Patterns of recurrence and second primary tumors in oral squamous cell carcinoma treated with surgery alone.

The aim of the present study is to review the recurrence patterns and incidence of second primary tumors (SPTs) in patients with oral squamous cell carcinoma (OSCC) who underwent surgery alone without postoperative adjuvant therapy. Data on patients recorded in the head and neck cancer registry of Cathay General Hospital were reviewed. A total of 72 patients with T1-3N0 OSCC who underwent surgery alone were included. Among the 72 patients, 44 had T1 tumors, 22 had T2 tumors, and 6 had T3 tumors. The 5-year overall survival (OS) rate was 77.3%, the recurrence-free survival rate was 74.1%, and the SPT-free survival rate was 73%. Eighteen (25%) patients had disease recurrence (regional recurrence in nine patients, local recurrence in seven patients, and locoregional recurrence in two patients). Most patients with local recurrence alone (6/7 patients, 85.7%) could be salvaged with treatment. However, locoregional control was obtained in only five (45.5%) of 11 patients with neck recurrence after surgical salvage therapy. At the time of analysis, 20 patients developed SPTs, and 15 (75%) of the SPTs were in the oral cavity. The annual incidence of SPT was 5%. Neck recurrence and SPT were associated with 48.4% and 24.4% lower 5-year OS rates, respectively. Multivariate analysis revealed that neck recurrence was a significant risk factor for low OS (p = 0.008). Neck recurrence was the most important prognostic factor for OS. The incidence of SPT development was high. Regular and long-term monitoring for recurrence and development of SPTs is necessary to improve the survival rate.

Complete unilateral maxillary sinus opacity in computed tomography.

BACKGROUND/PURPOSE: Unilateral maxillary sinus opacity can be caused by many diseases, but an exact diagnosis is difficult to make. The aim of this study was to describe the pathological conditions and clinical features of patients with unilateral maxillary sinus opacity. METHODS: From 2004 to 2008, 830 consecutive patients underwent sinus surgery or endonasal endoscopic biopsy at an academic tertiary care center. The preoperative computed tomography (CT) images for these patients were reviewed, and 11 6 patients were identified with complete unilateral maxillary sinus opacification. We then analyzed presenting symptoms, physical examinations, specific CT findings, and pathology. RESULTS: The most frequent diagnoses were as follows: chronic rhinosinusitis (52.6%), fungus ball (29.3%), antrochoanal polyp (2.6%), benign tumor (10.4%), and malignancy (5.1%). Fungus ball was the most common diagnosis (10/18, 55.6%) in the subgroup of patients with isolated maxillary sinus opacity without disease in the other sinuses. Nasal discharge and foul-smelling breath were more common in inflammatory disease than in neoplastic disease. Neoplastic disease was more likely to present as epistaxis; a polyp or mass revealed by nasal endoscopy; mass effect in the cheek, palate, or gingiva; and bony erosion on CT. Erosion of the maxillary posterolateral wall and extra-sinus extension suggested malignancy. CONCLUSION: Although unilateral maxillary sinus opacity is usually inflammatory in origin, fungal sinusitis and neoplastic disorder are also likely. A careful history-taking, a thorough head and neck examination including nasal endoscopy, and CT evaluation are all imperative for reaching a correct diagnosis.