The relationship between extend types and distant metastasis of nasopharyngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the relationship between extend types and distant metastasis of nasopharyngeal carcinoma (NPC).@*METHOD@#Retrospective analyze 260 patients with nasopharyngeal carcinoma, among which 162 cases were distant metastasis (metastasis group) and 98 cases were neither distant metastasis nor recurrence (disease-free group) over 5 years after radiotherapy. All these patients were staged depending on CT or MRI image before treatment and divided into local-regional type(T(1-2)N(0-1)) for 36 cases and upward invasion type (T(3-4)N(0-1)) for 68 cases and downward invasion type (T(1-2)N(2-3)) for 75 cases and mixed type (T(3-4)N(2-3)) for 81 cases. The differences between two groups was analyzed using Chi-square test.@*RESULT@#The local-regional type and upward invasion type was 25.3% for the metastasis group and 64.3% for the disease-free group. The downward and mixed invasion was 74.7% for the metastasis group and 35.7% for the disease-free group. The rate(proportion) of N(2-3) was significantly higher in metastasis group than in disease-free group with limited extension (84.4% vs. 33.3%, P < 0.01). The rates(proportion) of N(0-1) and N(2-3) were also significantly higher in metastasis group than in disease-free group with severity extension (T(3-4) (60% vs. 36.1% and 68.4% vs. 40%, P < 0.01).@*CONCLUSION@#The extent of cervical lymph node metastases is one of the most important factors of NPC with distant metastasis, severity extension of primary disease should also be in consideration. Even the limitations of primary disease, once cervical lymph node metastasis occurs, the risk of distant metastasis is significantly increased.

Clinical experience of cervical trachea sleeve resection / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To summarize the experience of cervical trachea sleeve resection.@*METHOD@#Twelve cases of sleeve resection between January 1985 and December 2006 were retrospectively analyzed. Six cases were adenoid cystic carcinoma, four cases were squamous cell carcinoma, one case was adenocarcinoma and one case was cervical tracheomalacia. Length of cervical trachea resection is three to six cm with primary anastomosis, among which five cases were over five cm, seven cases underwent laryngeal release and three cases underwent subtotal thyroidectomy. Nine cases were tracheal anastomotic stoma enwrapped with normal thyroid tissue and three cases were not.@*RESULT@#Laryngeal function and normal phonation were saved, anastomotic stoma healed up, and the tracheal mucosa appear normal in all the patients . The three years survival rate and five years' survival rate were 85.37% and 56.61% for the patients respectively.@*CONCLUSION@#Cervical trachea sleeve resection accorded with the principle of tracheal tumors therapy. It was conducive to healing of the tracheal anastomosis.

Effects on distant metastasis of misdiagnosis of nasopharyngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the effects of situation of misdiagnosis of nasopharyngeal carcinoma (NPC) on distant metastasis.@*METHOD@#The history of diagnosis and treatment of 85 newly diagnosed cases with nasopharyngeal carcinoma were studied by using itemized questionnaire purposely; 433 patients with different prognosis were analyzed retrospectively for the misdiagnoses and mistreatment, including surgical biopsy in the neck.@*RESULT@#(1) The rate of misdiagnosis of 85 patients was 72.64%, and the percentage decreased as the level of the hospitals increased; the majority of the patients (77.36%) were diagnoses within 1 month after the first symptom had appeared; the number of diseases misdiagnosed was 20, most common of which were lymphnoditis, tuberculosis of lymph node and secretory tympanitis; (2) Our data showed that among 433 patients analysed retrospectively, 60 cases had undergone surgical biopsy in the neck, 75% of whom had never received nasopharyngeal biopsy; 43 cases had underwent nasopharyngeal biopsy after the pathological diagnosis as metastatic carcinoma of neck biopsy (71.67%) and the rest (20.0%) received radiotherapy directly or after negative nasopharyngeal biopsy for merely 1 to 4 times; of those 43 cases who were diagnosed as NPC by nasopharyngeal biopsy, 79.17% got positive results at first sampling. (3) Rate of misdiagnosis and mistreatment including surgical biopsy in the neck of patients who had been tumor-free for 5 years or above was significantly lower than that of those who experienced distant metastasis after or before treatment (P < 0.05).@*CONCLUSIONS@#Misdiagnosis and mistreatment including biopsy by surgery of neck is common even in high-grade hospitals; it is doctor that is responsible for this situation; the high occurrence rate of misdiagnosis and mistreatment, biopsy by neck surgery, especially the delayed treatment after the neck biopsy are the factors that contribute to distant metastasis of NPC.

Correlation between expression of TIAM1 gene and carcinomas of larynx / 临床检验杂志

Objective To study the relation between Tiam1 gene(T lymphoma invasion/metastasis 1)and carcinomas of larynx metastasized to lymph node.Method Using reverse transcription polymerase chain (RT-PCR) mRNA overexpression of Tiam1 gene in 30 cases of carcinoma of larynx tissue,12 lymph nodes and 10 cases of normal larynx tissue was studied.Result The frequency of TIAM1 overexpression was 75% (6/8) in primary carcinomas of larynx with metastasis but only 18.7%(4/22) in those without metastasis(P=0.0072).Overexpression of TIAM1 in metastasized lymph nodes was observed in 100% (8/8) of lymph nodes with metastasis but in only 25%(1/4) of the lymph nodes without metastasis of carcinoma(P=0.0182).The frequency of TIAM1 overexpression was 33.3% (10/30) in primary carcinomas of larynx.Conclusion Our data suggest that the overexpression of the TIAM1 gene correlates with lymph node metastasis of carcinomas of larynx.

Clinicopathological analysis of 40 elder patients with thyroid carcinoma / 中国普通外科杂志

Objective To investigate the pathogenistic, clinical and pathologic characteristics and treatment in elder patients with thyroid carcinoma(TC). Methods The clinical and pathologic manifestation, the treatment and prognosis of forty elder patients with thyroid carcinoma were analysed. Results The incidence of TC in elder patients was 14.2% in all of the thyroid carcinomas in the same period. The clinical course was longer and the neoplasm was bigger. A majority of the pathology was follicular adenocarcinoma(35%), followed by adenocarcinoma, undifferentiated carcinoma and pipallary adenocarcinoma. Surgerical management was the primary therapy. 17 cases underwent redical thyroidectomy with neck dissection, 13 total thyroidectomy or subtotal thyroidectomy, 4 palliative resection. Isotopic or radiotherapy as an adjuvant therapy was done if necessary. Five year survival rat was 52.0%, mortality was 45.0% in follow up period. Conclusions The main causes of the poorer prognosis of elder patients with thyroid carcinoma are follows: ① the malignant degree of the tumor is higher; ② the reaction for the tumor in elder patients is duller. So it is important to pay attention to elder patients with thyroid nodule, and an operation should be done as quick as possible.

Papillary microcarcinoma of the thyroid / 中国普通外科杂志

5 mm) had a significant influence on the frequency and distribution of cervical lymph node metastasis. The local recurrent rate in palpable lymph node group was significantly higher than the non-palpable lymph node group. Conclusions Careful palpation, B type ultrasonography, exploratory operation and frozen section are very important factors to heighten diagnosis of PTMC. We believe that PTMC could be divided into two subsets: with the former of non-aggressive behaviors treated by conservative surgery, and the later of a potentially aggressive clinical course treated by a more aggressive procedure.