Squamous Cell Carcinoma Derived from a Skin Flap Used for Reconstruction of the Hypopharynx

Development of a secondary primary cancer in a skin flap is a rare complication. A 70-year-old man underwent partial laryngopharyngectomy, right neck dissection and reconstruction with a radial forearm free flap in 2004. Five years later, an exophytic tumor was found on the hypopharynx reconstructed with the radial forearm free flap. He underwent total laryngopharyngectomy, left neck dissection and reconstruction with a jejunal free flap in June 2009. Pathological findings suggested this was a primary cancer rather than a metastasis. Localization to the epidermis and dermis indicate that the tumor was derived from the surface of the skin flap.     

A contemporary review of indications for primary surgical care of patients with squamous cell carcinoma of the head and neck

The success of organ preservation protocols in laryngeal cancer has led to an increase in the use of primary chemoradiation in both laryngeal and extralaryngeal sites, despite a paucity of randomized controlled clinical trial data comparing nonoperative treatment to the gold standard of surgery followed by postoperative radiation for adverse pathologic features for head and neck cancer, and an increasing recognition that the high surgical salvage rates enjoyed by laryngeal cancer patients do not translate to extralaryngeal sites. These data suggest that there is a need to apply more rigorous standards to the use of organ preservation strategies and offer an opportunity to review the role of primary surgery in head and neck cancer. Laryngoscope, 2009     

下咽及食管异物多排螺旋计算机断层摄影诊断

  目的  探讨下咽及食管异物多排螺旋计算机断层摄影(multi-slice spiral computed tomography, MSCT)影像征像及诊断要点。  方法  回顾性分析25例经临床证实的急诊下咽及食管异物患者的临床及MSCT图像资料, 观察MSCT图像上食管异物的位置、形态, 测量异物的最长径以及异物中心距离环状软骨下缘的距离, 并观察食管边缘清晰程度、与邻近解剖结构的关系以及有无气肿并发症。  结果  MSCT能清晰显示所有患者下咽或食管异物的位置、大小以及与周围解剖结构的关系。25例患者异物位置以食管上段及食管下咽交界处为主。食管异物平均长度为(20.4±7.4)mm(5.4~42.0 mm), 异物中心距离环状软骨下缘平均约(13.1±17.0)mm(-5.0~30.0 mm)。  结论  MSCT可从异物位置、大小、与周围解剖结构关系及有无其他并发症多个方面为临床异物取出提供清晰的影像信息。     

Importance of postural change for accidental ingestion of dental prostheses: a case report

Accidental ingestion of dental prostheses requires immediate emergency action. The authors report a case of accidental ingestion of a dental prosthesis in a patient with a disorder of consciousness. The accidental ingestion was diagnosed by imaging examination, and the location of the dental prosthesis was explored under general anesthesia according to the preoperative examination images. However, no dental prosthesis was found in the hypopharyngeal region. The operators found a radiopaque region in the nasopharynx that was suspicious of a dental prosthesis by X-ray examination of the head and neck region. According to the X-ray examination, the dental prosthesis was removed from the nasopharynx. The patient’s postoperative course was uneventful. Postural change for cases of accidental ingestion of dental prostheses may be a simple and important lifesaving step in addition to traditional methods.     

VEGF-C及其受体FLT-4在喉及下咽癌淋巴转移中的作用

目的:研究喉及下咽部鳞癌组织中血管内皮生长因子-C(VEGF-C)及其受体VEGFR-3(FLT-4)在肿瘤淋巴转移中的作用和意义.方法:采用免疫组织化学SP法及图像分析,检测49例喉及下咽癌组织中VEGF-C、FLT-4的蛋白表达和相对含量.结果:49例喉及下咽部鳞癌组织VEGF-C表达阳性率为69.4%(34/49),FLT-4的阳性率为44.9%(22/49),其表达与VEGF-C阳性表达呈同向性改变.VEGF-C的表达强度与淋巴结转移密切相关(P＜0.05),与淋巴结转移之间存在相关关系(r=0.342,P＜0.05).淋巴结转移组FLT-4染色阳性脉管数较无转移组有增高趋势(P＜0.05);FLT-4的表达与淋巴结转移相关(r=0.312,P＜0.05).结论:VEGF-C在喉及下咽部鳞癌中,通过其特异性受体FLT-4,导致淋巴管的增生,促进肿瘤淋巴转移,从而影响患者的预后.检测VEGF-C(FLT-4),对肿瘤诊断、判断患者预后具有重要临床价值.     

Liposarcoma of the hypopharynx

A case of the unusual condition of liposarcoma of the hypopharynx extending submucosally down the oesophagus in a 64 year old male is reviewed. The clinical, radiological and pathological features are presented and the role of various radiological modalities is discussed.     

Total pharyngolaryngectomy for squamous cell carcinoma of the hypopharynx: a review

OBJECTIVES: To evaluate our experience with total pharyngolaryngectomy in the treatment of hypopharyngeal squamous cell carcinoma. STUDY DESIGN: Retrospective analysis of consecutively treated patients in an academic otolaryngology, head and neck department. METHODS: One hundred eighty patients who had total pharyngolaryngectomy performed for hypopharyngeal carcinoma were included in this study. Patients with a history of previous head and neck cancer were excluded. Clinicopathologic parameters were recorded and survival calculated using the Kaplan-Meier method. RESULTS: One hundred sixty-two (90%) of the patients were male, and the patients had a mean age of 62 years. The majority (91%) of patients had advanced overall clinical stage disease (stage 3,4). Thirty-one (17.8%) and 43 (24%) patients developed locoregional and metastatic disease recurrence, respectively. The 2- and 5-year disease-specific survival rates were 72% and 52%, respectively. Advanced nodal stage, perineural invasion, lymphovascular invasion, and positive margins were predictors of poor survival on univariate analysis, and lymphovascular invasion was an independent prognostic factor on multivariate analysis. CONCLUSION: Surgery and postoperative radiotherapy remains the treatment against which other modalities should be compared for advanced stage hypopharyngeal squamous cell carcinoma.