Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: This study aimed to evaluate the prognostic outcome for adolescent and young adult (AYA) generation patients with tongue squamous cell carcinoma (TSCC). METHODS: Data were obtained from the Head and Neck Cancer Registry of Japan, and patients who were newly diagnosed with TSCC from 2011 to 2014 were extracted. We compared the clinical parameter and survival of the ≤ 39 years old (AYA) patient group with the 40-79 (non-AYA) group. Propensity score matching (PSM) was used for survival analyses. RESULTS: Our cohort included 2221 patients with TSCC. AYA and non-AYA groups consisted of 258 and 1963 patients, respectively. The AYA group has a larger proportion of females than the non-AYA group (P < 0.001). Following PSM, both overall and disease-specific survival of the AYA group was significantly longer than those of the non-AYA group (P = 0.009 and P = 0.04, respectively). CONCLUSION: We demonstrated the survival superiority of AYA patients with TSCC compared to older adult patients. Therefore, our study results may reduce this anxiety by providing patients with appropriate information of prognosis for AYA patients with TSCC.

DOI： 10.1007/s10147-022-02279-6

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OBJECTIVE: Basal information of head and neck small-cell carcinoma (HNSmCC) including epidemiology, primary site, treatment, and prognosis remains sparse due to its rarity. We report here a multicenter retrospective study on the diagnosis, treatment, and outcomes of patients with HNSmCC. MATERIALS AND METHODS: This study involved 47 patients with HNSmCC from 10 participating institutions. Eight patients were excluded for whom no pathological specimens were available (n = 2) and for discrepant central pathological judgements (n = 6). The remaining 39 patients were processed for data analysis. RESULTS: As pretreatment examinations, computed tomography (CT) was performed for the brain (n = 8), neck (n = 39), and chest (n = 32), magnetic resonance imaging (MRI) for the brain (n = 4) and neck (n = 23), positron emission tomography-CT (PET-CT) in 23 patients, bone scintigraphy in 4, neck ultrasonography in 9, and tumor markers in 25. Primary sites were oral cavity (n = 1), nasal cavity/paranasal sinuses (n = 16), nasopharynx (n = 2), oropharynx (n = 4), hypopharynx (n = 2), larynx (n = 6), salivary gland (n = 3), thyroid (n = 2), and others (n = 3). Stages were II/III/IV-A/IV-B/IV-C/Not determined = 3/5/16/6/5/4; stage IV comprised 69%. No patient had brain metastases. First-line treatments were divided into 3 groups: the chemoradiotherapy (CRT) group (n = 27), non-CRT group (n = 8), and best supportive care group (n = 4). The CRT group included concurrent CRT (CCRT) (n = 17), chemotherapy (Chemo) followed by radiotherapy (RT) (n = 5), and surgery (Surg) followed by CCRT (n = 5). The non-CRT group included Surg followed by RT (n = 2), Surg followed by Chemo (n = 1), RT alone (n = 2), and Chemo alone (n = 3). The 1-year/2-year overall survival (OS) of all 39 patients was 65.3/53.3%. The 1-year OS of the CRT group (77.6%) was significantly better compared with the non-CRT group (31.3%). There were no significant differences in adverse events between the CCRT group (n = 22) and the Chemo without concurrent RT group (n = 9). CONCLUSION: Neck and chest CT, neck MRI, and PET-CT would be necessary and sufficient examinations in the diagnostic set up for HNSmCC. CCRT may be recommended as the first-line treatment. The 1-year/2-year OS was 65.3%/53.3%. This study would provide basal data for a proposing the diagnostic and treatment algorithms for HNSmCC.

DOI： 10.3389/fsurg.2022.1049116

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BACKGROUND: Adenoid cystic carcinoma of the trachea (ACCT) is a rare cancer; ACCT with thyroid invasion is particularly rare. We first suspected anaplastic thyroid carcinoma (ATC) but diagnosed ACC after performing fine needle aspiration cytology (FNAC). A tracheal origin was confirmed after operation. CASE DESCRIPTION: We report the case of a 77-year-old female presenting to our hospital with acute inspiratory dyspnea requiring emergency tracheotomy. Physical examination revealed a right anterior neck swelling with a hard and unmovable mass. Computed tomography (CT) and ultrasonography (US) showed tumor extension to the right thyroid lobe, and between the first and third tracheal rings, which caused severe stenosis of the lumen. Next, we performed FNAC. Clinical findings were highly suspicious for ACCT with thyroid invasion. Thirty-five days after the first visit to our department, the patient underwent total laryngectomy, cervical esophagectomy, and thyroidectomy with bilateral selective neck dissections at another hospital. The tumor was located in the right posterior wall of the trachea, with extension into the right thyroid gland. Pathological examination showed an infiltrative carcinomatous proliferation with tubular and cribriform patterns. The tumor was classified as pT4N1. A definite diagnosis was made after histopathological analyis of the surgical specimen confirmed ACCT. The tumor was found to be positive for FABP7, a putative prognostic marker of ACC, and metastasized to the lungs 3 years after the surgery. CONCLUSIONS: ACCT with thyroid invasion is an extremely rare malignant neoplasm. FNAC was useful for differentiating ACCT from other diagnoses and enabled appropriate surgical treatment.

DOI： 10.1272/jnms.JNMS.2022_89-207

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J04195&link_issn=&doc_id=20210120490004&doc_link_id=10.5981%2Fjjhnc.46.334&url=https%3A%2F%2Fdoi.org%2F10.5981%2Fjjhnc.46.334&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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BACKGROUND: Although the American Joint Committee on Cancer TNM classification has been amended to include human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) as an independent entity, to the authors' knowledge the optimized de-escalating treatment modality has not been established to date. METHODS: The authors conducted a retrospective, nationwide, observational study in patients with HPV-related OPSCC who were treated from 2011 to 2014 in Japan to determine the best treatment modality. RESULTS: A total of 688 patients who were newly diagnosed with HPV-related OPSCC who were treated with curative intent at 35 institutions and had coherent clinical information and follow-up data available were included in the current study. In patients with T1-T2N0 disease (79 patients), both the 3-year recurrence-free survival and overall survival (OS) rates were 100% in the group treated with radiotherapy (RT) as well as the group receiving concurrent chemoradiotherapy (CCRT). The 3-year OS rates were 94.4% (for patients with T1N0 disease) and 92.9% (for patients with T2N0 disease) among the patients treated with upfront surgery. In patients with stage I to stage II HPV-related OPSCC, the 5-year recurrence-free survival and OS rates were 91.4% and 92%, respectively, in the patients treated with CCRT with relatively high-dose cisplatin (≥160 mg/m2 ; 114 patients) and 74.3% and 69.5%, respectively, in the patients treated with low-dose cisplatin (<160 mg/m2 ; 17 patients). CONCLUSIONS: Despite it being a retrospective observational trial with a lack of information regarding toxicity and morbidity, the results of the current study demonstrated that patients with T1-T2N0 HPV-related OPSCC could be treated with RT alone because of the equivalent outcomes of RT and CCRT, and patients with stage I to stage II HPV-related OPSCC other than those with T1-T2N0 disease could be treated with CCRT with cisplatin at a dose of ≥160 mg/m2 .

DOI： 10.1002/cncr.33062

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This case report describes a recent case where a patient with hypopharyngeal cancer underwent resection and reconstruction with a free jejunum flap and the surgeons found a rare variation in the branching pattern of the common carotid artery. Specifically, the left facial artery arose directly from the common carotid artery, whereas the left superior thyroid artery arose from the facial artery. This branching pattern has not been reported previously. Although this is a hitherto unique case, head and neck and reconstructive surgeons should be aware of the possibility that this branching pattern may be present because it could complicate the outcomes of both neck dissection and reconstruction by free tissue transfer.

DOI： 10.1097/GOX.0000000000002305

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DOI： 10.1177/1066896918791031

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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DOI： 10.1007/s12328-018-0867-z

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Language：Japanese   Publisher：克誠堂出版(株)  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00398&link_issn=&doc_id=20180727150007&doc_link_id=%2Fad3ksgke%2F2018%2F006108%2F013%2F1008-1014%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3ksgke%2F2018%2F006108%2F013%2F1008-1014%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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Language：Japanese   Publisher：(株)医学書院  

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DOI： 10.5106/jjshns.26.363

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DOI： 10.5106/jjshns.25.409

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DOI： 10.5106/jjshns.25.415

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DOI： 10.1272/jnms.83.177

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科学会  

DOI： 10.3950/jibiinkoka.118.1053

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

DOI： 10.5631/jibirin.108.92

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DOI： 10.1272/jnms.82.14

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Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

DOI： 10.5106/jjshns.23.255

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DOI： 10.1186/1471-2334-13-398

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Language：Japanese   Publisher：(株)東京医学社  

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DOI： 10.1016/j.anl.2011.08.003

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DOI： 10.1111/j.1346-8138.2010.01103.x

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DOI： 10.1272/jnms.78.261

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Language：Japanese   Publisher：(株)篠原出版新社  

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

DOI： 10.5631/jibirin.104.341

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

DOI： 10.5981/jjhnc.36.417

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Language：Japanese   Publisher：日本医科大学医学会  

DOI： 10.1272/manms.6.167

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Language：Japanese   Publisher：日本医科大学医学会  

DOI： 10.1272/manms.6.101

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Language：Japanese   Publisher：日本医科大学医学会  

DOI： 10.1272/manms.6.61

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

DOI： 10.5981/jjhnc.36.101

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Language：Japanese   Publisher：(株)インターメルク  

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Language：Japanese   Publisher：(株)医学書院  

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Language：Japanese   Publisher：(NPO)日本気管食道科学会  

DOI： 10.2468/jbes.59.120

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Language：Japanese   Publisher：(株)医学書院  

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Language：Japanese   Publisher：日本医科大学医学会  

DOI： 10.1272/manms.4.32

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

DOI： 10.5981/jjhnc.33.499

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

DOI： 10.5981/jjhnc.33.375

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Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

DOI： 10.5106/jjshns.17.47

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Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

DOI： 10.5981/jjhnc.32.515

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Language：Japanese   Publisher：(株)全日本病院出版会  

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Language：Japanese   Publisher：JAPAN SOCIETY FOR HEAD AND NECK SURGERY  

頸部腫瘤の基本手術である頸部郭清術の手術術式について述べた。内頸静脈を保存する郭清術について概説し,より保存的な郭清を行う際の手技について詳述した。メスや剪刀で鋭的に剥離・切開する操作のコツを示し,郭清の限界設定の仕方,内・外頸静脈や浅頸動脈の保存,副神経の追跡あるいは頸動脈鞘の扱い,さらに胸鎖乳突筋を保存した郭清術におけるポイントを解説した。手術の基本手技習得に当たって注意すべき点を述べた。

DOI： 10.5106/jjshns.15.45

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Other Link： http://search.jamas.or.jp/link/ui/2005230352

Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

DOI： 10.5106/jjshns.15.55

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DOI： 10.1272/jnms.71.301

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Language：Japanese   Publisher：(株)医学書院  

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Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

DOI： 10.5981/jjhnc1974.27.62

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Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

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Language：Japanese   Publisher：(株)医学書院  

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Language：Japanese   Publisher：(株)医学書院  

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Language：Japanese   Publisher：(株)医学書院  

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1080/00016489850183575

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publisher：Japan Society for Head and Neck Cancer  

During the 15 years period from 1978 to 1992, 417 fresh cases of tongue squamous cell carcinoma were treated in the head and neck department of Cancer Institute Hospial.<br>In tongue cancer therapy, we often treat the primary lesion and the neck metastasis separately. In such cases, non-treated area around the suprahyoid muscles (submucosal area of the oral floor) exists. Recurrence from this area in our series are 6 cases (1.4%).<br>Group I (the primary lesions and the neck metastasis were treated separately) are 140 cases, and Group II (en bloc operation) are 120 cases. 5 cases are Group I, and 1 is Group II. In each case, suprahyoid muscles are preserved. 5 of 6 cases were lost in spite of our therapy. The risk f acter of this poor prognostic recurrence can not be determined.

DOI： 10.5981/jjhnc1974.22.83

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Language：Japanese   Publisher：耳鼻と臨床会  

11年間の頭頸部管腔癌患者1162例について観察人年法を用いて第2癌の発生を検討し, 相対危険度を解析した. 舌癌, 口腔癌, 下咽頭癌, 喉頭癌症例での第2癌発生は一般人口のそれより高率で認められた. 第2癌の臓器相関性は男性舌癌, 口腔癌, 下咽頭癌, 喉頭癌に対する口腔・咽頭および食道に認められた. さらに男性舌癌と下咽頭癌で胃癌, 喉頭癌で肺癌に相関性が認められた. しかし女性舌癌では口腔・咽頭のみに相関性が認められたに過ぎなかつた. 初発臓器によつては第2癌の発生間隔にも有意差が生じる可能性があつた. 症例数の少ない部位や女性症例の充分な検討はさらに多くの症例で解析する必要があると思われた.

DOI： 10.11334/jibi1954.37.5Supplement7_1311

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Language：Japanese   Publisher：Japan Society for Head and Neck Cancer  

From 1984 to 1989, 93 patients underwent free jejunal autograft reconstruction for lesions of the head and neck, at Cancer Institute Hospital, Japan. Eighty-four of these patients underwent pharyngoesophageal reconstruction.<br>A total of six patients experienced initial failure of the vascular anastomosis.<br>Three of these vascular complications were, however, recognized early and corrected, saving the jejunal graft. Therefore, the overall success rate for microvascular anastomosis was 97% (90/93).<br>The most common complication of the pharyngoesophageal reconstruction with myocutaneous flaps or forearm flaps was fistula formation, but in our series of free jejunal graft transfer, it was observed in only 2 cases. As abdominal complication, intestinal obstruction was seen in only one case.<br>All but 3 patients were able to maintain adequate swallowing function and can eat regular diet within 30 minutes. Twelve patients developed esophageal speech.<br>In conclusion, because of the minimum rate of fistula formation and acceptable swallowing function, we think free jejunal autograft is the best methods for pharyngoesophageal reconstruction to date.

DOI： 10.5981/jjhnc1974.17.2_122

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Language：Japanese  

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DOI： 10.5981/jjhnc.33.17

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DOI： 10.5106/jjshns.17.35

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Reconstruction after total pharyngo-esophagectomy has been a formidable challenge to head and neck surgeons. To clarify the advantages and disadvantages of different reconstructive methods after total pharyngo-esophagectomy, we retrospectively compared three methods of reconstruction from the point of view of blood loss, duration of surgery, complications, and functional results after surgery. Seventeen male patients with cancer of the hypopharynx or advanced cancer of the cervicothoracic esophagus with an age range from 54 to 72 years were included in this study. The reconstructive procedures consisted of gastric pull up (n=5), elongated gastric roll with micro-vascular anastomosis (n=7), and gastric pull up with free jejunal graft (n=5). There was no difference in the amount of blood loss or the average duration of surgery between each procedure. One case with gastric pull up developed a partial necrosis of the graft. In another case with gastric pull up with free jejunal graft, we found an anastomatic leakage. Although, no anastomatic leakage occurred in the cases with elongated gastric roll with micro-vascular anastomosis, complications related to resection were more frequent in these cases than in the other two procedures. One patient with elongated gastric roll with micro-vascular anastomosis and another patient with gastric pull up with free jejunal graft developed esophageal speech. These results suggest that there is no apparent difference amongst the three procedures and selection of the procedure should be done keeping in mind any associated systemic disease and/or the socio-economic condition of the patients who undergo total pharyngo-esophagectomy. © 2007, Japan Society for Head and Neck Cancer. All rights reserved.

DOI： 10.5981/jjhnc.33.17

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DOI： 10.5981/jjhnc.31.465

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To clarify the long-term results of connection between the cut-end of the right clavicle and the 1st rib in cases with mediastinal tracheostoma, the consequence of this connection and movement of the shoulder joint were reviewed. Six patients with cancer of the cervical esophagus extending into the thorax, and one patient with thyroid cancer, were treated with extensive circumferential resection of the mediastinal trachea. In all cases, the upper sternum and more than one-third of the right clavicle were removed, and bilateral accessory nerves were preserved upon neck dissection. Medical records of these patients were reviewed for shoulder pain, consequence of the stainless steel wire used for the connection, abduction angle, and torque of the shoulder joint, at more than six months after surgery. The wires were preserved in three cases, whereas in three cases at more than six months after surgery, the wires were cut, and in one case, the wire was disconnected from the clavicle. The abduction angle of three patients whose wires were preserved was more than 135°, and they did not complain of shoulder pain. The abduction angle of two out of three, whose wire was cut, was more than 135°, and that of the third one was 120°, and none of these patients complained of shoulder pain. One patient whose wire was disconnected has a poor abduction angle and a complaint of shoulder pain. The torque could be measured in four cases. The right shoulder torque in three out of four cases was equal to that of the left side. The torque of the cases with a successful wire-connection, or those that were cut more than six months after surgery, was not reduced, and the abduction angle of shoulder was well-preserved. Therefore, connecting the cut-end of the right clavicle and the 1st rib should be preferred in cases with mediastinal tracheostoma plasty. © 2005, Japan Society for Head and Neck Cancer. All rights reserved.

DOI： 10.5981/jjhnc.31.465

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Language：English   Publisher：ELSEVIER SCI LTD  

Objective: In order to clarify the factors affecting the survival of flaps, we performed a retrospective study on free flaps (187) used for reconstruction in head and neck surgery in 182 patients. Methods: Free jejunum flaps were used on 68 occasions, rectus abdommus myocutaneous flaps on 67. radial forearm flaps on 49, scapular osteocutaneous flaps on 2 and latissimus dorsi myocutaneous flap on ones occasion, during the period from May 1996 to April 2003. Post-operative circulatory complications at the recipient site were analyzed mainly in relation to a history of previous surgery, radiotherapy and chemotherapy. Results: Circulatory crisis was observed in seven cases and circulation was restored in two of them after emergency exploration, whereas the other five flaps failed to survive. The overall failure rate of free flaps was 2.7%. Wound infection at the recipient site was frequent in patients with a history of previous local cervical surgery. Flap failure was significantly more frequent in patients with a history of previous surgery and infection, except for 2 patients in whose case the microsurgical technique was inadequate. Flap failure was not observed in those patients whose irradiation field could be analyzed, or in the patients who received chemotherapy. Although the incidence of circulatory crisis as a consequence of inadequate microsurgical technique was observed in the early period of this retrospective study, their frequency has diminished in the last 2 years. Conclusion: The survival of flaps was affected by a history of previous surgery following wound infection, although a history of irradiation and chemotherapy would have no effects on flap failure. The appropriate choice of vessels and surgical skill are crucial for the success of free flaps from our experience. Emergency exploration was also crucial for the survival of the flap in the case of circulatory crisis. (C) 2004 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.anl.2004.03.003

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DOI： 10.5981/jjhnc1974.29.541

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DOI： 10.5981/jjhnc1974.29.541

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Language：Japanese   Publisher：Japan Society for Head and Neck Cancer  

In order to evaluate the effect and strategy of surgical treatment in patients with bilateral neck metastases of head and neck squamous cell carcinoma, a retrospective pathological study was carried out over a period of ten years. The five-year-survival rate of 16 cases of laryngeal carcinoma with pathological bilateral metastases was 31%. This rate was the best among all the cases of head and neck carcinoma included in this study. The survival rate of 32 hypopharyngeal carcinomas with pathological bilateral metastases was 19%. The number of histologically positive lymph nodes seemed to be of prognostic importance, since there was a statistically significant difference in survival between cases with six or more positive lymph nodes and less than six. Adjuvant chemotherapy was not effective in hypopharyngeal carcinoma, since there was no statistically significant difference in survival between those cases treated with and without adjuvant chemotherapy. The survival rate of 16 oropharyngeal carcinomas with pathological bilateral metastases was 13%, this being the worst in this study. Preoperative radiotherapy or neo-adjuvant chemotherapy followed by radiotherapy was effective in 29% of cases with oropharyngeal carcinomas with clinical bilateral metastases. After such therapy, these cases had no pathological residual tumors in cervical nodes, and the patients had long-term survival. This suggests that it is important to determine good responders with clinical bilateral metastases of oropharyngeal carcinoma treated preoperatively with radiotherapy and neoadjuvant chemotherapy, followed by radiotherapy. The survival rate of 16 lingual carcinomas with pathological bilateral metastases was 19%, but the cases with clinically and pathologically obvious bilateral metastases had a poor prognosis, with short-term (less than 2 years) survival. The patients with lingual carcinoma whose neck metastatic level of positive nodes was level III or more, also had a poor prognosis. Indication for surgery is thoroughly discussed in such cases with lingual carcinoma.

DOI： 10.5981/jjhnc1974.26.504

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Other Link： http://search.jamas.or.jp/link/ui/2004030786

Language：Japanese   Publisher：Japan Society for Head and Neck Cancer  

In order to evaluate the effect and strategy of surgical treatment in patients with bilateral neck metastases of head and neck squamous cell carcinoma, a retrospective pathological study was carried out over a period of ten years. The five-year-survival rate of 16 cases of laryngeal carcinoma with pathological bilateral metastases was 31%. This rate was the best among all the cases of head and neck carcinoma included in this study. The survival rate of 32 hypopharyngeal carcinomas with pathological bilateral metastases was 19%. The number of histologically positive lymph nodes seemed to be of prognostic importance, since there was a statistically significant difference in survival between cases with six or more positive lymph nodes and less than six. Adjuvant chemotherapy was not effective in hypopharyngeal carcinoma, since there was no statistically significant difference in survival between those cases treated with and without adjuvant chemotherapy. The survival rate of 16 oropharyngeal carcinomas with pathological bilateral metastases was 13%, this being the worst in this study. Preoperative radiotherapy or neo-adjuvant chemotherapy followed by radiotherapy was effective in 29% of cases with oropharyngeal carcinomas with clinical bilateral metastases. After such therapy, these cases had no pathological residual tumors in cervical nodes, and the patients had long-term survival. This suggests that it is important to determine good responders with clinical bilateral metastases of oropharyngeal carcinoma treated preoperatively with radiotherapy and neoadjuvant chemotherapy, followed by radiotherapy. The survival rate of 16 lingual carcinomas with pathological bilateral metastases was 19%, but the cases with clinically and pathologically obvious bilateral metastases had a poor prognosis, with short-term (less than 2 years) survival. The patients with lingual carcinoma whose neck metastatic level of positive nodes was level III or more, also had a poor prognosis. Indication for surgery is thoroughly discussed in such cases with lingual carcinoma.

DOI： 10.5981/jjhnc1974.26.504

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Other Link： http://search.jamas.or.jp/link/ui/2004030786

Language：English   Publisher：The Medical Association of Nippon Medical School  

To elucidate the presence and distribution of Endothelin-1 (ET-1) in tissues of human salivary glands, we performed an immunohistochemical analysis of ET-1 in 15 normal salivary glands, 8 adenolymphomas, 13 pleomorphic adenomas and 5 carcinomas, using the mouse monoclonal antibody against human ET-1. In normal glands, immunoreactivity for ET-1 was observed in the striated duct cells. In adenolymphomas, the columnar cells of the granular epithelium showed strong intracytoplasmic immunoreactivity. In carcinomas, moderate or strong immunoreactivity was observed in the tumor cells, whereas in pleomorphic adenomas, weak immunoreactivity was observed. A good relation was detected between the size of pleomorphic adenoma and ET-1 immunoreactivity, as well as between the duration of tumor in carcinoma and ET-1 immunoreactivity. The presence and distribution of ET-1 in salivary glands and salivary gland tumors suggests a possible role for ET-1 in the regulation of electrolytes and water transport in salivary glands, and as a growth-promoting factor for tumors. (J Nippon Med Sch 1998; 65 : 471-477)

DOI： 10.1272/jnms1923.65.471

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Language：Japanese   Publisher：Oto-Rhino-Laryngological Society of Japan Inc.  

The charts of 319 consecutive patients who underwent total laryngectomy at the Cancer Institute Hospital from 1971 to 1994 were reviewed in order to clarify the relationship between pharyngo-cutaneous fistula formation and age, the dose of pre-operative radiation and radical neck dissection, as well as the need for subsequent surgical repair. The patients did not need to undergo reconstruction by flaps at the time of laryngectomy. Radiation sources were limited to X ray radiotherapy and Cobalt 60. Of the 319 patients 204 (63.9%) underwent neck dissection. Both radical neck dissection and modified radical neck dissection were classified as neck dissection. The chi-square test was used to construct a table of the three parameters age, dose of radiation and neck dissection. With respect to age, the incidence of fistula formation was 13.4% (16 patients of 119) in patients at the age of 59 and below, 5.9% (7/118) in those from 60 to 69, and 8.5% (7/82) in those at 70 years and above. Our analysis reveals that the age at the time of surgery is not a predisposing factor for fistula formation in the three age groups (59 and below, between 60 and 69, and 70 and above). Similarly the need for subsequent surgical repair is also not age-related. With respect to radiation, the incidence of fistula formation was 8.0% (4/50) for patients who received radiotherapy less than 20 Gy, 6.3% (2/32) in those who received between 20 and 40 Gy, 2.6% (2/77) in those who received between 40 and 60 Gy, 13.2% (20/152) in those who received between 60 and 80 Gy and 25.0% (2/8) in those who received over 80 Gy. When the preoperative dose of radiation was divided into three classes, that is, less than 40 Gy, 40 to 60 Gy and over 60 Gy, we observed that the incidence of fistula formation increased significantly in the patients who received over 60 Gy. Surgical repair was also indicated more frequenly for those patients who received over 60 Gy than for those who received less than 60 Gy. With respect to neck dissection, the incidence of fistula formation was 12.2% (14/115) for the patients who did not undergo neck dissection or those who underwent only lymphadenectomy, 7.8% (9/115) for the patients who underwent unilateral neck dissection, and 7.9% (7/89) for those who underwent bilateral neck dissection. These data reveal that neck dissection, whether unilateral or bilateral, dose not increase the incidence of fistula formation, nor the need for subsequent surgical repair. Fistulae were present in 30 patients (9.4%) for 24 years, and 14 of these 30 patients did not need subsequent surgery. In these 30 patients with fistulae, we did not find patients with systemic disease such as diabetes mellitus prior to the surgery. When the period of 24 years was divided into 4 periods, the incidence of fistula formation was 19.0% (from 1971 to 1976), 6.9% (from 1977 to 1982), 10.3% (from 1983 to 1989) and 2.6% (from 1989 to 1994), that of the latest priod was the lowest with gradual improvement. The average dose of preoperative radiation was 57.7 Gy (from 1971 to 1976), 50.8 Gy (from 1977 to 1982), 39.6 Gy (from 1982 to 1988)and 45.7 Gy (from 1989 to 1994) and reduction in dose of radiation seemed to be one of the reasons for the lower frequency of fistula. Several surgeons performed the operations for different patients, but the procedure of laryngectomy was recently directed by an experienced surgeon. The study also indicates that the risk of fistula formation is reduced not only by the dose of radiation but also by improved surgical skill.

DOI： 10.3950/jibiinkoka.100.213

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Language：English  

Sixteen patients with lymphatic metastases to the neck and a histological diagnosis of undifferentiated carcinoma from an unknown primary lesion were assessed using immunohistochemical staining. The results revealed a non-epithelial tumor in 11 cases (malignant lymphoma in 5 cases) and an epithelial tumor in 3 cases. The patients with malignant lymphoma had a good outcome, but those with other non-epithelial tumors did not. Treatment of patients with an unknown primary tumor, especially undifferentiated carcinoma, should be carefully evaluated based on immunohistological examinations to identify malignant lymphoma. © 1994, The Oto-Rhino-Laryngological Society of Japan, Inc. All rights reserved.

DOI： 10.3950/jibiinkoka.97.2202

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DOI： 10.3950/jibiinkoka.97.2202

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