[OROPHARYNGEAL CANCER: THE VIRUS THAT CHANGED THE RULES].

INTRODUCTION: Head and neck cancer is the sixth most common malignancy worldwide. Along with other "classical" risk factors such as tobacco and alcohol use, the human papillomavirus (HPV) is well established to play a pivotal role in the development of head and neck cancers, particularly in oropharyngeal cancer (OPC). While head and neck cancer incidence decline worldwide, OPC is on the rise. The incidence of HPV-positive oropharyngeal carcinoma predominantly increased in younger, married male patients with higher socioeconomic status and with high-risk sexual practices. This OPC subtype is characterized by limited local tumor with a substantially larger regional nodal disease. However, HPV-positive OPC patients exhibited a significantly better prognosis than patients with HPV-negative OPC, leading to a recent change in the clinical guidelines. The current non-surgical standard of care for OPC results in excellent disease control, though associated with substantial toxicity. Numerous studies now focus on less intensive (i.e., deintensified) treatment for the improvement of patient safety while maintaining excellent disease control. Furthermore, the recent development of more advanced surgical techniques with promising outcomes may shift the therapeutic paradigm back to the operating room. During the past decade, there is widespread use of HPV vaccination, and lately, it was also approved for boys. However, the preventive effects of the HPV vaccine on head and neck cancers, particularly on OPC is yet to be determined.

Malignant Peripheral Nerve Sheath Tumor of the C2 Nerve Root: Case Report.

Here we present the case of a 36-year-old man who was found to have a symptomatic malignant neural sheath tumor growing from the C2 nerve root following a period of progressively worsening headaches. The patient was successfully treated with surgical resection resulting in resolution of cranial nerve deficits. Though uncommon, malignant peripheral nerve sheath tumor must be considered in the differential diagnosis of tumors involving the cervical nerve roots and carotid space.

Acute mastoiditis: the role of imaging for identifying intracranial complications.

OBJECTIVES/HYPOTHESIS: Brain CT is performed in patients presenting with acute mastoiditis (AM) to identify intracranial complications (ICC). Recently, however, the need for CT scans in such patients has been questioned owing to concerns regarding long-term effects of brain irradiation, with some clinicians claiming that the decision to scan should be based on a patient's clinical presentation. This study was aimed at characterizing the typical clinical presentation of patients who already have ICCs when diagnosed with AM, and to compare it to that of AM patients presenting without ICCs. STUDY DESIGN: Prospective case series. METHODS: All patients hospitalized with AM between July 1997 and December 2009 in an otologic tertiary referral center were divided into those with and those without ICCs on presentation. Prereferral clinical characteristics and the signs, symptoms, and inflammatory indexes at presentation were compared between the two groups. RESULTS: Of 71 patients presenting with AM, 10 had at least one ICC (sigmoid sinus thrombosis [nine patients], perisinus empyema [five patients], subdural abscess [one patient], and epidural abscess [one patient]). Patients with and without ICCs did not differ regarding most clinical characteristics or presenting signs and symptoms. None presented with neurological signs or cranial nerve deficits. CONCLUSIONS: It is not possible to define an evidence-based index of suspicion for ICCs in patients with AM. Diagnostic imaging at presentation accordingly remains mandatory.