Epidemiologic Survey of Head and Neck Cancers in Korea

Head and neck cancers have never been systematically studied for clinical purposes yet in Korea. This epidemiological survey on head and neck cancer patients was undertaken from January to December 2001 in 79 otorhinolaryngology resident-training hospitals nationwide. The number of head and neck cancer patients was 1,063 cases in the year. The largest proportion of cases arose in the larynx, as many as 488 cases, which accounted for 45.9%. It was followed by, in order of frequency, oral cavity (16.5%), oropharynx (10.0%), and hypopharynx (9.5%). The male:female ratio was 5:1, and the mean age was 60.3 yr. Surgery was the predominant treatment modality in head and neck cancers: 204 (21.5%) cases were treated with only surgery, 198 (20.8%) cases were treated with surgery and radiotherapy, 207 cases (21.8%) were treated with combined therapy of surgery, radiotherapy, and chemotherapy. Larynx and hypopharynx cancers had a stronger relationship with smoking and alcohol drinking than other primary site cancers. Of them, 21 cases were found to be metastasized at the time of diagnosis into the lung, gastrointestinal tract, bone, or brain. Coexisting second primary malignancies were found in 23 cases. At the time of diagnosis, a total of 354 cases had cervical lymph node metastasis accounting for 42.0%.

The Incidence and Clinical Symptoms of Palatine Tonsillar Hypertrophy in Elementary School Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Snoring and sleep apnea from tonsillar hypertrophy are the main problems for tonsillectomy and adenoidectomy, which are the most frequently performed surgical procedures in the pediatric population. The relative size of the palatine tonsils to the oropharynx gets smaller with increasing age, but little has been studied about the age distribution and the associated change in the clinical symptoms. We attempted to observe the incidence according to age and to determine the relationship between the tonsillar hypertrophy and snoring, and sleep apnea in obese children. MATERIALS AND METHODS: A total of 2,248 elementary school children in one district of Ansan City were entered in the study. The index of obesity, the presence and degree of tonsillar hypertrophy were determined and the symptoms due to tonsillar hypertrophy were investigated. RESULTS: The prevalence of tonsillar hypertrophy of grades 3 and 4 was 28.0% at 6yrs and 22.9% at 7yrs. The prevalence decreased dramatically after 10yrs, with the prevalence rate below 10%. The prevalence of palatine tonsillar hypertrophy was significantly higher in obese children than in non-obese children. The most common clinical symptoms determined from questionnaires were sore throat. Although snoring decreased with increasing age, sore throat accompanied by fever was more common with increasing age. CONCLUSION: The prevalence of palatine tonsillar hypertrophy rapidly decreased after the age of 10. Therefore, we believe that when making a decision to perform a tonsillectomy, the change in size of palatine tonsils with increasing age should be an important factor to consider along with clinical symptoms.

Microscopic Adenoidectomy Using the Electric Adenotome / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The conventional adenoidectomy is performed via the transoral approach and can be accomplished with adenoid curette, adenotome, and adenoid punch. This method has been associated with many complications. We performed an adenoidectomy using an electric adenotome under the operating microscope. The aim of this study was to compare the electric adenotome adenoidectomy with the conventional adenoidectomy and to evaluate the effectiveness and outcome of the electric adenotome surgery. MATERIALS AND METHODS: One hundred cases of microscopic adenoidectomy using the electric adenotome and one hundred cases of conventional methods using curette or punch forceps were examined. RESULTS: There was less incidence of intraoperative and postoperative bleeding in the electric adenotome adenoidectomy group. There were no differences regarding the postoperative outcome and recurrence rate between the electric adenotome method group and the conventional method group. CONCLUSION: Compared to the conventional method, the electric adenotome method has similar postoperativc result but has a lower incidence of intraoperative and postoperative bleeding. We suggest that adenoidectomy using an electric adenotome is an attractive surgical method in children with symptomatic adenoid vegetation,

Microscopic Partial Tonsillectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Conventional tonsillectomy with the naked eye has posed problems in obtaining a good surgical field and in minimizing damage to the adjacent tissue. Tonsillectomy using an operating microscope offers outstanding illumination and visualization of the surgical field, thereby reducing the incidence of complications associated with tonsillectomy. The objective of this study was to compare the surgical methods of the conventional and the microscopic tonsillectomies, and to evaluate the usefulness and effectiveness of the microscopic tonsillectomy. MATERIALS AND METHODS: Two hundred children between the ages of five and ten who received tonsillectomy between June 1995 and August 1998 at Korea University Hospital were divided into two groups,' one group underwent tonsillectomy using an operating microscope (Group 1, n=100) and the other group underwent tonsillectomy using the conventional dissection and snare technique (Group 2, n = 100). Duration of surgery, post-operative healing period, amount of intra and post-operative hemorrhage, post- operative pain score, and the incidence of post-operative cicatrical pharyngeal stenosis were compared between the two groups. RESULTS: There was no statistically significant diference in operating time and post-operative healing period between the two groups, but cicatrical pharyngeal stenosis due to post-operative scarring was more common in the group that underwent conventional tonsillectomy. The amount of hemorrhage both intra and post-operatively, and post-operative pain was significantly decreased in the microscopic tonsillectomy group. CONCLUSION: The widespread use of operating microscope in otolaryngological surgeries allows this technique to be applied to tonsillectomy with few problems. This technique affords decreased intra-operative bleeding, less post-operative complications, and decreased post-operative pain compared with conventional techniques. We believe that microscopic tonsillectomy is a safe, elegant and effective procedure that represents a new concept in tonsil surgery.

Clinical Experience of Chronic Recurrent Parotitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic recurrent parotitis has been considered as an ascending infection from the oral cavity, but its causes remain unknown. Although conservative mechanical and medical measures are usually effective in controlling the acute exacerbations of this disease, surgical treatment may become necessary when the infection become too frequent or severe for episodic treatment. This study was designed to evaluate the etiology and pathology, and to analyse the outcome of surgery. MATERIALS AND METHODS: A retrospective study was conducted on nine patients who were managed by surgery(seven patients: superficial parotidectomy, two patients: total parotidectomy) after failure with all conservative measures. The age distribution was from 25 to 72 years, with the mean of 44 years. RESULTS: Of nine patients, the numbers of recurrence were 1-5 times (with the average of three times). Duration of illness ranged from one to 42 years, with a mean of 12 years. Conservative treatments preceding surgery included parotid gland massage, sialogogues, repeated use of antibiotics, and Stensens duct probing in all patients. The disease persisted in all the patients despite these measures, but following parotidectomy (superficial: 7 patients, total: 2 patients), all had complete resolution of the disease. Two patients developed transient facial weakness (House-Brackmann grade II) postoperatively without permanent sequelae. Other complications included seroma in two patients, facial deformity in two patients, Freys' syndrome in one patient, and salivary fistula in one patient. CONCLUSION: Chronic recurrent parotitis, when deeply severe, causes significant. When all the conservative medical management fail, parotidectomy can be offered as the last resolution.

Immunohistochemical Classification and Clinical Evaluation of Nasal Malignant Lymphoma

BACKGROUND AND OBJECTIVES: Polymorphic reticulosis (PMR), a type of lethal midline granuloma, has characteristics of necrosis, angiocentricity, and angiogenesis, which is also known as nasal T-cell lymphoma. In this study, we classified PMR and nasal lymphoma using immunohistochemical staining and investigated the clinical characteristics of nasal malignant lymphoma including survival rates with treatment modalities. MATERIALS AND METHODS: Twenty-six patients previously diagnosed with PMR or nasal lymphoma from May 1992 to April 1997 were included in this study. We performed immunohistochemical staining with CD3, CD56 and CD79a for classification and reviewed the patients' clinical characteristics and survival rates, retrospectively. RESULTS: Of twenty-six patients, twenty-five patients were classified as having angiocentric lymphoma and only one patient with B-cell lymphoma. Higher mortality rates were observed in patients receiving chemotherapy alone than in those receiving chemotherapy and radiation therapy and in advanced stage. CONCLUSIONS: Early detection and combined treatment could improve the survival rate of patients with nasal malignant lymphomas.

The Mechanism of Retinoic Acid-induced Growth Suppression in Head and Neck Squamous Cancer Cell Lines / 대한암학회지

PURPOSE: Retinonic acid (RA) has been reported to induce differentiation and growth inhibition in various head and neck squamous cancer cell (HNSCC) lines. We hypothesized that this growth inhi bition might be explained by RA-induced apoptosis on cell cycle arrest mechanism. Therefore, we studied the degree of RA-induced apoptosis with variable RA concentration and exposure duration. MATERIAL AND METHODS: The flow cytometric evaluation of apoptosis degree and cell cycles were carried out with 7-amino actinomycin D (7AAD) and propium iodide (PI) respectively, with var ious RA exposure durations (2, 3, 6 day) and concentrations (conrol, 10 6, 10 7, 10 8, 10 9, 10 10 mole). Two different HNSCC lines (1483, SqCC/Y1) were used and the experiment was repeated twice. RESULTS: The maximal fraction of apoptosis in 1483 and SqCC/Y1 cell lines were observed at same concentration and exposure duration (1483: 6th day & 10 6, mole, and SqCC/Y1: 6th day & 10 6 mole). In our experimental model, RA did not induce specific cell cycle arrest in these HNSCC lines. However we observed S phase fraction increase in SqCC/Y1 cell line after RA treatment. CONCLUSION: We suppossed that in HNSCC lines, RA-induced cell growth inhibition could be explained by not only RA-induced apoptosis but also cell cycle arrest. Futher, in vitro study has been carried out to elucidate the RA-iduced cell growth inhibition mechanism in our laboratory.

Distribution of Beta-Catenin Expression in Adenoid Cystic Carcinoma of the Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: beta-catenin has functions in cell-cell adhesion with a complex of proteins that link cadherin to the cortical actin cytoskeleton and signal transduction through wnt developmental pathway. In this study, we investigated the distribution of beta-catenin in adenoid cystic carcinoma according to the histologic subtypes, perineural invasion, T classification, nodal status and stage. MATERIALS AND METHODS: Each formalin-fixed paraffin-embedded surgical specimens were obtained from seventeen patients with adenoid cystic carcinoma. We performed immunohistochemical staining with beta-catenin monoclonal antibodies and compared its staining patterns with patients' clinical characteristics. RESULTS: In tubular subtype, there were intense membranous staining pattern than other subtypes (p0.05). CONCLUSIONS: It is suggest that there are mixed functional roles of beta-catenin in adenoid cystic carcinoma in tumor aggressiveness.

Current Trend of Early Glottic and Tongue Cancer Management in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The management of early glottic, tongue and tongue base cancer remains controversial and the trends in the treatment rationale can be influenced by the clinician and/or the patient factors. This study assesses the current treatment trend in the management of glottic, tongue and tongue base cancer among the Korean Society of Head and Neck Surgeons membership. We want this data to give more information in regards to better selection of treatment against specific individual factors. MATERIALS AND METHODS: A survey instrument in the form of a questionnaire was designed by authors. The questionnaire was distributed to 91 members with 46 responses. After the data from these surveys were computerized, the analysis was performed using SAS software. RESULTS: The two most frequently used treatment regimens of T2N0 glottic cancers were conservation laryngeal surgery (45.7%) and radiation therapy alone (19.6%). T2N0 tongue cancer was usually treated with surgery (56.5%) and surgery with radiation therapy (26.1%). The treatment patterns for tongue base cancer were varied as follows: surgery, 23.9%; radiation therapy only, 21.7%; combined therapy, 30.4%; and patient choice, 23.9%. In situations where an unclear resection margin is found, participants usually underwent adjuvant postoperative radiotherapy. A trend toward lower application rates was noted from positive margin (82.6%) to close margin (67.4%) and the difference was statistically significant (p<0.020). Important factors to determine which patient should be entered into a combined therapy program after neck dissection were the N-staging system and the histological extracapsular spread of lymph node metastases. Examination of treatment rationale demonstrated that the most preferred form of treatment was based on the perception of superior oncologic outcomes (87.0%). Treatment recommendations were usually decided by the operator (52.3%) and the tumor board (25.0%). CONCLUSIONS: Treatment modalities were not significantly influenced by varied individual factors of participants. But a standard therapy has never been well defined. These varied factors in the management of early glottic, tongue and tongue base cancer and treatment rationale reflect that there are multiple influencing factors.

Bronchogenic Cyst Presenting as an Anterior Neck Mass / 대한이비인후과학회지

A bronchogenic cyst is an abnormality of pulmonary differentiation, usually detected in pediatric patients. The location of bronchogenic cysts in the midline of anterior neck has been described, but it is known to be quite rare. A case of a 6-year-old male with a palpable mass in the anterior neck is presented. The patient was admitted with a complaint of a 2 X 2 cm sized, soft, non-tender mass in the anterior neck. The clinical impression was that of a thyroglossal duct cyst ; however, the histopathologic diagnosis of a bronchogenic cyst was made on the surgical specimen, Following surgical treatments, the recovery was uneventful. Since masses of the head and neck may encompass a variety of histopathologic diagnoses, it is important to include bronchogenic cysts in differential diagnoses for infants and children.

p27(Kip1) and Ki-67 Expression in Mucoepidermoid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: p27(Kip1), novel cyclin-dependent kinase inhibitor plays an important role in the inhibition of cell cycle progression by binding to the cyclin E/cyclin-dependent kinase (CDK) 2 complex. And a nuclear antigen Ki-67, expressed in all phases of cell cycle except G0, is a reliable cellular proliferative index. The present study investigated p27(Kip1) and Ki-67 expressions in mucoepidermoid carcinoma for their usefulness of indicator in tumor progression, aggressiveness and prognosis. MATERIALS AND METHODS: Formalin-fixed paraffin-embedded surgical specimens were obtained from patients with mucoepidermoid carcinoma. We performed immunohistochemical staining with p27(Kip1) and Ki-67 monoclonal antibodies and compared its labeling index with patients' clinicopathologic characteristics and survival rates. RESULTS: There was significant correlation between low p27(Kip1), high Ki-67 expression and high grade, large tumor size, positive nodal status and high stages. Also, Ki-67 expression showed significant inverse correlation with p27(Kip1) expression and there were high survival rates in high p27(Kip1) and low Ki-67 patients. CONCLUSIONS: Therefore, p27(Kip1) and Ki-67 are good and reliable predictive markers of tumor progression, aggressiveness and prognosis in mucoepidermoid carcinomas.

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.

Clinical Analysis of Voice Change as a Parameter of the Premenstrual Syndrome / 대한이비인후과학회지

OBJECTIVES: We have attempted to evaluate the relationship between voice change and the premenstrual syndrome (PMS) by observing changes of the acoustic parameter between the proliferative stage and the premenstrual period. MATERIALS AND METHODS: Twenty-eight women were studied for 2 months for this research. Each person was asked to produce an /a/ sound for 5 seconds at the proliferative phase of the menstrual cycle and then 1-2 days before menstruation. The sound of the voice in each case was recorded and analyzed by the Doctors speech science program. Subjects were divided into PMS positive and negative groups according to the Dignostic and Statistical Manual of mental disorder (DSM-IV). RESULTS: Compared with the acoustic parameters between two period, there was not a significant difference in all subjects. In the PMS positive group (N=16), jitter was significantly increased during the premenstrual period compared with proliferative stage (p=0.048). There was no correlation between the patients PMS score and the severity of voice change. CONCLUSION: The change of voice parameter was objectively identified in PMS positive group, so more careful voice habituation was required during the prementrual period.

A Case of Malignant Triton Tumor In Nasal Cavity / 대한이비인후과학회지

Malignant triton tumor is a rare and usually aggressive sarcoma consisting of a malignant schwannoma with rhabdomyoblastic differentiation. Although this tumor is usually found at the extremities, 20% of cases are located in the head and neck region. This unusual tumor has not yet been described in the Korean Journal of Otolaryngology-Head and Neck Surgery. Malignant triton tumor is histologically high-grade, with large numbers of mitoses, prominent necrosis, and cellular pleomorphism. The clinical course for malignant triton tumor is usually one of rapid growth, early metastasis, and poor outcome in spite of therapy. Recently we experienced a case of malignant triton tumor, which involved the nasal cavity, maxillary and ethmoid sinus. The malignant tumor was treated with wide surgical excision followed by radiation therapy.

Significance of p53 Mutation and Expression of Rb, MIB1 in Laryngeal Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Treatment results of laryngeal carcinoma may depend on the microscopic environment of the primary lesion. If there is an abundance of lymphatic channels, the laryngeal lesion is more likely to develop frequent cervical metastases, leading to treatment failure. Prognosis of the laryngeal carcinoma is usually determined by clinical staging. However, it does not account for the oncobiological characteristics and microscopic environments. The importance of biological markers including p53, Rb and MIB1 as a prognostic factor has yet to be determined. To determine the relationship between the prognosis and biological characteristics of p53, Rb, and MIB1 in laryngeal cancers. MATERIALS AND METHODS: Thirty seven laryngeal carcinoma specimens were studied for p53 gene mutation by PCR-SSCP and expression pattern of Rb and MIB1 proteins by immunohistochemistry. RESULTS: p53 gene mutation was found in 32.4% with nine cases in exon 5, two cases in exon 7, and two cases in exon 8, respectively. Higher incidence of p53 gene mutation was found in supraglottic cancer (p>0.05). Negative expression rate for Rb was 29.7% and positive MIB1 expression rate was 32.4%. There was no significant correlation between the treatment success and p53 gene mutation, expression pattern of Rb and MIB1 gene. CONCLUSION: p53 gene mutation and expression pattern of both Rb and MIB1 showed little value as a prognostic factor. However, in cases where p53 and Rb tumor suppressor gene mutation were found in combination, the prognosis was poor. In this regard, such marker might be used as one of the important biological prognostic factors.

Amplification of int-2 in Head and Neck Squamous Cell Carcinomas and Adjacent Mucosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is important to identify potential biomarkers of tumorigenesis that can be utilized on histologically normal epithelia to determine the level of risk of tumor development. With the goal of possibly identifying a biomarker for the process of development of head and neck cancer, the amplification of int-2 was observed in patients with head and neck squamous cell carcinoma. MATERIALS AND METHODS: Fluorescence in situ hybridization using cosmid int-2 probe was performed on paraffin-embedded specimens from tumor and tumor-adjacent and tumor-distant epithelia of 20 patients. Buccal mucosa of cancer-free subjects who smoked and did not smoke cigarettes were used as control. Dot blot hybridization using digoxigenin-labeled int-2 probe was also performed on the frozen tissue from tumor and tumor-adjacent epithelia of 14 patients. RESULTS: In in situ hybridization, buccal epithelia of cancer-free subjects who smoked and did not smoke cigarettes, and tumor-distant epithelia of the patients with head and neck squamous cell carcinoma showed no int-2 amplification. However, eleven of tumor tissue (55%) and five of tumor-adjacent epithelia (25%) in 20 cases showed int-2 amplification. In dot blot hybridization, five tumor tissue (35.7%) and 2 tumor-adjacent epithelia (14.3%) in 14 cases, of which tumor tissue were all found to have int-2 amplification, showed int-2 amplification. CONCLUSION: The amplification of int-2 in the tumor tissue and the tumor-adjacent epithelia of the same cases supports the concept of field cancerization or clonal extension. Such genotype parameters may provide a genetic basis for the development of early recurrence or second primary tumors after therapeutic treatment of head and neck squamous cell carcinomas.

Treatment Results of Soft Tissue Sarcomas in the Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Soft-tissue sarcomas of the head and neck are extraskeletal malignant tumors derived from cells of mesenchymal origin and are relatively rare, accounting for less than 1 percent of all neoplasms in this region. The purpose of this study is to analyze the clinical features and the treatment outcome of the head and neck soft tissue sarcomas. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 32 patients who were diagnosed and treated for primary soft-tissue sarcomas of the head and neck from 1991 to 1996. RESULTS: The sarcomas composed 2.3% of the head and neck malignant tumors in our institute. Thirty-two cases consisted of nine rhabdomyosarcomas, six malignant fibrohistiocytoma, six malignant schwannomas, and 12 other soft tissue sarcomas. The age at diagnosis ranged from 10 months to 67 years. The tumors were developed most commonly in the nasal cavity and paranasal sinuses. Surgical excision was performed in 20 patients and surgical excision with postoperative radiotherapy was used in 10 patients. Chemotherapy was done in two cases. The overall recurrence rate of the soft-tissue sarcoma was 49.6%. The recurrence rates according to the treatment modality were 60% (surgery), 20% (surgery+radiotherapy), and 50% (chemotherapy), respectively. CONCLUSION: The treatment outcome of the soft-tissue sarcoma is poor. Based on these results, multimodality therapy is recommended for the treatment of the head and neck sarcomas.

Radiological Measurements of the Paranasal Sinuses Using Ostiomeatal Unit CT in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: As the endoscopic sinus surgery continues to gain popularity, the application of endoscopic sinus surgery has extended to children. The knowledge about the variation of the paranasal sinuses in children is essential to perform sinus operations without complication. To identify the difference of the paranasal sinuses between children and adults, we have measured the cribriform plate, the ethmoid roof (lateral lamella of the lamina cribrosa), the width of the anterior ethmoid sinus and the position of the sphenoid sinus. MATERIAL AND METHODS: Ostiomeatal unit CT scans of the paranasal sinuses obtained in consecutively imaged cases were analysed. The subjects were 58 children who were divided into two groups. One group had 22 children from ages 4 to 10 and the second group had children from ages 11 to 16. RESULTS: The length of the lateral lamella was 4.5+/-1.6 mm (group 1) and 5.4+/-2.9 mm (group 2). The depth of the lateral lamella was 4.1+/-1.4 mm (group 1) and 5.3+/-2.2 mm (group 2). The width of the cribriform plate was 2.5+/-0.9 mm for Group 1 and 2.8+/-0.9 mm for Group 2. The width of upper portion in the anterior ethmoid sinus was 7.9+/-2.1 mm for Group 1 and 9.2+/-2.9 mm for Group 2. The width of lower portion in the anterior ethmoid sinus was 9.7+/-2.2 mm for Group 1 and 13.5+/-3.1 mm for Group 2. The front of the sphenoid sinus was 45.9+/-6.6 mm from the anterior nasal spine for Group 1 and 50.9+/-7.1 mm for Group 2. CONCLUSION: Since the length and depth of the lateral lamella in children were greater than the reported lengths in the adults, it is suggested that the lateral lamella in children is more prone to danger than in adults. The distance between the anterior nasal spine and anterior face of the sphenoid sinus in children was 5 to 10 mm shorter than in the adults.

Expression of p53, mdm-2, nm23 and TGFalpha in Primary and Second Primary Cancers in Multiple Head and Neck Cancers / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Development of second primary cancer is an important biological characteristic of head and neck squmaous cell carcinoma. In the past, the development of second primary cancer has been explained by the field cancerization theory. However, recent reports support the common common clonal origin theory. Common clonal origin theory states that following the initial transformation, the progeny of the transformed clone spread through the mucosa and gives rise to the geographically distinct but genetically related tumor. The objective of this study is to compare the expression pattern of p53, mdm-2, nm23 and TGFalpha which are proteins involved in the development, growth and metastasis of tumor in primary and second primary cancers of multiple head and neck cancer. MATERIALS AND METHODS: Expression of p53, mdm-2, nm23 and TGFalpha were analysed by immunohistochemical study of 12 paraffin embedded sections from 6 patients (3 synchronous tumors, 3 metachronous tumors) who were surgically treated for multiple head and neck cancer. RESULTS: p53, mdm-2, nm23 and TGFalpha were expressed in the same pattern in 3 patients (50%) of primary and second primary cancers. CONCLUSION: In our study, we observed the same expression patterns in 3 cases; however, it was difficult to conclude based on this result alone the clonality relationship between primary and second primary cancer. We suggest that further studies using molecular biological techniques are needed to identify the early genetic events of carcinogenesis.

Polysomy of Chromosome 17 Predicting Treatment Failure in Head and Neck Squamous Cell Carcinomas / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The two major biologically distinct patterns of treatment failure following definitive therapy for the patients with head and neck squamous cell carcinoma are the recurrence of primary tumor and the development of second primary tumor. The purpose of this study is to determine whether the polysomy of chromosome 17 has prognostic significance and is associated with the pattern of treatment failure. MATERIAL AND METHODS: We performed nonfluorescent, nonisotopic, in situ hybridization using chromosome-specific centrometric DNA probe for chromosome 17 on formalin-fixed, paraffin-embedded specimens from the tumor tissue and the resection margins of 42 head and neck squamous cell carcinomas were treated with definitive local therapy. RESULTS: In the tumor tissue, the polysomy of chromosome 17 was a significant predictor for recurrence and treatment failure. In the resection margins, the polysomy of chromosome 17 also showed a predictive significance for the treatment failure. Although there was a chromosomal change in the resection margins believed to be negative on light microscopy, it was also related to the treatment failure. CONCLUSION: The polysomy of chromosome 17 may be a valuable marker for identifying individuals who have the high risk of developing recurrence and treatment failure.