Use of 18F-Fluorodeoxyglucose Positron Emission Tomography in Patients with Rare Head and Neck Cancers

OBJECTIVES: The clinical utility of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been demonstrated in major head and neck cancers (HNCs) but is unclear in rare HNCs. We therefore evaluated FDG PET in the management of patients with rare HNCs. METHODS: FDG PET and CT/MRI scanning were performed at the initial staging and/or the follow-up in 24 patients with rare HNCs, 10 with melanoma, 9 with sarcoma, 3 with olfactory neuroblastomas, and 2 with basal cell carcinoma. The diagnostic accuracy of CT and FDG PET for detecting primary tumors and metastases were compared with a histopathologic reference. The association between the PET results and the clinicopathologic parameters predicting tumor invasion, histologic grade and disease-free survival (DFS), was assessed. RESULTS: The overall accuracies of FDG PET and CT/MRI were 92% and 79%, respectively, for detecting primary tumors and 91% and 74%, respectively, for nodal metastases, but the differences were not significant due to the small number of patients. The sensitivity and specificity of FDG PET for detecting distant metastases and second primary tumors were 100% and 87%, respectively. Follow-up FDG PET correctly diagnosed locoregional recurrence in all 12 patients, as shown by biopsy, and distant metastases in 6 patients. However, thickness of melanoma, histologic grade of sarcoma, and DFS were not associated with tumor FDG uptake. CONCLUSION: FDG PET may be useful for staging, posttreatment monitoring, and detection of distant metastases and second primary tumors in patients with rare HNCs.

Relationship between the Expression of Ku70/80, p53, Epidermal Growth Factor Receptor and Cyclooxygenase-2 and Prognosis in Squamous Cell Carcinoma of the Tonsil / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to find out if Ku70/80, p53, EGFR and COX-2 expressions are associated with prognostic variables and to examine the survival rate in tonsillar squamous cell carcinoma. SUBJECTS AND METHOD: From October 1991 to April 2006, 52 cases of paraffin-embedded tonsillar specimens were obtained by surgical resection in the Asan Medical Center. All tissue samples were subjected to immunohistochemical staining for Ku70/80, p53, EGFR and COX-2. Clinical factors such as age, treatment modality, TNM stage were evaluated nad detailed analyses were performed regarding the relationship between the expression of molecular markers, overall survival and disease free survival rates. RESULTS: In the Ku70 expression, there were no cells that did not stain and 3 cases where less than 75% of cells stained positive. In the Ku80 expression, there was one case that did not stain and 3 cases where less than 75% of cells that stained positive. The positivity of p53, EGFR and COX-2 was 19% (10/52), 2% (1/52), 50% (26/52), respectively. There was a significant correlation between p53 and survival (overall and disease free) in the univariate analysis (p=0.049, p=0.017). However, there was no correlation in the multivariate survival analysis (p=0.187, p=0.078). CONCLUSION: This study finds that the expression of p53 correlates with an unfavorable prognosis in tonsillar squamous cell carcinoma. The p53 protein can be a biological marker for prediction of prognosis in tonsillar squamous cell carcinoma.

A Case of Cochlear Implantation in Otosclerosis / 대한이비인후과학회지

Otosclerosis is known to be rare in orientals, but there have been a few reports of the clinically suspicious otosclerosis cases in Korea. Otosclerosis is a bony disorder involving endochondral bone of the otic and labyrinthine capsule. Advanced and very advanced otosclerosis are conditions in which the otosclerotic involvement of the otic capsule has progressed to result in profound deafness with undetectable bone and air conduction thresholds. The patients, who have severe to profound hearing loss due to otosclerosis, potentially benefit from a stapes surgery and optimal hearing aid fitting. But there are a few reports that cochlear implantation may provide these patients with a superior outcome. We report a 58 year-old man with severe to profound hearing loss, which was a first reported case of cochlear implantation employed to treat otosclerosis in Korea. We present this with a review of the related literature.

Clinical Analysis of the Laryngeal Premalignant Lesion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is hard to adequately define the clinical and histologic characteristics of laryngeal premalignant lesions that herald the potential for progression to invasive squamous cell carcinoma especially in the Korean population. The aim of this study was to analyze prognostic factors of laryngeal premalignant lesions in the Korean population. MATERIALS AND METHOD: A retrospective analysis was undertaken in 88 patients with laryngeal premalignant lesions. All were diagnosed with laryngeal keratosis and dysplasia on pathology. RESULTS: 66 patients showed keratosis, 12 patients mild dysplasia, 4 patients moderate dysplasia, and 6 patients severe dysplasia. Of the 88 patients available for follow up (ranging from 6 to 135 months), six patients (6.8%) developed invasive squamous cell carcinoma. Use of CO2 Laser was not associated with cancer progression (p=0.641). In contrast, grade of dysplasia was significantly associated with cancer risk (p=0.032). CONCLUSION: The laryngeal premalignant lesion represents a possible passage to cancer in a limited number of cases, but with a more probability for high degree dysplasia in respect to low degree dysplasia.