[Effects on distant metastasis of misdiagnosis of nasopharyngeal carcinoma].

OBJECTIVE: To investigate the effects of situation of misdiagnosis of nasopharyngeal carcinoma (NPC) on distant metastasis. METHOD: The history of diagnosis and treatment of 85 newly diagnosed cases with nasopharyngeal carcinoma were studied by using itemized questionnaire purposely; 433 patients with different prognosis were analyzed retrospectively for the misdiagnoses and mistreatment, including surgical biopsy in the neck. RESULT: (1) The rate of misdiagnosis of 85 patients was 72.64%, and the percentage decreased as the level of the hospitals increased; the majority of the patients (77.36%) were diagnoses within 1 month after the first symptom had appeared; the number of diseases misdiagnosed was 20, most common of which were lymphnoditis, tuberculosis of lymph node and secretory tympanitis; (2) Our data showed that among 433 patients analysed retrospectively, 60 cases had undergone surgical biopsy in the neck, 75% of whom had never received nasopharyngeal biopsy; 43 cases had underwent nasopharyngeal biopsy after the pathological diagnosis as metastatic carcinoma of neck biopsy (71.67%) and the rest (20.0%) received radiotherapy directly or after negative nasopharyngeal biopsy for merely 1 to 4 times; of those 43 cases who were diagnosed as NPC by nasopharyngeal biopsy, 79.17% got positive results at first sampling. (3) Rate of misdiagnosis and mistreatment including surgical biopsy in the neck of patients who had been tumor-free for 5 years or above was significantly lower than that of those who experienced distant metastasis after or before treatment (P < 0.05). CONCLUSIONS: Misdiagnosis and mistreatment including biopsy by surgery of neck is common even in high-grade hospitals; it is doctor that is responsible for this situation; the high occurrence rate of misdiagnosis and mistreatment, biopsy by neck surgery, especially the delayed treatment after the neck biopsy are the factors that contribute to distant metastasis of NPC.

[Relationship between the expression of estrogen and progestogen receptors in distant metastasis of nasopharyngeal carcinoma].

OBJECTIVE: To explore the relationship between the expression of estrogen and progestogen receptors (ER/PR) in distant metastasis of nasopharyngeal carcinoma (NPC). METHOD: The expression of ER/PR were detected with immunohistochemical SP method in 81 nasopharyngeal carcinoma who had been treated and followed-up. RESULT: (1) The positive rates of ER and PR in the tissue of NPC were 35.8% and 53.1%. (2) The expression intensity of PR in T stage has obvious statistically significance (P < 0.01), the expression intensity and positive rates of ER in IVb stage were obviously higher than the other stage (P < 0.01). (3) The positive rates of ER and PR in patients of the distant metastasis group (including the distant metastasis found before and after radiotherapy) were obviously higher than the group who have been alive with no evidence of disease for five or more than five years after radiotherapy (P < 0.01) and P < 0.05). CONCLUSION: The positive expression of ER and PR in NPC were well correlated with the distant metastasis, and it increased gradually. Positive expression, especially the strong positive expression points out the bad prognosis. Endocrine treat may reduce and postpone the distant metastasis.

[The constrastive analysis on distant metastasis before and after radiotherapy of nasopharyngeal carcinoma].

OBJECTIVE: To explore the duration related to distant metastases of nasopharyngeal carcinoma (NPC). METHOD: One hundred and three cases with confirmative diagnosis of NPC, in which the distant metastasis had happened before radiotherapy, were called the natural metastasis group. Another one hundred and thirty-eight cases, in which the distant metastasis had happened after radiotherapy, were called the metastasis after radiotherapy group. The clinical data and appearance time on distant metastasis from the two groups were analyzed. RESULT: It took 10.78 months (95% CI: 8.68-12.88) on average in the natural metastasis group from the primary symptom to the distant metastasis, and 20.77 months on average in the metastasis after radiotherapy group. Comparing the two groups, there was highly remarkable difference (P < 0.01). The distant metastasis happened in 91.26% of the cases in the natural metastasis group in 2 years. And in 1 year and in 2 years, the distal metastasis incidences of the natural metastasis group was higher than those of the metastasis after radiotherapy group by 34.41% and 28.94%, respectively. The distant metastasis happened in all cases in the natural metastasis group in 5 years, while in 2.9% of the cases in the metastasis after radiotherapy group beyond 5 years. There wasn't any obvious difference in the patients' sex and the appearance rate of the primary symptom (P > 0.05). But in the metastasis after radiotherapy group, the patients were younger and the T and N stages were earlier. CONCLUSION: The distal metastasis in the metastasis after radiotherapy group was at least 1-2 years later than that in the natural metastasis group. It was perhaps relative to the younger patients and the earlier stages.

[Investigation of the site of origin to develop micro-focal nasopharyngeal carcinoma].

OBJECTIVE: To investigate the prevalent area where the nasopharyngeal carcinoma (NPC) initially would develop most frequently in the nasopharynx. METHODS: From March, 1994 to June, 2003, the data of original micro-focus of 32 pathologically confirmed NPC were retrospectively reviewed, All cases were shown by CT to have stages T(0) or T(1) lesions. RESULTS: On clinical examination, only 3 cases (9.4%) were found to have original micro-tumor in the recess, the other 29 cases (90.6%) had developed from the other regions including 20 (69.0%) from the roof and 9 cases (31.0%) from the posterior wall, all with the mucosa in the recess smooth and symmetrical. However, CT images showed that membrane of all the nasopharyngeal walls, including the recess, were normal in 24 cases (75.0%); except the micro-foci were observed on one side of the posterior wall in 5 cases (15.6%) but still with the recess normal, One lateral wall and/or the recess were involved with abnormal appearance in 3 cases (9.4%) who were clinically found to have NPC focus originated from the recess. CONCLUSION: Our data suggest that the roof of nasopharyngeal cavity may be the area likely to develop the original NPC micro-focus, followed in frequency by the posterior wall, with the recess the least likely. The recess involvement observed in advanced lesions may be the extension of the NPC focus from the original site on the roof or the posterior wall of nasopharynx.

[Correlation between infiltration of local lesion and distant metastasis of nasopharyngeal carcinoma].

OBJECTIVE: The aim of this study was to study the correlation between local and regional infiltration and distant metastasis of nasopharyngeal carcinoma(NPC). METHOD: Materials of 204 NPC cases primarily treated (including 101 cases with tumor free and a period of survived time for 5 or more years after radiotherapy and 103 cases with distant metastasis after radiotherapy ). The extent and the way of local aggressiveness were made sure by studying their CT. Then the single-factor and COX analysis were adopted to analyze. RESULT: Single-factor analysis showed the extent of aggressiveness of nasal sinuses, base of skull, cranial nerves, parapharyngeal space, laterals and number, size, fixation of neck lymph nodes of metastasis, clinical stage, T and N stage had statistical significance (P <0.05); Multi-factor analysis merely showed aggressiveness of nasal sinuses, cranial nerves, laterals and number, size of neck lymph nodes, clinical stage had statistical significance; Analysis of correlation between the situations of local aggressiveness and regional infiltration showed that the occurrence of metastasis of lymph nodes and its degree in metastasis group of post-radiotherapy was obviously higher than that in non-metastasis group (P < 0.05, P < 0.01), while the degree of local aggressiveness, the involvement of base of skull and the parapharyngeal space were not. CONCLUSION: Regional infiltration and its degree are the most important and stable factors that affect the distant metastasis in NPC patients after radiotherapy, and primary lesion intrigues distant metastasis mainly through occurrence of metastasis of regional lymph nodes.

[The management of thyroid well-differentiated carcinoma invading the upper aerodigestive tract].

OBJECTIVE: To investigate the management and prognosis of thyroid well-differentiated carcinoma invading the upper aerodigestive tract. METHODS: A retrospective analysis of the management was performed done 62 patients with thyroid well-differentiated carcinoma invading the upper aerodigestive tract. The main method of surgery was shaving excision, and the other means including partial thyrochondrectomy, total laryngectomy, sleeve tracheal resection, sternocleidomastoid myoperiosteal flap and myodermal flap reconstruction, or simply palliative excision. Some patients received postoperative radioactive isotope therapy and radiotherapy. All patients were followed-up for 2 to 15 years with an average of 6.5 years. RESULTS: The best curative effect was proved in the patients with local invasion, with the lumen uninvolved and their locoregional control rate was 100.0% (17/17). And the second choice was in patients with more extensive involvement of the upper aerodigestive tract structures. For them, extensive surgical management was done attempting to remove all gross disease followed by reconstruction, their locoregional control rate was 87.5% (7/8). And the third place was designated to patients with local invasion for which shaving excision was performed even though minor residual disease was left, their locoregional control rate was 55.6% (5/9). The poorest result went to simple palliative excision. For 17 patients with minor residual tumor, the locoregional control rate of those who were given postoperative radioactive isotope therapy was significantly higher than those without. CONCLUSION: According to the limits and degree of invasion in the upper aerodigestive tract by thyroid well-differentiated carcinoma, different ways of surgery is indicated. For patients with residual disease, radioactive isotope therapy should be used to improve the result and life quality. Advanced lesions should be given postoperative radio therapy.

[Benign symmetric lipomatosis].

OBJECTIVE: To explore the clinical feature of benign symmetric lipomatosis (BSL) so as to improve its diagnosis and treatment. METHOD: 28 patients of BSL treated in our hospital were analyzed and literature was reviewed. Surgical management is used in all patients. RESULT: There were no patients died. All patients were satisfactory with their appearance and function improved. 28 patients were followed up for 2-15 years (average 6 years and 5 months), only 5 cases recurred. CONCLUSION: BSL usually occurs in middle age men. Patients have a striking appearance "hump back" because of a diffuse, symmetric distribution of the lipomatous tissue in the cervical region. The etiology is related to alcohol abuse. Operation is the most effective treatment. The radical surgical therapy should not be emphasized because the important anatomic structures may be damaged. Abstaining from alcohol may help to reduce the rate of recurrence.

[Significance of detecting serum tumor supplied group of factors in differential diagnosis of neck masses].

BACKGROUND & OBJECTIVE: It was reported that serum tumor supplied group of factors (TSGF) were useful in differential diagnosis of various benign and malignant tumor. However, there was little report involving the differential diagnosis of neck masses. This study was designed to evaluate the significance of serum TSGF in differential diagnosis of neck masses. METHOD: Serum TSGFs on the samples from 128 patients with neck masses were detected by immunohistochemistry. Forty seven non-tumor patients served as control. RESULTS: Serum TSGF level and positive rate in various malignant group (including nasopharyngeal carcinoma, non-Hodgkin's disease, and metastatic carcinoma which primary lesion remained unknown) were higher than that in benign mass group (including cervical lymphoadenitis, or reactive hyperplasia, and neck lymphoid tuberculosis without general active tuberculosis), with very significant difference (all P < 0.01). There was no significant difference between two benign masses or neck benjgn masses or neck benign masses and non tumor patients (all P > 0.05). The differential diagnosis parameters of positive serum TSGF for neck malignant masses were: sensitivity 78.16%, specificity 75.61%, efficiency 77.34%, positive predictive value [PV(+)] 87.18%, negative predictive value [PV(-)] 62.00%. CONCLUSION: Determination of serum TSGF was useful in differential diagnosis of neck masses.