Liposarkomi su učestali tumori mekih tkiva u odraslih, međutim u regiji glave i vrata predstavljaju samo 2–9% malignih mezenhimalnih tumora. Najčešće su to liposarkomi subkutanog tkiva lica, ...vlasišta, dubokih mekih tkiva vrata, parafaringealnog i retrofaringealnog prostora te aerodigestivnog trakta (larinksa, orofarinksa i hipofarinksa). Opisani su i liposarkomi žlijezda slinovnica i štitne žlijezde. Prikazani bolesnik je u trenutku dijagnoze imao samo 32 godine, što je iznimna rijetkost, jer se dob bolesnika sa liposarkomima prema podatcima iz dostupne literature kreće u rasponu od 40 do 60 godina. Lokalizacija tumora u prednjoj regiji vrata suprasternalno također predstavlja rijetko sijelo koje do sada nije opisano u dostupnoj literaturi. Liposarkomi su zloćudni tumori koji najčešće nastaju de novo. U prikazanog pacijenta tumor je smješten u regiji 6 na vratu, citološki dijagnosticiran kao lipom, uz redovite kontrole ultrazvukom praćen u vremenskom intervalu od tri godine. Zbog kliničke slike ubrzanog rasta i početnih znakova volumne kompresije postavljena je sumnja na mogućnost postojanja sarkoma podrijetla masnog tkiva. Zbog nepovoljne lokalizacije i nemogućnosti postizanja širokih resekcijskih rubova, u bolesnika je učinjena potpuna kirurška resekcija tumora s resekcijskim rubovima diktiranim anatomskim smještajem vitalnih struktura vrata i medijastinuma. Kako je u patohistološkom nalazu reseciranog tumora bio opisan proboj čahure, u dogovoru s onkologom provedena je postoperativna adjuvantna radioterapija.
Objectives/Hypothesis
Thyroglossal duct cyst (TGDC) is a common congenital anomaly, but TGDC carcinoma is rare. Thyroglossal duct cyst carcinoma management is controversial, especially that of the ...orthotopic thyroid gland. We aim to provide an insight into the pathologic basis of this management controversy through the review of 28 TGDC cancer cases, thus far the largest such series to our knowledge.
Study Design
Retrospective.
Methods
Twenty‐eight cases recorded as TGDC cancer in the hospital database were reviewed; their initial clinical diagnosis from medical chart review (DX1) and final pathological review diagnosis (DX2) through pathology slides review by our pathologist (blinded to DX1) were compared. The thyroid gland management and pathology were evaluated.
Results
In the 28 TGDC carcinoma (hospital‐recorded diagnosis) patients, DX1 and DX2 were respectively reported as 53% and 14% TGDC carcinoma, 11% and 29% as pyramidal lobe primary, and 4% and 25% as metastatic Delphian node. Thirty‐two percent of cases were in the indeterminate category, in both DX1 and DX2, but included different patients. Thyroidectomy was performed in 54% of the cases, papillary thyroid cancer (PTC) was reported in 37% of these thyroid glands. Concurrent thyroid gland malignancy was reported in all Delphian node and pyramidal lobe PTC patients.
Conclusion
The diagnosis of TGDC cancer comprises a heterogeneous group that includes true TGDC cancer, pyramidal lobe primary, Delphian node metastasis, and indeterminate cases. We propose a new terminology of upper neck papillary thyroid carcinoma (UPTC) to denote this heterogeneous group and recommend a rational algorithm for management. Correct pathologic subcategory and thyroid ultrasonography are essential for optimal management of thyroid gland in UPTC cases.
Level of Evidence
4. Laryngoscope, 126:1709–1714, 2016
The aim of this study is to test the possible prognostic significance of p53 and Ki67 expression in inverted papilloma of the lateral nasal wall and adjacent sinuses regarding their malignant ...potential and recurrence. 49 biopsies of the lateral nasal wall and adjacent sinuses obtained from 41 patients from three hospitals were investigated. Immunohistochemically demonstrated p53 and Ki67 expression was measured and statistically evaluated. p53 immunoreactivity was demonstrated in most of papillomas with carcinomas but only in two benign papillomas, while Ki67 demonstrated stronger immunoreactivity in carcinomas and surrounding epithelium. Immunohistochemical staining of inverted sinonasal papillomas for p53 and Ki67 can give useful information concerning the existence of synchronous carcinoma and, in case of high Ki67, a hint toward possible recurrence.
Inverted papilloma is generally considered a benign unilateral sinonasal tumor. Its synchronous bilateral multicentric occurrence is extremely rare. A 22-year-old male patient presented with stage ...III inverted papilloma involving both ethmoid sinuses, both frontal sinuses, and cribriform area. The patient also had a large osteoma emanating from the basal part of the frontal sinus septum, which completely obstructed both nasofrontal recesses, leaving no communication between the sinuses and the nasal cavity. The frontal sinus septum was intact, so there was no communication between the 2 sides either. Following the era of aggressive surgical approaches dominated by lateral rhinotomy and medial maxillectomy, the advent of endoscopic techniques has dramatically improved visualization of sinus chambers and nasal cavity, resulting in lower morbidity and similar results to those achieved with open surgical procedures. In our patient, the concomitant presence of a huge frontal sinus osteoma posed an unacceptable risk for endoscopic resection due to the possible residual disease in the nasofrontal recess regions. Surgical resection remains the mainstay treatment and should be tailored in accordance with the localization and spread of disease. The surgeon should be ready to use different surgical approaches and, if intraoperatively needed, to modify them accordingly.
Background
Data from patients with post‐ablative dural defects reconstructed using a free temporalis muscle fascia graft (FTFG) after resection of anterior or central skull base tumors were ...retrospectively analyzed.
Methods
The primary predictor and outcome variables were the reconstructive methods for dural repair and postoperative cerebrospinal fluid (CSF) leakage rate, respectively.
Results
Eighty patients were included, and 94 postoperative dural reconstructions were performed using FTFG. The postoperative CSF leakage rate was 3.19%. The postoperative CSF leakage rates did not significantly differ between open and endonasal endoscopic surgeries (1.92% vs. 4.88%; p > 0.05). In cases completed using the endonasal endoscopic approach, the postoperative CSF leakage rate was significantly associated with the intraoperative CSF leak flow (p < 0.05).
Conclusions
Post‐ablative dural defect reconstruction using FTFG resulted in low postoperative CSF leakage and complication rates comparable to those of free fascia lata graft from available literature.
The mouse transcription factor Noto is expressed in the notochord and involved in its development. Noto mouse mutants, Noto(tc/tc)(truncate) and Noto(GFP/GFP) (Noto null mutant), exhibit a segmental ...lack of the notochord in the caudal part of the embryo and subsequent tail truncation in adult animals. In order to address the relationship between the tail bud (the undifferentiated mesenchymal cells in the tip of the embryo tail) and the caudal notochord, Noto(GFP/GFP), a loss- of-function mutant, was analyzed. Taking advantage of Noto(GFP/+) heterozygotes, we could track Noto-GFP-expressing cells from the tail bud over the tail cord to the caudal notochord, and confirm a morphological continuum from the tail bud mesenchyme to the caudal notochord. Loss of Noto affected tail bud morphogenesis: Noto-GFP-expressing cells were scattered in the tail bud mesenchyme. They segregated in the notochord-like structure within the medullary cord instead at the tail cord, which subsequently disappeared. In the tail cord, instead of the notochord, additional lumen of the tail gut was formed. These findings suggest that Noto is involved in both rearrangement and morphogenesis of the tail bud during notochord formation.
Abstract
Hyalinizing clear cell carcinoma (HCCC) is a rare, predominantly minor salivary gland tumor. Most of these tumors occur in the oral cavity, mainly the palate and tongue. Primary localization ...of the tumor in the region of the nasal cavity and paranasal sinuses is extremely rare and, with only a few cases reported in the literature so far. We present an extremely rare case of a 61-year-old woman with hyalinizing clear cell carcinoma (HCCC), occupying the left posterior nasal and nasopharyngeal cavity, as a primary tumor location. The patient total recovery was uneventful, and she is now free of disease at three years postoperative follow-up.
To validate the prognostic capacity of several preoperative and intraoperative parameters of hearing preservation after vestibular schwannoma surgery.
A retrospective study of a consecutive series of ...29 patients treated with the enlarged middle cranial fossa approach. Quantitative parameters were tumor volume, linear tumor size, pure-tone and speech audiometry, pure-tone average, speech discrimination score, speech reception threshold, auditory brainstem response (ABR; intra-aural interpeak latency I-V, interaural wave V latency difference), and the vestibular caloric test (speed and frequency). Qualitative parameters were fundus involvement by the tumor (in magnetic resonance imaging and surgical record), nerve of tumor origin (in magnetic resonance imaging and surgical record), ABR parameters (well-shaped ABRs: waves I, III, and V present; presence of wave V).
All patients were divided into 2 groups on the basis of postoperative hearing: preserved hearing (55%) or nonpreserved hearing (45%). The Kolmogorov-Smirnov test was used to evaluate normality of distribution for continuous data. The t test was applied for normally distributed continuous data and the Mann-Whitney test for nonnormally distributed continuous data. The chi2 test was used for comparisons of categoric data.
Tumor volume was found to be the only statistically significant prognostic parameter for hearing preservation (p = 0.007). The cutoff point for the "critical" tumor volume for hearing preservation was calculated to 0.20 cm. None of the other parameters reached statistical significance.
Tumor size is a predictive factor for hearing preservation after vestibular schwannoma surgery, and patients with smaller tumors, based on volume measurement, have significantly better chances for retaining hearing. This has an impact on decision making and timing of surgery.
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