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ABSTRACT: Renal cell carcinoma (RCC) tends to metastasize hematogenously, although metastasis to the head and neck is rare. We report 3 cases of RCC head and neck metastasis within the last 6 years. CASE 1: A 74-yearold woman presented with cervical metastasis from RCC 4 years after right total nephrectomy, involving modified neck dissection. She later had additional surgery and radiation for further distant metastases, survived almost 5 years after the first neck metastasis. CASE 2: A 60-year-old man showed metastatic RCC in the right parotid gland 3 years after right total nephrectomy, involving superficial parotidectomy. CASE 3: A 54-year-old man presented with a metastasis lesion from RCC to the right maxillary sinus 7 years after left total nephrectomy, involving total maxillectomy. Distant metastasis reportedly often occurs long after initial primary RCC treatment. Physicians considering metastatic RCC in differential head and neck diagnosis and resection could conceivably promote better prognosis.
Nippon Jibiinkoka Gakkai Kaiho 11/2011; 114(11):864-8.
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Arata Horii,
Masayuki Hirose,
Ryuichi Mochizuki,
Keisuke Yamamoto,
Masahiro Kawamoto,
Tadashi Kitahara, Yoshifumi Yamamoto,
Takayuki Kawashima,
Atsuhiko Uno,
Takao Imai,
Suetaka Nishiike,
Hidenori Inohara
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ABSTRACT: Bipolar scissors tonsillectomy followed by cooling down the pharyngeal mucosa has advantages in terms of postoperative pain and intraoperative blood loss compared with cold dissection.
The purpose of this study was to compare the postoperative pain between bipolar scissors tonsillectomy followed by cooling the pharyngeal mucosa and a traditional cold dissection.
A total of 189 patients aged more than 16 years were operated due to habitual tonsillitis, obstructive sleep apnea syndrome, and IgA nephropathy. Of these, 79 patients were operated using bipolar scissors followed by cooling the pharyngeal mucosa with 4°C saline for 10 min just after the removal of tonsils. The other 110 patients underwent cold dissection tonsillectomy. Outcome measures were intraoperative blood loss, operative time, postoperative pain evaluated on a visual analog scale, and postoperative secondary hemorrhage.
Significantly lower levels of intraoperative blood loss and less postoperative pain were obtained in bipolar scissors tonsillectomy followed by cooling the pharyngeal mucosa compared with cold dissection. Postoperative hemorrhage needing hemostatic surgery occurred in 2 of 79 patients who underwent bipolar scissors tonsillectomy with cooling, while it occurred in 1 of 110 patients after cold dissection. However, the difference was not statistically significant.
Acta oto-laryngologica 07/2011; 131(7):764-8. · 0.98 Impact Factor
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ABSTRACT: Concurrent chemoradiotherapy (CCRT) is increasingly used in organ preservation for head and neck squamous cell carcinoma (HNSCC), with surgery as second-line treatment for salvaging locoregional failure. The significance of post-CCRT salvage surgery, however, remains to be established. We report complications and clinical outcome in 34 salvage surgeries on 30 subjects with advanced HNSCC treated by docetaxel and cisplatin concurrent with conventional radiotherapy. Postoperative complications occurred in 9 (30%) subjects and 10 (29%) surgeries. There was no significant difference in complication incidence between salvage surgeries for persistent disease (7 of 19 cases, 37%) and those for recurrent disease (3 of 15 cases, 20%). Complication incidence in isolated neck dissection (6 of 21 cases, 29%) did not differ significantly from that in primary site resection (4 of 13 cases, 31%). Most frequent complications were dysphagia and skin flap necrosis, occurring in 5 subjects each. Three with dysphagia underwent percutaneous endoscopic gastrostomy, and two with skin flap necrosis led to pharyngocutaneous fistula, requiring pectoralis major myocutaneous flap repair. No carotid artery rupture or chyle fistula occurred. Overall 3-year survival after salvage surgery was 74% for persistent disease, and 87% for recurrent disease. Although post-CCRT salvage surgery harbors high risk of complication, it renders good survival and is recommendable for all whose disease is operable.
Nippon Jibiinkoka Gakkai Kaiho 12/2010; 113(12):889-97.
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ABSTRACT: We retrospectively evaluated the efficacy of neck dissection followed by radiotherapy by using the clinical outcome in 15 patients (median age: 60 years) with upper cervical lymph node (level II) metastasis from unknown primary carcinoma undergoing curative treatment from 1999 to 2007. The male-to-female ratio was 4 : 1, and the histopathological diagnosis in 11 patients (73.3%) was squamous cell carcinoma. Clinical N status was distributed as follows: N1, 1; N2a, 4; N2b, 8; and N2c, 2. Of the 15 patients, 13 patients (86.7%) underwent neck dissection and 11 (84.6%), including 2 unresectable cases undergoing concurrent chemoradiotherapy using DOC and CDDP making their condition resectable, underwent neck dissection combined with radiotherapy. Follow-up was from 5 to 72 months (median: 39 months). In 2 of 6 patients, we detected the primary site at the ipsilateral tonsil through tonsillectomy conducted concurrently with neck dissection. Overall 5-year survival determined by the Kaplan-Meier method was 88.9%, and only 1 patient died of metastasis without achieving complete response 29 months after initial treatment. None of the 15 was observed to have local regional recurrence or distant metastasis after initial treatment. These results indicate that neck dissection followed by radiotherapy is recommended for improving the outcome of patients with cervical lymph node metastasis from an unknown primary carcinoma.
Nippon Jibiinkoka Gakkai Kaiho 01/2009; 111(12):734-8.
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ABSTRACT: Fine-needle aspiration cytology (FNAC) is the diagnostic modality of first choice for characterization of parotid mass lesions, while magnetic resonance imaging (MRI) should not be requested routinely. MRI can be reserved until FNAC shows the indication for surgical intervention.
Although both FNAC and MRI are useful preoperative diagnostic modalities for parotid mass lesions, it is not well established which modality is more effective. In the present study we sought to address the relative value of FNAC and MRI in relation to the differential diagnosis of benign and malignant parotid mass lesions.
Eighty-one patients with parotid mass lesions (60 benign and 21 malignant) who had preoperatively undergone FNAC and MRI were reviewed retrospectively.
Unsharp margin and infiltration into adjacent tissues on MRI significantly correlated with a malignant histology. The sensitivity/specificity/accuracy of FNAC and MRI were 90%/95%/94% and 81%/92%/89%, respectively. Either FNAC or MRI served equally to predict the malignant nature of parotid mass lesions. Furthermore, the combination of FNAC and MRI yielded no diagnostic advantage over either modality alone. Accurate histological typing rates by FNAC were 80% and 62% for benign and malignant lesions, respectively.
Acta oto-laryngologica 04/2008; 128(10):1152-8. · 0.98 Impact Factor
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ABSTRACT: Synchronous malignancy of squamous cell carcinoma (SCC) and malignant lymphoma (ML) in the head and neck region is extremely rare. Here, we report the case of a 57-year-old man with a right-sided neck mass; he was referred to our hospital in September 2001. A series of staging work-ups revealed that he was simultaneously affected by oropharyngeal SCC and nasopharyngeal ML. He underwent conventional radiotherapy, and both the primary tumors showed complete remission. The metastatic lymph nodes showed poor response to the radiotherapy, and the patient was surgically salvaged by modified radical neck dissection. Although systemic chemotherapy against ML was scheduled, he refused the treatment and died of disseminated ML. It is essential to determine the lesion that should be given priority treatment in case of double primary malignancies; this can be facilitated by determining the prognosis of each malignancy.
Auris Nasus Larynx 07/2007; 34(2):273-6. · 0.76 Impact Factor
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Yusuke Oji,
Hidenori Inohara,
Mitsuhiro Nakazawa,
Yoko Nakano,
Shiro Akahani,
Shin-ichi Nakatsuka,
Satoko Koga,
Ai Ikeba,
Sakie Abeno,
Yuichiro Honjo, Yoshifumi Yamamoto,
Soichi Iwai,
Kaori Yoshida,
Yoshihiro Oka,
Hiroyasu Ogawa,
Jun-ichi Yoshida,
Katsuyuki Aozasa,
Takeshi Kubo,
Haruo Sugiyama
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ABSTRACT: The expression levels of the Wilms' tumor gene WT1 were examined in 56 cases of head and neck squamous cell carcinoma (HNSCC) using quantitative real-time reverse transcriptase-polymerase chain reaction (RT-PCR). They included 4 cases of floor of mouth, 9 of gingiva, 25 of tongue, 10 of oropharynx, 3 of hypopharynx, and 5 larynx squamous cell carcinoma (SCC). All (100%) of 4 cases of floor of mouth, 5 (56%) of 9 gingiva, 17 (68%) of 25 tongue, 8 (80%) of 10 oropharynx, all (100%) of 3 hypopharynx, and all (100%) of 5 larynx SCC overexpressed the WT1 gene in the range of 3.07 x 10(-4)-8.60 x 10(-1) levels (the WT1 expression level in K562 leukemic cells was defined as 1.0). Thus, 42 (75%) out of 56 cases of HNSCC overexpressed the WT1 gene. The high expression level of the WT1 gene significantly correlated with poor histological tumor differentiation and high tumor stage of HNSCC. Immunohistochemical analysis confirmed the expression of WT1 protein in 6 cases (one floor of mouth, 2 tongue, 2 oropharynx, and one larynx SCC) with overexpression of the WT1 gene. The direct sequencing analysis of the WT1 genomic DNA showed no mutations in any of 10 exons of the WT1 gene in 5 different HNSCC. These findings suggest an important role of the wild-type WT1 gene in the tumorigenesis of HNSCC.
Cancer Science 07/2003; 94(6):523-9. · 3.33 Impact Factor
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ABSTRACT: Galectin-3, a beta-galactoside binding lectin, is highly expressed in thyroid carcinomas of follicular cell origin, whereas neither benign thyroid adenomas nor normal thyroid tissues express galectin-3. We previously showed that antisense inhibition of galectin-3 expression markedly reduced the malignant phenotype of thyroid papillary carcinoma cells. In the present study we transfected galectin-3 cDNA into TAD-2 normal thyroid follicular cells. Stable transfectants expressing galectin-3 acquired the phenotype of serum-independent growth, clonogenicity in soft agar, as well as loss of contact inhibition. We also compared the gene expression profile of the galectin-3 transfectants to that of the vehicle control, which revealed that a series of genes were differentially expressed between the two. They include proliferating cell nuclear antigen, replication factor C, and retinoblastoma genes that participate in G1-S transition. These results indicate the transformation of thyroid follicular cells by galectin-3 and possible involvement of galectin-3 in cell cycle.
Cancer Letters 06/2003; 195(1):111-9. · 4.24 Impact Factor
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ABSTRACT: This phase I study of weekly low-dose administration of cisplatin (CDDP) and docetaxel (DOC) combined with concurrent conventionally fractionated radiotherapy was designed for locoregionally advanced head and neck cancer.
Twelve patients were treated at varying levels of DOC (level 1: 5 mg/m2/week, level 2: 7.5 mg/m2/week, level 3: 10 mg/m2/week) with CDDP constant at 20 mg/m2/week in four cohorts of three patients. Radiation was given at 1.8-2.0 Gy/fraction to a total dose of 60-70.2 Gy.
Hematological toxicities, except lymphocytopenia, were minimal. Mucosal toxicities, especially grade 3 mucositis, were common. Dose-limiting toxicity was grade 3 pain, although level 3 did not reach a maximum tolerated dose. No grade 4 toxicities were observed. Complete response rate ranged from 33% to 67% in the various dose levels.
This concurrent chemoradiotherapy seems to be a promising treatment modality, in which level 3 is the recommended dose for a phase II study.
Anticancer research 24(6):4135-40. · 1.73 Impact Factor
