Laryngeal cancer involving a branchial cleft cyst.

BACKGROUND: Benign secondary neck lesions in the setting of laryngeal cancer have been described, but not with branchial cleft cysts. This article describes a branchial cleft cyst in a laryngectomy/neck dissection specimen. METHODS AND RESULTS: A 44-year-old woman presented to our emergency department with an obstructing laryngeal tumor that was staged as a T4N0M0 squamous cell cancer on the basis of clinical and radiographic findings. After laryngectomy with bilateral neck dissections, the neck specimen contained a right-sided branchial cleft cyst, which was directly invaded by tumor. In addition, the location of the cyst relative to the larynx suggested that this was a third branchial cleft cyst. CONCLUSION: This is the first report of a laryngeal carcinoma invading a branchial cleft cyst. Staging discrepancies may result from concurrent head and neck lesions, altering treatment plans, or changing the prognosis for the patient. Lesions such as this are nearly impossible to diagnose preoperatively, and a high index of suspicion for advanced cancer should be maintained.

Outcome analysis of patients with squamous cell carcinoma of the head and neck and hepatitis C virus.

OBJECTIVE/HYPOTHESIS: Infection with the hepatitis C virus (HCV) is a global problem with over 170 million people infected. Recently, we have noticed that a large number of patients diagnosed with squamous cell carcinoma of the head and neck (SCCHN) have also been diagnosed with HCV. A review of the literature reveals little information concerning this patient population. The objective of this study was to compare the outcome of SCCHN patients who have been exposed to HCV with naïve SCCHN patients. STUDY DESIGN: Retrospective chart review. METHODS: A retrospective chart review from June 1991 through December 2002 was performed to identify patients diagnosed with SCCHN who were screened for HCV. Patients were stratified into two groups (HCV positive and HCV negative). Data were recorded on patients for status of disease at last clinic visit, pretreatment serum albumin and hematocrit levels, and RNA quantities of HCV. Statistical analysis was performed using paired t test to compare serum albumin and hematocrit levels. Kaplan-Meier survival curves were used to compare outcomes. The log-rank test was used to determine significance. Cox regression was used to examine the association of prognostic predictor variables with overall survival and disease-free survival. RESULTS: There was no difference noted in 5 year survival between hepatitis C positive and hepatitis C negative groups in overall outcomes (66.7% vs. 67.9%, P = 1.000) or 5 year disease-free survival (90.5% vs. 80.8%, P = .514). The two groups, HCV positive versus HCV negative, also had similar serum albumin levels (3.62 g/dL vs. 3.72 g/dL, P = .37) as well as serum hematocrit levels (42.9% vs. 41.0%, P = .12). Serum levels of hepatitis C RNA were obtained in seven patients, with only one being undetectable. The only prognostic predictor variable that was significantly associated with overall survival was age. None of the predictor variables were significantly associated with disease-free survival. CONCLUSION: Co-infection with HCV, although prevalent in the Veterans Administration Hospital population, did not affect patient outcome as defined by disease-free survival. Patients who were seropositive for HCV had comparable serum albumin levels as well as serum hematocrit when compared with HCV negative patients.

Prevalence and epidemiology of hepatitis C virus in patients with squamous cell carcinoma of the head and neck.

OBJECTIVE: Recently, we have noticed that a large number of patients with squamous cell carcinoma of the head and neck (SCCHN) are also infected with the hepatitis C virus (HCV). A review of the literature has revealed no published studies examining this association. The objective of this study was to determine the incidence and epidemiology of HCV infection in patients with SCCHN. STUDY DESIGN: A retrospective chart review. METHODS: Patients diagnosed with SCCHN were analyzed to determine whether they were screened for HCV. Patients were then stratified into two groups (HCV positive and HCV negative). The patient's age at onset, site and stage of the tumor at presentation were determined, and statistical analysis was performed. RESULTS: Ninety-nine (26%) patients were screened, and 21 (21.2%) were HCV positive. This incidence was increased when compared with previously published data (9.9%) (P < .0038). HCV-positive patients presented at an earlier age (51 years) versus the HCV-negative group (60 years) (P < .0002). There were no significant differences in the site or stage at presentation. CONCLUSIONS: In this study, 21% of patients diagnosed with SCCHN were found to be infected with HCV. These patients presented at an earlier age but had similar presentation with respect to site and stage. More research is needed to determine the significance of HCV infection in this patient population.

Collision tumor of apocrine carcinoma and squamous carcinoma occurring in the ear.

An unusual case of a cutaneous collision tumor comprised of a squamous cell carcinoma and an apocrine carcinoma occurring in the auricle of an 82-year-old man is presented. Microscopic study confirmed 2 distinct tumors: a squamous cell carcinoma arising in the epidermis and an adjacent apocrine carcinoma. We discuss the diagnostic criteria and review pertinent recent literature. To our knowledge, this is the first English language report of such a collision tumor.