Surgical Neck Dissection Research Articles

Island Nasolabial Flap for Tongue Reconstruction: Locoregional Flap of Choice and an Alternative to Free Flap for Tongue Cancer.

Reconstruction following excision for tongue cancer carries important functional consequences. Island nasolabial flap (NLF) is robust and oncologically safe and has a good functional outcome, identical to free flap reconstruction. We retrospectively analyzed the data of 11 tongue cancer patients operated between January 2019 and August 2019. Surgical resection and neck dissection followed by immediate reconstruction by island NLF were done. Post-operative functional outcome assessed using the University of Washington Quality of Life Questionnaire. Age of patients ranged between 39 and 70years. All patients had either T2 or T3 tongue cancer. No incidence of flap necrosis noted in any patient. On an average, all were discharged between 3rd and 5th post-operative days. Cosmetic and functional outcomes were satisfactory in all patients. Island nasolabial has an excellent reach and can reach any part of the oral cavity, even to the contralateral side and base of the tongue. It has an excellent post-operative tongue function, almost equivalent to free flap. Hence, it should be considered locoregional flap of choice for tongue reconstruction.

Evaluation of Tubercular Cervical Lymphadenopathy: Diagnostic and Therapeutic Utility

Introduction: Lymphadenitis is the most common extrapulmonary manifestation of tuberculosis. It remains both diagnostic and therapeutic challenge as not only mimics other diseases but also inconsistent physical and laboratory findings. Diagnosis is difficult often requiring biopsy.
 Aim: Aim of the study was to evaluate the role of surgical dissection of tuberculous cervicle lymphadenopathy for diagnosis as well as therapeutic purpose.
 Methods: This observational study was conducted during the time period of 01 july 2015 to 30 june 2017 in ENT & Pulmonology department, combined military hospital Dhaka on 100 patients who have undergone surgical neck dissection.
 Result: In our study total 100 patients were biopsied. Among them 56 patient was diagnosed as tubercular lymphadenitis after lymphnode excision biopsy. Among them 47 tubercular lymphadenitis patient responded to ATT (CAT-1), only 2 patient developed cold abscess which required further surgery. Six patient showed relapse during follow-up and 9 patient did not respond to CAT-1 treatment (treatment failure). Surgical intervention along with CAT-2 treatment showed cure in all of them. 2nd surgical interventions were done in total 17 patients, 2 TB abscess during ATT (CAT-1 HRZE), 9 treatment failure patients and 6 relapse patients along with ATT (CAT-2 SHRZE) and all these patients had no relapse or treatment failure during further follow up.
 Bangladesh J Otorhinolaryngol; October 2017; 23(2): 127-132

Extranodal Extension as an Independent Prognostic factor in Laryngeal Squamous Cell Carcinoma Patients.

The presence of Lymph node metastasis with extranodal extension (ENE) is considered to be an important adverse prognostic factor for survival in patients with head and neck cancer. The aim of this study was to determine the prognostic significance of ENE in patients with laryngeal squamous cell carcinoma (LSCC). Three hundred and fifty-five patients with LSCC who underwent surgical resection and neck dissection were included. The status of cervical lymph node was classified into three groups: pathological negative nodal (pN-), pathological positive nodal without ENE (ENE-), and pathological positive nodal with ENE (ENE+). A total of 85 of 355 (23.9%) LSCC were pathological nodal positive, and ENE was detected in 22/355 (6.2%) patients. ENE was associated with drinking (p=0.005), T stage (p=0.000), tumor location (p=0.000), and differentiation degree (p=0.000). The number of lymph node metastasis in ENE+ group was associated with almost twice compared to ENE- group (p=0.005). The 5-year overall survival rates for patients in the pN-, ENE-, and ENE+ groups were 86.4±2.6%, 75.9±6.3%, and 53.7±12.7%, respectively (p=0.000). After adjusting for confounding variables, ENE+ was associated with more than five times the hazard of death than pN- cases (p=0.000), and more than twice the hazard of death than ENE- cases (p=0.036). Compared to N2-3/ENE- cases, N2-3/ENE+ cases had the poorest survival rate (p=0.013). ENE+ was associated with worse outcomes compared to pN - or ENE- status. ENE is an independent prognostic factor in LSCC, and could be an indicator of the need for adjuvant treatment.

Musculoskeletal Disorders of the Cervical Spine Following Neck Dissections Due to Malignancies of the Head And Neck

Neck dissections are surgical interventions aiming the removal of lymph nodes from specific areas of the neck, together with non-lymphatic structures falling within the scope of the operation – m. sternocleidomasstoideus (MSCM), v. jugularis interna (VJI), n. accessorius (N.XI). Due to the involvement of important anatomical structures in the neck dissections, postoperative outcoomes and complications associated with impaired function of the musculoskeletal system of the neck arise.
 The purpose of the present study is to determine the degree of cervical spine movements depending on the volume of surgical neck dissection.
 Methods. The goniometry method was used to evaluate the motor function of the operated patients. The results obtained were analyzed via SPSS Vers23.0.
 Results. A statistically significant difference was observed postoperatively at the 3rd month in all directions of movement studied in the three groups of operative interventions (neck dissections): flexion – F(2,65)=643.566, p<0.001; extension – F(2,65)=445.045, p<0.001; lateral flexion – F(2,65)=314.077, p<0.001; rotation – F(2,65)=121.980, p<0.001.
 Conclusion. Assessment of the cervical spine shows that all directions of movement are affected, most significantly affecting lateral flexion in all groups of operated patients with neck dissection.

An Anatomical Feasibility Study Using a Great Auricular Nerve Graft for Ipsilateral Inferior Alveolar Nerve Repair.

The great auricular nerve (GAN) has been used for trigeminal and facial nerve repair and the inferior alveolar nerve (IAN) are often sacrificed during segmental mandibulectomy. To our knowledge, only 1 case report has discussed IAN repair using GAN after segmental mandibulectomy. The goal of this study is to clarify the feasibility of using GAN for IAN repair. Eleven sides from 6 fresh frozen Caucasian cadavers were used for this study. The mean age at the time of death was 82.3 years. A submandibular skin incision was made 2 finger breadths below and parallel to the inferior border of the mandible. The GAN was identified and then the mental foramen was found via extraoral dissection. The buccal cortical bone was removed 5 mm posterior to the mental foramen to the wisdom tooth area. Next, the anteroposterior length of the window was measured. The diameter of the IAN at the first molar tooth area was measured. Finally, the GAN was cut with maximum available length to compare to the length of the window in the mandible. The anteroposterior length of the window and diameter of the IAN ranged from 23.1 to 31.2 mm and 1.2 to 2.1 mm, respectively. The length of the available GAN was longer than the ipsilateral bony window of the mandible on all sides. This study might encourage surgeons to consider a new way to treat patients who undergo segmental resection of the mandible with surgical neck dissection with injury to their IAN.

Development and Assessment of a Novel Composite Pathologic Risk Stratification for Surgically Resected Human Papillomavirus–Associated Oropharyngeal Cancer

Human papillomavirus-associated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) is a distinct form of head and neck squamous cell carcinoma (HNSCC) with its own American Joint Committee on Cancer staging system. However, pathologic risk stratification for HPV+ OPSCC largely remains based on the experience with HPV-unassociated HNSCC. To compare the survival discrimination of traditional pathologic risk stratification for both HPV+ OPSCC and HPV-unassociated HNSCC and derive a novel pathologic risk stratification system for HPV+ OPSCC with improved survival discrimination. In this retrospective cohort study, we used the National Cancer Database to identify 15 324 patients diagnosed with nonmetastatic HNSCC between January 1, 2010, and December 31, 2013, who were treated with upfront surgery and neck dissection. We compared traditional pathologic risk stratification for HPV+ OPSCC and HPV-unassociated HNSCC and then derived a novel pathologic risk stratification system. Analyses were performed from July 1, 2018, to January 31, 2019. Definitive primary surgical resection and neck dissection. Survival discrimination of pathologic risk stratification systems measured with concordance indices. This retrospective cohort study included 15 324 patients (10 779 men and 4545 women; mean [SD] age, 59.9 [11.8] years) with surgically treated nonmetastatic HNSCC. Separation of survival curves for HPV-unassociated HNSCC using traditional pathologic risk stratification (5-year overall survival for the low-, intermediate-, and high-risk groups) were 76.2%, 54.5%, and 40.9%, respectively. Separation curves for HPV+ OPSCC were 93.2%, 88.9%, and 83.7%, respectively. Human papillomavirus-unassociated HNSCC had a concordance index of 0.68, whereas HPV+ OPSCC had a concordance index of 0.58. A novel risk stratification system for HPV+ OPSCC that more closely fits actual survival rates for HPV+ OPSCC was derived. The system incorporated the composite number of pathologic adverse features. This composite risk stratification system was associated with an improved concordance index of 0.67 for HPV+ OPSCC. Adjuvant treatment with radiation was not associated with improved survival for patients categorized as low risk according to the new risk stratification system, but this treatment was associated with improved survival for patients in the intermediate- and high-risk groups. Traditional pathologic risk stratification shows poor survival discrimination for HPV+ OPSCC and classifies many patients with an excellent prognosis as high risk. We derived a novel composite pathologic risk stratification system for HPV+ OPSCC that may be associated with improved survival discrimination.

Differentiation Between Benign and Metastatic Cervical Lymph Nodes Using Ultrasound.

Purpose:The oral cavity is the most common site for squamous cell carcinoma, which has a distinct predilection for lymphatic spread before distant systemic metastasis. The cervical lymph node status is a very important consideration in the assessment of squamous cell carcinoma. Ultrasound is a noninvasive and inexpensive technique that can be used to differentiate between the benign and metastatic nodes. So the aim of this study was to evaluate reliability of ultrasound for such differentiation and to correlate them with histopathological finding.Materials and Methods:A total of 200 lymph nodes from 38 patients histopathologically proven for oral squamous cell carcinoma who underwent surgical neck dissection were considered. The patients underwent ultrasound examination of cervical lymph nodes prior to surgical neck dissection. The lymph nodes were differentiated into benign and metastatic based on the assessment of size, shape, shortest diameter/longest diameter (S/L ratio), margin, and internal architecture, and also the internal echo structure of the lymph nodes and histopathological findings were analyzed.Results:On correlation of ultrasonographic diagnosis with histopathological evaluation for metastatic lymph nodes, the overall accuracy of ultrasonographic analyses was 77.83%, and the sonographic criterion of irregular margin showed the highest predictability followed by the size. The correlation of internal echo structure with histopathological findings was highly variable.Conclusion:The ultrasound parameters such as size, shape, margin, S/L ratio, and internal echo structure might assist in differentiation between benign and metastatic lymph nodes. Combining these findings should raise the accuracy, as each sonographic parameter has some limitation as a sole criterion.

Quantitative lymph node burden as a 'very-high-risk' factor identifying head and neck cancer patients benefiting from postoperative chemoradiation.

Adjuvant chemoradiation (CRT) is standard for head and neck squamous cell carcinoma (HNSCC) patients with positive margins or extranodal extension (ENE) following surgery. However, emerging evidence suggests the number of positive lymph nodes (LNs) is the dominant determinant of survival in non-oropharyngeal HNSCC and thus may better identify those benefiting from treatment intensification. Patients from the National Cancer Database diagnosed with non-oropharyngeal HNSCC (oral cavity, larynx, hypopharynx) between 2004 and 2014 and undergoing surgical resection, neck dissection, and postoperative radiotherapy (RT) were included. Multivariable regression with first-order interaction terms was used to model the interaction between postoperative CRT and continuous number of positive LNs with respect to overall survival. In total, 7144 patients met inclusion criteria. In multivariable analysis, increasing number of positive LNs was associated with both increasing mortality (P < 0.001) and increasing benefit from postoperative CRT versus RT alone (interaction P < 0.001). While there was no benefit from postoperative CRT in patients with 0-2 LN+ [hazard ratio (HR) 0.96, 95% confidence interval (CI) 0.86-1.07, P = 0.47], increased benefit was seen in those with 3-5 LN+ (HR 0.84, 95% CI 0.70-1.00, P = 0.05) and those with ≥6 LN+ (HR 0.65, 95% CI 0.51-0.82, P < 0.001) in multivariable models. By contrast, margin status and ENE did not reliably identify patients benefitting from postoperative CRT based on statistical tests of interaction. Even in patients with ENE, positive margins, or both, only those with ≥6 LN+ had improved survival with postoperative CRT. Increasing metastatic nodal burden was associated with increased benefit from CRT compared with RT alone, surpassing conventional high-risk factors in identifying patients benefiting from CRT. Stratification by metastatic LN number may characterize a very-high-risk patient cohort best suited for treatment intensification.

Assessment of morphological parameters associated with neural invasion in oral squamous cell carcinoma.

Aims:Neural invasion (NI) is a form of tumor spread distinct from lymphatic and vascular invasion. It has been correlated with aggressive behavior, disease recurrence and increased morbidity and mortality. Despite the importance of NI as a prognostic indicator, the mechanism and associated factors are poorly understood. Hence, the aim of this study was to determine morphological parameters associated with NI in oral squamous cell carcinoma (OSCC).Methodology:One hundred and five archival specimens of patients with primary OSCC who underwent surgical excision and radical neck dissection were included in the study. The presence of NI was analyzed in slides and correlated with clinical as well as morphological parameters using univariate and multivariate analysis.Results:NI was identified in 31 cases (29%) of OSCC. NI was significantly associated with tobacco habit, lymphovascular invasion and positive surgical margins. Multivariate analysis further emphasized these factors to be significant risk factors for NI. Peri-NI and intra-NI significantly associated with the size of the tumor, while the distance of invasion was associated with advanced stage.Conclusion:NI is associated with multiple morphological parameters and its identification may have a significant impact on the management and prognostic evaluation of OSCC.

Clinical behaviours and prognoses of high- and low-risk parotid malignancies based on histology.

To report 5-year survival in patients with primary parotid malignant tumours and assess the impact of various factors on survival or local control among diverse histologic groups. A total of 65 patients with primary parotid malignant tumours who had surgery between 2003 and 2014 were identified. Demographic characteristics including age, T stage, N stage and clinical or pathological performance were analysed. According to risk stratification (based on pathology), 65 primary parotid malignant tumours were divided into high-risk (23, 35.38%) and low-risk (35, 53.85%) groups. Overall survival (OS) and disease-free survival (DFS) were recorded by the Kaplan-Meier methods. The 5-year overall survival rate for primary parotid malignant tumours was 70.9%. Patients older than 60years with fixed mass, pain, facial-nerve palsy and high-grade N stage had adverse OS and DFS. Upon multivariable analysis, facial-nerve palsy (HR 24.59; 95% CI 2.338-178.446; P = 0.002) was the only independent predictive factor for OS. Patients with high-risk parotid malignant types were more likely to have tumour pain, facial-nerve palsy (Chi-square test: < 0.0001 and 0.02), lymphatic metastasis and local/regional recurrence (Chi-square test: 0.008 and 0.012). Compared with low-risk parotid carcinoma, tumours with high-risk histological features tend to need aggressive surgical extirpation, neck dissection and postoperative radiotherapy.

Prognostic factors and selection criteria in the retreatment of head and neck cancers

ObjectivesTo determine predictors of treatment selection, outcome, and survival, we examined a cohort of previously irradiated head and neck squamous cell carcinoma (HNSCC) patients. Materials and methodsWe retrospectively analyzed 100 patients at our institution who were treated for recurrent or second primary (RSP) HNSCC, focusing on subgroups receiving reirradiation (ReRT) alone and those undergoing surgical salvage (SS) with or without post-operative reirradiation therapy (POReRT). Logistic regression modeling was performed to identify factors predictive of retreatment modality. Cox regression modeling was used to determine prognostic factors for progression free survival (PFS) and overall survival (OS). ResultsReRT alone was less likely in current smokers and neck recurrences, with reirradiation more likely in primary site recurrences. POReRT was significantly more likely in patients with positive surgical margins (PSM), neck dissection, or organ dysfunction. POReRT omission negatively impacted PFS when PSM (HR: 8.894, 95% CI: 1.742–45.403) and perineural invasion (PNI) (HR: 3.391, 95% CI: 1.140–10.089) were present. Tracheostomy was associated with worse OS, but ReRT alone and POReRT improved OS. PSM correlated with worse OS, regardless of whether POReRT was given (HR: 14.260, 95% CI: 2.064–98.547). ConclusionThis analysis confirms known factors for predicting outcome and shows nonsmoking status and primary site recurrence as predictors for ReRT alone. POReRT for PSM and PNI improves PFS. Tracheostomy patients are more likely to have ReRT due to acute toxicity not limiting treatment and POReRT improves OS compared to surgery alone. The presence of PSM negatively impacts survival which cannot be overcome by POReRT.

Excision of Cystic Lymphangioma in A Patient with Neurofibromatosis Type I

No published study has analyzed the prognostic factors of surgically treated oral squamous cell carcinoma (OSCC) in relation to both survival and quality of life (QoL). The aim of this study was to analyze postoperative QoL in relation to survival to identify which parameters can predict the long-term outcome allowing the best QoL.This retrospective cohort study considered 167 patients affected by OSCC treated surgically at the Otolaryngology Department of Cattinara Hospital (Trieste, Italy) by a single surgeon. We collected data about the main prognostic factors and the postoperative QoL 12 month after surgery.The 5-year overall survival rate was equal to 68.1%, and the 5-year disease-specific survival was 77.8%. In this sample, 32% of patients also underwent adjuvant chemoradiotherapy. On stepwise Cox regression, the best predictors of disease-specific survival were the N stage (P < .001) and tumor depth of invasion (P < .001). QoL was affected by N stage, depth of invasion, invasive surgical approach, radiotherapy, and neck dissection (P < .05).The prognostic factors that affect both survival rates and residual QoL are the surgical approach, the neck stage, and the depth of invasion, all of which can be minimized by early diagnosis.

Development of a novel salivary gland cancer lymph node staging system.

Current lymph node (LN) staging for salivary gland cancer (SGC) is extrapolated from mucosal head and neck squamous cell carcinoma. However, given its unique biology and clinical behavior, it is possible that a SGC-specific LN staging system would be more accurate. Patients from the National Cancer Data Base with nonmetastatic SGC of the head and neck who were diagnosed from 2004 through 2013 and underwent surgical resection and neck dissection removing at least 10 LNs were included. Multivariable models were constructed to assess the association between survival and LN factors, including number of metastatic LNs, extranodal extension, LN size, and lower LN involvement. Overall, 4520 patients met the inclusion criteria. An increasing number of metastatic LNs was found to be strongly associated with worse survival without plateau. The risk of death increased more rapidly up to 4 LNs (hazard ratio, 1.34; 95% confidence interval, 1.27-1.41 [P < .001]), and was more gradual for additional LNs >4 (hazard ratio, 1.02; 95% confidence interval, 1.01-1.03 [P < .001]). LN size, extranodal extension, and lower LN involvement appeared to have no impact on survival when accounting for the number of metastatic LNs. Recursive partitioning analysis was used to create a novel SGC LN staging system in which N0 indicates 0 positive LNs, N1 indicates 1 to 2 positive LNs, N2 indicates 3 to 21 positive LNs, and N3 indicates ≥ 22 positive LNs. This system exhibited greater concordance than the current American Joint Committee on Cancer (eighth edition) system. Quantitative LN burden is an important determinant of survival in patients with SGC. Use of this variable may improve SGC staging. Cancer 2018. © 2018 American Cancer Society.

A Novel Approach to Identifying the Spinal Accessory Nerve in Surgical Neck Dissection.

Intraoperative identification of the spinal accessory nerve (SAN) is key in reducing nerve injury. This study aims to explore the surgical anatomy of the SAN and 2 landmarks for its identification-the sternocleidomastoid branch of the occipital artery (SBOA) and superior sternocleidomastoid tendon (SST)-to propose a novel method of identifying the SAN during surgical neck dissections. Twelve cadavers underwent bilateral level II-V neck dissection identifying the SAN, SBOA, and SST. Variation was documented and distance between landmarks and the SAN measured. The most common arrangement had the SST most superficially followed by the SBOA and then the SAN. The SAN was 3.63 ± 4.02 mm from the artery and 2.31 ± 1.72 mm from the tendon. A triangle-bordered by the tendon laterally, artery medially, and digastric muscle superiorly-contained the SAN in 95.8% of cases. This relationship translated into a reliable technique to identify the SAN intraoperatively, which has been used successfully in practice.

Use of medial upper arm free flap in oral cavity reconstruction: a preliminary study

The medial upper arm has previously been proposed as a potential free flap donor site, but the clinical application of such flaps in head and neck reconstruction has not been popular. The preliminary results of the clinical application of medial upper arm free flaps in oral cavity reconstruction are reported here. Five patients with oral cancer underwent surgical resection and neck dissection, with simultaneous reconstruction using a medial upper arm free flap. Functional outcomes were investigated using the University of Washington Quality of Life Questionnaire. Sensory-motor functions of the upper arm donor site were recorded before and after surgery. Four flaps were successfully transferred. One flap was abandoned during surgery because of a lack of perforators, and a forearm flap was used instead. All patients survived without loco-regional recurrence or distant metastasis. Functional outcomes, especially swallowing and speech, were satisfactory. The donor site scar was well hidden, with no functional impairment. This initial experience shows that the medial upper arm free flap represents an alternative perforator flap for oral cavity microsurgical reconstruction. The well-hidden scar and better texture match compared with other flaps make it suitable for oral cavity reconstruction.

Prognostic indicators of improved survival and quality of life in surgically treated oral cancer

No published study has analyzed the prognostic factors of surgically treated oral squamous cell carcinoma (OSCC) in relation to both survival and quality of life (QoL). The aim of this study was to analyze postoperative QoL in relation to survival to identify which parameters can predict the long-term outcome allowing the best QoL. This retrospective cohort study considered 167 patients affected by OSCC treated surgically at the Otolaryngology Department of Cattinara Hospital (Trieste, Italy) by a single surgeon. We collected data about the main prognostic factors and the postoperative QoL 12 month after surgery. The 5-year overall survival rate was equal to 68.1%, and the 5-year disease-specific survival was 77.8%. In this sample, 32% of patients also underwent adjuvant chemoradiotherapy. On stepwise Cox regression, the best predictors of disease-specific survival were the N stage (P < .001) and tumor depth of invasion (P < .001). QoL was affected by N stage, depth of invasion, invasive surgical approach, radiotherapy, and neck dissection (P < .05). The prognostic factors that affect both survival rates and residual QoL are the surgical approach, the neck stage, and the depth of invasion, all of which can be minimized by early diagnosis.

Hypothyroidism in Carcinoma of the Tongue with Adjuvant Treatment.

ObjectiveThe objective of this study was to evaluate the incidence of hypothyroidism with adjuvant treatment in oral tongue carcinoma patients treated primarily with surgery.Materials and methodsA retrospective review was carried out to analyze hypothyroidism incidence and its relation to adjuvant treatment (radiation/radio-chemotherapy) in oral tongue carcinoma after the primary surgical ablation and neck dissection. Hypothyroidism was analyzed in relation with dose of radiation, gender, and adjuvant treatment modality.ResultsThe study analyzed the patients who were treated between January 2012 and June 2015. Among 705 patients with carcinoma of the tongue treated primarily with wide local excision and neck dissection, 383 received adjuvant treatment. A total of 215 patients received radiation, and 168 received concurrent radio-chemotherapy. Of 378 patients, 78 developed hypothyroidism during follow-up: 27 patients received concurrent radio-chemotherapy, and the remaining 51 received only radiation. Lower neck received 40–48 Gy in 2 patients, 50 Gy in 74 patients, and 60–70 Gy and concurrent radio-chemotherapy in 27 patients. Median follow-up was 32 months. Hypothyroidism occurred in 21.5% of patients with squamous cell carcinoma of the oral tongue. The minimum period to develop hypothyroidism was 3 months in this study. Gender and adjuvant treatment were not found to be significant for the incidence of hypothyroidism.ConclusionsA significant number of patients with carcinoma of the tongue who receive adjuvant treatment will develop hypothyroidism, hence frequent monitoring of thyroid function is advised during follow-up.

Analysis of the lymphoepithelial carcinoma of the salivary gland: 12 cases report

Objective:To improve recognization of clinical, imaging and pathological characteristics of lymphoepithelial carcinoma (LEC) of the salivary glands.Method:The clinical manifestations, imaging features, histological and immunohistochemical characteristics of LEC of the salivary glands (n = 12) between 2003 and 2013 were retrospectively reviewed.Result: Four cases of male and 8 cases of female were enrolled, and the average age of 53.25 years. Ten lesions were located in the parotid gland, and 2 cases were in the submandibular gland. Two cases were unilateral multiple tumors, 10 cases were unilateral solitary tumor, 4 cases were with cervical lymph node metastasis and 1 case was with peripheral facial paralysis. Ten patients had positive EB VCA IgA test. Homogeneous density and obvious enhancement were achieved in all lesions on CT scan. 8 cases were with irregular shapes, partially or ill-defined margin, and heterogeneous enhancement. Incomplete capsule was found in 4 cases, while no obvious capsule was found in 6 cases. HE staining showed that the infiltrative tumors were formed by the presence of sheets or nests of epithelial cells and interstitial lymphoid tissue. Immunohistochemistry staining revealed that the epithelial cells were reactive for pan CK, the lymphoid cells showed reactivity for both CD20 and CD3 markers. All cases underwent primary tumor and involved gland resection with ipsilateral neck dissection, and postoperative radiotherapy, and 2 cases combined with postoperative chemotherapy. The 3 year survival rate of patients was 75.0%(9/12), and 3 cases died of local recurrence or (and) distant metastasis within 1-2 years of definite diagnosis.Conclusion: LEC of salivary gland is associated with EB virus infection. Most cases present with unilateral solitary mass, and incidence of regional lymph node involvement is high. The imaging characteristics of tumor seem to be malignant on CT scan in most cases. Treatment includes multimodality therapy including surgical resection, neck dissection, and radiotherapy. Local recurrence and distant metastasis are the main causes of death.

Prognostic significance of surgical extranodal extension in head and neck squamous cell carcinoma patients.

Lymph node metastasis with extranodal extension represents one of the most important adverse prognostic factors for survival in patients with head and neck squamous cell carcinoma. We propose that extranodal extension occurs to differing extents. The aim of this study was to determine the prognostic significance of extranodal extension in patients with head and neck squamous cell carcinoma. Two hundred and ninety-eight patients with head and neck squamous cell carcinoma who underwent surgical resection and neck dissection were included. Cervical lymph nodes were classified into four categories: (i) pathological N negative, (ii) extranodal extension negative, (iii) non-surgical extranodal extension and (iv) surgical extranodal extension. Lymph node metastases were detected in 67.1% of laryngeal/hypopharyngeal cancer patients and 52.7% of oral cancer patients. The 3-year disease-specific survival rates for patients in the pathological N negative, extranodal extension negative, non-surgical extranodal extension and surgical extranodal extension groups were 90.9%, 79.6%, 63.8% and 48.3%, respectively. In laryngeal/hypopharyngeal cancer patients, surgical extranodal extension was associated with a significantly poorer disease-specific survival than a pathological N negative, extranodal extension negative or non-surgical extranodal extension status. In oral cancer patients, no significant differences were observed between the non-surgical and surgical extranodal extension groups. However, non-surgical extranodal extension was associated with a poorer disease-specific survival than a pathological N negative or extranodal extension negative status. Surgical extranodal extension was a poor prognostic factor in patients with head and neck squamous cell carcinoma. The prognostic significance of surgical extranodal extension differed between laryngeal/hypopharyngeal and oral cancer patients. The clinical significance of surgical extranodal extension was much greater for patients with laryngeal/hypopharyngeal cancer than oral cancer.

The Benefit of Adjuvant Radiation in Surgically-Treated T1-2 N1 Oropharyngeal Squamous Cell Carcinoma.

ImportanceThe benefit of adjuvant radiation in surgically treated T1‐2N1 oropharyngeal cancer without adverse pathologic features remains unclearObjectivesTo compare population‐level survival outcomes in surgically‐treated T1‐2N1 oropharyngeal squamous cell carcinoma (OPSCC) with and without the use of adjuvant radiation.Study DesignRetrospective population‐based study using the Surveillance, Epidemiology, and End Results (SEER) registry data from 1998–2011.SettingPopulation‐level study.ParticipantsPatients with T1‐2N1 OPSCC treated with surgical resection and neck dissection with or without adjuvant radiation.Intervention(s) for Clinical Trials or Exposure(s) for observational studiesThe use of postoperative adjuvant radiation.Main Outcome(s) and MeasuresOverall and disease‐specific survival.ResultsRadiation was utilized in 74% of patients and was positively associated with extracapsular extension and well‐differentiated histology. The use of radiation was associated with improved mean overall survival (124 v. 108 months, p=0.023) and a non‐significant increase in mean disease‐specific survival (138 v. 131 months, p=0.053).Conclusions and RelevanceThe use of adjuvant radiation is associated with improved survival in surgically‐treated T1‐2N1 squamous cell carcinoma of the oropharynx with unknown HPV status.Level of EvidenceIV