Search PubMed⌕ Search

Biomedical subjects

A Ferlito

Publications and source records attributed to A Ferlito.

At least 217 records · Page 12Linked to original sources
PubMedDate not supplied

Classification and terminology of neck dissections.

With the proliferation of operations designed to treat cervical metastatic nodal disease, it has become ever apparent for the need to more clearly and precisely communicate the location of the metastatic cervical nodes and the specific surgery performed. To this end, this paper reviews the variety of operations and the resultant confusing terminology that has emerged over the past five decades. It is suggested that a simplified technology be used that specifically describes the nodal levels dissected, the relevant nonlymphatic structures removed, and those structures that are preserved. It is also suggested that the new imaging-based nodal classification be used to standardize the definition of the nodal levels. It is hoped that this approach will eliminate many of the often confusing and nondescriptive terms and there by facilitate better inter-physician and inter-institutional communication.

Head and Neck Neoplasms↗
PubMedDate not supplied

Surgical treatment of the neck in cancer of the larynx.

Current concepts in management of the clinically negative and clinically positive neck in laryngeal cancer are reviewed. Occult disease in the neck not detected by physical and radiographic examination may also be difficult to identify on routine histologic examination. Immunohistochemistry or molecular analysis may detect metastatic involvement not apparent by light microscopy. The surgeon should be aware of the relatively high incidence of micrometastases in patients with laryngeal cancer to establish optimal treatment approaches. Elective treatment of the neck is recommended for supraglottic tumors staged T2 or higher, and glottic or subglottic tumors staged T3 or higher. The neck may be treated electively by either surgery or irradiation, but irradiation is best reserved for cases where that modality is employed for the primary tumor. Elective neck dissection provides important information for prognostic purposes and therapeutic decisions, by establishing the presence, number, location and nature of occult lymph node metastases. The selective lateral neck dissection (levels II, III and IV), unilateral or bilateral, is the procedure of choice for elective treatment. Paratracheal nodes (level VI) should be dissected in cases of advanced glottic and subglottic cancer. Complete radical or functional neck dissections are excessive in extent, as levels I and V are almost never involved. Sentinel lymph node biopsy may fail to detect tumor on frozen section examination or may not reveal 'skip' metastases. The clinically involved neck is usually treated by complete radical or functional neck dissection of levels I through V. Selective neck dissection has been employed successfully in selected cases, particularly for N1 or occasionally N2 nodal involvement. The selective neck dissection can be extended to include structures at risk. More advanced disease has been treated in this manner often in association with adjuvant chemotherapy and/or irradiation. While the benefit of adjuvant treatment is difficult to assess, it appears most useful in cases with extranodal spread of disease, a factor associated with the worst prognosis.

Chemotherapy, Adjuvant↗
PubMedDate not supplied

Surgical management of the neck in thyroid cancer.

Thyroid cancer is a relatively common clinical problem. The American Cancer Society has estimated 1,050,000 newly diagnosed cancers in 1999 in the United States, of which 16,000 are expected to be of thyroid origin. Although most thyroid cancers have an excellent prognosis as compared with other malignant tumors, it is estimated that approximately 1,225 deaths will be attributed to the disease [1].

Humans↗
PubMedDate not supplied

General considerations on distant metastases from head and neck cancer.

Mortality in head and neck cancer is due to locoregional disease, distant metastases or intercurrent disease. As treatment of the primary tumor and cervical metastases has improved, the proportion of deaths from co-morbidity and from distant metastases has increased. Distant metastases almost invariably herald a poor prognosis in head and neck cancer with an average survival of 4.3-7.3 months and treatment is usually palliative. Reliable detection is important to prevent inappropriate treatment. The risk is related to the site, stage and histology of the primary tumor and the presence of cervical metastases. Early detection and treatment of cervical metastases may prevent distant metastases. Accurate staging of tumors helps to identify high-risk tumors that should be specifically investigated for distant metastases.

Head and Neck Neoplasms↗
PubMedDate not supplied

Incidence and sites of distant metastases from head and neck cancer.

The incidence of distant metastases in head and neck squamous cell carcinoma (SCC) is relatively small in comparison to other malignancies. Distant metastases adversely impact survival and may significantly affect treatment planning. The incidence of distant metastases is influenced by location of the primary tumor, initial T and N stage of the neoplasm, and the presence or absence of regional control above the clavicle. Patients with advanced nodal disease have a high incidence of distant metastases, particularly in the presence of jugular vein invasion or extensive soft tissue disease in the neck. Primary tumors of advanced T stages in the hypopharynx, oropharynx and oral cavity are associated with the highest incidence of distant metastases. Pulmonary metastases are the most frequent in SCC, accounting for 66% of distant metastases. It may be difficult to distinguish pulmonary metastasis from a new primary tumor, particularly if solitary. Other metastatic sites include bone (22%), liver (10%), skin, mediastinum and bone marrow. An important question remains as to how intensely pre- and postoperative screening for distant metastases should be performed. Preoperative chest X-ray is warranted in all cases. If the primary tumor and nodal status place the patient at high risk for pulmonary metastasis, then preoperative computed tomography scan of the chest should be done. Screening for distant metastases at other sites is usually not indicated in SCC of the upper aerodigestive tract. Postoperatively, annual X-rays of the chest are usually sufficient, but in high-risk situations a chest X-ray performed every 3-6 months may be beneficial. Certain histologic types of primary tumor have greater or lesser propensity to metastasize distantly, and have a different natural history. Adenoid cystic carcinoma metastasizes frequently, even in the absence of extensive local or regional disease. Basaloid squamous cell carcinoma and neuroendocrine carcinomas also metastasize widely. Extensive evaluation for distant metastases is justified for these tumors. Knowledge of the natural history of various neoplasms and the factors that contribute to distant metastases as well as good judgement are essential for cost-effective treatment planning and decision-making with regard to pre- and postoperative evaluation for distant metastases in cancer of the head and neck.

Bone Neoplasms↗
PubMedDate not supplied

Screening tests to evaluate distant metastases in head and neck cancer.

Investigation for distant metastases is part of the staging process of a primary tumor or recurrent disease before treatment. The lung is the most frequent site followed by bone and liver. Advanced stage and cervical metastases are the most important predictors of metastases. Almost all distant metastases are associated with lung metastases. Computed tomography scan of the chest is the single most effective investigation. The value of routine screening tests is questionable and merits further investigation.

Bone Neoplasms↗
PubMedDate not supplied

Distant metastases from thyroid and parathyroid cancer.

Thyroid cancer represents a unique biological tumor where even with the high incidence of distant metastases, the overall prognosis is not as poor as many other human cancers. The overall long-term survival in patients presenting initially with distant metastasis is approximately 50%. The overall incidence of distant metastases varies between 10 and 35%, depending upon the histology. The overall incidence is directly related to various histologies - being least in papillary thyroid carcinoma (10%) and highest in Hürthle cell tumor (33%). The incidence of distant metastases is also very high in patients with medullary and anaplastic thyroid cancer. The incidence of distant metastases at the time of initial presentation in differentiated thyroid cancer is approximately 4%. In high-risk patients - especially in patients with extrathyroidal extension or massive nodal metastasis - the distant metastases can be evaluated after total thyroidectomy with radioactive iodine ablation. Pulmonary metastases are very common in young individuals, but they are extremely well treated and the mortality from distant metastases in this group is very low. However, distant metastases in patients with poorly-differentiated carcinoma have a poor prognosis. In high-risk patients, generally a total thyroidectomy should be undertaken so that the patient can undergo radioactive iodine dosimetry and ablation as indicated. The surveillance in patients with thyroid cancer includes: close clinical follow-up, chest X-ray, and radioactive iodine dosimetry. Thyroglobulin is commonly used as a prognostic marker in patients having undergone total thyroidectomy. The incidence of distant metastases in medullary thyroid cancer is high, mainly to the lung and liver. Persistent hypercalcitonemia is an indication of regional or distant metastases. A variety of diagnostic tests are helpful, such as octreotide scanning, computed tomography scan, magnetic resonance imaging and positron emission tomography scan. Laparoscopy to evaluate the surface of the liver is also an important investigation to detect distant metastases. The incidence of distant metastases is very high in patients with anaplastic thyroid cancer, but most of the time the outcome depends on the locoregional recurrence and massive disease in the central compartment. The parathyroid cancer is quite rare, less than 1%, in patients undergoing parathyroidectomy. The diagnosis of parathyroid cancer is made by pathological features but the most certain method of diagnosis of a malignant tumor of the parathyroid is the identification of secondary deposits. The incidence of distant metastasis is difficult to determine due to the rarity of this condition, but the most common site is the lung. Patients with distant metastasis have recurrent progressive hypercalcemia along with high parathormone level.

Carcinoma↗
PubMedDate not supplied

The treatment of distant metastases in head and neck cancer--present and future.

At the present time the occurrence of distant metastases in patients with head and neck squamous cell carcinoma means that lifespan is measured in months. In most instances treatment is purely palliative. Isolated lung metastasis can be successfully removed with long-term disease control in selected patients. Radiotherapy can be useful for palliation of bone metastases and occasionally lung or brain metastases. Chemotherapy does not have a major impact at the present time except for the treatment of metastases from nasopharyngeal cancer. Palliative symptomatic care, along with appropriate pain control, is essential since pain management is very important in these patients. A significant change in the survival of patients with head and neck cancer is only likely to occur by the development of new approaches to treatment. Blocking tumor angiogenesis and treatment based on genetic abnormalities or cell surface receptors offer the two strategies that are most likely to be successful.

Head and Neck Neoplasms↗
PubMedDate not supplied

Angiosarcoma of the larynx. Case report.

Angiosarcoma of the larynx is an uncommon malignant tumor of mesenchymal origin. A case of angiosarcoma of the epiglottis was followed for about 6 years. Diagnostic and clinicopathologic findings outline the importance of a correct differential diagnosis from other vascular malignant tumors (malignant hemangiopericytoma and Kaposi's sarcoma). A critical review of the literature is included.

Aged↗
PubMedDate not supplied

Diagnosis and treatment of verrucous squamous cell carcinoma of the larynx: a critical review.

Verrucous squamous cell carcinoma of the larynx is a clinical and pathological entity which was recognized only in recent years. It is a highly differentiated variant of squamous carcinoma whose incidence is difficult to assess (3.82% of all laryngeal malignant lesions in our series of 3,012 patients seen from 1966 through 1983). The laryngologist and the pathologist must cooperate closely to formulate a correct diagnosis, because the microscopic findings may not show cytological criteria for malignancy, while the clinical appearance of the exophytic, broadly implanted, and fungating lesion is suggestive of malignancy. A large enough specimen is required to carry out adequate investigations in order to differentiate the lesion from keratosis, verruca vulgaris, or squamous cell carcinoma with a verrucous appearance. The most effective form of treatment is surgery, because radiotherapy has shown a high rate of recurrence or persistence of tumor and because there is the risk of occasional anaplastic or sarcomatoid transformation as seen in this and other sites. Neck dissection is not indicated because the tumor has not shown an ability to spread to regional lymph nodes or to distant organs.

Carcinoma, Papillary↗
PubMedDate not supplied

Laryngeal involvement by mycosis fungoides.

Symptomatic involvement of the larynx by mycosis fungoides is rare. We report a case of mycosis fungoides occurring in the larynx of a 74-year-old man. The laryngeal localization was the first visceral manifestation of the disease to be detected clinically.

Aged↗
PubMedDate not supplied

Diagnosis and treatment of small cell carcinoma of the larynx: a critical review.

Small cell carcinoma of the larynx is an uncommon neuroendocrine tumor with particular pathologic, therapeutic, and prognostic connotations. The first case of this lesion was observed in Canada in 1972. Fourteen cases of small cell carcinoma of the larynx were observed in the Ear, Nose, and Throat Department of Padua University in a series of 3,284 primary and secondary laryngeal and hypopharyngeal malignant neoplasms. This number constitutes the largest collection from a single institution in the literature and brings the total recorded cases to 66. The tumor is thought to arise from the argyrophilic Kulchitsky cells normally found in laryngeal mucosa. The diagnosis is based on the light microscopic appearance of the neoplasm and can be confirmed by electron microscopy. The differential diagnosis must be made from carcinoid, atypical carcinoid, small cell squamous carcinoma, small cell ductal carcinoma, lymphoma, mycosis fungoides, and metastatic lung small cell cancer. Systemic chemotherapy with radiation therapy is the accepted manner of treatment today. The survival of the patients treated with these modalities may be significantly improved, and some patients may be cured.

Aged↗
PubMedDate not supplied

Malignant laryngeal epithelial tumors and lymph node involvement: therapeutic and prognostic considerations.

The relationship among various malignant epithelial tumors of the larynx, with or without their respective lymph node and visceral metastases, is discussed. The tumors considered include squamous cell carcinoma, verrucous squamous cell carcinoma, spindle cell squamous carcinoma, small cell carcinoma, atypical carcinoma, mucoepidermoid carcinoma, adenoid cystic carcinoma, and primary malignant melanoma. Other, rarer, malignant epithelial neoplasms of the larynx are only mentioned. The choice of therapy should be determined by tumor stage, oncotype, and patient status.

Carcinoma, Adenoid Cystic↗
PubMedDate not supplied

Morphological observations of immunobiology of laryngeal cancer. Evaluation of the defensive activity of immunocompetent cells present in tumour stroma.

A series of 104 patients with squamous cell carcinoma of the larynx was studied with regard to tumour-host interaction. Prognostic evaluation was based upon histologic grading and morphological evidence of host immune response, judged by the presence and degree of lymphocyte and plasma cell infiltration in tumour stroma. Histologic grade and lymphoplasma-cellular infiltration do correlate with the 5-year survival. The immune response, however, seems to be a favourable prognostic sign only for well differentiated tumours; in our series, all poorly differentiated neoplasms showed minimal or no cellular response. The survival rate increases with the increasing intensity of cellular response within each class of tumour cell differentiation. Small lymphocytes are the basic elements of cell-mediated immune response. After tumour antigenic stimulation they change into immunoblasts which in turn would produce "committed" lymphocytes which would recognize and destroy tumour cells.

Adult↗