Early Cervical Metastasis Research Articles

Occurrence of contralateral lymph neck node metastasis in patients with squamous cell carcinoma of the oral cavity.

Introduction: Squamous cell carcinoma represents about 90% of malignancies of the mouth and about 38% of the head and neck tumors. The behavior of the cancer is very aggressive, presenting early cervical metastasis and, often contralateral ranging from 0.9 to 36%. Objectives: This study aims to analyze clinical and pathological factors that may influence metastasis of squamous cell carcinoma in cervical lymph nodes and relate this occurrence in the contralateral primary tumor, with disease prognosis and the interference of this type of metastasis in the survival rate of patients with this pathology. Material and Metohds: It was conducted a retrospective study from medical records of patients with Squamous Cell Carcinomas with homolateral lymph node metastasis and contralateral attended at the clinic of Head and neck surgery of Hospital São Vicente de Paulo in Passo Fundo – RS - Brazil, from 2000 to 2008. Results: Analyzing the charts of patients with metastatic and metastatic contralateral side it was observed that patients with initial stage presented a higher survival with statistical significance (p=0,035). Conclusions: The occurrence of metastases in lymph nodes of contralateral position to the primary lesion was not the main fator that influenced the survival of the group. Key words:Squamous cell carcinoma, oral cavity, contralateral, death rate, lymphatic metastasis, prognosis.

The evolving management of laryngeal neuroendocrine carcinomas

Laryngeal neuroendocrine neoplasms are divided into two broad categories based on their tissue of origin: epithelial and neural [1]. Laryngeal epithelial neuroendocrine neoplasms are all malignant lesions (carcinomas) and are a subset of neoplasms that share specific morphologic, histochemical, immunohistochemical, ultrastructural and molecular characteristics. The major categories of laryngeal neuroendocrine carcinomas are typical carcinoid (well differentiated neuroendocrine carcinoma), atypical carcinoid (moderately differentiated neuroendocrine carcinoma), small cell neuroendocrine carcinoma (poorly differentiated neuroendocrine carcinoma) and large cell neuroendocrine carcinoma (poorly differentiated neuroendocrine carcinoma) [2]. The neural category consists only of paraganglioma which is invariably benign [3]. Although neuroendocrine neoplasms are uncommon in the larynx, they represent the most common non-squamous neoplasms arising in this area and to date more than 700 cases of them have been reported in the literature [1]. The atypical carcinoid is the most frequent laryngeal neuroendocrine carcinoma, followed by small cell neuroendocrine carcinoma, carcinoid tumor, and large cell neuroendocrine carcinoma. However, in the past large cell neuroendocrine carcinoma was classified under the umbrella term of atypical carcinoid so it may actually be more common than previously realized [4]. Accurate classification of the laryngeal epithelial neuroendocrine carcinomas requires knowledge of specific pathologic criteria separating the major categories. Neuroendocrine carcinomas of the larynx have widely varying prognosis, clinical management, and response to therapy. Thus, accurate classification is essential. Immunohistochemistry is an important diagnostic adjunct in the evaluation of these tumors, as it allows for definitive demonstration of neuroendocrine differentiation. For typical carcinoid, conservation surgery, particularly supraglottic laryngectomy, may be suitable because the supraglottis is the most frequent site of involvement. Transoral CO2 laser surgery can be a good alternative for appropriate cases because of the functional results and lower morbidity [5]. Elective neck dissection is not warranted. Bilateral selective neck dissection (levels II and III) is only indicated for clinically or pathologically proven cervical metastases [6]. The mainstay of treatment for atypical carcinoid of the larynx is surgical resection. As most tumors are located in the supraglottis, supraglottic laryngectomy is often the procedure of choice. Transoral CO2 laser surgery has been also employed to resect these tumors with oncologically sound results and with low morbidity [7]. Elective neck dissection appears to be warranted in view of the high incidence of both early cervical metastasis and subsequent involvement of cervical lymph nodes. Bilateral dissection of sublevel IIA and level III is only adequate for elective surgical treatment of the neck in supraglottic tumors [8]. Bilateral selective neck dissection (levels II and III) should be used therapeutically for metastatic disease. Post-operative radiotherapy is indicated in the presence of cervical lymph node metastases. Painful skin metastases from an This paper was written by members of the International Head and Neck Scientific Group (www.IHNSG.com).

Neuroendocrine tumors of the larynx.

A review of the international literature has revealed 68 paragangliomas, 42 large cell, and 74 small cell tumors of the larynx. Paragangliomas are usually benign, although malignant cases have been reported. Large cell tumors are malignancies associated with a high incidence of early cervical metastasis. Small cell tumors are aggressive cancers characterized by early, diffuse metastatic disease. All three neoplasms demonstrate a propensity for the supraglottic larynx. While surgery remains the treatment of choice for paragangliomas and large cell cancers, small cell cancers are best treated by radiotherapy and chemotherapy. The determinate 5-year survival for patients with paragangliomas, large cell, and small cell cancers is 60%, 34%, and 14%, respectively. While representing distinct clinical entities, these neoplasms demonstrate similar ultrastructural and histochemical features and should be classified as neuroendocrine tumors of the larynx (NETL). A comprehensive analysis of these laryngeal tumors is presented herein. Their clinical behavior and management options are reviewed and a scheme for their nomenclature and classification is proposed.

An unusual thyroid tumor in a child

Malignant neoplasms of the thyroid gland are quite rare in children. Winship, in his classic article, could find only 562 cases in the literature. The histopathological patterns resemble those of the adult tumors. Despite early cervical metastasis, the prognosis in general is favorable, with many long-term survivals. Prior exposure to radiation of the head and neck is a definite pre-disposing factor. Teratomas of the neck are a medical curiosity--less than 100 cases are described in the literature. The vast majority of these are found during the neonatal period, and are benign histologically. These are usually large, cystic, bulky masses which produce mechanical obstruction of the upper airway and digestive tract. Only one of these tumors, described by Pupovac in 1896, has been considered malignant. A six-year-old child was examined with a right thyroid mass of three months' duration. The thyroid scan showed a "cold nodule." At surgery, a well-encapsulated mass was found. The pathology showed a predominance of malignant spindle cells, with areas of papillary carcinoma; however, there were well-defined mucous glands present in the tumor. Clinically the child has remained well and asymptomatic. The slides have been extensively reviewed. To my knowledge no such tumor has been previously described. The tumor is considered to be a malignant thyroid tumor growing out of teratomatous tissue.