Solitary pulmonary metastasis from a gingival cancer of 36 years ago: A case report.

INTRODUCTION: Unlike a squamous cell carcinoma (SqCC), an adenoid cystic carcinoma (ACC) is an uncommon histology of all head and neck cancers. The clinical significance of a pulmonary metastasectomy differs greatly between these two types of cancers. A solitary pulmonary nodule in a patient with a history of both these different malignancies is a diagnostic and therapeutic challenge. PRESENTATION OF CASE: An 81-year-old woman presented with a right lung nodule detected by chest computed tomography (CT) one year after a tongue SqCC surgery. She had a remote history of gingival cancer 36 years prior, which was not assessed in detail during the initial work up. We suspected that the nodule was a primary lung cancer and she underwent a right basal segmentectomy. Histology revealed an ACC, which was proven to be a metastasis from the gingival cancer. DISCUSSION: An ACC is an uncommon type of cancer arises mainly in the salivary glands. It is characterized by a long-term behavior and the histology of ACC is a favorable prognostic factor. With its favorable histology and disease free interval of over 30 years, a better outcome would be expected than that of a primary lung tumor or a metastasis from the tongue SqCC. Furthermore, we could have made a differential diagnosis of a metastatic ACC before the surgery with more careful research for a previous history of a gingival cancer. CONCLUSION: Our case emphasized that a precise history taking of any malignancy, even if that of more than 30 years prior, is crucial.

Quattro Flap Tracheotomy-The impact of a novel surgical technique for young infants.

BACKGROUND: Tracheotomy for pediatric patients is a surgical procedure with greater technical difficulty and higher rates of morbidity and mortality than that in adults. We report a new technique for pediatric tracheotomy that reduces the issue of granulation and recannulation after accidental decannulation. METHODS: Clinical data were retrospectively reviewed for 32 pediatric patients aged 3weeks-32months who underwent Quattro Flap Tracheotomy (QFT) at our hospital. The technique for the procedure is described and illustrated in detail. We analyzed the complications of surgery and the prognosis of patients. RESULTS: Twenty-seven out of 32 pediatric tracheotomy patients were aged <12months. Overall, one patient with subglottic stenosis developed granulation and required a resection. Three patients with granulation were cured using conservative treatment. Neither pneumothorax nor accidental decannulation and failure to reinsert the cannula occurred with QFT. No tracheotomy-related deaths occurred. The overall rate of postoperative complications was lower in the study group (4/32 cases, 12.5%) than in the control group (12/32 cases, 37.5%; p=0.041). CONCLUSION: QFT is a new method for pediatric tracheotomy that should be performed in younger infants. If performed appropriately, QFT may reduce the incidence of complications and death in many cases that involve persistent granulation. LEVELS OF EVIDENCE: IV.

[A Case of Infantile Cervical Ectopic Thymus].

We report herein on a case of ectopic cervical thymus in a 5-year-old boy and the literature is reviewed. Swelling of the right neck was seen in the patient in his newborn period and it was diagnosed as cystic disease of the neck in a previous hospital at 4 months of age. Ultrasonography (US) and MRI revealed a cervical tumor consisting of a solid component in our hospital, and histopathologic examination showed no evidence of malignancy. The lesion revealed almost no change in size but showed a mosaic pattern on US, whereon the parents agreed to the removal of the tumor. Intraoperatively, the tumor could be easily dissected from the surrounding tissue and resected. The pathological diagnosis was normal thymic tissue. The postoperative course was uneventful and no complication or immunological disorders were seen. A cervical ectopic thymus is a congenital lesion that results from abnormal thymic migration during embryogenesis. Most patients are asymptomatic and the condition is found incidentally. Preoperative diagnosis of cervical ectopic thymus in children is rarely made, so surgical treatment is the definitive means of pathological diagnosis. This disease should be listed in the differential diagnosis for neck masses in children, and should be suspected when the mosaic pattern is detected in the lesion on US.

Hypermethylation of collagen α2 (I) gene (COL1A2) is an independent predictor of survival in head and neck cancer.

OBJECTIVES: Collagen production plays a role in the development of tumors from cancer cells. The aim of the present study is to examine the involvement of epigenetic alteration of Collagen α2 (I) (COL1A2) gene expression in cases of head and neck squamous cell carcinoma (HNSCC). METHODS: COL1A2 expression was examined in a panel of cell lines using RT-PCR. The methylation status of the COL1A2 promoter was studied using bisulfate sequencing and methylation-specific PCR (MSP). RESULTS: COL1A2 expression was absent in 6 of 11 (54.5%) UM-SCC cell lines, whereas three nonmalignant cell lines had stable expressions. MSP analysis showed that 46/98 (46.9%) contained methylated alleles. COL1A2 methylation was significantly correlated with tumor size (P = 0.041), lymph node status (P = 0.008), tumor stage (P = 0.011), H-cadherin methylation (P = 0.039) and disease-free survival (P = 0.005). On multivariate Cox proportional hazard regression, which included age, sex, smoking status, and alcohol exposure, both tumor stage and COL1A2 methylation remained independent prognostic factors. CONCLUSIONS: This study suggests that CpG hypermethylation is a likely mechanism of COL1A2 gene inactivation, supporting the hypothesis that the COL1A2 gene may play a role in the tumorigenesis of HNSCC and may serve as an important biomarker.