) of laryngeal cancer, 80 cases (39%) of oropharyngeal and hypopharyngeal cancer, and 34 cases (16%) of cancer of the oral cavity. Fifty-five patients (27%) did not receive any blood transfusion while 152 patients were transfused with different amounts of blood. At the univariate analysis, nodal involvement, clinical stage, type of therapy, status of surgical margins, and metastatic spread beyond the nodal capsule appeared to be significantly linked to prognosis. After adjustment for other prognostic variables, transfused patients showed a twofold higher hazard ratio as compared to nontransfused patients, but such an unfavorable predictive value should be evaluated in the context of the other prognostic correlates of cancer of the head and neck.