Differentiation between IgG4-related Mikulicz disease and Sjögren's syndrome: A review case report and literature review.

RATIONALE: IgG4-related diseases cause lesions in various organs throughout the body. In otorhinolaryngology, IgG4-related Mikulicz's disease is suspected and diagnosed based on the presence of lesions of the head and neck, salivary and lacrimal gland enlargement, and bilateral sinus opacity concentrated on the maxillary sinuses. However, in some cases, it is necessary to consider about differentiation between IgG4-related Mikulicz's disease and Sjögren syndrome. PATIENT CONCERNS AND DIAGNOSIS: A 75-years-old male patient visited our hospital with bilateral otitis media with effusion, which was resistant to conservative treatment. Other symptoms at presentation included enlarged bilateral submandibular and sublingual glands marked oral dryness, severe decrease in saliva secretion (1 mL/10 minutes), and dry eyes. We conducted a Schirmer's and fluorescent dye tests, both of which were positive. High serum IgG4 levels were observed, and although the Sjögren syndrome (SS)-A/SS-B antibodies were negative, marked hypolacrimation and tear secretion were observed. Therefore, a detailed examination considering both IgG4-related Mikulicz's disease and SS was conducted. Salivary gland scintigraphy performed prior to the salivary gland biopsy revealed a marked decrease in uptake, which satisfied the diagnostic criteria for SS; however, it was difficult to diagnose IgG4-related disease based on the diagnostic definition. INTERVENSIONS: Although a definitive diagnosis of SS was made, the persistent otitis media with effusion that was resistant to conservative treatment and bilateral mixed hearing loss were confirmed. As mixed hearing loss is considered an otological symptom of IgG4-related disease, oral steroid treatment was administered. OUTCOME: Thereafter, marked recovery of hearing and reduced swelling and induration of the bilateral parotid and submandibular glands were observed. Clinically, IgG4-related Mikulicz's disease was strongly suspected, but a definite diagnosis of SS was made. LESSONS: In the absence of an IgG4-related Mikulicz's disease diagnosis, careful differentiation between IgG4-related Mikulicz's disease and 2 diseases and their diagnostic criteria was essential.

[Complete response in a case of advanced oropharyngeal cancer (T4aN2bM0) treated with concomitant cetuximab and radiotherapy].

We report favorable results achieved using a combination of cetuximab and radiotherapy to treat an elderly patient with advanced oropharyngeal cancer complicated by cardiovascular disease and renal dysfunction.The case was a 78-year-old man who was referred to our hospital with the chief complaint of pharyngeal pain and swelling of the right side of the neck. The patient was diagnosed with oropharyngeal cancer (T4aN2bM0) based on a cytological diagnosis of Class V squamous cell carcinoma and CT findings.Because the patient had a history of hypertension, chronic renal failure, diabetes mellitus, cerebral infarction, angina pectoris, and prostate cancer, we determined that surgical excision and chemoradiotherapy using platinum-based drugs would be difficult.We therefore treated the patient with a combination of cetuximab and radiotherapy. Grade 3 mucous membrane disorder and Grade 2 dermatitis were observed during the course of treatment, but the treatment was completed without any other adverse events.A contrasted CT image taken after the completion of treatment showed that the primary tumor and cervical lymph node metastases had disappeared and the patient thus achieved a complete response.As of 6 months after treatment, there has been no recurrence or metastasis.As shown in this case, combination therapy with cetuximab and radiotherapy can be curative even in elderly patients with advanced oropharyngeal cancer and numerous complicating conditions.

[T2 laryngeal cancer study in our department].

Laryngeal cancer is the most common malignant tumor in the head and neck region.Because early detection and treatment are possible, outcomes are relatively good.Many studies have reported on the treatment of laryngeal cancer.Different hospitals have used generally similar treatment regimens.However, factors such as laryngeal preservation and the treatment of choice for patients with T2 laryngeal cancer still differ among hospitals.Survival rates can be increased depending on treatment, sometimes at the cost of losing voice functions that could have been preserved.In our department, we have emphasized curative treatment and the preservation of organs and functions.We have mainly used chemoradiotherapy concurrently with S-1 and nedaplatin for the treatment of T2 laryngeal cancer.We studied 27 patients(23 men and 4 women)with T2 laryngeal cancer, who received first-line therapy in our department from April 2005 through March 2010. Their mean age was 64.1 years(range, 42 to 80).The mean follow-up period was 30.6 months(range, 2 to 60 months).The tumor-nodemetastasis classification was T2N0M0 in 24 patients, T2N1M0 in 1, and T2N2bM0 in 2.In our department, the disease-specific survival rate was 96.3%. The complete response rate was 88.9%, and the laryngeal preservation rate was 92.6%.

[Laryngeal cancer treatment outcomes in our department].

Laryngeal cancer is one of the most common types of head and neck cancer. Numerous studies have reported treatment outcomes, and therapeutic approaches and results are generally well established. However, the widespread use of concurrent chemoradiation therapy(CCRT)has led to differences among hospitals in laryngeal preservation rates in patients with T2 and T3 tumors. CCRT is the mainstay of treatment for laryngeal cancer in our department, given our goals of achieving organ and functional preservation, as well as radical cure. Our regimen for CCRT is comprised of chemotherapy with S-1 plus nedaplatin, concurrently with radiation therapy(SN therapy). We report outcomes obtained from 60 patients with laryngeal cancer who received first-line treatment in our department from April 2005 through March 2010. Cumulative survival rates according to disease stage were as follows: Stage I, 100%; Stage II, 96. 2%; Stage III, 83. 3%; and Stage IV, 48. 8%. The complete response rate after SN therapy was 84. 3%. After excluding patients with T4 tumors, the laryngeal preservation rate was 85. 7%.

[A case of hypopharyngeal cancer successfully treated with concurrent S-1, nedaplatin and radiotherapy].

A 68-year-old man was admitted with hoarseness. Laryngofiberscopy showed a tumor that obstructed the posterior hypopharyngeal wall and the larynx, and biopsy revealed well-differentiated squamous cell carcinoma. CT demonstrated bilateral cervical lymph node metastases. The patient was diagnosed as having hypopharyngeal cancer(T4N2cM0)and was treated with concurrent S-1, nedaplatin and radiotherapy(hereafter referred to as SN therapy). CT and endoscopy after primary treatment showed disappearance of the tumor, and the treatment outcome was assessed as complete response(CR). Currently, the patient is being treated with S-1 as adjuvant chemotherapy in the outpatient setting, and no recurrence or metastasis has been observed. These results suggest that SN therapy was effective for advanced hypopharyngeal cancer from the viewpoint of both curative treatment and organ and function preservation.