[Usefulness and indication of superselective intra-arterial chemotherapy via the radial artery for advanced head and neck cancer--aN indication for inaccessible to treatment with seldingers method].

UNLABELLED: Neck metastasis is the most significant predictive indicator of head and neck cancer. Various treatments including surgery and chemoradiation have typically resulted in poor outcomes. As a result, we have applied progressive interventional radiology (IVR), Seldinger's method, in cases deemed to have poor prognostic factors. However, a recurring problem with the standard procedure has been cases in which the target artery cannot be successfully accessed. As a result of this limitation, we have initiated an approach whereby we proceed from the radial artery in order to control neck metastasis. OBJECTIVE: Evaluate the usefulness of superselective intra-arterial chemotherapy via the radial artery for advanced head and neck cancer. METHOD AND PATIENTS: From May, 1998 to December 2010, 25 patients for whom catheter insertion in the thyrocervical artery, a major branch of the subclavian artery, was impossible, were treated using superselective intra-arterial chemotherapy via the radial artery. Intra-arterial chemotherapy was administered at 100-150 mg/m2 of CDDP and 10-15 mg/m2 of DOC four times per week, with 60 Gy radiation therapy being concurrently. Analysis of the success of insertion, duration of time required for insertion to the target artery, chemotherapy effective rates, and method safety were carried out retrospectively. RESULT: For the target arteries in which catheters could not be effectively inserted using Seldinger's method, insertion was successful and CDDP was safely administered. No complications in regards to intra-arterial chemotherapy were observed. The mean time to insert the catheter into the target arteries was approximately 25 minutes. In contrast, when applying Seldinger's method the mean time was over 1 hour with the result being failure to insert the catheter within the target arteries. Working with our approach, the effective rate of chemotherapy recorded was 100%. The 5-year overall survival rate was 38%. Furthermore, the patients could walk and move freely on the day of treatment. CONCLUSION: This novel method proved useful for the treatment of advanced head and neck cancer in poor prognostic cases in which the target arteries could not be accessed using Seldinger's method.

Problems of primary T-cell lymphoma of the thyroid gland--a case report.

In the following report we discuss a very rare case of malignant T-cell lymphoma of the thyroid gland that developed in a 70-year-old woman with a past history of hypothyroidism due to chronic thyroiditis. The chief complaint was a rapidly growing neck mass. CT and ultrasonographic examination revealed a diffuse large thyroid gland without a nodule extending up to 13 cm. Although presence of abnormal lymphoid cells in the peripheral blood was not found, the sIL-2 Receptor antibody and thyroglobulin measured as high as 970 U/ml and 600 ng/mL respectively. Fine needle aspiration cytology diagnosed chronic thyroiditis. A preoperative diagnosis of suspicious malignant lymphoma of the thyroid gland accompanied by Hashimoto's thyroiditis was made, and a right hemithyroidectomy was performed to definite diagnosis. Histological examination revealed diffuse small lymphocytic infiltration in the thyroid gland associated with Hashimoto's thyroiditis. Immunohistochemical examination showed that the small lymphocytes were positive for T-cell markers with CD3 and CD45RO. The pathological diagnosis was chronic thyroiditis with atypical lymphocytes infiltration. However, Southern blot analysis of tumor specimens revealed only a monoclonal T-cell receptor gene rearrangement. Finally, peripheral T cell lymphoma was diagnosed. Therefore, the left hemithyroidectomy was also performed one month later. No adjuvant therapy was performed due to the tumor stage and its subtype. The patient is well with no recurrence or metastasis 22 months after the surgical removal of the thyroid. As malignant T-cell lymphoma of the thyroid gland with Hashimoto's thyroiditis was difficult to diagnose, gene rearrangement examination needed to be performed concurrently.

Coexistence of pyriform sinus fistula, ectopic lingual thyroid, and ectopic cervical thymus.

OBJECTIVE: We report an extremely rare case of coexistence of pyriform sinus fistula, ectopic lingual thyroid, and ectopic cervical thymus. CASE REPORT: A 16-year-old girl with ectopic lingual thyroid had suffered repetitive painful swelling in the left anterior neck. Barium swallow radiography and computed tomography revealed a fistula arising from the pyriform sinus running down to the anterior neck. She underwent transcervical fistulectomy with preservation of the recurrent laryngeal nerve. Histopathological examination of the surgical specimen showed coexisting thymic tissue. CONCLUSION: This illustrative case exemplifies the different embryological origin of the thyroid from that of the third and fourth pharyngeal pouch derivatives.

Usefulness of Choline-PET for the detection of residual hemangiopericytoma in the skull base: comparison with FDG-PET.

BACKGROUND: Choline is a new PET tracer that is useful for the detection of malignant tumor. Choline is a precursor of the biosynthesis of phosphatidylcholine, a major phospholipid in the cell membrane of eukaryotic cells. Malignant tumors have an elevated level of phosphatidylcholine in cell membrane. Thus, choline is a marker of tumor malignancy. METHOD: The patient was a 51-year-old man with repeated recurrent hemangiopericytoma in the skull base. We performed Choline-PET in this patient after various treatments and compared findings with those of FDG-PET. RESULTS: Choline accumulated in this tumor, but FDG did not accumulate. We diagnosed this tumor as residual hemangiopericytoma and performed the resection of the residual tumor. FDG-PET is not appropriate for skull base tumor detection because uptake in the brain is very strong. CONCLUSION: We emphasize the usefulness of Choline-PET for the detection of residual hemangiopericytoma in the skull base after various treatments, compared with FDG-PET.

Successful function-preserving therapy for chondroblastoma of the temporal bone involving the temporomandibular joint.

We present a case involving a late diagnosis of chondroblastoma of the temporal skull base involving the temporomandibular joint (TMJ). Following an initial misdiagnosis and unsuccessful treatment over a period of 5 years, the patient was referred to our department for further evaluation and possible surgical intervention for occlusal abnormalities, trismus, clicking of the TMJ, and hearing impairment. Based on preoperative immunochemical studies showing positive reaction of multinucleated giant cells for S-100 protein, the final diagnosis was chondroblastoma. The surgical approach - postauricular incision and total parotidectomy, with complete removal of the temporal bone, including the TMJ via the extended middle fossa - was successful in preserving facial nerves and diminishing clinical manifestations. This study highlights a misdiagnosed case in an effort to underline the importance of medical examinations and accurate differential diagnosis in cases involving any tumor mass in the temporal bone.