Primary non-Hodgkin's lymphoma of the larynx.

Three cases of primary non-Hodgkin's lymphoma of the larynx are described. Histologically, two tumours belonged to the category of low grade B-cell lymphomas of the small cell type (extranodal marginal zone B-cell lymphoma and lymphoplasmacytoid lymphoma), and the third was classified as a peripheral T-cell lymphoma of unspecified type. The clinical stage was IE in two cases, and IV in another case. In two cases, complete remission was obtained with radical radiotherapy. But in the other case, which was histologically lymphoplasmacytoid lymphoma, the response to radiotherapy was poor, and surgery was required. There was no relapse subsequent to treatment. Primary non-Hodgkin's lymphoma of the larynx is rare. Several reported cases have clinical features similar to those of MALT-type lymphomas arising in other extranodal sites. Although most of the reported cases have been cured with radiotherapy, in some cases dissemination to other extranodal sites may occur. Therefore careful periodic evaluation is imperative.

[Salivary duct carcinoma of the parotid gland. Case report and review of the literature].

Salivary duct carcinoma is an uncommon neoplasm which was first described by Kleinsasser et al. in 1968. They pointed out the histologic resemblance of this tumor to ductal carcinoma of the breast and termed it salivary duct carcinoma. Since then, about sixty cases, including some with suspicious pathologic pictures, have been reported. The characteristic microscopic features of salivary duct carcinoma are composed of comedo necrosis, a cribriform and papillary pattern of intraductal growth and aggressive infiltration to adjacent structures. Salivary duct carcinoma, which is the highest-grade malignancy among salivary gland tumors, must be treated aggressively with curative extended surgery. We present the case of a 74-year-old woman with salivary duct carcinoma of the parotid gland. She complained of left facial palsy and left subaural mass. For this advanced tumor involving facial palsy and subaural cutaneous invasion, en block resection with cutaneous reconstruction with a deltopectoral flap and postoperative radiation therapy was performed. She is alive without evidence of recurrence more than four years after this combined therapy.

[Inverted papillomas in the nose and paranasal sinuses].

Inverted papillomas in the nose and/or paranasal sinuses exhibit a high recurrence rate, and an association with malignancy. Early diagnosis and aggressive surgical therapy are thus essential. Seventeen cases of inverted papilloma seen at Saitama Cancer Center over a 17-year period were reviewed. Common presenting symptoms, the primary papilloma sites and the results of surgical treatment were as follows. 1) Almost all patients complained of nasal obstruction. The usefulness of nasal biopsy of the tumor was confirmed, with 12 cases being diagnosed as having inverted papilloma pre-operatively. Inverted papilloma without squamous cell carcinoma caused osseous thinning, but did not destroy the bone. 2) It was found that the primary site of the papilloma involved the lateral wall of the nasal cavity. Lateral Rhinotomy was therefore recommended as a standard treatment. 3) The recurrence rate was 1/12 after Lateral Rhinotomy. Two cases had complaints associated with the Lateral Rhinotomy, nasolacrimal duct stenosis, and a scar in the median corner of eye. 4) Only one case had concomitant squamous cell carcinoma in the nose and maxillary sinus. This patient received chemo therapy, radiation therapy and finally maxillectomy, but the inverted papilloma recurred several times. Six years later, squamous cell carcinoma recurred and lead to this patient's death.

Analyses of distant metastases in squamous cell carcinoma of the head and neck and lesions above the clavicle at autopsy.

The frequency of distant metastases was studied in 112 patients who had squamous cell carcinoma of the head and neck. All of these patients died of the tumor and underwent postmortem examinations. Forty-one (37%) of the 112 patients had distant metastases at the time of death. There was a significant correlation between development of distant metastases and the presence of cervical nodes. Of the patients who had distant metastases, 63% had evidence of tumor in the cervical nodes, whereas 37% of these patients were free of disease in the neck. Patients with residual or recurrent tumors in the cervical nodes had a high risk of distant metastases.

[Clinical pathology of hypopharyngeal cancer--comparison between TN and pTN].

Seventy patients with the hypopharyngeal cancer who underwent pharyngolaryngoesophagectomy with bilateral neck dissection between 1978 and 1990 were examined retrospectively to compare TN and pTN in these patients and clarify the clinical pathology of the hypopharyngeal cancer. Among the 70 cases of hypopharyngeal cancer, there were 46 cases of piriformis sinus cancer (PSC) and 24 cases of postcricoid cancer (PCC). The pathological diagnosis of all these cases was squamous cell carcinoma (SCC). The following results were obtained: 1. Invasion of the thyroid gland was seen in 8 cases of PCC (33.3%) and 6 cases of PSC (13.0%). The thyroid gland can be preserved in PSC, whereas its removal is indicated in PCC. 2. Twenty-nine cases of N0 necks proved to be pN0-2b in 27 cases (93.1%) which may be controlled by homolateral neck dissection, and pN2c in 2 cases (6.9%), which requires bilateral neck dissection. On the other hand, 29 cases of N1-2b necks which represent one-sided neck metastasis were pN0-2b in 15 cases (51.7%) and pN2c in 14 cases (48.3%). These results demonstrate that N0 necks can, in the majority of cases, be controlled by homolateral neck dissection alone but that N1-2b necks require bilateral neck dissection. 3. Occult neck metastases were observed in PCC more often than in PSC, because paratracheal metastases of PCC were difficult to expose before surgery. 4. Pathological neck metastases of both PSC and PCC were most commonly situated in the superior and middle internal jugular nodes. Paratracheal metastases of PCC was found pathologically in 10 cases (41.7%). Paratracheal nodes must be dissected meticulously during the resection of PCC.(ABSTRACT TRUNCATED AT 250 WORDS)

[Simultaneous bilateral neck dissections].

From April 1985 to December 1989, 65 patients with advanced head and neck squamous cell carcinoma, underwent simultaneous bilateral neck dissection (SBND) at Saitama Cancer Center. Three and five year survival percentages were 53 and 42%, respectively. In patients without histologic involvement of cervical nodes, five year survival rate was 83%, whereas in those with nodal involvement five year survival fell to 32% (p less than 0.005). The conclusion were the following: (1) Of 38 patients diagnosed to have lymph node involvements on one side of neck before operation, 8 patients (22%) were found to have bilateral lymph node metastasis in clinicopathological study. Of 13 patients having no clinical lymph node metastasis on both sides of neck, 7 patients (54%) were found to have unilateral lymph node metastasis. Of 16 patients diagnosed to have bilateral lymph nodes involvement, 10 patients were found to have bilateral neck metastasis and 2 had unilateral neck metastasis. (2) Of 35 cases of hypopharyngeal canners, 19 cases had clinically positive lymph nodes on one side of neck. Of these 19 cases, 5 cases (26%) had histologically positive nodes on the opposite side. 14 (40%) of 35 cases had metastasis on the opposite side. In conclusion, SBND is a proper treatment for metastatic cervical cancer from a primary lesion of the head and neck, especially in hypopharyngeal cancers, because the rate of recurrence seems to be related more to the difficulty in controlling lymph node metastasis than to the failure in treatment of the primary cancer.

[Reconstruction of hypopharynx and cervical esophagus using a free jejunal graft].

Forty-four patients with cancer in the hypopharynx and cervical esophagus underwent pharyngoesophageal reconstruction with a free jejunal graft after total removal of a tumor combined with resection of the circumferential tissues. The graft survival rate was 93.2% (41 of 44). Postoperative complications occurred in 16 patients (36.4%), which included postoperative death in one (2.3%), graft necrosis in 3 (6.8%), fistula formation in 4 (9.1%) and graft stricture in 3 (6.8%). All 3 cases of graft necrosis underwent successfully reimplantation. The mean interval time was 20.9 days until oral intake was possible. Thirty-two of 42 patients (76.2%) were able to take usual food. Esophageal speech was limited in the selected cases by this procedure. A cumulative survival rate of 5 years was 40.6% in this series. This method of reconstruction should be advocated as one of relatively safe and reliable procedures for patients with hypopharyngeal and cervical esophageal cancer.

Intramuscular myxoma of the neck.

Intramuscular myxomas are extremely rare tumors in the neck. In reviewing the world literature, we found a total of five cases of intramuscular myxoma that occurred in the head and neck region. The purpose of this study is to report an unusual case of intramuscular myxomas that were found bilaterally in the digastric muscles of a girl who presented with a painless palpable mass in the neck.

Adenocarcinoma of the sublingual gland: case report and 50 year review of the literature.

Primary adenocarcinoma arising in the sublingual gland is extremely rara, accounting for six cases reported in extensive survey of the literature for the period of 1930 to 1981. A case of adenocarcinoma of the sublingual gland is documented, demonstrating a highly malignant nature of the disease. This neoplasm possesses particular therapeutic problems owing to the relative lack of symptoms and the delay of initial medical observation after the onset of symptoms.