Modified Radical Neck Dissection Research Articles

Squamous Cell Carcinoma of Nasofacial Groove

Abstract Introduction: Cutaneous squamous cell carcinoma is a malignant tumour that develops in the squamous cells that make up the middle and outer layers of the skin. It often forms on parts of skin frequently exposed to sunlight. It is usually not life-threatening, though it can be aggressive causing serious complications. However, nasofacial groove is a very uncommon area for the origin of squamous cell carcinoma. Case Report: A 65-year-old housewife with hypertension and type 2 Diabetes Mellitus presented with painless swelling over right nasofacial groove for last 5 months which was insidious in onset, gradually progressive to reach the present size. On clinical examination, oval, localized, non-tender, hard 2cm x 2cm swelling was found over right nasofacial groove. Diagnostic nasal endoscopy was within normal limit. Computed Tomography showed a well-defined heterogenous oval mass over the right maxilla extending over right nasofacial region. Aspiration cytology yielded a few round to oval epithelial cells and fibrous stroma in a haemorrhagic background. A provisional diagnosis of appendageal tumour of nasofacial groove was made. Surgical excision was done under general anaesthesia. Gross examination showed predominantly solid and grey mass. Microscopically the lesion showed features of moderately differentiated squamous cell carcinoma. Further Total Maxillectomy with Modified Radical Neck Dissection type 3 has been done. Discussion: Squamous cell carcinoma of the skin may mimic nasolabial cyst. Hence the diagnosis should be kept in mind while dealing with a suspicious case of nasolabial cyst.

Neurofibroma of the vagus nerve as an incidental finding during left modified radical neck dissection for papillary thyroid cancer

Neurofibroma of the vagus nerve as an incidental finding during left modified radical neck dissection for papillary thyroid cancer

Never too young for a salivary gland carcinoma ex-pleomorphic adenoma

BackgroundCarcinoma ex-pleomorphic adenoma (CXPA) can either arise primarily as a de novo or from the malignant transformation of a benign pleomorphic adenoma (PA). CXPA mostly occurs in adults aged 50 to 70 years; hence, the occurrence of CXPA in younger ages is not common.Case presentationWe report a 27-year-old female who had a history of submandibulectomy for pleomorphic adenoma, and presented with recurrent left submandibular swelling for 4 months. The mass was rapidly increasing in size and was associated with occasional throbbing pain. Examination showed a multilobulated, firm left submandibular swelling with no overlying skin changes. FNAC was performed twice, by conventional and ultrasound-guided techniques, and both concluded as benign salivary gland tumours. CT scan and MRI revealed a well-demarcated tumour with an area of necrosis within, with no obvious invasion into surrounding soft tissue and no significant lymphadenopathy. Having high suspicion of a malignant transformation, the tumour was resected with a concurrent modified radical neck dissection. The histopathological examination confirmed a carcinoma ex-pleomorphic adenoma with the myoepithelial malignant component. The patient subsequently received adjuvant radiotherapy. This case demonstrated that CXPA, although rare, can occur in young adults. Pre-operative FNAC and radiological imaging may mimic a pleomorphic adenoma.ConclusionThe presence of recurrent tumours with rapid growth should alarm the clinician about a possible malignant transformation of a benign parotid tumour.

Safety and surgical outcomes of single-port trans-axillary robot-assisted thyroidectomy: Experience from a consecutive series of 300 patients.

Since the introduction of the single-port (SP) robotic system, SP trans-axillary robot-assisted thyroidectomy (SP-TART) has been performed. We aimed to evaluate the safety and surgical outcomes of SP-TART in a consecutive series of 300 cases. We analyzed 300 patients with thyroid disease who underwent SP-TART from October 2021 to May 2023 in St. Mary's Hospital in Seoul, Korea. We analyzed the patients' clinicopathological characteristics and perioperative outcomes according to surgical extent. Of the 300 cases analyzed, 250 patients underwent less than total thyroidectomy (LTT), 31 patients underwent total thyroidectomy (TT), and 19 patients underwent TT with modified radical neck dissection (TT c mRND). The mean operative times for LTT, TT, and for TT c mRND were 69.8±23.6, 104.2±30.7, and 223.7±72.4min, respectively. Complications, including postoperative bleeding, transient hypoparathyroidism, and vocal cord palsy, were observed in nine, six, and six LTT, TT, and TT c mRND cases. The SP-TART method is a safe and feasible surgical option with a short operative time, good surgical outcome, and excellent cosmetic results.

Effect of proprioceptive neuromuscular facilitation versus low level laser therapy on shoulder adhesive capsulitis post-neck dissection surgery

IntroductionNeck dissection (ND) operations are performed to treat known metastatic neck illness. These operations have been associated with chronic neck and shoulder problems. In patients who have had a ND, adhesive capsulitis (AC) is one of the causes of shoulder dysfunction.MethodsForty patients with AC following modified radical neck dissection (MRND) surgeries were chosen at random and divided into two groups of equal size. The low-level laser therapy (LLLT) group (group A) received LLLT with: wavelength – 830 nm, output – 50 mw, maximum frequency – 5000 Hz, pulse duration – 50 ns, and average dose – 9 J/cm2 for 20 min, plus traditional physical therapy (mobilisation technique, myofascial release, range of motion (ROM), and strengthening exercises) for 30 min. The proprioceptive neuromuscular facilitation (PNF) group (group B) received PNF for 25–30 min in addition to traditional physical therapy. The treatment period was 3 times each week and lasted for eight weeks. The discomfort in the shoulder was measured using the visual analogue scale (VAS). Shoulder impairment and pain were assessed by the SPADI scale and the shoulder ranges of motion were assessed using the universal goniometer technique. All measures were taken before and after the intervention.ResultsThe findings reveal that there was a significant enhancement in all variables in both groups A and B after therapy compared to before the treatment (p < 0.001). After therapy, there were no obvious changes in the VAS and SPADI values among the groups (p > 0.05). However, statistical analysis showed significant improvement in the PNF group (group B) in shoulder flexion, abduction and external rotation in comparison to that of the LLLT group (group A) after treatment (p < 0.001).ConclusionsPNF proved to be more effective than LLLT in increasing ROM but was as effective as LLLT in decreasing shoulder pain and dysfunction in AC post ND surgery.

Variations of the trapezius branch of the accessory nerve: an anatomic study

Although modified radical neck dissections have increased in popularity to reduce morbidity secondary to intraoperative accessory nerve damage, inadvertent injury still often occurs. As this phenomenon is thought to be due to anatomic variation in the trapezius branch of the accessory nerve, it is imperative to better understand the nuances of these anatomic variations to better inform surgical decision-making. A total of 24 accessory nerves were dissected, exposed, and traced in 15 cadavers. Three aspects of the accessory nerve were identified and recorded: the course of the trapezius branch in relation to the sternocleidomastoid, the number of trapezius branches at muscle insertion, and the number of cervical rootlet contributions. Four different anatomic patterns for the trapezius branch were identified, with the most common being where the trapezius branch separates from the main accessory nerve just medial to the sternocleidomastoid and courses deep to the sternocleidomastoid (58.3%). Most (75%) trapezius branches entered the muscle as a single nerve, whereas some (21%) were inserted as two separate nerves. The number of cervical rootlet contributions for each trapezius branch varied from zero to three. Bilateral anatomic variations were also noted. Even when the accessory nerve and its branches are thought to be spared during neck dissection, patients may postoperatively present with different degrees of accessory nerve damage. There may be unrecognized anatomic pathways that the nerve takes that may confer a higher risk of unintentional damage, especially those that have greater exposure within the anterior triangle unprotected by the sternocleidomastoid.

The Effect of Laterality in Modified Radical Neck Dissection on the Risk of Intraoperative Bradycardia: A Retrospective Cohort Study.

Background Intraoperative bradycardia is a hardly studied complication of modified radical neck dissection (MRND). Methods Using convenient sampling, we retrospectively studied a cohort (n = 159) of patients who underwent MRND at Papanikolaou General Hospital, Thessaloniki, Greece between 2019 and 2020 to investigate whether MRND laterality (bilateral vs. unilateral) affects the occurrence of intraoperative bradycardia (a pulse rate lower than 50 bpm). Results Roughly two-thirds of the patients underwent unilateral MRND, and the rest underwent bilateral MRND. Bradycardia was observed in 25.8% of the cohort. We used logistic regression and investigated several potential confounding factors. Unilateral MRND was associated with a lower risk of intraoperative bradycardia compared to bilateral MRND in the simple regression model (relative risk (RR): 0.555, 95% confidence interval (CI): 0.331-0.932, p = 0.027). MRND laterality was not significantly associated with intraoperative bradycardia (p = 0.082) in the multiple regression model, whereas an American Society of Anesthesiologists physical status (ASA-PS) score of 3 vs. 4 (adjusted odds ratio (aOR) = 0.125, 95% CI: 0.0340-0.457, p = 0.002), the presence of atrial fibrillation (aOR = 11.4, 95% CI: 4.10-31.8, p < 0.001) and induction of anesthesia with dexmedetomidine (aOR = 4.57, 95% CI: 1.34-15.6, p = 0.015) were significantly associated with intraoperative bradycardia. Conclusions MRND laterality was close to statistical significance. Bigger sample sizes may provide more definitive information since the effect of MRND laterality on intraoperative bradycardia remains unclear. Our findings can inform clinical practice so that clinicians know when to expect bradycardia and are better prepared to manage it.

Bilateral axillo-breast approach (BABA) robotic neck dissection for papillary thyroid carcinomas

Papillary thyroid carcinoma (PTC), the most commonly diagnosed thyroid malignancy, frequently presents with lymph node metastases. Effective management of metastatic lymph nodes is crucial due to the disease's high recurrence rates. Herein, we present our approach to robotic thyroidectomy and central/lateral neck node dissection, which has shown comparable oncologic outcomes, reduced complications, and improved cosmetic results compared to open surgeries. We detail the surgical procedure, from patient positioning and flap dissection, through central and lateral neck dissection, to closure. The BABA robotic modified radical neck dissection (MRND) is primarily recommended for patients with well-differentiated thyroid carcinoma, predominantly PTC, presenting with suspected or pathologically confirmed lateral neck metastasis. We also discuss the application of the da Vinci robot settings in performing precise procedures and preserving critical anatomical structures. This comprehensive review provides insights into the effectiveness of BABA robotic thyroid surgery and central/lateral neck node dissection in managing PTC.

Extraskeletal Myxoid Chondrosarcoma of Floor of Mouth-A Rare Case Report and Review of Literature.

Chondrosarcomas are rare malignancies of the cartilage and myxoid chondrosarcoma is its variant which commonly occurs in soft tissue of extremities. Extraskeletal chondrosarcoma is a rare malignant neoplasm of bone or soft tissue origin and is characterized by the presence of spindle cells admixed with well differentiated cartilage or chondroid stroma. They are mostly radioresistant tumours and surgical resections with adequate margins is considered as the ideal treatment modality with adjuvant radiotherapy in high grade tumours and add on chemotherapy, in case of presence of poor prognostic factors. A 51-year-old diabetic, hypertensive female patient presented to our outpatient department with difficulty in chewing food for a duration of 6 months. On clinical examination, she had an ulceroproliferative growth involving right lower alveolus and floor of mouth. MRI face and neck with contrast showed a 4.1 × 2.9 × 4.5cm lesion involving right lower alveolus extending to floor of mouth. Biopsy showed features of extraskeletal myxoid chondrosarcoma. She was planned for upfront surgery (Right composite resection with modified radical neck dissection with free fibula flap). Patient was stable post-surgery and was discharged in stable condition. Final histopathology report was high grade myxoid chondrosarcoma. The case was presented in tumour board and the patient was planned for adjuvant radiotherapy. She has been on regular follow up for the past 2 years and shows no signs of recurrence. Extraskeletal myxoid chondrosarcoma of oral cavity is a rare entity and very few cases are reported. It is a malignant neoplasm which is diagnosed with the help of immunohistochemistry. Surgery is the ideal modality of treatment accompanied by adjuvant radiotherapy in cases of high-grade tumours.

SAT535 ANKRD26-RET Fusion Positive Metastatic Papillary Thyroid Carcinoma - Advanced Presentation of a Rare Mutation

Abstract Disclosure: H. Hashmi: None. A. Ankireddypalli: None. L. Burmeister: None. A. Nelson: None. K. Amin: None. Background: While rearranged during transfection (RET) protooncogene mutations have been commonly associated with thyroid malignancy, ankyrin repeat domain containing protein 26 (ANKRD26) has been primarily linked to hematologic malignancy. Exon 29 of ANKRD26 (Chromosome [Chr] 10p12.1) has been shown to fuse with exon 12 of RET (Chr 10q11.21), resulting in a genetic fusion mutation ANKRD26:RET. This is a rare genetic mutation in papillary thyroid cancer with only one previously reported case. We report the first case in the US of this novel genetic mutation with a unique clinical presentation. Clinical Presentation: A 48-year-old, male patient presented with lower back pain radiating to the lower extremities of one year duration. MRI lumbar spine revealed an irregular mass lesion in the L1 vertebral body with extraosseous soft tissue extension, L1 compression fracture and extension into the T12 body. CT CAP revealed a 4.8 x 3.6 cm, heterogenous right thyroid lobe with tracheal compression and sub centimeter pulmonary nodules in the left lower and right middle lobes. Biopsy of the L1 paravertebral mass was diagnostic for metastatic thyroid carcinoma of a follicular pattern. Molecular testing with a next generation sequencing fusion profile assay was positive for ANKRD26:RET gene rearrangement. Thyroid ultrasound was notable for a solid, hypoechoic, 3.2 x 3.1 x 2.9 cm right lobe nodule with echogenic foci and level 4 lymph nodes with loss of reniform shape and fatty hilum. FNA of the nodule and right level 4 lymph node was suspicious for follicular neoplasm. The patient was admitted for acute cord compression necessitating extensive laminectomy, vertebral reconstruction and resection of the L1 paraspinal tumor. Pathology was positive for metastatic, follicular variant, papillary thyroid carcinoma. Total thyroidectomy, central and right modified radical neck dissection was performed. Pathology demonstrated a 4.2 cm papillary carcinoma, follicular type with tall cell variant; confined to the thyroid. Extensive angioinvasion (≥ 4 vessels) and lymphatic invasion was present. 10/32 positive lymph nodes. TNM grading was T3aN1bM1. Summary: The only other case of ANKRD26-RET fusion positive papillary thyroid cancer in the literature was reported by Staubitz et al in Germany in 2019. They reported a case of a 78-year-old male with follicular variant papillary thyroid carcinoma (pT3,pN0,M0). To our knowledge, our case is the second worldwide and the first to be reported in the United States of this rare fusion protein positive thyroid cancer. Such an aggressive presentation with distant osseous metastases has to our knowledge not been previously described. Conclusion: The clinical and therapeutic implications of this rare genetic mutation are not currently well elucidated. We present this case with the intent to expand the existing literature and increase recognition of this rare genetic mutation. Presentation Date: Saturday, June 17, 2023

Cranio-Caudal Identification and Preservation of Spinal Accessory Nerve during Modified Radical Neck Dissection

Introduction: The spinal accessory nerve (SAN) is encountered during neck dissection surgeries and is at the highest risk for iatrogenic injury, which may lead to shoulder syndrome. This functional deformity can be avoided by preservation of SAN in modified radical neck dissection (MRND). Description: Many techniques are described in the literature for SAN preservation, one of which is the identification of Erb’s point and dissection in the posterior triangle where the SAN leaves the sternocleidomastoid (SCM) muscle. However, this technique for identification and preservation of SAN requires a skilled and trained surgeon to avoid any iatrogenic injury to SAN. Conclusion: Therefore, a study was carried out on 30 patients to find if the cranio-caudal dissection of SAN helps in the preservation of the nerve during MRND surgeries at the beginner’s level.

Stimulated thyroglobulin and pre-ablation antithyroglobulin antibody products can predict the response to radioiodine therapy of TgAb-positive differentiated thyroid cancer patients: a retrospective study.

We aimed to explore the predictive value of stimulated thyroglobulin (sTg) and pre-ablation antithyroglobulin (pa-TgAb) products for the effect of radioiodine therapy (RAIT) on TgAb-positive differentiated thyroid cancer (DTC) patients. In this study, we enrolled 265 patients with TgAb-positive DTC who underwent RAIT after total thyroidectomy (TT). Based on the last follow-up result, the patients were divided into two groups: the excellent response (ER) group and the non-excellent response (NER) group. We analyzed the factors related to the effect of RAIT. The ER group consisted of 197 patients. The NER group consisted of 68 patients. For the univariate analysis, we found that the maximal tumor diameter, whether with extrathyroidal extension (ETE), bilateral or unilateral primary lesion, multifocality, preoperative TgAb (preop-TgAb), pa-TgAb, sTg × pa-TgAb, initial RAIT dose, N stage, and surgical extent (modified radical neck dissection or not), showed significant differences between the ER group and NER group (all p-values <0.05). The receiver operating characteristic (ROC) curves showed that the cutoff value was 724.25 IU/ml, 424.00 IU/ml, and 59.73 for preop-TgAb, pa-TgAb, and sTg × pa-TgAb, respectively. The multivariate logistic regression analysis results indicated that pa-TgAb, sTg × pa-TgAb, initial RAIT dose, and N stage were independent risk factors for NER (all p-values <0.05). For the Kaplan-Meier analysis of disease-free survival (DFS), the median DFS of the patients with sTg × pa-TgAb < 59.73 and initial RAIT dose ≤ 100 mCi was significantly longer than that of the patients with sTg × pa-TgAb ≥ 59.73 (50.27 months vs. 48.59 months, p = 0.041) and initial RAIT dose >100 mCi (50.50 months vs. 38.00 months, p = 0.030). We found the sTg and pa-TgAb conducts is a good predictor of the efficacy of RAIT in TgAb-positive DTC patients. It can play a very positive and important role in optimizing treatment, improving prognosis, and reducing the burden of patients.

Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment.

Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment.

A Rare Case of Horner's Syndrome after Neck Dissection Operation

The classic triad of ipsilateral palpebral ptosis, pupillary miosis, and facial anhidrosis defines Horner's syndrome, which results from cervical sympathetic chain damage. This is an uncommon complication of neck surgery like thyroidectomy and neck dissection. A fifty-two-year-old male patient presented with papillary thyroid carcinoma with lymph nodes metastases, underwent total thyroidectomy with central and left lateral modified radical neck dissection. One day after the operation, the patient presented with signs of Horner's syndrome.

Assessment of level IIB lymph nodes in oral cancer - Should we spare or care?

Objectives The extent of neck dissection over the years has evolved from a radical neck dissection to a super-selective neck dissection with an attempt to achieve a balance between oncological safety and acceptable morbidity. There is an ongoing debate concerning dissection of level IIB in both node negative and positive patients, primarily due to the low incidence of metastasis in this region and possible spinal accessory nerve injury. In this study, we intended to find the rate of metastasis to level IIB nodes in patients who were treated with neck dissection for oral cancers. Material and Methods Patients with squamous cell carcinoma of the oral cavity who underwent neck dissection were analyzed. Patients with clinically node negative (cN0) disease underwent selective neck dissection (SND), whereas patients with clinically node positive (cN+) disease underwent modified radical neck dissection (MRND). Results Out of the total 34 patients, 12 patients underwent MRND and 22 patients underwent SND. In the MRND group, three patients (25%) had positive level IIB nodes. The median number of IIB nodes removed was two and the median number of positive IIB nodes was one. In the SND group, the median number of IIB nodes removed was three and none of the patients had positive level IIB node. Conclusion In oral cancer with cN+, routine dissection of level IIB nodes has both therapeutic and prognostic values. Whereas, in patients with cN0, routine dissection of level IIB nodes can be omitted. Further large volume studies are needed on cN0 disease.

Novel method of identifying spinal accessory nerve during modified radical neck dissection in level 2: “SMS Hospital point” and “Upward Pointing Arrow” sign

Neck dissection is now a part and parcel in management of oral malignancies. Like all other surgical procedures, it has a few morbidities, which include iatrogenic trauma to the spinal accessory nerve leading to atrophy of ipsilateral trapezius and sternocleidomastoid muscle. A few identification markers for the nerve have been described in the literature. The markers or structures described previously are not so accurate and give only an approximate idea of where the nerve could be. We have discovered a simple and easily reproducible marker and a sign which helps us identify the nerve each and every time without fail. The junction of posterior belly of digastric nerve, internal jugular vein, and spinal accessory nerve is the point where the proximal end of the nerve is found, and the structures together form an “upward pointing arrow” which helps identify the nerve precisely during neck dissection.

Nodal frozen section + elective neck dissection as an alternative to sentinel lymph node biopsy for the management of cT1-2N0 oral squamous cell carcinoma patients: a viability and accuracy study

PurposeOral Squamous Cell Carcinoma (OSCC) is characterized by a high aggressiveness and a tendency to metastasize. The management of the neck in cT1-2N0 patients c follows three strategies: watchful waiting, elective neck dissection (END) or sentinel lymph node biopsy (SLNB). The aim was to assess the viability of intraoperative frozen sections of the nodes of cT1-2N0 to spot occult metastases as an alternative to SLNB, performing a modified radical neck dissection (MRND) in intraoperatively positive patients. Methods: The patients were treated at the Maxillo-Facial Surgery Unit of Policlinico San Marco of Catania between 2020 and 2022. END was performed in all patients, including frozen section examination of at least one clinically suspicious node per level. In case of positivity after frozen section examination, neck dissection was extended to levels IV and V. Results: All frozen sections were compared with a definitive test after paraffin inclusion. During surgery, 70 END were performed, and 210 nodes were analyzed with frozen sections. Among the 70 END, 52 were negative after frozen Sects. (156 negative nodes), and surgery was ended. Five of the 52 negative ENDs resulted in pN + after paraffin inclusion (9.6%), which underwent postoperative adjuvant treatment. The sensibility of our END + frozen section method was 75%, while the specificity of our test was 94%. The negative predictive value was 90,4%.ConclusionsElective neck dissection + intraoperative frozen section could be an alternative to SLNB to spot occult nodal metastases in cT1-2N0 OSCC due to the opportunity to perform a one-step diagnostic/therapeutic procedure.

Dissecting the tumor microenvironment of papillary thyroid carcinomas in primary tumor and metastatic lymph nodes at single-cell resolution.

e15182 Background: Although often well-differentiated and indolent, papillary thyroid carcinomas (PTCs) frequently metastasize to regional lymph nodes (LNs) especially in younger patients. It is unclear what factors of the local microenvironment promote LN metastases. To this end, we used single-cell RNA sequencing (scRNA-seq) to characterize the immune compartment of pair-matched primary tumor and metastatic LN samples from patients with PTC. Methods: In total, we processed 14 fresh surgical specimens from 7 patients undergoing primary total thyroidectomy and bilateral modified radical neck dissection between July 2018 and July 2019. CD45+ immune cells were isolated for library generation per 10X Genomics protocol for Single Cell 5’ v2 chemistry dual index. Data analysis was performed by Seurat and BBrowser. Differentially expressed genes were identified by Venice. Results: Pair-matched primary tumor and metastatic LN samples from 7 patients were included (mean [SD] age, 42.9 [17.4]). Histologic subtypes include classical PTC (n = 3), anaplastic (n = 2), tall cell variant (n = 1), and diffuse sclerosing variant (n = 1). The median number of positive metastatic LNs was 9 (range: 4-41) and the median number of examined LNs was 67 (range: 15-86). The majority of patients were pN1b (n = 6) or pN1a (n = 1) per AJCC 8th Edition. In total, we analyzed 26,659 individual cells by scRNA-seq, including 10,558 cells from the primary tumor and 16,101 cells from the metastatic LN. Unbiased clustering identified 6 major populations including B cells (CD79A/B, IGKC), T/natural killer (NK) cells (CD3E, CD247), myeloid cells (LYZ, FCER1G), thyrocytes (TG, EPCAM), endothelial cells (PECAM1, CD34), and fibroblasts (COL1A1/2, ACTA2). In a pooled analysis, we identified increased myeloid cells and thyrocytes within primary tumor samples. By contrast, there were increased B cells and T/NK cells within the metastatic LN samples. We found that IL7R is highly enriched by B and T/NK cells within metastatic LNs compared to primary tumor (B cells: log2 fold-change -1.26, P= 1.36x10-65; T/NK cells: log2 fold-change -1.23, P= 1.56x10-147). Further, CCL2 is significantly enriched by myeloid cells within the primary tumor compared to cells within the metastatic LN (log2 fold-change 2.16, P= 1.70x10-83). Lastly, TNFRSF12A (TWEAKR) is highly upregulated by thyrocytes within the metastatic LN as compared to cells from the primary tumor. Ongoing validation of these three targets (IL7R/FOXP3, CCL2/CD163, TNFRSF12A/PAX8) will be performed in an independent set of 25 patients with PTC with paired primary tumor-metastatic LNs. Conclusions: Collectively, our data indicate that there are increased immunosuppressive signals with the microenvironment that allow for PTC to colonize distant metastatic LNs. IL7R and TNFSRF12A may serve as a novel therapeutic target for patients with locally advanced PTC.

재발성 갑상선암 수술 중 신경 모니터링 1예

The recurrent laryngeal nerve is a critical structure that must be carefully preserved during thyroid surgery. Any injury to this nerve can result in severe complications, including hoarseness, aspiration, and respiratory difficulty. Therefore, preserving the recurrent laryngeal nerve during surgery is crucial. In patients with a history of previous thyroid surgery, identification and preservation of the recurrent laryngeal nerve can be more challenging. We report a case of 43-year-old man diagnosed with recurrent papillary thyroid cancer who had previously total thyroidectomy with bilateral central neck dissection and right modified radical neck dissection due to papillary thyroid cancer. Re-do operation was successfully done without nerve injury using laryngeal nerve monitoring with electromyogram tube.

Ameloblastoma of the Mandible With Carcinoma Transformation in a Young Adult.

Ameloblastic carcinoma (AC) is a rare and aggressive malignant epithelial odontogenic tumor making up less than 1% of malignant head and neck tumors. The majority of cases occur in the mandible with a minority occurring in the maxilla. Most occur de novo, while rare cases of AC have resulted from transformation from ameloblastoma. Here, we present a case in which a 30-year-old man presented with proptosis and a recurrent right temporal mass, which had been previously diagnosed as ameloblastoma on surgical pathology. CT findings demonstrated local invasion, and he was subsequently taken to the operating room for right craniotomy, infratemporal and middle cranial fossa tumor resection, and right modified radical neck dissection with reconstruction. Final pathology, which included areas of early focal necrosis, loss of peripheral palisading, and hyperchromatism, confirmed the diagnosis of ameloblastoma with transformation to AC. We further discuss radiologic and histopathological signs of this rare tumor, as well as recommended treatment modalities.