An algorithm for preoperative differential diagnostics of parotid tumours on the basis of their dynamic and diffusion-weighted magnetic resonance images: a retrospective analysis of 158 cases.

BACKGROUND: To verify the usefulness of a new algorithm for preoperative differential diagnostics of parotid tumours on the basis of their dynamic and diffusion- -weighted magnetic resonance imaging (MRI). MATERIALS AND METHODS: The retrospective analysis included 158 consecutive surgical patients with parotid tumours. Aside from ultrasound-guided fine needle biopsy, the protocol of preoperative evaluation included dynamic and diffusion-weighted MRI. According to the new diagnostic algorithm, the result of fine needle biopsy was considered only in the case of lesions with time to peak enhancement (Tpeak) > 60 s and washout rate (WR) ≤ 30% on dynamic MRI and apparent diffusion coefficient (ADC) ≤ 1.7 × 103 mm/s2 on diffusion-weighted MRI, or those presenting with concomitant lymphadenopathy. The accuracy of this algorithm was verified against final histopathological diagnoses. RESULTS: The new algorithm gave 10 true positive and 2 false positive results, as well as 132 and 14 true and false negative results, respectively. Its sensitivity and specificity (41.7% and 98.5%, respectively) were the same as in the case of fine needle biopsy alone. None of the 59 tumours that were qualified as benign solely on the basis of preoperative MRI turned out to be malignant on postoperative histopathological examination. CONCLUSIONS: Interpreted together, dynamic and diffusion-weighted MRIs provide the same accuracy in preoperative differential diagnostics of parotid tumours as fine needle biopsy. This substantiates the use of diagnostic algorithms in which biopsy would serve mostly as a secondary test to verify selected ambiguous radiological diagnoses. (Folia Morphol 2018; 77, 1: 29-35).

Renal clear cell carcinoma metastasis to salivary glands - a series of 9 cases: clinico-pathological study.

Metastatic tumors involving salivary glands arising from the non-head and neck area are very rare. Renal cell carcinoma (RCC) is known for its high propensity for metastasis to unusual localizations. RCC metastasis to the maxillofacial area is an uncommon event (16%), but metastasis to salivary glands is extremely rare. We report a series of 9 such cases retrieved from two institutions. The group included 6 females and 3 males. The age at diagnosis ranged from 60 to 97 years (mean 72.6 years). The tumors involved the parotid gland in 7 cases, and the submandibular and small salivary gland of the oral cavity in 1 case each. The size of tumors ranged from 0.4 to 5 cm. Total parotidectomy with selective neck dissection was performed in 4 cases, while superficial parotidectomy was performed in 1 case and simple resection in 3 cases. Histologically, all the tumors were clear cell renal cell carcinomas, and therefore the differential diagnosis mainly included clear cell variants of salivary gland carcinomas. The parotid gland was the initial manifestation of renal malignancy in 4 of the cases, while in the remaining 5 cases a history of RCC had been known. The salivary gland involvement developed from 11 months to 13 years after the time of diagnosis of the primary tumor. In 2 cases it was the first site of dissemination. Pathologists need to maintain a high index of suspicion for the possibility of metastasis when confronted with oncocytic or clear cell neoplasms developing in salivary glands. RCC, although rare, should be included in this differential diagnosis.

Giant cribriform adenocarcinoma of the tongue showing PRKD3 rearrangement.

Cribriform adenocarcinoma of the tongue and minor salivary glands (CAMSG) was first described 16 years ago. It typically presents as a mass at the base of the tongue with early spread to lymph nodes, but without potential for distant metastases. In the 2005 World Health Organization Classification of Tumors the entity was classified as a possible variant of polymorphous low-grade adenocarcinoma (PLGA). Since then, more than 40 cases have been described in the English literature. Recently, PRKD1-3 translocation was found in more than 80% of CAMSGs. In some of those cases ARID1A or DDX3X was the translocation partner. We reviewed 183 primary carcinomas of major and minor salivary glands, resected at the Medical University of Gdansk, Poland, in the period 1992-2012, and identified only one case of CAMSG. A giant tumor developed at the base of the tongue in a 76-year-old man. The primary tumor was resected with multiple bilateral cervical lymph node metastases. The patient received radiotherapy but died 10 months after the surgery due to causes not related to the primary cancer. The tumor presented PRKD3 rearrangement as confirmed by FISH. As the tumor is extremely rare (it represented only 0.5% of salivary gland tumors in our series), the controversy on its nosological status is still unresolved. This is the first report in the world literature of a patient who died in the course of CAMSG.

Signs and symptoms of parotid gland carcinoma and their prognostic value.

The aim of this study was to analyse signs and symptoms present in patients with parotid gland carcinoma and to assess their prognostic value. A retrospective study of data from 131 patients who were treated surgically was performed. Evaluation of prognostic factors was possible in 109 patients who completed a minimum 5 year follow up. The most common sign and symptoms were parotid mass (96.9%), pain (40.4%), enlarged cervical lymph nodes (32.0%), facial nerve palsy (20.6%) and overlying skin infiltration (19.8%). In 20% of all cases there were no symptoms of tumour malignancy. The average duration of symptoms suggesting malignancy was 4 months. In univariate analysis, the strongest prognostic value was found for facial nerve palsy; it reduced nearly tenfold (9.7) the 5-year disease-free survival. The subsequent poor prognostic factors were: skin infiltration, enlarged cervical lymph nodes, tumour fixation and tumour size (>4 cm). Pain and the dynamics of tumour growth were not statistically significant for survival rate. Significant difference in 5-year disease free survival rate was found between the groups of patients, according to the number of symptoms suggesting malignancy. The multivariate analysis showed that only facial nerve palsy and skin infiltration were independent prognostic factors.

Hyperbaric oxygen therapy in the treatment of complications of irradiation in head and neck area.

BACKGROUND AND PURPOSE: We have investigated the treatment results of hyperbaric oxygen (HBO2) to patients with radiation-induced tissue complications. MATERIAL AND METHODS: Eight patients (1.4%) from 548 with head and neck cancers treated surgically with post- or preoperative radiotherapy or radiotherapy alone in standard doses who developed postradiation complications (6 patients with laryngeal chondroradionecrosis, 1 patient with osteoradionecrosis of the temporal bone, and 1 patient with soft tissue radionecrosis) are presented. To evaluate radiation reactions occuring in the head and neck region, we used the Chandler grading system for classification of postradiation larynx injuries and SOMA/LENT score for classification of postradiation injuries of mucosa of upper aerodigestive tract. Grades I and II in those grading systems are expected side effects of radiation therapy, thus our cases were all in grades III and IV. The HBO2 was performed after failure of the conventional treatment (antibiotics, steroids, topical therapy). The number of HBO2 expositions was from 8 to 39 and the delay to therapy from 2 to 22 months. RESULTS: Symptoms resolved in all treated patients. Six patients with laryngeal chondroradionecrosis had no symptoms after therapy and in three of them after partial laryngectomy the decannulation was performed. In one patient with mucosal radionecrosis after total laryngectomy, the esophageal fistula was closed and in one patient with osteoradionecrosis of the temporal bone, wound debridement followed. CONCLUSION: The authors' experience supports the increasing clinical evidence that HBO2 is an effective adjunct therapy for treatment of complications of irradiation in head and neck area.

The effect of hyperbaric oxygen on nasal mucociliary transport.

Nasal mucociliary transport was measured in a group of 30 adult patients (eight women and 22 men; age range 21-78 years, mean 47.9 years) treated with hyperbaric oxygen (HBO) therapy and in a control group of 32 adult subjects (two women and 30 men; age range 20-50 years, mean 32.0 years) compressed in a hyperbaric chamber without oxygen therapy. The treated patients breathed 100% oxygen at 250 kPa pressure for 60 min. Subjects from the control group were compressed in the hyperbaric chamber at 250 kPa for 70 min. Nasal mucociliary transport was measured with the saccharin clearance test. After exposure to HBO, the nasal mucociliary transport time was significantly decreased by 26% (P < 0.01) and returned to the original value after 24 h (increased by 8.3%, P = 0.25). In the control group, compressed in air, there were no statistically significant changes. This study shows that simultaneous compression and pure oxygen cause an increase in nasal mucociliary transport. The mechanism of activation of mucociliary clearance is probably the increased oxygenation of blood plasma and enhancement of metabolism in ciliated epithelium.

A case of multisymptomatic relapsing polychondritis in a 22-year-old woman.

A case of multisymptomatic relapsing polychondritis in a 22-year-old woman. We report a case of a 22-year-old woman with relapsing polychondritis (RP)--a rare and little known systemic autoimmune disease characterised by episodic inflammation of cartilaginous structures (ear, nose, bronchi, trachea, larynx, ribs, cardiovascular system). This patient presents with a seven-year history, initiated by the saddle nose. The patient developed a multitude of symptoms: auricular chondritis, ocular symptoms, recurrent arthritis, respiratory complications (laryngotracheomalacia, bilateral vocal cord palsy), sensorineural hearing loss and enchondroma of the humeral bone. The examination of an auricle biopsy by an immunofluorescent method and a positive serum reaction from the patient to normal cartilage supported the immunological nature of relapsing polychondritis. Treatment consisted of orally administered prednisone and diaminodiphenylsulfone (Dapsone).

[Primary malignant neoplasms of nasal septum in the material of ENT Department at Medical University in Gdansk]. / Pierwotne nowotwory zlosliwe przegrody nosa w materiale Kliniki Otolaryngologii AM w Gdansku.

The authors presented 25 years experience of ENT Department Medical University of Gdansk in treatment 28 primary malignant neoplasms of nasal septum. The aim of the study was to analyse epidemiological (age, sex, addictions etc.), morphological and clinical data of these tumors, methods of treatment and their results. Histologically the most often recognized neoplasm was squamous cell carcinoma (15 of 28 cases--53.6%) and malignant melanoma (6 of 28 cases--21.4%). Diagnostic and clinical difficulties in this group of patients were presented. The treatment results were compared to the results obtained in the whole group of patients with malignant neoplasms of the nose and paranasal sinuses.

[Unusual history of the chemodectoma of parapharyngeal space]. / Klebczak przestrzeni przygardlowej o nietypowym przebiegu klinicznym.

A case of chemodectoma in 58 year old woman is presented. The tumour was located in the parapharyngeal space. During preoperative arteriography and embolization a hemiparesis was noticed, probably caused by the thrombus in the cerebral medial artery. Early radiological examination of brain arteries allowed to perform specific treatment in only two hours time from the onset of the paresis. The treatment was successful--neurological symptoms have receded after 24 hours. Few days later patient was operated on--the tumour was removed with part of the vagus nerve. No serious postoperative complications were observed.

[Hyperbaric oxygen therapy as a method of treatment of laryngeal and pharyngeal radionecrosis]. / Hiperbaria tlenowa jako metoda leczenia zmian popromiennych gardla i krtani.

The authors described two cases of palatine tonsil carcinoma treated with surgery and subsequent radiation therapy after which occurred severe radionecrosis of the larynx, pharynx and oral cavity. These subjects were treated with hyperbaric oxygen therapy (HBO). Complete resolution of postradiation changes was observed. The authors described: 1) basic changes in the tissues caused by radiation therapy; 2) the mechanisms of healing activity of hyperbaric oxygen.

[Hypopharyngeal carcinoma in 24 years old female]. / Rak gardla dolnego u 24-letniej kobiety.

A case of multifocal squamous cell carcinoma of posterior wall of the hypopharynx in 24 year female was described. A course of the disease and treatment were presented. Despite radical combined therapy patient died 1,5 year after the tumor diagnosis.

[Necrotizing sialometaplasia. Case report]. / Martwicza metaplazja slinianki podzuchwowej. Opis przypadku.

The authors present a rare case of inflammatory disease of submandibular salivary gland (necrotizing sialometaplasia), in which the histopathological examination was of particular value while estimating the final diagnosis. Review of world literature concerning this disease was made.

[Laryngeal carcinoma in brothers]. / Rak krtani u braci.

The most important etiologic factors of laryngeal carcinoma are tobacco smoking and heavy drinking as well as precancerous changes of laryngeal mucosa. The significance of genetic or family factor is still not explained. Two brothers, 45 and 48 years old, in which supraglottic carcinomas were diagnosed, are presented. The tumor localisation was the same in both brothers. In each of the patients supraglottic horizontal laryngectomy and neck dissection were performed. In one brother 5-year disease free survival was obtained, in second the distant and regional metastases were cause of death after two years.

[Malignant schwannoma of parotid gland. Case report and review of literature]. / Zlosliwy nerwiak oslonkowy slinianki przyusznej. Opis przypadku i przeglad literatury.

The authors described a rare malignant neoplasm of peripheral nerve sheath, sarcomatous neurillemoma, localized in parotid gland in 72-year female. Findings of the computer tomography, nuclear magnetic resonance and Doppler-ultrasound are presented and discussed. A review of world literature, including 14 cases of this tumor, was made.

Seasonal cell proliferation in the chemosensory epithelium and brain of red-backed salamanders, Plethodon cinereus.

The chemosensory epithelium of vertebrates retains the ability to produce new receptor neurons throughout life, presumably as a mechanism to replace aging or damaged receptors. We examined cell division in the main olfactory and vomeronasal epithelia of red-backed salamanders (Plethodon cinereus) because previous studies had shown that the volume of sensory epithelia changes seasonally. Cell division was compared throughout the year by injecting salamanders once with 5-bromo-2'-deoxyuridine (BrdU), which is incorporated into the DNA of cells during DNA synthesis, and sacrificing them one hour after injection. We used immunocytochemistry to locate cells that had arisen from cell division since BrdU injection and compared the number of labeled cells per area among animals. Animals collected in May had significantly more labeled nuclei than animals collected in any other month. However, proliferation rates among the other months were not significantly different and were quite low. Labeled nuclei also were found around the cerebral ventricles of salamanders collected in May, but rarely in any other month, although other tissues in the head often were heavily labeled. Cell proliferation appears to be up-regulated in the chemosensory epithelia and in the telencephalon during May, and we hypothesize that new receptors, and perhaps their interneurons in the telencephalon, are being generated in anticipation of seasonal events that are mediated by chemoreception.

[Merkel cell carcinoma in otolaryngology]. / Rak z komórek Merkela w otolaryngologii.

The authors presented two cases of Merkel cell carcinoma, a rare malignant neoplasm of neuroendocrine origin located in parabasal layer of epithelium. The first described case was 67 year old woman, after resection of primary tumor of eyelid, with metastases in lymph nodes of parotid gland. The second case was 44 year old woman with the primary tumor in retroauricular region. The patient underwent radiotherapy 23 years earlier due to malignant lymphoma. Basing on the available literature the authors discussed clinical and histological features of this malignancy, they stressed the important role of immunohistochemical tests in the diagnosis.

[Extracapsular spread of lymph nodes as a prognostic factor in laryngeal carcinoma]. / Naciek zewnatrztorebkowy wezlów chlonnych z przerzutami jako czynnik rokowniczy w raku krtani.

The authors analysed clinical and morphological data of 105 patients with laryngeal carcinoma metastases in cervical lymph nodes treated in Department of Otolaryngology Medical University of Gdansk in the years 1976-1985. The incidence of extracapsular spread and its relation to certain features of primary tumor and regional lymph nodes were estimated. The authors presented treatment results in two group of patients--with and without presence of extracapsular spread and stated prognostic value of extracapsular spread in patients with laryngeal carcinoma.

[Bilateral neck dissections]. / Obustronne operacje wezlowe szyjne.

The structure of lymphatic system of the larynx causes that in some cases node metastases may occur bilaterally. In many patients bilateral neck dissection is indicated. In material of 252 patients with laryngeal carcinoma, treated in ENT Department in Gdansk in 1976-1985, an assessment of frequency and indications to one-stage bilateral neck dissection was made. Among 252 patients, bilateral operations were performed in 50, i.e. 20%. We have found that in 29 patients of 50 were nodal metastases, in 12 unilateral and in 17 bilateral. The analysis of long-term results of treatment showed 23.5% of 5-year survivals in patients with bilateral metastases and 42.3% in patients with unilateral metastases. To base on these data we consider that bilateral one-stage neck dissection should be a standard treatment in many cases of laryngeal carcinoma.

[Effectiveness of elective neck dissection in patients with laryngeal carcinoma]. / Ocena skutecznosci elektywnej operacji wezlowej na szyi u chorych na raka krtani.

The authors presented material of 711 patients with laryngeal cancer treated in Department of Otolaryngology Medical University of Gdansk in the years 1976-1995 estimating effectiveness of elective neck dissection. 402 patients (56.6%) had N0 stage and in 162 of them elective neck dissection was performed. Occult metastases were found in 21% of N0 patients. Comparing treatment results in this group to inoperated N0 patients the authors found higher percentage of survival and lower incidence of failure after elective neck dissection.

[Long term result of treatment of laryngeal carcinoma (1981-1990)]. / Odlegle wyniki leczenia raka krtani (1981-1990).

Long term results were evaluated on the basis of the epidemiological and clinical analysis of 386 patients treated surgically because of squamous cell carcinoma of the larynx in the ENT Department, Medical University of Gdansk between 1981-1990. Full recovery was achieved in 52.3% of patients, failure was found in 26.9%. In the treatment evaluation the following factors were taken into account: the age of patients, T and N classification and clinical staging, primary location of the tumour. The treatment results, concerning the years 1981-1990 were compared to the ones obtained in our clinic in 1971-1980; it has been stated that the differences between the percentage of recoveries and the failures are statistically unimportant.