ABSTRACT
Esthesioneuroblastoma remains a challenging disease because of its rarity, the complexity of surrounding structures, missing opinions of optimal treatment protocol, and complications associated with necessary surgery. Our objective was to analyse the management and outcome of a cohort of patients with esthesioneuroblastoma from 1990 to 2009 in a tertiary medical centre. There were 17 eligible patients (8 males and 9 females) with the median age of 53 years (range 20-75 years). An obvious inconsistency was noted in the management of the various tumours of the present series during the two decades due to a lack of a uniform treatment protocol. The median follow-up time was 57.5 months (range 3-158 months). Nine patients (seven with curative treatment intent) died of the disease with the median time from diagnosis to death of 60 months (range 3-161 months). Eight patients had no evidence of the disease at last follow-up visit (median 76 months, range 24-119 months). Recurrences were documented in seven of the patients. The median time from end of primary treatment to a recurrence was 57 months (range 6-110 months). The 5-year overall survival and disease-free survival was 68 and 62%, respectively. The management of ENB should be planned by an experienced head and neck surgeon as part of a multidisciplinary team in a tertiary referral setting. Multimodality therapy with long-term follow-up is preferable and should be set based on the available disease-specific classifications for clinical staging and histopathological grading.
Subject(s)
Esthesioneuroblastoma, Olfactory/therapy , Nasal Cavity , Nose Neoplasms/therapy , Adult , Aged , Combined Modality Therapy , Disease-Free Survival , Esthesioneuroblastoma, Olfactory/diagnosis , Esthesioneuroblastoma, Olfactory/mortality , Esthesioneuroblastoma, Olfactory/secondary , Female , Humans , Male , Middle Aged , Neoplasm Recurrence, Local , Nose Neoplasms/diagnosis , Nose Neoplasms/mortality , Nose Neoplasms/pathology , Paranasal Sinus Neoplasms/diagnosis , Paranasal Sinus Neoplasms/mortality , Paranasal Sinus Neoplasms/pathology , Paranasal Sinus Neoplasms/therapy , Survival Rate , Young AdultABSTRACT
OBJECTIVES/HYPOTHESIS: To determine clinical features, health-related quality of life, and adult voice in patients with a history of juvenile-onset recurrent respiratory papillomatosis (JORRP). STUDY DESIGN: Case-control study. METHODS: All 32 patients with JORRP treated at Helsinki University Hospital between 1975 and 1994 were invited to an outpatient visit in spring 2008, and 18 of them (56%) entered the study. Each patient had an age- and gender-matched control subject with similar smoking habits. Videolaryngostroboscopy was performed and voice quality determined by acoustic and perceptual analysis. Voice-quality characteristics of the whole patient group and the recurrence-free patients were examined separately. Subjective voice-related disability was studied with voice handicap index (VHI) and health-related quality of life with a 15D questionnaire. RESULTS: Acoustic analysis showed that patients had statistically significantly higher values in percent jitter, percent shimmer, and noise-to-harmonics ratio. Perceptual analysis indicated higher scores for patients in overall grade, roughness, breathiness, and strain. Acoustic and perceptual values for recurrence-free patients (n = 14) were also significantly higher than those for their matched paired controls. No statistically significant differences emerged for handicap related to voice or to health-related quality of life. Four study patients (22%) had undergone tracheotomy, indicating severity of juvenile-onset disease. CONCLUSIONS: JORRP is a risk factor for permanent laryngeal pathology and voice-disturbances in adulthood.
Subject(s)
Quality of Life/psychology , Voice Disorders/diagnosis , Voice Disorders/psychology , Adolescent , Adult , Age of Onset , Aged , Case-Control Studies , Child , Child, Preschool , Disability Evaluation , Female , Humans , Infant , Laryngeal Neoplasms/diagnosis , Laryngeal Neoplasms/psychology , Laryngeal Neoplasms/surgery , Laryngoscopy , Male , Middle Aged , Papilloma/diagnosis , Papilloma/psychology , Papilloma/surgery , Sound Spectrography , Speech Acoustics , Stroboscopy , Video Recording , Young AdultABSTRACT
CONCLUSIONS: Metastatic disease should always be considered as a potential differential diagnosis in the adult patient with a cystic neck lesion. OBJECTIVES: The most common cause of a cystic neck lesion in young adults is a branchial cleft cyst (BCC). In older patients metastatic lymph nodes may be easily misdiagnosed as BCC. This study aimed to investigate the incidence of unsuspected carcinoma in routinely excised cervical cysts at a tertiary care teaching hospital and to determine the characteristics of benign BCC and cystic malignancy in preoperative imaging. PATIENTS AND METHODS: A total of 196 consecutive adult patients operated on with the initial diagnosis of benign lateral cervical cyst were identified and the hospital charts and imaging studies were reviewed. The mean age of the patients was 40 years (range 17-79 years). RESULTS: Metastatic squamous cell carcinoma was demonstrated histologically postoperatively in six (3.1%) patients and metastatic papillary thyroid carcinoma in one (0.5%) patient. Therefore, the incidence of unsuspected carcinoma in the cystic neck lesions initially diagnosed as BCC was 3.6%. The preoperative imaging appearances of these lesions had been considered identical to that of BCC.
