A RETROSPECTIVE STUDY OF CORRELATION BETWEEN DEPTH OF MALIGNANT TONGUE ULCER AND CERVICAL METASTASIS

BackgroundIn India, the oral tongue cancer is the fourth most common type of cancer among all cancers andsecond most common in cancers of oral cavity in males. Though there are advances in thediagnosis and treatment of the oral malignancies including the tongue, the failure rates in cancerof the oral tongue are high as the tongue malignancy has higher chances of spreading to necklymph nodes compared with other oral cancers.MethodA retrospective review of the case records of 55 patients who underwent surgery for thetreatment of carcinoma of the tongue was carried off in the department of General Surgery andOnco-surgery at the GCS Hospital, Ahmedabad to ensure the pattern of cervical lymph nodemetastasis and to assess the sensitivity of depth of malignant tongue ulcer in predicting its nodalspread.ResultsAmong 55 patients, diagnosed with carcinoma tongue and operated for hemi glossectomy alongwith MRND, Lymph node metastasis was present in 22 (40%). Out of these 22 patients, themean depth of invasion was 11 mm. In patients without lymph node metastasis, the mean depthof invasion was 8.3 mm.Chances of cervical lymph node metastasis increases with increment in the depth of malignanttongue ulcer.ConclusionThe infiltration depth of the malignant tongue ulcer can be used as an autonomous predictor forthe presence of nodal metastasis.

Supervivencia de pacientes con metástasis cervical de primario desconocido en el Instituto Nacional de Oncología y Radiobiología. 2007-2012

Resumen Introducción: Las metástasis cervicales con primario oculto representan el 5% de los tumores de cabeza y cuello. Su diagnóstico y tratamiento han sufrido modificaciones con los años según las diferentes investigaciones, con vistas a mayores tasas de supervivencia. Objetivo: Determinar la supervivencia global y según diferentes variables. Material y Método: Investigación retrospectiva, descriptiva y longitudinal de 96 pacientes diagnosticados en el Instituto Nacional de Oncología y Radiobiología (INOR) en el periodo 2007-2012, manteniéndose el seguimiento hasta el 31 de diciembre de 2017. Resultados: De los pacientes estudiados, 65 eran hombres (67,7%) y 31 mujeres (32,3%), para una razón de 2,1:1, con una media de edad de 61,4 años. El tabaquismo estuvo presente en el 64,6% de la población. El nivel ganglionar más afectado fue el II y 41 pacientes (42,7%) presentaron una enfermedad N1 al diagnóstico. En 42 pacientes (43,8%) estuvo presente el grado histológico poco diferenciado. Al 70,9% se les practicó cirugía con adyuvancia o sin ella y el 86,5% tuvo respuesta completa. El tumor primario apareció en el 13,5% de los casos, más frecuente en amígdala. La supervivencia global a los 5 años fue del 74% y resultaron variables determinantes de supervivencia el estado ganglionar y la extensión extraganglionar. Los resultados coinciden con la literatura revisada. Conclusión: La supervivencia global a los 5 años de los pacientes con metástasis cervical de primario oculto es elevada, tiene tendencia a mejorar con el paso de los años y está determinada por el estado ganglionar y la extensión extracapsular de forma inversamente proporcional.

Abstract Introduction: Cervical metastases with occult primary represent 5% of head and neck tumors. Its diagnosis and treatment have been modified over the years according to different investigations, with a view to higher survival rates. Aim: To determine the overall survival and according to different variables. Material and Method: A retrospective, descriptive and longitudinal investigation of 96 patients diagnosed at INOR in the period 2007-2012 was carried out, with follow-up until December 31, 2017. Results: Of the patients studied, 65 were men (67.7%) and 31 women (32.3%), for a ratio of 2.1: 1, with a mean age of 61.4 years. Smoking was present in the 64.6% of the population. The most affected lymph node level was level II and 42 patients (43.8%) presented N1 disease at diagnosis. Poorly differentiated histological grade was present in 42 patients (43.8%). 70.9% underwent surgery with or without adjuvant surgery and 86.5% had a complete response. The primary tumor appeared in 13.5% of cases, more frequent in the amygdala. Overall survival at 5 years was 74%, and survival variables were lymph node status and extranodal extension. The results coincide with the reviewed literature. Conclusion: The overall 5-year survival of patients with occult primary cervical metastasis is high, tends to improve over the years, and is determined by lymph node status and extracapsular extension in an inversely proportional manner.

Hallazgo incidental de metástasis de carcinoma de tiroides en disección de cuello por carcinoma de laringe / Incidental finding of metastasis due to thyroid´s carcinoma in a neck dissection by larynx carcinoma

RESUMEN Introducción: El fenómeno de las neoplasias primarias múltiples se ha descrito en cabeza y cuello, de forma metacrónica y sincrónica. Caso clínico: Hombre de 54 años, piel negra y procedencia rural con carcinoma escamoso de laringe T3N1M0, etapa III, que en disección de cuello se encontró incidentalmente metástasis ganglionar de carcinoma papilar de tiroides, sin evidencia clínica de lesión tiroidea. Luego se realizó ecografía y gammagrafía de la glándula cuyos resultados no mostraron alteración alguna. Conclusiones: El carcinoma de tiroides es hallado incidentalmente en el espécimen resecado después de cirugía por cáncer de cabeza y cuello en 0,3 - 1,9 por ciento de los pacientes. Por este motivo debe evaluarse bien la glándula tiroides previa cirugía de cabeza y cuello(AU)

ABSTRACT Introduction: The phenomenon of multiple primary neoplasms has been described in the head and neck in a synchronous and metachronous way. Clinical case: A 54 years old man, black skin and rural origin with a T3N1M0 larynx squamous cell carcinoma, stage III that in a neck dissection was incidentally found a node metastasis of papillary thyroid carcinoma, without clinical evidence of thyroid lesion. This was followed by ultrasound and nuclear scan of the gland, whose results did not show any alteration. Conclusions: The thyroid carcinoma is found incidentally in the resected specimen after surgery by head and neck cancer in 0.3 - 1.9 percent of patients. The thyroid gland must be well assessed after head and neck surgery(AU)

Debut de adenocarcinoma de próstata en adenopatía cervical metastásica: reporte de caso clínico / Debut of prostate adenocarcinoma in metastasic cervical adenopathy: clinical case report

INTRODUCTION: Prostatic carcinoma is a tumor that occurs mainly in men older than 50 years. More than 95% correspond to adenocarcinomas and their degree of tumor differentiation is related to metastasis and death. Becausemetastasis to cervical lymphatics is infrequent and with worse survival, a clinical case will be presented. Clinical case: A 62-year-old man, in whom late prostate cancer was later, investigated after multiple imaging studies, biopsies and immunohistochemistry. Discussion: The diagnosis of prostatic carcinoma can be precociously investigated by a simple Rectal Touch coupled with specific Prostate Antigen (PSA), performed in primary care, especially in men with ages close to the fifth decade of life.

Prognostic significance of soft tissue deposits in laryngeal carcinoma / Importância prognóstica de depósitos de tecido mole no carcinoma laríngeo

Abstract Introduction: Soft tissue deposits is tumorous islands apart from lymph nodes and occasionally diagnosed in neck dissection specimens. Their importance has begun to be recognized, however, their value has not been investigated in laryngeal cancer as a single tumor site. Objective: To investigate the prognostic value of soft tissue deposits in patients with laryngeal carcinoma. Methods: Medical records of 194 patients with laryngeal carcinoma who were treated primarily by surgery and neck dissection were reviewed. Prognostic significance of soft tissue deposits was assessed along with other clinical and pathological findings. Recurrence rates, overall and disease-specific survival rates were examined. Results: The incidence of soft tissue deposits was found to be 7.2% in laryngeal carcinoma. N stage was more advanced in patients who had soft tissue deposits. Regional recurrence rate was higher and disease specific and overall survivals rates were significantly lower in patients with soft tissue deposits in univariate analysis. However, in multivariate analysis, soft tissue deposits were not found as an independent risk factor. Conclusion: In laryngeal carcinoma, soft tissue deposits was diagnosed in patients with more advanced neck disease and their significance was lesser than other factors including extranodal extension.

Resumo Introdução: Depósitos de tecido mole são ilhas tumorais diferente dos linfonodos e ocasionalmente diagnosticados em amostras de esvaziamento cervical. Sua importância começou a ser reconhecida, mas seu valor não foi investigado no câncer de laringe como um único local de tumor. Objetivo: Investigar o valor prognóstico do depósito de tecido mole em pacientes com carcinoma laríngeo. Método: Os prontuários de 194 pacientes com carcinoma laríngeo tratados principalmente por cirurgia e esvaziamento cervical foram analisados. O significado prognóstico dos depósitos de tecido mole foi avaliado juntamente com outros achados clínicos e histopatológicos. As taxas de recidiva, as taxas de sobrevida geral e específicas da doença foram avaliadas. Resultados: Observou-se uma incidência de depósitos de tecido mole de 7,2% no carcinoma laríngeo. O estágio N foi mais avançado em pacientes com depósitos de tecido mole. A taxa de recorrência regional foi maior e as taxas de sobrevida geral e específica da doença foram significativamente menores nesses pacientes na análise univariada. No entanto, na análise multivariada, o depósito de tecido mole não foi observado como um fator de risco independente. Conclusão: No carcinoma laríngeo, o depósito de tecido mole foi diagnosticado em pacientes com doença cervical mais avançada, mas sua significância foi menor do que outros fatores, inclusive a extensão extranodal.

Is elective neck dissection needed in squamous cell carcinoma of maxilla?

OBJECTIVES: To define the risk of occult cervical metastasis of maxillary squamous cell carcinoma (SCC) and the therapeutic value of elective neck dissection (END) in survival of clinically negative neck node (cN0) patients. MATERIALS AND METHODS: Sixty-seven patients with maxillary SCC and cN0 neck were analyzed retrospectively, including 35 patients with maxillary gingiva and 32 patients with maxillary sinus. RESULTS: Of 67 patients, 10 patients (14.9%) had occult cervical metastasis. The incidence of occult cervical metastasis of maxillary gingival SCC was higher than that of maxillary sinus SCC (17.1% and 12.5%, respectively). The 5-year overall survival rate was 51.9% for the END group and 74.0% for the non-END group. The success rate of treatment for regional recurrence was high at 71.4%, whereas that for local or locoregional recurrence was low (33.3% and 0%, respectively). CONCLUSION: The incidence of occult cervical metastasis of maxillary SCC was not high enough to recommend END. For survival of cN0 patients, local control of the primary tumor is more important than modality of neck management. Observation of cN0 neck is recommended when early detection of regional recurrence is possible irrespective of the site or T stage. The key enabler of early detection is patient education with periodic follow-up.

Cervical metastases and prognosis of oral maxillary squamous cell carcinoma:A retrospective study / 实用口腔医学杂志

Objective:To investigate the incidence of cervical metastasis of oral and maxillary squamous cell carcinoma(SCC)and to define its impact factors.Methods:A retrospective study of patients with SCC of hard palate and maxillary alveolus treated by surgery from 2002 to 2011.Results:The incidences of cervical metastasis and occult metastasis were 17.2%(11 /64)and 9.8%(5 /51)re-spectively.pT classification and vascular invasion were correlated with cervical metastasis.Occult metastatic risk was significantly higher in pT4 patients.Presence of positive nodes impaired prognosis significantly.Conclusion:Overall and occult metastasis of oral and maxillary SCC were highly associated with pT classification.Routine and synchronous elective neck dissection(END)is recomend for the treatment of T4 lesions while observation is alternative for T1 -T3 lesions.

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

Introduction: 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 factorsthat 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. Materials and Methods: 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. Results: 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%. Conclusion: 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.

A Double Immunohistochemical Study on the Expression of Matrix Metalloproteinase-2 and Type IV Collagen in Squamous Cell Carcinoma of the Oral Cavity and Oropharynx / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Matrix metalloproteinase-2 (MMP-2) is produced by tumor cells that specifically cleaves type IV collagen, one of the major constituents of basement membrane. The MMP-2 and type IV collagen have been postulated to have an important role in the invasion and spread of malignant tumors. However, little has been reported about expression of MMP-2 and type IV collagen in primary tumors and metastatic lymph nodes of oral cavity and oropharynx simultaneously. So we investigated that MMP-2 and type IV collagen can be used as the prognostic indicators of metastasis in squamous cell carcinoma of oral cavity and oropharynx. MATERIALS AND METHODS: Double immunohistochemistry was used to detect MMP-2 and type IV collagen in 32 primary tumors (14 cases had metastatic nodes and 18 cases had no metastatic node) of surgically treated squamous cell carcinoma of the oral cavity and oropharynx. The findings were compared to clinical findings of each cases. RESULTS: The immunoreactivity of MMP-2 increased significantly as more destructive patterns of basement membrane components in primary tumor (p=0.019) than metastatic lymph nodes. The cases with cervical metastasis showed more destructive patterns than cases with absence of cervical metastasis in primary tumor (p=0.003), but expression of MMP-2 had no correlation with presence or absence of cervical metastasis. The cases with diffuse invasion showed more destructive pattern than cases with any other patterns in primary tumor. However, expression of MMP-2 had no correlation with invasion mode of primary tumor. In metastatic lymph node, neither of them had no correlation with invasion mode. No statistical correlations in expression of MMP-2 and type IV collagen were detected between primary tumor and metastatic lymph nodes. CONCLUSION: The expression patterns of MMP-2 and type IV collagen in oral cavity and oropharyngeal squamous cell carcinoma can be useful in predicting cervical metastasis.