Presence Of Cervical Metastases Research Articles

Papillary Thyroid Microcarcinoma: Insights from a Cohort of 257 Thyroidectomized Patients.

Papillary thyroid microcarcinoma management evolved, and less aggressive strategies are now considered. Questions, however, remain on these tumors' behavior, particularly on developing countries' real ground healthcare scenarios. Our aim is to gather insights on the natural history of papillary thyroid microcarcinoma on patients treated with thyroidectomy in Brazil. Consecutive patients diagnosed with papillary thyroid microcarcinoma had their clinical characteristics, interventions, and outcomes described. Patients were classified as incidental or nonincidental based on the diagnosis after or before surgery, respectively. A sum of 257 patients were included, 84.0% of which were women, and the mean age was of 48.3±13.5 years. The mean tumor size was of 0.68±0.26 cm, 30.4% were multifocal, 24.5% had cervical metastasis, and 0.4% distant metastasis. The nonincidental and incidental tumors differed in tumor size (0.72±0.24 and 0.60±0.28 cm, respectively, p=0.003) and in presence of cervical metastasis (31.3% and 11.9%, respectively, p<0.001). Male sex, nonincidental diagnosis, and younger age were independent predictors of cervical metastasis. After 5.5 years (P25-75 2.5-9.7) of follow-up, only 3.8% of patients had persistent structural disease (3.4% cervical). Predictors of persistent disease at multivariate analysis included cervical metastasis and multicentricity. In conclusion, incidental and nonincidental papillary thyroid microcarcinoma patients of the population studied displayed excellent outcomes. Cervical metastasis and multicentricity were frequent findings and prognostic factors for persistent disease.

Impact of TNM® 8th edition on thyroid cancer retrospective staging

Introduction: Thyroid carcinoma has a global survival close to 97% in 15 years. The 8th TNM® has recently been proposed, with changes that include an increase in the cut-off age from 45 to 55 years, a change in the role of microscopic extra-thyroidal tumor invasion (which is no longer considered a criterion for the classification of T3 tumors), and the presence of cervical metastases as a criterion for staging. As a result, a large proportion of patients are transferred to earlier stages. Methods: Retrospective descriptive cross-sectional study carried out through analysis of the medical records of patients undergoing thyroidectomy at HC-UFPR from January 2014 to December 2017. Inclusion criteria were patients with a postoperative pathological anatomic diagnosis of well-differentiated thyroid carcinoma (DTC) who underwent primary surgery in the study period. Results: 197 patients underwent thyroidectomy during the period considered, 58 with thyroid neoplasia and 34 with DTC. Eight patients had lymph node metastasis, five (14.70%) as N1a and three (8.83%) as N1b. Of the total sample, six (12.5%) patients presented downstaging from the 7th to the 8th edition of the TNM®. One of the re-staged patients had bone metastasis during follow-up and died during surgery to correct a pathological fracture. Conclusion: In this study sample, the update of the TNM® in its 8th edition resulted in the downstaging of six (12.5%) patients with DTC. A longer follow-up and a larger sample are necessary to correctly assess the impact of this change on patient prognosis.

Criteria for the selection of surgical treatment in the thyroid cancer

Objective: to evaluate the procedure for the surgical management of the thyroid cancer and the criteria for the selection Patients and method: eighteen patients with cancer of thyroid programmed to surgical procedures. Results: the 83, 3% of the series was 45 years or more. No exist T1. Twelve patients were intermediate risk. Radiologic studies and the fine needle aspiration were the methods of evaluation preoperative. Total thyroidectomy was the most common surgery and the histology more frequent was papilar carcinoma. The neoplasies of 4cms or more, the frozen section and the findings in the operating room were be used to adapt the surgical plan in the 66,6% of the serie. Neck dissection was indicated in the clinics lymph nodes. Conclusions: the surgical extension depends of the tumoral size, the presence of cervical metastasis, the infiltration of adjacent structures and frozen sections. The thyroidectomy total with or without lymphadenectomy were the procedures more frequent, other intervention of salvage and palliative intention represents surgical options. The sanitary crisis determinates some problems in the therapeutic process

The role of E-cadherin and β-catenin in laryngeal cancer.

Epithelial cadherins with catenins form the E-cadherin-catenin complex that acts on cell-to-cell adhesion. The loss of these complex lead to the reduction or absence of epithelial cadherin expression in the cell membrane, cytoplasmic accumulation of β-catenin and its translocation to the nucleus, contributing to carcinogenic events. The objective of this study was to evaluate the expression of epithelial cadherin and β-catenin in patients with laryngeal tumor. A retrospective study of 52 patients with glottic or supraglottic squamous cell carcinoma was conducted and evaluated according to the tumor site, histological differentiation, TNM stage, survival analysis and compared with the immunohistochemical expression of epithelial cadherin and β-catenin. We observed statistically significant association between the epithelial cadherin expression reduction and supraglottic localization of the lesion, the presence of cervical metastasis, poorly differentiated tumors and locally advanced tumors when in glottic topography. Related to the expression of β-catenin, statistical significance was also found to the presence of cervical metastasis and tumor of low differentiation with the decreased expression of this marker. Regarding survival analysis, the low expression of β-catenin is related to worse overall survival and the reduction of expression of both markers to worse disease-free survival. We concluded that the reduction in expression of the markers studied leads to a prognostic impact as they are related to tumors with greater local aggressiveness and presence of cervical metastasis.

Is There Evidence for the Presence and Relevance of the PD-1/PD-L1 Pathway in Oral Squamous Cell Carcinoma? Hints From an Immunohistochemical Study

To examine oral squamous cell carcinoma (OSCC) specimens for programmed death ligand-1 (PD-L1) expression and presence of programmed death-1 (PD-1)-positive tumor-infiltrating lymphocytes (TILs) and to determine possible clinicopathologic implications. It was hypothesized that PD-L1 expression and PD-1-positive TIL presence in OSCC would have no clinical relevance. The authors implemented a retrospective cohort study design. The study cohort was chosen in compliance with predefined inclusion criteria. Demographic, clinical, and histopathologic data were gathered. Tissue microarrays were obtained from paraffin-embedded OSCC specimens and analyzed immunohistochemically for PD-L1 expression and PD-1-positive TIL infiltration. PD-L1 positivity of OSCC specimens served as the predictor variable and neck node metastasis served as the primary outcome variable. Descriptive and inferential statistics were computed and the significance level was set at a P value less than or equal to .05. The study sample was composed of 88 patients (48 men, 40 women; mean age, 61.34yr). Marked PD-L1 expression was detected in 29% of OSCC specimens (26 of 88) and 83% of specimens (73 of 88) exhibited a high rate of PD-1-positive TIL infiltration. PD-L1 positivity of OSCC samples was significantly associated with the anatomic origin of OSCC (P= .039), presence of cervical metastasis (P= .039), and high PD-L1-positive TIL infiltration (P= .033). A considerable proportion of OSCCs exhibited marked PD-L1 expression. This could be associated with clinical parameters. PD-L1 expression in OSCC might differ depending on its anatomic origin. PD-1-positive TILs could be detected in most OSCC specimens. These findings might indicate a potential role for the PD-1 and PD-L1 pathway in OSCC.

Accuracy of MRI in Prediction of Tumour Thickness and Nodal Stage in Oral Tongue and Gingivobuccal Cancer With Clinical Correlation and Staging.

Squamous cell carcinoma of lower gingivo-buccal complex and tongue are the most common cancer in the Indian sub-continent. The value of imaging in the staging of Oral Squamous Cell Carcinoma (OSCC) is in judging operability, assessment of the prognostic characteristics and dimensions of the primary tumour, depth of tumour invasion, the presence of cervical metastasis and detection of bone infiltration. This study evaluated squamous cell carcinomas of the oral cavity (tongue and gingivo-buccal complex) on the basis of their appearance, soft tissue extent, depth of tumour invasion and staging. Further, this study assessed the accuracy of MRI in the detection of cervical lymph nodal metastasis on the basis of ADC values on diffusion weighted MR sequence. T1- and T2-weighted MR, diffusion-weighted sequences and post contrast T1W sequences were performed in various planes on biopsy proven squamous cell carcinomas (61 cases) involving tongue and/or gingivo-buccal region. Depth of tumour invasion was calculated on axial images of post contrast T1W images. The Apparent Diffusion Coefficient (ADC) was measured by using two b factors (500 and 1000 s/mm(2)). MRI findings were compared clinically and histopathologically. Average depth of invasion calculated on MRI was 8.47mm and by histopathology was 6.85mm. Pearson's correlation coefficient was 0.988. Shrinkage factor was 0.8. A 71% of patients with depth of invasion greater than 9mm showed evidence of cervical lymph nodal metastasis at one or another levels. Cut-off value to discriminate between malignant and benign lymph nodes was 1.038 x10-3 mm(2)/s in the present study. Depth of tumour invasion in oral malignancies can be measured reliably on MRI which helps in predicting cervical lymph node metastasis. Benign or malignant cervical lymph nodes can be differentiated on diffusion-weighted imaging of MRI on the basis of their ADC values.

Correlation between vascular endothelial growth factor expression and presence of lymph node metastasis in advanced squamous cell carcinoma of the larynx

IntroductionSquamous cell carcinoma is the most common neoplasm of the larynx, and its evolution depends on tumor staging. Vascular endothelial growth factor is a marker of angiogenesis, and its expression may be related to increased tumor aggressiveness, as evidenced by the presence of cervical lymphatic metastases. ObjectivesTo evaluate the expression of the vascular endothelial growth factor marker in non-glottic advanced squamous cell carcinoma of the larynx (T3/T4) and correlate it with the presence of cervical lymph node metastases. MethodsRetrospective clinical study and immunohistochemical analysis of vascular endothelial growth factor through the German scale of immunoreactivity in products of non-glottic squamous cell carcinomas. ResultsThis study analyzed 15 cases of advanced non-glottic laryngeal tumors (T3/T4), four of which exhibited cervical lymphatic metastases. There was no correlation between vascular endothelial growth factor expression and the presence of cervical metastases. ConclusionAlthough vascular endothelial growth factor was expressed in a few cases, there was no correlation with the spread of cervical lymph metastases.

High expression of S100A4 and endoglin is associated with metastatic disease in head and neck squamous cell carcinoma

The presence of cervical metastasis is responsible for high morbidity and mortality rates in individuals with head and neck squamous cell carcinoma (HNSCC). S100A4, a pleiotropic EF-hand calcium-binding protein, is expressed in various normal and cancer cell types. During cancer progression, molecular disturbances in S100A4 can modulate the activity and expression of pre-metastatic and metastatic genes. In this study, we investigated the association between S100A4 methylation status and protein expression as well as the expression of the S100A4 related-proteins annexin A2 (ANXA2), matrix metallopeptidase-9, and endoglin, for metastasis and other clinicopathological parameters in HNSCC. Formalin-fixed, paraffin-embedded blocks of metastatic and non-metastatic HNSCC and matched cervical lymph node (LN) samples (metastatic LN=mLN, non-metastatic=nmLN, and control LN (lymphadenitis)=cLN) were submitted for methylation specific-polymerase chain reaction and immunohistochemistry. Our results showed that S100A4 methylation status failed to demonstrate association with cervical metastasis and other clinicopathological factors related to HNSCC. HNSCC samples from patients that presented with metastatic disease showed high S100A4 and endoglin expression (p<0.05). In conclusion, molecular disturbances in S100A4 and endoglin expression might regulate the formation of cervical metastasis in HNSCC.

Enlarged lymph nodes in head and neck cancer: Analysis with triplex ultrasonography

Background:Presence of cervical metastasis is one of the factors influencing the outcome of patients with carcinoma of the head and neck, its early detection is potentially very important. Triplex ultrasonography technology have definitive role in detecting clinically undetectable involvement of lymph nodes (LNs). The purpose of this study was to evaluate, whether triplex ultrasonography characterization of cervical LNs could, with an acceptable degree of certainty, differentiate malignant from benign/reactive LNs, in order to prevent invasive diagnostic procedures.Materials and Methods:A total of 50 patients with oral cancer, were subjected to ultrasonographic investigation of the neck for grayscale, color flow imaging, and pulsed Doppler. All the parameters were compared with histopathologic examination. Correlation was then made between ultrasound and Doppler investigation and histopathology results to evaluate the sensitivity specificity, positive predictive value (PPV) and negative predictive value (NPV) of color Doppler ultrasonography in detecting metastatic neck nodes.Results:Study results showed that malignant LNs, especially metastatic nodes, are accompanied with significantly high resistive index (RI) and pulsatility index (PI) values, rounded shape, size, loss of central hilar echogenicity and peripheral vascularity. Among these sonographic findings, nodal shape (longitudinal nodal diameter to transverse diameter ratio or L/T ratio), RI and PI values were more accurate for differentiating benign from malignant LNs.Conclusion:In this study, triplex sonographic findings had relatively high accuracy in differentiating benign from malignant cervical LNs. Ultrasound hence can be recommended for initial non-invasive evaluation of the neck in patients with oral cancers with or without palpable cervical lymph nodes.

The platysma myocutaneous flap (PMF) for head and neck reconstruction: A retrospective and multicentric analysis of 91 T1–T2 patients

The platysma myocutaneous flap (PMF) was first applied to intraoral reconstructions in 1978. PMF is not only an alternative to microvascular flaps but it also represents an excellent reconstructive choice especially in cases where free tissue transfer cannot be carried out.Failure and complications rate have been described as varying from 18 to 45% and this is why this flap should not be used in specific cases such as in the presence of cervical metastases and in cases of mandibulectomy and simultaneous reconstruction with alloplastic materials.The purpose of this study is to examine the experience and results obtained in three different and independent institutes where PMF has been adopted in 91 patients for head and neck cancer reconstructions.The authors report their departments’ separate but simultaneous experiences with PMF for small and middle-size soft tissue defects in a 10-year period.

Analysis of ECOG performance status in head and neck squamous cell carcinoma patients: association with sociodemographical and clinical factors, and overall survival

In the present study, we analyzed sociodemographical and clinical factors, and the Eastern Cooperative Oncology Group performance status (ECOG-PS) scale in head and neck squamous cell carcinoma (HNSCC) patients. We evaluated the impact of a range of variables on overall survival. We investigated a sample of HNSCC patients (n = 671), using sociodemographical and clinical information, and survival data collected from a review of epidemiological, clinical, and treatment reports. Statistical associations were analyzed by bivariate and multivariate statistical tests. Statistical significance was set at p < 0.05. Of patients 85.4% recorded good ECOG-PS scores. Poor ECOG-PS scores were associated with the covariates indicative of dysphagia [odd ratios (OR) = 2.660, CI 95% = 1.661–4.260, p = 0.000] and large-size malignant disease (T3–T4; OR = 5.337, CI 95% = 2.251–12.652, p = 0.000). Overall survival analysis revealed that ECOG-PS scores (OR = 1.879, CI 95% = 1.162–3.038, p = 0.010), tumor size (OR = 1.665, CI 95% = 1.035–2.680, p = 0.036), and the presence of cervical metastasis (OR = 3.145, CI 95% = 2.008–4.926, p = 0.000) were independent predictors. Evaluation of physical consumption in head and neck cancer patients at diagnosis may indicate a more aggressive type of malignant disease. Thus, the ECOG-PS scale may help to identify HNSCC patients in need of rapid referral, who may benefit from specific therapeutic and rehabilitative interventions.

Role of ultrasound in detection of metastatic neck nodes in patients with oral cancer

Head and neck cancer is one of the most physically and emotionally devastating cancers and often leaves the patient disabled and disfigured. The presence of cervical metastasis is one of the factors that influence the outcome of the patients. Cervical lymph node metastasis plays an essential role in the treatment and prognosis of head and neck cancer patients. The assessment of the cervical lymph node status still remains an unsolved problem. We conducted a study to compare the diagnostic accuracy of clinical palpation and ultrasonogram (USG) in the detection of metastatic cervical nodes from oral squamous cell carcinoma patients. Ten patients (age range, 45-63 years; mean age, 54 years) with squamous cell carcinoma in the head and neck region underwent clinical palpation and USG. The results of each modality were analyzed for sensitivity, specificity, positi ve predictive value, negative predictive value and accuracy. Pathologic analysis of the surgical resection served as the reference standard. USG yielded a sensitivity, specificity, positive, negative predictive value and accuracy as 85.7%, 90%, 92.3%, 81.8% and 87.5% whereas clinical palpation yielded a sensitivity, specificity, positive, negative predictive value and accuracy as 68.7%, 87.5%, 91.6%, 58.3% and 75%. USG is a reliable and valuable tool for metastatic lymph node screening in head and neck cancer patients. It is a cheap, noninvasive, easy-to-handle and cost-effective diagnostic method. USG performed better than clinical palpation in detecting cervical metastatic nodes.

Medullary Thyroid Cancer: A Retrospective Analysis of a Cohort Treated at a Single Tertiary Care Center Between 1970 and 2005

To identify prognostic factors of clinical outcome and long-term survival in medullary thyroid cancer (MTC). Retrospective case series of 51 consecutive patients (mean age 46.9 years, 57% female) treated at a single tertiary university medical center from 1970 to 2005. Medical records were reviewed for demographic data, laboratory and clinical course, treatment, and long-term outcome. At presentation, 25 patients (49%) had local disease and 26 (51%) had metastatic disease (three with distant metastases). RET mutations were identified in nine of 23 patients tested. The patients with hereditary disease were younger than the patients with sporadic disease (p < 0.001) and had lower calcitonin levels at diagnosis (p = 0.004) and more multicentric tumors (p = 0.02). Initial surgery consisted of total thyroidectomy in 47 patients, with neck dissection in 26; 22 patients achieved long-term remission. The 5-, 10- and 15-year survival rates were 88%, 85%, and 77%, respectively. On univariate analysis, distant metastases during the course of the disease and elevated calcitonin levels postoperatively were significant prognostic factors of reduced survival (p = 0.001 and 0.016, respectively). Lymph node involvement at initial surgery was associated with a lower remission rate (p = 0.016) but had no impact on long-term survival (p = 0.269). Patients with MTC have a generally favorable outcome, perhaps owing to recent advances in diagnosis and treatment. Although postoperative serum calcitonin level and distant metastases are the only determinants of long-term survival, the presence of cervical metastases is predictive of a higher risk of recurrent or persistent disease.

Metástase cervical nos tumores malignos da parótida

OBJETIVO: Analisar fatores que influenciam a ocorrência de metástase linfática cervical e a sobrevida nos tumores malignos epiteliais da glândula parótida. MÉTODO: Analisamos retrospectivamente os prontuários de 150 pacientes tratados em nossa instituição de 1974 a 1998. Vinte e quatro pacientes foram excluídos do estudo por não terem sido tratados primariamente por cirurgia. O 126 pacientes restantes foram submetidos a parotidectomia e incluídos neste estudo. Setenta e quatro pacientes tiveram sua cirurgia complementada por radioterapia pós-operatória. Trinta e quatro pacientes foram submetidos ao esvaziamento cervical associado a parotidectomia. A idade média foi de 49 anos. Todos os pacientes foram estadiados pela Classificação TNM da UICC de 1997, sendo 49 pacientes estágio I, 27 estágio II, 22 estágio III, and 28 estágio IV. A influência dos fatores analisados na ocorrência de metástase cervical foi estabelecida pelo teste do chi quadrado e por análise multivariada. A influência de fatores prognósticos na sobrevida específica de doença (SED) em 5 e 10 anos foi estabelecida pelo método de Kaplan-Meier e pelo teste log-rank. RESULTADOS: O tipo histopatológico de 40 pacientes foi o carcinoma mucoepidermóide, de 18 pacientes o adenocarcinoma (SOE), de 18 pacientes o carcinoma de células acinares, de 15 pacientes o carcinoma adenóide cístico, de 11 pacientes o carcinoma exadenoma pleomórfico, de 11 pacientes o carcinoma de ducto salivares, e de 13 pacientes outras histopatologias. Vinte e cinco pacientes apresentaram recidivas, 17 recidivas locais, quatro recidivas regionais, e quatro recidivas loco-regionais. A incidência geral de metástase linfática cervical foi de 17,5%. Metástases linfáticas cervicais ocultas ocorreram em cinco pacientes daqueles submetidos a esvaziamento cervical profilático. A presença de paralisia facial no diagnóstico, a idade, o estágio T, e o grau de malignidade foram relacionados a ocorrência de metástase linfática cervical na análise multivariada. Cinco fatores influenciaram negativamente o prognóstico, estágio T3-T4, alto grau de malignidade, presença de metástase cervical, paralisia facial no diagnóstico, e idade acima de 50 anos. A SED em 10 anos foi de 97% para o estágio I, 81% para o estágio II, 56% para o estágio III, e 20% para estágio IV. CONCLUSÕES: O grau de malignidade e o estágio foram os fatores prognósticos mais importantes. Apesar de ser um estudo retrospectivo e não randomizado, nossos dados sugerem que o esvaziamento cervical profilático deve ser considerado em casos de tumores de alto grau de malignidade, estágio T3-T4, e na presença de paralisia facial no diagnóstico.

Is Selective Neck Dissection Adequate Treatment for Node-Positive Disease?

Selective neck dissection, or the selective removal of nodal groups at risk for harboring cervical metastases, is an extension of the concept of the functional neck dissection first introduced in the 1960s. Until 1963, radical neck dissection (RND) was the standard surgical treatment of the cervical lymphatic nodes. In 1963 Suarez proposed a conservative, functional approach to neck dissection that was popularized by Bocca et al. These authors described the removal of cervical lymph nodes from levels I through V with their enveloping fascial sheath while sparing nonlymphatic anatomic structures adjacent to, but not containing, lymph nodes, such as the accessory nerve, internal jugular vein, and sternocleidomastoid muscle. The resulting modified RND (MRND) has been shown to avoid the cosmetic and functional morbidity associated with the classic RND without compromising oncologic safety or efficacy as a staging and therapeutic procedure. Various modifications of the functional or MRND have been proposed for the elective treatment of the clinically negative neck (cN0) when surgical treatment of the primary tumor is planned and the risk of occult metastases is greater than 20%. Selective neck dissections are based on the observation that tumors of the upper aerodigestive tract drain to predictable nodal levels according to the site of the primary tumor, and that a comprehensive neck dissection encompassing all 5 nodal levels may therefore be unwarranted. The incidence of occult metastases in the cN0 neck exceeds 20% for tumors arising from the oral cavity, oropharynx, hypopharynx, and supraglottic larynx. The presence of cervical metastases is associated with a poorer prognosis. Accurate detection of occult metastases is difficult, as approximatively 50% of occult metastases are less than 5 mm and missed on physical and radiologic examination. Extracapsular spread may be present in as many as 50% of patients with occult metastases. If neck dissection is performed therapeutically when neck disease becomes clinically apparent, survival and surgical salvage rates are significantly decreased. An appropriately selected SND, which removes lymph nodes only at the levels likely to harbor metastatic disease, provides important prognostic information and, in some circumstances, may be therapeutic. In a review of 1119 RNDs performed electively for cN0 neck disease and therapeutically for clinically node-positive neck disease, Shah found that occult metastases were present in 33% of elective neck dissections and that level V was never involved in the absence of involvement of other nodal levels. Levels I, II, and III were at greatest risk for nodal metastases from squamous cell carcinoma of the oral cavity, and levels II, III, and IV were at greatest risk for metastases from carcinomas of the oropharynx, hypopharynx, and larynx. These findings support the use of supraomohyoid neck dissection (removing lymph nodes from levels I through III) for patients with cN0 oral cavity tumors in cN0 patients and anterolateral neck dissection (removing lymph nodes from levels II through IV) in patients with cN0 tumors of the oropharynx, hypopharynx, and larynx. Byers et al have shown that “skip metastases” to level IV occur in 16% of patients with squamous cell carcinoma of the oral tongue and advocate removal of level IV nodes as part of SND for oral tongue cancer. The regional recurrence rate following SND alone in patients with histologically negative nodes (pN0) is approximately 5%, which compares favorably with the rate in patients undergoing MRND for clinically and histologically negative nodal disease. It is generally accepted that SND is as effective as comprehensive neck dissection in staging the cN0 neck and is adequate treatment for the pN0 neck. The therapeutic efficacy of SND in patients with pathologic node-positive neck disease, however, is more controversial. Data Christine G. Gourin, MD

Maxillary bone invasion by gingival carcinoma as an indicator of cervical metastasis.

To evaluate the significance of maxillary bone invasion by gingival carcinoma as an indicator of cervical metastasis. Twenty-one patients with squamous cell carcinoma of the upper gingiva were included in the study. The extent of bone invasion was assessed by dental CT. Six patients had cervical metastases at the initial examination and eight more developed them during the 2-year follow-up period. The relationship of cervical metastases with age and gender of these patients, as well as with the size of the lesion and extent of bone invasion, was examined by logistic multivariate regression analysis. There was a significant relationship between the presence of bone invasion and the presence of cervical metastasis (P<0.05). Maxillary bone invasion is an indicator of cervical metastasis in gingival carcinoma.

Risk factors associated with hypothyroidism after laryngectomy

Hypothyroidism is a well-documented complication after treatment of head and neck cancer and is particularly significant among patients undergoing laryngectomy. The objective of this study was the identification of factors associated with the development of hypothyroidism in this population. Records of 136 patients treated with laryngectomy were retrospectively reviewed in an attempt to define a risk factor profile for patients in whom hypothyroidism is most likely to develop after laryngectomy. The Cox proportional hazards model was used to identify factors significantly related to an increased risk for development of hypothyroidism. The actuarial method was used to estimate the period of greatest risk for the development of hypothyroidism. Increased risks were found for patients who were female ( P = 0.0049), received preoperative radiation therapy ( P = 0.0022), had invasion of the thyroid gland by tumor ( P = 0.0003), had presence of cervical metastases ( P = 0.0022), and had postoperative fistula ( P = 0.0095). From the actuarial method, we estimated that the period of time when patients were at greatest risk for development of hypothyroidism was between 0 and 14 months after surgical intervention. Wound complications were twice as frequent in hypothyroid patients. Perioperative awareness of risk factors associated with the development of hypothyroidism in patients undergoing laryngectomy allows for early recognition and management of hypothyroidism and may reduce the number of complications related to wound healing and fistula. (Otolaryngol Head Neck Surg 2000;123:211–7.)

頚部転移巣から発見された甲状腺微小癌症例

Papillary microcarcinomas (PMCs) which are 1.0cm or less in diameter are a specific subgroup of thyroid cancer. As the prevalence of these tumors found in autopsy cases was reported to be 10 to 28.4% in Japan, the necessity of surgical treatment of PMCs has been questioned. However, PMCs are often found in conjunction with advanced metastases in cervical lymph nodes, lung, etc..We reviewed eight cases with PMCs revealed by the presence of cervical metastases over the past 10 years. Five cases were revealed by manifest cervical lymph node metastases. Two of the other three cases were operated on for treatment of metastatic lesions subsequent to other diagnoses, notably a parotid tumor and lateral cervical cyst. The PMCs were revealed in a postoperative histological study of these two cases. The remaining case was discovered incidentally during neck dissection for laryngeal cancer. Preoperative ultrasonography was undertaken in seven cases. Two cases showed multif ocal small high echoic spots without tumors and one case showed no abnormal findings in the thyroid.In all cases, total thyroidectomy, unilateral or bilateral neck dissection and postoperative radioiodine scintigraphy were performed. Multifocal tumors in the thyroid were proven histologically in four cases. In one case, the primary lesion was not found even in a postoperative histological study.In accordance with these observations, PMCs revealed by cervical metastases shoul be treated as advanced thyroid carcinomas.

DNA ploidy as a predictor of cervical metastasis in advanced squamous carcinoma of the tongue.

Flow cytometric analysis of nuclear DNA content was performed in 34 squamous cell carcinomas of oral cavity and base of tongue tumours using archived paraffin-embedded tissues. The DNA content was correlated with the presence of cervical metastasis. Ten and 24 patients were classified as early (I & II) and advanced (III & IV) clinical stages, respectively. The DNA index (DI) was grouped into diploid (DI 0.85-1.15) and non-diploid. Seven (70%) tumours were non-diploid in clinical stages I & II. Four out of 7 (57%) developed initial and late cervical lymph node metastasis (p > 0.05). There were 15 (62.5%) non-diploid tumours in clinical stages III & IV. Thirteen out of 15 (86.7%) had cervical lymph node metastases (p < 0.05). However, the survival period and the incidence of recurrent disease for the whole group did not show any association with DNA ploidy. Our results suggest that DNA content may be useful as a reliable predictor of regional metastasis in advanced stage carcinoma of the tongue.

Squamous cell carcinoma of the lip.

We reviewed 117 consecutive patients with squamous cell carcinoma of the lip. The retrospective review includes age, race, location, risk factors, TNM classification, histologic differentiation, treatment methods, recurrent disease, site of recurrence, and follow-up status. Results reveal prognosis is related to original tumor size, location, local recurrence, histologic grade, and presence of cervical metastasis. The presence of cervical lymph node disease reduces the survival from 90 to 50 percent; the survival after recurrent disease to the neck is 10 percent. When a prophylactic suprahyoid neck dissection shows involvement with tumor, 83 percent of patients have metastasis to cervical lymph nodes. The overall recurrence rate is 20 percent. Over 60 percent of the recurrent disease is due to tumors less than 4 cm in diameter. The local recurrence rate is 7 percent, but reexcision of the local recurrence gives a 75 percent cure rate. Aggressive surgical treatment is recommended for identifiably poor prognostic lesions and includes surgical excision, prophylactic suprahyoid neck dissection, and possible radical neck dissection.