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At least 1,711 records · Page 95Linked to original sources
PubMed1980

Malignant melanoma of the external ear. Review of 102 cases.

The medical records of 102 patients with a diagnosis of melanoma of the external ear seen at The M.D. Anderson Hospital over approximately a 30 year period were reviewed. Survival was correlated with the sex, the clinical appearance of the lesion, the anatomic site of origin, the microscopic thickness and level of invasion, the absence or presence of clinical and pathologic nodal metastasis, the type of neck dissection and the type of definitive surgical treatment to the ear. The thickness and nodal metastasis adversely affected prognosis. Proper surgical treatment usually involves less than total amputation of the ear. A randomized prospective study should answer the question of whether elective neck dissection of the periauricular, parotid and upper posterior cervical and jugulodigastric nodes is justified. The use of chemoimmunotherapy offers a negligible therapeutic benefits for disseminated disease but may be of prophylactic value in a planned, adjunctive protocol for poor risk patients.

Adolescent↗
PubMedDate not supplied

Regional lymph node metastases in well-differentiated thyroid carcinoma.

The status of regional lymph node metastases was assessed in 171 patients with thyroid cancer who underwent a variety of thyroidectomy procedures with regional lymph node dissection at Kanazawa University, from January 1979 to March 1986. The rates of regional lymph node metastasis in minimal and ordinary thyroid cancer were 57% and 84% respectively. Since the rates of lymph node metastasis were high not only in the central cervical compartment but also in the lateral jugular compartment, modified radical neck dissection in the ipsilateral neck is at least recommended in patients with these thyroid cancers. Furthermore, high frequencies of bilateral regional lymph node metastases were found in patients with obviously widespread involvement of the bilateral lobes, with cancer located in the isthmus, with clinically detectable bilateral or contralateral jugular lymph node metastases and with histological involvement in the contralateral paratracheal lymph nodes. Bilateral modified radical neck dissection is recommended in these patients.

Adenocarcinoma↗
PubMedDate not supplied

[Reintervention to complete the surgical treatment of thyroid cancer. Indications and histopathological findings].

In Mexico, 39% of 158 patients operated on for thyroid cancer require reoperative thyroid surgery. We retrospectively reviewed the indications and histopathological findings of 60 patients reoperated on because of: a) suspected persistent or recurrent disease; b) high risk patients treated by lobectomy; c) different histology; d) complete lack of information, e) and distant metastasis. In 53 cases (88%), the initial surgery was nodulectomy or lobectomy, and in seven (11%) was subtotal or near-total thyroidectomy. Among the 60 reoperations, 50 were completion total thyroidectomy and 10 were near-total thyroidectomy. In 27 cases (45%) a neck dissection was additionally done. Histologic examination revealed thyroid carcinoma in 32 cases (53%) and neck node metastasis in 28 cases (47%). Complications included six cases (9%) of permanent palsy of the recurrent laryngeal nerve after the initial surgery outside of our hospital and two cases (1.75%) of reoperated cases. In four reoperated patients (6.6%), permanent hypoparathyroidism was developed. It is mandatory to complete thyroidectomy and neck dissection in a high proportion of patients initially treated in general hospitals due to an inadequate criteria in the selection of the extension of thyroidectomy and treatment of neck node metastases. Histologic findings of these patients support our indications to complete the surgical treatment.

Adolescent↗
PubMed2004

New aspects in parotid gland surgery.

We present our results of current research on parotid gland surgery at our clinic. a) Histopathological characteristics of pleomorphic adenomas, especially of capsular alterations like thin capsule areas, capsule-free regions, satellite nodules, and pseudopodia in the different subtypes were analyzed in 100 consecutive patients. 51 pleomorphic adenomas were classified as stroma-rich type, 35 as cell-rich-type, and 14 as classical subtype. 97% of all tumors showed areas with very thin (< 20 mm) capsules. Stroma-rich tumors showed the absolute greatest regions of very thin capsules and exhibited focal absence of encapsulation in 71% of the tumors. 11% of the cell-rich and 43% of the classical subtype tumors also presented capsule-free areas. Satellite nodules and pseudopodia were present in 33% of the stroma-rich tumors, respectively 23% in cell-rich, and 21% in classical subtype tumors. Therefore, enucleation or local dissection of the pleomorphic adenoma can not be a sufficient surgical treatment of this special tumor entity. We recommend lateral or total parotidectomy as the treatment of choice. b) To ascertain the incidence of clinically apparent and occult lymph node metastases in patients with major salivary gland cancers we analyzed 160 consecutive patients that underwent parotidectomy and neck dissection. Histologically confirmed positive neck was found in 53% of all cases. The histology of the primary tumor had a significant influence on the incidence of lymph node metastasis: Highest incidence of 89% (16/18) was found in undifferentiated carcinomas, however also so-called low-risk tumors showed a rate from 22% to 47%. Of the 139 patients with clinical N0 neck 45% had occult neck metastasis. In conclusion neck dissection should be considered as an integral part of the surgical concept in major salivary gland cancer patients.

Adenoma, Pleomorphic↗
PubMed1997

Detection of cervical metastasis. A meta-analysis comparing computed tomography with physical examination.

BACKGROUND: Despite extensive coverage in recent literature, controversy continues with regard to the relative sensitivities of computed tomography (CT) and physical examination (PE). OBJECTIVE: To identify a statistically significant consensus. DATA SOURCES: Initially, data were reviewed on 47 consecutive patients with head and neck cancer on whom a total of 53 neck dissections were performed. These data were combined with findings from a 15-year MEDLINE review of the English-language literature, including references. STUDY SELECTION: All publications that contained a direct comparison of CT with PE, with appropriate data availability, were included. DATA EXTRACTION: Multiple-observer independent extraction was used. A total of 647 neck dissections were included in the meta-analysis. The definition of metastasis varied minimally among studies as follows: (1) nodal size, greater than 10 to 15 mm; (2) multiplicity of 8- to 10-mm nodes; or (3) evidence of necrosis. Necks were compared for positivity or negativity rather than for the actual nodal staging. In all cases, a final determination was made by results of histopathologic examination of surgical specimens. DATA SYNTHESES: The results in this review favored CT over PE but were not statistically significant by use of the Fisher exact test. A combination of the present study's data with those of the literature review yielded the following meta-analysis results: sensitivity, 83% (CT) vs 74% (PE) (P = .002); specificity, 83% (CT) vs 81% (PE) (P = .7); and accuracy, 83% (CT) vs 77% (PE) (P = .006). Overall, PE identified 75% of pathologic cervical adenopathy; this detection rate increased to 91% with the addition of CT. The results of sensitivity analysis confirmed homogeneity across study designs. CONCLUSIONS: Computed tomography is a more sensitive indicator of cervical metastasis than PE. More importantly, these diagnostic modalities were additive, with CT significantly enhancing the detection rates of PE alone. All patients who are at risk for cervical metastasis should have CT or equivalent radiographic imaging performed prior to therapeutic intervention. Future studies correlating CT detection rates to the primary site and staging are needed before more specific conclusions can be drawn.

Head and Neck Neoplasms↗
PubMed1995

[Microvascular anastomoses in reconstructive head and neck surgery].

At the ENT Department of the University of Lübeck, 57 microvascular tissue transplants with 129 anastomoses (61 arterial and 68 venous) have been performed in the last three years. Arteries have always been anastomosed end to end. The venous anastomoses have primarily been performed as end-to-side unions with the jugular vein. In nine patients, great distances between the donor and recipient vessel had to be connected with venous interponates. In two cases in which veins were lacking in the neck after radical neck dissection or radiation fibrosis, we used the cephalic vein or veins of the capsule of the thyroid gland as recipient vessels. The jejunal or osteomyocutaneous transplants were first fitted into the defect before performing the anastomosis. The jejunal peristalsis and the required freedom of movement in shaping the bone necessitated this technique. Microvascular anastomosis was first performed on the transplant of the radialis flap and the neurovascular infrahyoid muscular flap, and then they were integrated into the defect. We lost two transplants postoperatively because of venous thrombosis. In this article wie describe our anastomosis technique, the frequency distribution of recipient vessels, and the rules and characteristics of microvascular anastomosis after radiation and neck dissection.

Adolescent↗
PubMed1999

[Value of B-image ultrasound in patients with carcinomas of the upper aerodigestive tract and N0 lymph node stage].

BACKGROUND: The wait-and-see policy in patients with a N0 neck stage is not common. PATIENTS AND METHOD: One hundred twenty-one patients with a pT1 or pT2 carcinoma of the upper aerodigestive tract and a N0 neck stage in ultrasound studies underwent transoral laser microsurgery without neck dissection or radiation therapy. In these patients the probability of survival and local or regionals recurrence were analyzed in a follow-up period of 18 to 36 months. RESULTS: Thirty patients in whom cervical lymph nodes were detected in ultrasound studies, underwent a curative neck dissection procedure. In 8 of these 30 patients, lymph node metastases were histologically demonstrated, and 6 patients showed a local recurrence. The probability of survival was 1.0 and the probability of being free of local or regional recurrence was between 0.95 and 0.6 depending on the tumor location. CONCLUSIONS: A wait-and-see policy will not necessarily alter the prognosis, which depends on the location of the tumor. Ultrasound follow-up studies should be performed at regular intervals.

Adult↗
PubMed2006

[A case report of cancer of the lip--complete response by a neo-adjuvant chemotherapy using a novel method of TS-1 administration].

We experienced a 49-year-old man with cancer of the lower lip (squamous cell carcinoma, T1N2cM0). We planned surgical treatment including bilateral neck dissection and started a new TS-1 administration method as a neo-adjuvant chemotherapy. One course of this chemotherapy consisted of 3 weeks'administration including 5-day administration and 2-day termination following 1 week rest. TS-1 was given at 120 mg/day. After the first course of chemotherapy, the primary tumor disappeared, and the neck lymph node metastases were markedly reduced. There was no obvious side effect except mild stomatitis. Since we assumed that the lymph node palpated in left neck was a residual tumor, we performed left neck dissection. Histopathological examination revealed that there was no cancer cell but hyalinization in the removed specimen of lymph node, suggesting that the effect of the chemotherapy was a pathologically complete response. We concluded that our novel TS-1 administration method was extremely effective for head and neck squamous cell carcinomas with high potential and without any severe side effects.

Antimetabolites, Antineoplastic↗
PubMedDate not supplied

[Lymphadenectomy in the differentiated thyroid carcinoma].

BACKGROUND: In this study the authors analyze the indications and the type of surgical procedure to perform on the neck lymph nodes in cases of differentiated thyroid carcinoma. METHODS: The study has been carried in a retrospective way. Between 1993 and 2001, 93 differentiated thyroid cancer were observed. There were 72 women and 21 men, with a mean age of 45.9 years (range 18-77). Patients have been divided into three groups: the first included 25 patients who underwent only thyroidectomy (24 total thyroidectomy, 1 lobectomy); the second group included 52 patients who underwent total thyroidectomy and lymphadenectomy of the central compartment. The third group included 16 patients who underwent total thyroidectomy and functional neck dissection. The median follow-up was 65.9 months. RESULTS: The postoperative complications was similar between three groups. Follow-up has shown similar survival and recurrences between groups. CONCLUSIONS: The elective lymphadenectomy of the central could be a solution for a routine treatment of differentiated thyroid cancer without lymph node involvement. The presence of cervico-lateral node metastases imposes a functional neck dissection.

Adolescent↗
PubMed2004

[Clinical analysis of 57 patients with poorly differentiated carcinomas of the supraglottic larynx].

OBJECTIVE: To investigate the clinical characteristics, treatment and prognosis for poorly differentiated supraglottic carcinomas. METHODS: A retrospective study was conducted in 57 cases of poorly differentiated supraglottic carcinomas treated in our hospital from 1980 to 1998. The distribution of the patients according to UICC in 1997 was as follows: stage I 4, stage II 15, stage III 18, stage IV 30. Of the 57 patients, 25 were treated with surgery alone, 9 with irradiation alone, 14 with surgery following preoperative radiation, 7 with postoperative radiation following surgery and 2 with surgery following preoperative chemotherapy. Total laryngectomy was performed on 23 patients and partial laryngectomy on 25 patients. The concurrent neck dissections were undergone for 31 cases (17 unilateral side, 14 bilateral side) and the upper neck dissections for 12 cases. RESULTS: The overall 5-year survival rate, accumulated cervical metastasis rate, metastasis rate of bilateral side of neck, distant metastasis rate, cervical recurrent rate and locally recurrent rate were 47.4% (27/57), 63.2% (36/57), 24.6% (14/57), 21.1% (12/57), 28.1% (16/57) and 10.5% (6/57), respectively. In addition, the local recurrent rate for partial laryngectomy was 12% (3/25). 5-year survival rate for each TNM staging decreases gradually. The difference in 5-year survival rate between T1 + T2 and T3 + T4 and the difference between N0 + N1 and N2 + N3 were statistically significant (chi2 = 4.942, P = 0.026; chi2 = 4.306, P = 0.038). No evidence in our analysis was found about the difference in 5-year survival rate between surgery alone and surgery combined with radiotherapy. The effect of surgery combined with radiotherapy on patients at N2 and N3 was relatively superior to that of surgery alone. CONCLUSIONS: Poorly differentiated carcinomas of the supraglottic larynx had characteristics of the advanced stage in terms of earlier lymph node metastasis and a relatively high rate of cervical and distant metastasis. Surgery was still the primary treatment for this disease and it was feasible to perform partial laryngectomy on certain patients. For patients with T3 who need partial laryngectomy and patients with advanced N stage, the combination of surgery with radiotherapy was supposed to be a priority.

Adult↗
PubMed1993

[Topographical and clinico-oncologic analysis of locoregional recurrence after transoral laser surgery for laryngeal cancer].

204 patients with carcinoma in situ or infiltrating carcinoma of the larynx were treated with transoral laser partial laryngectomies and, in selected cases, staged neck dissections and postoperative radiotherapy. 169 tumours were glottic, 28 supraglottic and 7 subglottic in origin. Up to now, 21 local and regional recurrences were diagnosed. 16 patients presented with recurrent tumour in the larynx, 3 in the larynx and in the cervical lymph nodes, and two in the neck only with no recurrence at the site of the primary. Out of 19 recurrences in the larynx, 10 were found at the anterior commissure, 5 in the transglottic space, 1 in the arytenoid region and two in the supraglottis. The vast majority of all recurrences were discovered during the first two years after primary treatment. 14 patients were treated with total laryngectomy, two with a second transoral laser resection, one with supraglottic laryngectomy, one with subtotal laryngectomy and two with neck dissections. One patient refused further treatment. 5 patients have so far died due to uncontrollable tumour spread. The analysis of local recurrences demonstrates, that deeply infiltrating tumours at the anterior commissure cannot be steadily removed by transoral laser surgery. Future development of transoral procedures must either focus on complete transoral resection of the anterior part of the thyroid cartilage or at least achieve thermal sterilisation of this area.

Carcinoma in Situ↗
PubMed1988

[Results of surgical treatment of tongue cancer].

Fourty-four patients with squamous cell carcinoma of the tongue have been treated by surgery. Twenty-two out of 44 patients were treated by a glossectomy alone and the remaining 22 by en bloc dissection with a glossectomy and neck dissection. The 5-year cumulative survival rate of these 44 cases was 86.1%, broken down as follows: stage I (20 cases), 100%; stage II (9 cases), 88.9%; stage III (11 cases), 72.7%; and, stage IV (4 cases), 50%. Four cases had a recurrence in the primary site, and 6 in the cervical region. Five out of 44 cases died (4 from tongue cancer, and one from other causes). Further, 3 out of 5 cases died of a recurrent cancer in the primary focus or in the neck. Thus, it has been concluded that control of the primary focus and neck metastasis is important for the treatment of tongue cancer, and that surgery also is an excellent therapy for tongue cancer.

Carcinoma, Squamous Cell↗
PubMed1994

Acquired laryngomalacia as a cause of obstructive sleep apnea.

We describe a patient who, 4 years after a radical neck dissection and radiotherapy, presented with obstructive sleep apnea; upon bronchoscopy, he was found to have acquired laryngomalacia. Inspiration induced upper airway obstruction due to a large flaccid epiglottis, large aryepiglottic folds, and edema of the supraglottic area. We suggest that acquired laryngomalacia can lead to obstructive sleep apnea. Patients with obstructive sleep apnea after radical neck dissection need to be evaluated for laryngomalacia with fiberoptic laryngobronchoscopy. Examination of the upper airway is useful to determine the nature and extent of any upper airway collapse.

Adult↗
PubMed1989

Surgery for cancer of the buccal mucosa.

Buccal Mucosa cancer is common in India, T4 tumours being the most common (66%). T1 tumours are rarely seen (4%). Disease-free survival (DFS) at 18 mo with surgery alone for T2, T3, and T4 tumours is 57%, 43%, and 21%, respectively. Addition of postoperative radiation therapy (RT) for T3 and T4 lesions increases DFS to 60% and 35%, respectively. Marginal mandibulectomy is advocated for lesions close to the lower gingiva when the bone is clinically and radiologically uninvolved. The local control rate with marginal mandibulectomy is 79%. In T3/T4 tumours, results with supraomohyoid dissection are comparable to radical neck dissection when the upper jugular nodes are histologically negative. In T4 tumours, histological grading forms an important parameter for identification of a favourable subset. In well-differentiated tumours DFS was 48% with surgery and 72% with surgery and postoperative RT; in moderately differentiated tumours it was 12% and 21%, respectively; and in the poorly differentiated group there were no survivors.

Cheek↗
PubMed2002

Diagnosis and treatment of isolated neck metastases of adenocarcinomas.

AIMS: Cervical metastases of adenocarcinoma or undifferentiated large cell carcinoma (ULCC) (non-squamous cell carcinoma) of unknown primary origin are rare and often accompanied by distant metastases at multiple sites in the body. Nevertheless, in the past decades, several patients have presented in our clinic with isolated neck metastases of this type of malignancy. The aim of our study is to evaluate the clinical behaviour of these cases and to define the role of surgery and radiotherapy. METHODS: Over the past 24 years, we selected 15 out of 270 patients (6%) with isolated cervical lymph node metastases of adenocarcinoma (six) or ULCC (nine) of unknown primary origin. Diagnosis was made either by histology or by fine needle aspiration cytology. Treatment consisted of (selective) neck dissection and/or radiotherapy. RESULTS: The clinical presentation of isolated cervical metastases of adenocarcinoma compared with ULCC is equivalent, with an overall median survival time of 25 months (confidence interval 21--29 months). Combined therapy was correlated with an increased and persistent regional control and was associated with longer duration of survival. CONCLUSIONS: Patients with isolated cervical neck node metastases of adenocarcinoma or ULCC of unknown primary origin are rare and the diagnostic process to identify this subgroup requires a systemic work-up. In selected cases treatment should concentrate on (selective) neck dissection combined with radiotherapy to achieve a prolonged survival.

Adenocarcinoma↗
PubMed2001

[Differentiated microcarcinoma of the thyroid gland in 45 cases].

OBJECTIVE: To offer therapeutic management for patients with microcarcinoma of the thyroid gland (TMC). METHOD: Forty-five patients with TMC were treated from 1993, including 10 males and 35 females. Homolateral total thyroidectomy + contralateral subtotal thyroidectomy + homolateral functional neck dissection was taken as routine. RESULT: Among 168 patients with differentiated carcinoma of the thyroid gland, 45 patients were TMC (26.78%). Homolateral metastasis of lymph node presented in 11 (24.44%) of the TMC patients. No operation complications. All patients were followed up. No recurrence, no death. CONCLUSION: The lymph node metastasis appears to be high. Homolateral total thyroidectomy + contralateral subtotal thyroidectomy + homolateral functional neck dissection was effective and essential.

Adult↗
PubMed1985

Cervical lymph node metastases. Incidence and implications of extracapsular carcinoma.

The incidence and prognostic significance of extracapsular spread (ECS) of tumor in cervical lymphatics was investigated. The surgical specimens from 349 patients treated for squamous cell carcinoma by radical neck dissection between 1978 and 1982 have been examined retrospectively. Follow-up data were available relative to recurrence rate, site of recurrence, and disease-free intervals. Fifty-nine percent of the patients with N1 cervical metastases had ECS. Patients were classified according to the histopathologic findings in the radical neck dissection specimens. The three groups identified were patients with normal nodes, patients with no ECS, and patients with ECS. The histopathologic evidence of ECS was associated with a statistically significant reduction in survival when compared with patients without ECS. The disease-free interval between treatment and the development of recurrent disease was shorter for patients with ECS than for patients with no ECS.

Carcinoma, Squamous Cell↗
PubMed1997

Insular thyroid carcinoma in adolescents: a potentially lethal endocrine malignancy.

BACKGROUND: Insular thyroid carcinoma is intermediate in aggressiveness between well differentiated and anaplastic thyroid carcinomas. METHODS: The authors describe two children with insular thyroid carcinoma who had markedly different outcomes. In the first case, a girl age 15 years, 2 months presented with a large pulsatile mass in the right thyroid lobe. In the second case, a girl age 16 years, 3 months presented after total thyroidectomy was performed elsewhere for confirmed pTNM Stage I insular thyroid carcinoma. RESULTS: In Case 1, total thyroidectomy was performed, and histologic examination revealed insular thyroid carcinoma with lymph node involvement. Six weeks postoperatively, neck masses reappeared. There was significant radioactive iodine uptake in the thyroid bed and in a palpable right supraclavicular lymph node; this was associated with an increased serum thyroglobulin level. Ultrasound-guided biopsy of the lymph node confirmed recurrent insular carcinoma, and neck dissection was performed. Six weeks later, there was 0.35% iodine uptake in the neck, and the patient was treated with 300 mCi of (131)I. She had no signs of recurrence when last seen 22 months postoperatively. In Case 2, the patient was given 29.9 mCi of (131)I for remnant ablation. Four months postoperatively, fine-needle aspiration biopsy of a high jugular lymph node demonstrated recurrence. The patient was given 200 mCi of (131)I but had no significant response. Right modified neck dissection was performed, followed by external beam radiation. Despite aggressive treatment with a further 500 mCi of (131)I, progressive lung and mediastinal metastases developed, followed by brain metastasis. The patient died 31 months after the initial diagnosis. CONCLUSIONS: Insular thyroid carcinoma may occur and behave aggressively in children. Vigorous initial surgical and radioactive iodine treatments are warranted.

Adolescent↗