Buccal fat pad flap for transoral repair of radiation-induced necrosis in the lateral oropharyngeal wall.

Soft tissue necrosis (STN) is a late toxicity after radiotherapy. Extensive tissue defects due to STN near the carotid artery, such as in the lateral oropharyngeal wall, may lead to infectious pseudoaneurysms associated with fatal bleeding. Such defects are usually treated with transcervical reconstructive surgeries, which are highly invasive and technically difficult. We report a case in which a buccal fat pad (BFP) flap was used for minimally invasive transoral repair of tissue defects due to radiation-induced STN in the lateral oropharyngeal wall. The BFP flap covered the tissue defect, and the wound epithelialized completely. The patient had no dysfunctional mouth opening, speech, or swallowing. The BFP flap can be easily harvested via a minimally invasive transoral approach and is expected to be further utilized for radiation-induced STN in the lateral oropharyngeal wall.

Long-Term Outcomes of End-Flexible-Rigidscopic Transoral Surgery for Pharyngolaryngeal Cancer.

OBJECTIVE: End-flexible-rigidscopic transoral surgery (E-TOS) is a new and minimally invasive transoral surgery for resection of Tis-selected T3 pharyngolaryngeal cancers. We evaluated long-term oncological outcomes and whether postoperative voice and swallowing function were preserved following E-TOS. METHODS: In this retrospective single-center study, 154 patients treated with E-TOS using a curved retractor, flexible-tip rigid endoscope, and thin curved instruments were included. Their survival rate, larynx preservation rate, and disease control rate were estimated using the Kaplan-Meier method. Postoperative voice function was evaluated using both objective and subjective tests. Postoperative swallowing function was assessed using the Hyodo score and the functional outcome swallowing scale. RESULTS: The 3-year and 5-year overall survival, disease-specific survival, disease-free survival, laryngectomy-free survival, local control, and loco-regional control rates post E-TOS were 89.8% and 82.2%, 95.6% and 92.3%, 78.5% and 70.3%, 87.2% and 80.9%, 93.9% and 92.5%, and 87.2% and 85.7%, respectively. Both objective and subjective postoperative voice and swallowing function tests were within normal limits in more than 90% of the patients. CONCLUSION: E-TOS is an effective, safe, low-cost, and minimally invasive transoral surgery for Tis-selected T3 pharyngolaryngeal cancer; it also preserves postoperative voice, larynx, and swallowing function. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:1415-1424, 2023.

Postoperative Intensity-Modulated Radiation Therapy for Myoepithelial Carcinoma in the Parotid Gland.

Myoepithelial carcinoma (MC) is an extremely rare form of tumor, with no standard treatment established to date. Although several reports have discussed postoperative radiation therapy (PORT), few have applied intensity-modulated radiation therapy (IMRT), and none has described the dose and radiation field in detail. In this report, we describe a case of MC of the parotid gland that was treated with high-dose IMRT (70 Gy) after partial resection. The patient, a 61-year-old female, underwent excisional surgery and was diagnosed with MC arising from a pleomorphic adenoma (PA). Postoperative irradiation was administered as 70 Gy in 35 fractions of local radiation. The patient had cancer recurrence in the irradiated field. However, no serious adverse events associated with the radiation therapy have been confirmed, implying that postoperative high-dose radiation therapy may be safely administered via IMRT.

Defect repair with fibrin glue/polyglycolic acid after endoscopic laryngopharyngeal cancer resection.

OBJECTIVES/HYPOTHESIS: In 2013, we introduced a modified technique for mucosal/muscle layer defect coverage with fibrin glue and polyglycolic acid (PGA) sheets (mMCFP technique) in patients undergoing endoscopic transoral surgeries for laryngopharyngeal cancers. This technique allows easy and convenient coverage of the wound surface, even when it involves the laryngopharyngeal lumen. To our knowledge, use of the MCFP technique for coverage of postoperative mucosal and/or muscle layer defects involving the laryngopharyngeal lumen has not been reported. The aim of the present study was to retrospectively evaluate the safety of our mMCFP technique used simultaneously with endoscopic transoral resection of Tis, T1, T2, and select T3 pharyngeal and supraglottic cancers. STUDY DESIGN: A single centre retrospective study. METHODS: Between June 2013 and February 2019, 102 patients underwent simultaneous end-flexible-rigidscopic transoral surgery and wound coverage using our mMCFP technique. All patients required mucosal and/or muscle layer resection. For all patients, we recorded the incidence of postoperative complications and the time period for which the PGA sheets could be observed after surgery. RESULTS: In 41%, 35%, and 8% patients, the PGA sheets could be observed on the wound surface for 2, 3, and 4 weeks, respectively. Other than postoperative bleeding in two patients (2%), no postoperative complications were recorded. CONCLUSIONS: The findings of this study suggest that our mMCFP technique is a safe and simple method for the repair of mucosal and/or muscle layer defects after endoscopic transoral surgery for laryngopharyngeal cancers. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:1740-1745, 2020.

Clinical outcomes of end-flexible-rigidscopic transoral surgery (E-TOS) in patients with T1-selected T3 pharyngeal and supraglottic cancers.

BACKGROUND: Endoscopic laryngo-pharyngeal surgery (ELPS), which is a transoral minimally invasive surgery using a gastrointestinal endoscope and a curved laryngopharyngeal retractor, is effective to treat primary lesions of superficial laryngopharyngeal cancers. To extend concepts of ELPS to invasive laryngopharyngeal cancers, we developed end-flexible-rigidscopic transoral surgery (E-TOS) from ELPS by changing a gastrointestinal endoscope to a flexible-tip rigid endoscope. AIMS/OBJECTIVES: To retrospectively evaluate oncological outcomes and laryngopharyngeal functional preservation of E-TOS in patients with T1-selected T3 laryngopharyngeal cancers. MATERIAL AND METHODS: In 47 patients T1-selected T3 pharyngeal and supraglottic cancers were resected by E-TOS using the flexible-tip rigid endoscope and curved instruments. Negative resection margin was histopathologically evaluated. The survival, preservation of larynx, and disease control rates were estimated using Kaplan-Meier method. RESULTS: Curative resection was achieved in 94% of patients. No patient complained prolonged swallowing dysfunction or hoarseness after E-TOS. Postoperative bleeding, stenosis of the pharynx and esophageal entrance, and local recurrence was observed each in one patient. The 3-year overall survival, disease-specific survival, laryngeal preservation, local control, and locoregional control rates were, 86%, 93%, 100%, 98%, and 79%, respectively. CONCLUSION: E-TOS is an effective minimally invasive surgery for T1-selected T3 pharyngeal and supraglottic cancers with preserving laryngeal function.

Bilateral epithelial-myoepithelial carcinoma of the parotid glands.

BACKGROUND: The most common histological diagnosis of bilateral parotid gland neoplasm is Warthin tumor. Bilateral malignant tumors of the parotid gland are extremely rare. METHODS: A 60-year-old man presented with a painless mass in the right preauricular area and an MRI scan showed multiple masses in the parotid glands, bilaterally. A standard superficial parotidectomy was performed on the right parotid gland followed by subtotal parotidectomy on the left. The diagnosis was synchronous bilateral epithelial-myoepithelial carcinoma arising in the parotid glands. RESULTS: Histopathology of the tumor on both sides indicated epithelial-myoepithelial carcinoma. There was no evidence of locoregional or remote disease during a 5-year follow-up period. CONCLUSION: Malignant tumors should be included in the differential diagnosis of bilateral parotid gland tumors. Management of unilateral malignant parotid tumors should involve careful observation of the contralateral parotid gland.

Neck and superior mediastinal granular cell tumor excised via a combined approach.

Granular cell tumor (GCT) is an uncommon tumor of Schwann cell origin. GCT occurs in various sites throughout the body, but mediastinal GCT is very rare. We present an extremely rare case of GCT of the neck and superior mediastinum. A 36-year-old man with a 3-month history of cough was investigated at our hospital. CT and MRI revealed a spindle-shaped mass in the left neck and superior mediastinum, with features suggesting a neurogenic tumor. The tumor was successfully excised via combined neck incision and video-assisted thoracoscopic surgery. Histopathological examination showed proliferation of polygonal and spindled cells with eosinophilic granule-rich cytoplasm. These cells were S-100 protein positive, and the cytoplasmic granules were periodic acid-Schiff positive. Based on these histopathological and immunohistochemical findings, a diagnosis of GCT was established. The patient developed hoarseness immediately after the operation, and laryngoscopy revealed the left vocal cord palsy in the paramedian position, which resolved after about 3 months. The tumor did not recur during the following 10 months.

Adult dermatomyositis with bleeding ulcer in the pharynx.

Dermatomyositis (DM) is one of the idiopathic inflammatory myopathies caused by complement-mediated vasculopathy or vasculitis in the muscle. Although the gastrointestinal (GI) mucosa has been reported to be involved as a result of vasculitis or vasculopathy, ulceration in the pharynx is a rare manifestation of DM. A 54-year-old woman complaining of muscle weakness in the extremities, low-grade fever, and dysphagia was diagnosed as having DM. Despite medical treatment with corticosteroids and immunosuppressive agents, her DM progressed rapidly, leading to exacerbation of the dysphagia. About 3 weeks after undergoing tracheostomy as a preventive measure against aspiration, the patient developed intractable respiratory tract hemorrhage. Repeated laryngoendoscopy revealed a bleeding ulceration in the pharynx that required hemostasis with electric cautery under general anesthesia. No bleeding recurred thereafter. Histopathologically, the pharynx exhibited nonspecific inflammatory cell infiltration in the muscle tissue. This rare manifestation may be considered in cases of DM with unexplainable airway bleeding.

[A case of metastatic salivary duct carcinoma successfully treated with trastuzumab-based targeted therapy].

Salivary duct carcinoma is a malignant salivary neoplasm with a poor prognosis. Effective treatment for remote metastases has not been recognized. We report herein on a case of this tumor overexpressing HER2 successfully treated with trastuzumab-based molecular targeted therapy. The patient was a 69-year-old man, who developed remote metastases into the liver and the thoracic vertebra six months after surgery and postoperative irradiation for the primary and nodal lesions. After targeted therapy including paclitaxel and trastuzumab, these metastatic lesions showed rapid and continued regression. After paclitaxel was discontinued due to peripheral neuropathy in the extremities, trastuzumab monotherapy followed without resulting in cardiotoxicity. After three years since development of remote metastases, the patient is doing well without re-progression of the disease.

Simultaneous genomic identification and profiling of a single cell using semiconductor-based next generation sequencing.

Combining single-cell methods and next-generation sequencing should provide a powerful means to understand single-cell biology and obviate the effects of sample heterogeneity. Here we report a single-cell identification method and seamless cancer gene profiling using semiconductor-based massively parallel sequencing. A549 cells (adenocarcinomic human alveolar basal epithelial cell line) were used as a model. Single-cell capture was performed using laser capture microdissection (LCM) with an Arcturus® XT system, and a captured single cell and a bulk population of A549 cells (≈ 10(6) cells) were subjected to whole genome amplification (WGA). For cell identification, a multiplex PCR method (AmpliSeq™ SNP HID panel) was used to enrich 136 highly discriminatory SNPs with a genotype concordance probability of 10(31-35). For cancer gene profiling, we used mutation profiling that was performed in parallel using a hotspot panel for 50 cancer-related genes. Sequencing was performed using a semiconductor-based bench top sequencer. The distribution of sequence reads for both HID and Cancer panel amplicons was consistent across these samples. For the bulk population of cells, the percentages of sequence covered at coverage of more than 100 × were 99.04% for the HID panel and 98.83% for the Cancer panel, while for the single cell percentages of sequence covered at coverage of more than 100 × were 55.93% for the HID panel and 65.96% for the Cancer panel. Partial amplification failure or randomly distributed non-amplified regions across samples from single cells during the WGA procedures or random allele drop out probably caused these differences. However, comparative analyses showed that this method successfully discriminated a single A549 cancer cell from a bulk population of A549 cells. Thus, our approach provides a powerful means to overcome tumor sample heterogeneity when searching for somatic mutations.