Adult Laryngeal Ossified Hemangioma: Difficulties in Differential Diagnosis.

Adult laryngeal hemangiomas are uncommon and often poorly symptomatic. The authors describe a laryngeal hemangioma with acute airway obstruction and radiologic findings suggesting a chondrosarcoma-like neoplasm, while pathologic features were consistent with an ossified hemangioma. The presence of fields of bone metaplasia into a classical cavernous hemangioma is an unusual phenomenon which, to our knowledge, was never previously described in the larynx. Difficulties concerning the differential diagnosis and modality of treatment are also discussed.

Skull Base Metastasis From Occult Renal Cell Carcinoma.

Skull base metastases are extremely rare. The authors report a case of a 65-year-old man who presented with a headache and diplopia secondary to a skull base metastasis from occult renal cell carcinoma. Since there were no other systemic metastases, radical nephrectomy and radiotherapy of the unresectable skull base location were performed. He subsequently received immunotherapy with sunitinib, everolimus, and sorafenib with local and systemic control of the disease after 53 months from surgery. When metastasis is unresectable radical nephrectomy and radiotherapy aimed at the metastasis may be of benefit improving quality of life. Immunotherapy may provide alternative treatment strategies improving the outcomes of patients affected by this rare pathology with historically poor prognosis.

Isolated Hypoglossal Nerve Palsy Mimicking a Base of Tongue Tumor.

Isolated paralysis of hypoglossal nerve is uncommon, generally being associated with other neuropathies. A careful differential diagnosis is necessary to recognize the underlying diseases, some of which can be life-threatening. The authors report a patient of an 80-year-old woman presenting with an isolated hypoglossal palsy, mimicking a tongue neoplasm. Through a careful clinical workup and thanks to the aid of the imaging, it was possible to identify the presence of signal alterations due to a subacute denervation of the affected hemitongue and to exclude the presence of a tumor. The patient was clinically diagnosed as isolated hypoglossal palsy, resulting from a thrombo-embolic accident involving the nerve along its course. The authors propose some useful means for the differential diagnosis and review the literature.

Voluminous Myoepithelioma of the Minor Salivary Glands Involving the Base of the Tongue.

Myoepithelioma is an extremely rare tumour subtype and diagnosis is based on a wide variation of cellular morphology. FNAC specimens do not always suffice for a definitive differential diagnosis which depends on histology and immunohistochemistry of the lesion. Case Presentation. A 54-year-old female came to our attention with dysphagia and dyslalia of 6-month standing. Ear, Nose, and Throat (ENT) examination revealed a voluminous mass on the right portion of the base of her tongue, where postcontrast T2-weighted Magnetic Resonance Imaging (MRI) evidenced a hyperintense lesion. The fine-needle aspiration specimen taken for cytology was not diagnostic, as a differential diagnosis between myoepithelioma and a malignant neoplasm of the salivary glands necessitates parameters that cytology alone cannot provide. Therefore, the whole lesion was excised by diode laser through a transoral approach. Histology and immunohistochemistry of the completely excised lesion confirmed a myoepithelioma.

Percutaneous Sclerotherapy With OK-432 of a Cervicomediastinal Lymphangioma.

The present study reports a case of percutaneous sclerotherapy of a giant cystic cervicomediastinal lymphangioma using OK-432. To the best of our knowledge, percutaneous sclerotherapy of a mediastinal lymphangioma using OK 432 has not previously been reported in the English literature.

Juvenile nasopharyngeal angiofibroma: comparison between endoscopic and open operative approaches.

BACKGROUND AND AIM: Juvenile nasopharyngeal angiofibroma (JNA) is a rare vascular and fibrous tumor that most commonly affects males in prepuberal and adolescent age. Traditionally, these tumors have been removed, after selective embolization, with the open surgical approach (degloving), but the interest in the endoscopic resection, especially for small tumors, has increased in recent years. To present our experience of JNA management, comparing the endoscopic approach and open/combined approach. MATERIALS AND METHODS: We conducted a retrospective, cross-sectional, and descriptive study of 12 young men, ages between 9 and 19 years (mean: 13), suffering from nasopharyngeal angiofibroma and treated with open surgery (N = 6), with endoscopic excision (N = 5) or with combined approach (N = 1). We reviewed demographical data, clinical presentation, surgical approach as well as time of surgery, of hospitalization, need of blood transfusion during surgery, and complications occurred during hospitalization. RESULTS: All JNA patients were male. The average age at diagnosis was 13.7 years (range 9-19 years). Approximately, 8.3% were classified as Önerci I, 41.7% as Önerci II, and 50.0% as Önerci III. Preoperative embolization was carried out in all patients. All patients were submitted to primary surgical resection, and 2 of them required intraoperative blood transfusion. The overall recurrence rate was 8.3% and the cure rate was 100%. CONCLUSION: This study confirmed that endoscopic approach gives excellent results in small and medium dimensions tumors, whereas open surgery remains a safe procedure for patients with larger tumors.

Giant Cervico-mediastinal Well-differentiated Liposarcoma.

Liposarcomas are rare entities and those located in the neck and mediastinum are exceptional. We report the case of a 58 year-old Caucasian male who presented with dysphonia, mild dysphagia to solids, dyspnoea at exertion and cough due to a giant mass of the neck originating from the deep cervical space at C6 vertebral level spreading into the posterior mediastinum. The lesion, that was associated with a right vocal cord palsy, caused severe lateral displacement of the trachea and oesophagus. The case has been managed by complete surgical resection through a combined cervical and thoracic approach associated with a tracheostomy due to the risk of bilateral recurrent nerve dysfunction at the end of the intervention. The tumour was diagnosed as a encapsulated low-grade liposarcoma. Six months after surgery the tracheostomy was closed. At 24 months clinical and radiological follow-up the patient is doing well and disease free.

Unusual metastases from tall cell variant of papillary thyroid cancer.

BACKGROUND: Tall cell variant (TCV) cancer is considered more aggressive than the classic variant of papillary thyroid cancer (PTC). Distant metastases are more common among this variant and affect survival. Little is known about the molecular pattern of this histotype. METHODS: This is a report of 2 cases of unusual metastases from TCV, BRAF V600E-positive. RESULTS: A 38-year-old woman developed subcutaneous metastases during short-term follow-up; at medium-term follow-up, the patient showed detectable stimulated serum thyroglobulin without disease evidence at imaging. A 33-year-old man presented incidental thymic metastases at time of surgical treatment; this is the first case of not ectopic thymic metastases from PTC. CONCLUSION: TCV may present with unusual metastases already during early follow-up. The more aggressive behavior could be linked to the higher prevalence of BRAF point mutations, but only a long-term follow-up might clarify if this association could worsen the prognosis. Moreover, skin metastases have been predictive factors of worse outcome in our patients, but not thymic metastases.

Prevalence and characteristics of HPV infection in oropharyngeal cancer.

BACKGROUND: The purpose of this prospective study was to analyze the human papillomavirus (HPV) infection status and its impact on the outcome in a consecutive series of patients affected by oropharyngeal cancer. METHODS: The specimens of consecutive subjects surgically treated for oropharyngeal squamous cell carcinoma were obtained. Samples were collected by broom-type cell sampling devices and they underwent the Roche Linear Array HPV Genotyping Test to identify the presence of HPV types. RESULTS: In all, 52 patients were enrolled. The presence of HPV was detected in 13 samples, with HPV type 16 as the most frequently encountered type. Statistically significant associations were found between HPV-positive patients and a higher tumor grading (P < 0.05), and between HPV-positive patients and a higher number of negative prognostic factors (P < 0.05). CONCLUSIONS: A subset of oropharyngeal squamous cell carcinomas with a higher tumor grading is strongly linked to HPV16 infection.

Delayed carotid pseudoaneurysm: a life-threatening complication after endoscopic sinus surgery.

Internal carotid artery pseudoaneurysm is a rare but potentially lethal complication of sinus surgery. We present 2 cases of delayed carotid pseudoaneurysm development after internal carotid laceration during functional sinus surgery for chronic sinusitis to emphasize the need to follow up the patients with profuse bleeding perioperatively and to identify when to suspect iatrogenic vascular malformations.

Total nasal prosthesis after resection of a recurrence of skin carcinoma on a forehead flap in a post-rhinectomy site.

The nose is the most common site for facial skin cancer; nonmelanoma skin cancers are the most common tumors of this region. Median and paramedian forehead flaps have been proposed for nasal defects greater than 2.5-3 cm in diameter. The aim of this study was to describe a peculiar case of a recurrence of a squamous cell carcinoma in a forehead flap of a post-rhinectomy site managed by a fabrication of a total nasal prosthesis as salvage procedure. To the best of our knowledge, this is the first reported case in the scientific literature of a recurrence of a squamous cell carcinoma in a forehead flap of a post-rhinectomy site; this peculiar clinical report adds knowledge in the complex field of nasal reconstruction.

The effectiveness of psychological first aid as a disaster intervention tool: research analysis of peer-reviewed literature from 1990-2010.

OBJECTIVE: The Advisory Council of the American Red Cross Disaster Services requested that an independent study determine whether first-aid providers without professional mental health training, when confronted with people who have experienced a traumatic event, offer a "safe, effective and feasible intervention." METHODS: Standard databases were searched by an expert panel from 1990 to September 2010 using the keyword phrase "psychological first aid." Documents were included if the process was referred to as care provided to victims, first responders, or volunteers and excluded if it was not associated with a disaster or mass casualty event, or was used after individual nondisaster traumas such as rape and murder. This search yielded 58 citations. RESULTS: It was determined that adequate scientific evidence for psychological first aid is lacking but widely supported by expert opinion and rational conjecture. No controlled studies were found. There is insufficient evidence supporting a treatment standard or a treatment guideline. CONCLUSION: Sufficient evidence for psychological first aid is widely supported by available objective observations and expert opinion and best fits the category of "evidence informed" but without proof of effectiveness. An intervention provided by volunteers without professional mental health training for people who have experienced a traumatic event offers an acceptable option. Further outcome research is recommended.

Intraoral transposition of pedicled temporalis muscle flap followed by zygomatic implant placement.

Despite the recent advances of sophisticated reconstructive surgical techniques, management of maxillectomy defects continues to be challenging. For a selected group of patients, who cannot sustain a sophisticated microsurgical reconstructive procedure, a prosthetic obturator is indicated to separate the oral cavity from the sinonasal cavities. After the development of the osseointegration concept, dental implants have proven to be indicated for the rehabilitation of patients who underwent maxillectomy. Recently, surgeons can use a computer-assisted software package, which enables them to insert implants after a detailed analysis of the residual bone. For some patients with limited amount of residual maxillary bone, unusual surgical sites such as the zygomatic complex have been tested. We introduce a successful 2-step surgical procedure using a pedicled temporalis muscle flap and zygomatic implant placement to reconstruct a maxillary defect after oncological resection.

Clinical and molecular features of mucosa-associated lymphoid tissue (MALT) lymphomas of salivary glands.

BACKGROUND: To analyze clinical features and to discuss the modality of investigation and treatment of a series of mucosa-associated lymphoid tissue (MALT) lymphomas. To investigate the prevalence of aberrant promoter methylation, responsible for gene inactivation, in a selected panel of genes potentially involved in the pathogenesis of B-cell malignancies as O6-methylguanine-DNA methyltransferase (MGMT), p73, death-associated protein kinase (DAP-k). METHODS: Nine patients with primary MALT lymphoma of the salivary glands were retrospectively reviewed. MGMT, p73, DAP-k apoptotic pathways were tested. RESULTS: Methylation of DAP-k was common (5/8; 63%). Histological examination ensured diagnostic confirmation, whereas fine-needle aspiration cytology was not definitively diagnostic. CONCLUSION: Histological assessment is the gold standard in the diagnosis of salivary gland lesions. Parotidectomy represents a safe and reliable diagnostic tool leading to a definite diagnosis of MALT lymphomas in all cases and curative without other treatment in early-stage MALT lymphoma.

[Prognostic factors for definitive hypoparathyroidism following total thyroidectomy]. / Factores pronósticos de hipoparatiroidismo definitivo tras tiroidectomía total.

INTRODUCTION AND OBJECTIVE: Hypocalcaemia, transient in most cases, is the main complication after thyroid gland surgery with regard to functional impairment of the parathyroid glands or other reversible factors. Sixty-seven patients who underwent thyroidectomy were evaluated to identify potential clinical, pathological and surgical factors that might be predictive for frank hypocalcaemia following total thyroidectomy. METHODS: Serum samples were taken preoperatively and postoperatively to measure total calcium levels. Patients' plasma calcium levels were recorded post-operatively along with such factors as age, gender, thyroid function, definitive pathology-based diagnosis, accidental removal and auto-transplantation of parathyroid glands, re-intervention to identify risk factors for the development of definitive hypoparathyroidism (DH). All comparisons were made between patients with hypocalcaemia and normal levels of post-operative calcaemia. RESULTS: Transient acute hypocalcaemia was identified in 25 of 67 patients (43.3 %). DH was identified in 8 (11 %) patients. CONCLUSIONS: Our study revealed that the only risk factor for DH was a calcium level of less than 7.5 mg/dL within the first 24 hours following surgery; this is a reliable, inexpensive and rapid parameter that is highly predictive of the onset of HD. No statistical significant associations were detected with other factors such as thyroid function, histology, accidental removal or autotransplantation of parathyroid glands, thus it is possible to state that careful manipulation of the parathyroid to preserve the periglandular vascularization is of vital importance to ensure correct post-operative functionality.

Factores pronósticos de hipoparatiroidismo definitivo tras tiroidectomía total / Prognostic factors for definitive hypoparathyroidism following total thyroidectomy

Introducción y objetivo: La hipocalcemia tras tiroidectomía total constituye la mayor complicación, en la mayoría de los casos, transitoria, en relación con un daño funcional de las paratiroides u otros factores reversibles. Se trata de un estudio sobre 67 pacientes sometidos a tiroidectomía total para identificar posibles factores clínicos, anatomopatológicos y quirúrgicos predictivos de hipocalcemia definitiva tras tiroidectomía total. Métodos: Recogida de valores plasmáticos de calcio en el período postoperatorio y factores como edad, sexo, funcionalidad tiroidea, diagnóstico anatomopatológico definitivo, extirpación accidental de las paratiroides y su autotrasplante, reintervención para identificar factores de riesgo para el desarrollo de hipoparatiroidismo definitivo. Las comparaciones han sido efectuadas entre los pacientes con hipocalcemia y concentraciones normales de calcemia post-operatoria. Resultados: La hipocalcemia aguda transitoria ha sido identificada en 25/67 pacientes (43,3 %). El hipoparatiroidismo definitivo ha sido identificado en 8 (11 %) pacientes. Conclusiones: En nuestro estudio ha supuesto que una calcemia después de 24 h de la intervención quirúrgica inferior a 7,5 mg/dl sea un factor altamente pronóstico de hipoparatiroidismo definitivo; esta determinación es un parámetro fiable, económico, rápido y muy predictivo del desarrollo de hipoparatiroidismo definitivo. No se han encontrado asociaciones estadísticamente significativas con otros factores, como funcionalidad tiroidea, histología, extirpación accidental o autotrasplante de las paratiroides, así que podemos afirmar que una atenta manipulación de las paratiroides conservando cuidadosamente la vascularización glandular representa un factor de fundamental importancia para garantizar una normal funcionalidad paratiroidea postoperatoria

Introduction and objective: Hypocalcaemia, transient in most cases, is the main complication after thyroid gland surgery with regard to functional impairment of the parathyroid glands or other reversible factors. Sixty-seven patients who underwent thyroidectomy were evaluated to identify potential clinical, pathological and surgical factors that might be predictive for frank hypocalcaemia following total thyroidectomy. Methods: Serum samples were taken preoperatively and postoperatively to measure total calcium levels. Patients' plasma calcium levels were recorded post-operatively along with such factors as age, gender, thyroid function, definitive pathology-based diagnosis, accidental removal and auto-transplantation of parathyroid glands, re-intervention to identify risk factors for the development of definitive hypoparathyroidism (DH). All comparisons were made between patients with hypocalcaemia and normal levels of post-operative calcaemia. Results: Transient acute hypocalcaemia was identified in 25 of 67 patients (43.3 %). DH was identified in 8 (11 %) patients. Conclusions: Our study revealed that the only risk factor for DH was a calcium level of less than 7.5 mg/dL within the first 24 hours following surgery; this is a reliable, inexpensive and rapid parameter that is highly predictive of the onset of HD. No statistical significant associations were detected with other factors such as thyroid function, histology, accidental removal or autotransplantation of parathyroid glands, thus it is possible to state that careful manipulation of the parathyroid to preserve the periglandular vascularization is of vital importance to ensure correct post-operative functionality

[Hydrological indications in the therapy of pharyngitis]. / Indicazioni idrologiche nella terapia delle faringiti.

Pharyngitis is an inflammatory disease of the mucosal and submucosal structures of the throat. Infection may or may not be a component of the disease. Pharyngitis is one of the common illness for which patients visit primary care physicians. Most of them are diagnosed by clinical evaluation and usually respond to treatment with antibiotics, but exceptions occur when pharyngitis is caused by non bacterial inflammatory processes like virus, mycoses, reflux of gastric juices, tobacco or alcohol abuse. In these cases, as alternative and preventive, could be indicated the thermal therapy. For many centuries thermal waters have been used in the treatment of chronic inflammations of the upper respiratory airway, such as pharyngitis, with good results. Different thermal waters are currently used, in particular sulfur or sulfur- salty- bromine-, iodine- or sulfur-sulfate-bicarbonate-carbonate alkaline or sulfur-arsenical-ferruginous, normally utilized by inhalation or irrigation or aerosol-therapy. The principal pharmacological activity of these waters is connected to the concentrations of H2S, halogens (Iodine e Bromine), sulfates, arsenic and the level of radioactivity, concerning their antimicrobial power and the mucolytic effect of sulphur.

[Deep neck infections: a retrospective study]. / Le infezioni profonde del collo.

A retrospective study was carried out on 79 patients with deep neck infections (DNI) admitted to our Department between 1990 and 2005 in order to review our experience with DNI and verify if diabetic and immunocompromised patients have more aggressive infections and poorer prognosis. Demographics, clinical presentation, etiology, site of infection, associated systemic diseases (26.6%-21/79), microbiology, treatment and complications were considered.

Role of radiotherapy in the treatment of cervical lymph node metastases from an unknown primary site: retrospective analysis of 113 patients.

PURPOSE: The management of patients with cervical lymph-node metastases from unknown primary site (UPS) remains a matter of discussion. This study aimed to analyze the results and prognostic factors in a series of patients treated with radiotherapy. METHODS AND MATERIALS: Data from 113 patients who presented with cervical lymph nodes metastases from UPS treated from 1980 to 2004 were reviewed. Eighty-seven patients (77.0%) were squamous cell carcinoma (SCC). Ninety-one patients were treated with curative and 22 with palliative intent. Fifty-nine of 113 patients (52.2%) received surgery followed by radiotherapy and 54 of 113 (47.8%) received radiotherapy alone. Radiotherapy was delivered to the neck and pharyngeal mucosa in 67 patients and to the ipsilateral or bilateral neck in 45 patients. Twenty-one patients (18.5%) also received chemotherapy. RESULTS: The 5-year overall survival rates were 40.7% for the entire group and 46.6% for the SCC subgroup. The occurrence of the occult primary was observed in 23 of 113 patients (20.3%), 19 (82.6%) within the head and neck region. At multivariate analysis, treatment with curative intent and extensive irradiation of bilateral neck and pharyngeal mucosa were favorable prognostic factors for the whole series, and treatment with curative intent, extensive irradiation of bilateral neck and pharyngeal mucosa, and absence of extracapsular spread were favorable prognostic factors for the SCC subgroup. CONCLUSIONS: Patients with cervical lymph node metastases from UPS have a similar prognosis to those affected by other head and neck malignancies. Curative treatment strategies including neck dissection and extensive irradiation by three-dimensional conformal radiation therapy resulted in significantly better outcomes.

Contralateral cervical lymph node metastases in pyriform sinus carcinoma.

OBJECTIVE: We designed a retrospective study to evaluate the incidence of contralateral neck metastases in squamous cell carcinoma of the pyriform sinus. STUDY DESIGN AND SETTING: Sixty-three patients with strictly unilateral squamous cell carcinoma of the pyriform sinus who underwent bilateral neck dissection at the time of primary surgery were included in this study. The medical records of all patients were reviewed. A multivariate statistical analysis was performed, considering some clinical and histologic parameters of T stage and N stage in relation to contralateral neck metastases. RESULTS: Contralateral neck metastases were histopathologically confirmed in more than 20% of the cases examined (13 out of 63 patients), of whom 3 were clinically staged as N2c, 2 N2b, 5 N2a, 2 N1 and 1 N0. The percentage of occult contralateral neck metastases was 77% (10/13 cases). Poorly differentiated tumors (P= .02) and the involvement of the lateral wall (P= .036) showed a statistically significant correlation with stage pN2c. Also T size and ipsilateral N stage were associated with the presence of contralateral neck metastases. CONCLUSIONS: Our data suggest that elective bilateral neck dissection is recommended in patients with locally advanced squamous cell carcinoma of the pyriform sinus. EBM RATING: C-4.