Signet ring cell adenocarcinoma of the oropharynx: presentation of a rare case and review of the literature.

Intracellular mucin-producing adenocarcinomas, so called signet ring cell adenocarcinomas (SRCAs), are most commonly found in the stomach or lower GI-tract. They occur far less frequently at other locations such as prostate, pancreas, mammarian gland or within the oropharyngeal cavity. We present the case of a patient who suffered from indolent cervical nodular tumour. Biopsy and histopathological workup showed parts of a poorly differentiated SRCA with p53 overexpression and mutations. Immunostaining gave no further hints for the origin of the malignancy. Thorough staging revealed an extended tumour of the oropharynx as primary origin. The definitive surgical therapy consisted of a transoral tumour resection with CO(2)-laser and bilateral neck dissection. Final classification was pN2c cM0 G3 R0 L1 V0. Adjuvant fractioned radiotherapy with 66 Gy was applied because of bilateral lymph node metastases and extracapsular spread. So far only few cases of oropharyngeal SRCAs have been published. These tumours turned out to be either metastases from gastric or lower gastrointestinal primaries, or had the small salivary glands as origin. In all published cases, as well as in our case, radical surgical resection was the first step of a curative therapy trial. Adjuvant targeted therapy with drugs like, e.g. herceptin or imatinib was not possible because of genetic and immunhistochemical findings. Because of the small numbers of published cases, an evaluation long-term outcomes and significance of different adjuvant therapy regimes is barely possible at this time.

The value of herbal medicines in the treatment of acute non-purulent rhinosinusitis. Results of a double-blind, randomised, controlled trial.

In a prospective, randomised, double-blinded controlled study, we compared the efficacy and safety of two different treatment options with the herbal medicines cineole and a combination of five different components for acute viral rhinosinusitis. One hundred and fifty patients with acute and viral rhinosinusitis (75 patients in each treatment group) were enrolled. The diagnosis rhinosinusitis was made according to a defined symptoms-sum-score which was based on rhinoscopic and clinical signs which are characteristic for rhinosinusitis. The primary endpoint was the amelioration of the symptoms-sum-score, which includes all relevant characteristics for rhinosinusitis as headache on bending, frontal headache, sensitivity of pressure points of trigeminal nerve, impairment of general condition, nasal obstruction, rhino-secretion, secretion quantity, secretion viscosity and fever in a treatment period of 7 days. The mean reduction of the symptoms-sum-score after 4 days was 6.7 (+/-3.4) and after 7 days 11.0 (+/-3.3) in the cineole group and 3.6 (+/-2.8) after 4 days and 8.0 (+/-3.0) after 7 days in the control group. The differences between both groups were clinically relevant and statistically significant after 4 and 7 days (P < 0.0001). This result is validated by the amelioration of the secondary endpoints headache on bending, frontal headache, sensitivity of pressure points of trigeminal nerve, impairment of general condition, nasal obstruction and rhino-secretion. These findings correlate with the statistically significant difference of the estimation of B-scan ultrasonography. It is safe to use both medications for 7 days in patients with acute viral rhinosinusitis. Treatment with cineole is clinically relevant and statistically significant, more effective in comparison to the alternative herbal preparation with five different components.