Akimori Kanazawa

A Case of Cervical Paraganglioma: Usefulness of FDG PET Imaging and a Possibility of Rare Origination

Cervical paragangliomas are rare tumors derived from neural crest cells. Anatomic imaging techniques rely upon the characteristic spatial relations and the high vascularity of this tumor. Results of computed tomography (CT), magnetic resonance imaging (MRI), and arteriography initially led us to the preoperative diagnosis of cervical paraganglioma. In our case, 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET), a type of functional imaging, was also carried out and demonstrated abnormally increased tracer uptake; this approach was thus successful for visualizing paraganglioma. FDG PET imaging may be useful in the detection of benign paraganglioma. On surgical exploration of the neck, the tumor was found to arise from the vagus nerve, whereas the hypoglossal nerve was encompassed by the tumor in its upper portion. The intraoperative findings suggested the possibility that the tumor had arisen from the hypoglossal nerve.

The syndrome of inappropriate antidiuretic hormone secretion associated with chemotherapy for hypopharyngeal cancer

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is characterized by hyponatremia and the plasma hypoosmolality induced by water retention attributable to persistent antidiuretic hormone (ADH) release. It has been reported that SIADH may occur due to various factors in patients with malignant tumor. We report a case of hypopharyngeal cancer complicated by SIADH following chemotherapy. A 72-year-old woman with hypopharyngeal cancer was treated by oral administration of S-1 and intravenous administration of low-dose cisplatin following radiation therapy. General fatigue and coma occurred during the third course of this chemotherapy, using S-1 and low-dose cisplatin. We believed that she had SIADH because of the results of examinations including hyponatremia, serum hypoosmolality and increasing serum ADH level. We treated her by fluid restriction and intravenous administration of hypertonic saline and furosemide, and she recovered. Unfortunately, her hypopharyngeal cancer gradually progressed and she died of acute pneumonia three months later.

Nitric Oxide induces Apoptosis of the Hair Cells of Cochlea

Objective Nitric oxide (NO) has a toxic effect on neuronal cells related to glutamate receptors. NO released from post-synaptic cells with glutamate receptors can induce nearby cell death. In this experiment, we examined the effect of NO on cochlear hair cells. Methods Two concentrations, 0.5 and 0.1 molar concentration (MC) of 1-hydroxy-2-oxo-3-(3-aminopropyl)-3-isopropyl-1-triazene (NOC-5), which is a NO donor, were placed on the round window of the guinea pig cochlea and its morphological changes were investigated at 12, 28, 72 h after the treatment. Results By the trypan blue dye extrusion method, the cell death was recognized in the outer hair cells at the percentage 0, 36.0±6.6, 4.9±1.2% at 12, 28, 72 h after treatment respectively in the group 0.5 MC NOC-5, but no inner hair cell death was recognized. In the group of 0.1 MC NOC-5 and control any cell death was not detected. Transmission electron microscopy revealed this cell death was characteristic of apoptosis. Conclusion The findings that apoptosis was induced in the outer hair cells of the organ of Corti by NO suggests the possibility that the cochlea is affected when extra NO release occurs there, leading to cochlear dysfunction.

Transmucosal coil migration after endovascular management for carotid artery pseudoaneurysm: a late complication.

Sir, We previously reported a case of successful obliteration of carotid artery pseudoaneurysm employing endovascular management with a stent and detachable coils [1]. Here we describe the subsequent clinical course of the patient after the endovascular treatment. We carefully followed the patient, and 2 years after the procedure hypopharyngeal discomfort was noted. Fiberoptic pharyngoscopy demonstrated a coil on the hypopharyngeal wall (Figure 1), and radiography of the neck revealed that the coil previously placed in the pseudoaneurysmal sac had migrated transmucosally to the hypopharyngeal surface (Figure 2). Because left carotid angiography demonstrated complete absence of blood flow in both the external carotid artery and the pseudoaneurysm, suggestive of complete embolization of the pseudoaneurysm, we successfully cut and removed the migrated coil without massive bleeding under fiberoptic pharyngoscopy (Figure 3). No special retriever was required for this procedure.

Concurrent Chemoradiotherapy with Pirarubicin and 5-fluorouracil for Resectable Oral and Maxillary Carcinoma

Objective We present the response rate and adverse effects of our regimen of concurrent chemoradiotherapy with pirarubicin (THP) and 5-fluorouracil (5-FU) for oral and maxillary carcinoma. Patients and methods Fifteen patients with oral (10 cases) or maxillary (5 cases) squamous cell carcinoma who underwent our concurrent chemoradiotherapy with the combination of intraarterial pirarubicin, intravenous continuous 5-fluorouracil, and radiation between March 2001 and February 2003 in our department were entered in this study. THP (5 mg/day) was infused into the lingual or maxillary artery one hour before radiation on days 1–5 and 8–12, while intravenous 5-FU (150 mg/m2/day) was instilled continuously on days 1–5, 8–12, 15–19, and 22–26 in accordance with the radiation schedule (2 Gy/day). Consequently, total doses of THP, 5-FU, and radiation were 50 mg, 3000 mg/m2 and 40 Gy, respectively. After the treatment series, response rate and adverse effects were evaluated. Results Response rate achieved 100% (12 cases exhibited a complete response and the remaining 3 a partial response). Notably, all 10 patients with oral carcinoma exhibited complete response. The main adverse effects were leucopenia (6/15) and mucositis (6/15), both of which were acceptable. Conclusions This concurrent chemoradiotherapy is very useful for oral and maxillary carcinoma as a preoperative modality with remarkably high response rate and acceptable adverse events.

Carotid artery pseudoaneurysm as a rare sequela of surgery for laryngeal cancer

Formation of carotid artery pseudoaneurysm is uncommon after intensive treatment for head and neck cancer. We encountered a case of postoperative formation of pseudoaneurysm at the left carotid bifurcation in a diabetic man. The risk factors for carotid artery pseudoaneurysm in the patient included diabetes mellitus, previous radiotherapy to the neck, neck dissection, and postoperative Staphylococcus aureus infection secondary to accidental pharyngocutaneous fistula. We successfully obliterated this pseudoaneurysm using a Smart stent and detachable coils without neurological deficits. The possibility of vascular injury after treatment for head and neck cancer must be considered, especially in patients with risk factors for it due to previous treatment.

Spindle cell carcinoma as a locally recurrent malignancy after surgery for early lingual squamous cell carcinoma

Spindle cell carcinoma (SpCC) of the tongue is a relatively rare malignancy. We treated a patient with metachronous early squamous cell carcinoma (SCC) in both margins of the tongue (right side first followed by left side). Eight years after treatment for the first SCC by surgery and radiotherapy, the second SCC occurred in the contralateral margin of the tongue. Surgical resection was performed for the second SCC, with local recurrence 8 months later associated with pathological change from SCC to SpCC. The SpCC was completely resected with wide surgical margins in combination with bilateral neck dissection. However, the patient developed pulmonary metastasis and died of respiratory failure 4 months after the final surgery. Postoperative inflammatory reaction followed by scar formation in the previously irradiated surgical site might have caused the transition from SCC to SpCC during the process of recurrence.

Probable Function of Boettcher Cells based on results of Morphological Study: Localization of Nitric Oxide Synthase

Boettcher cells lie on the basilar membrane beneath Claudius cells. The cells are considered supporting cells for the organ of Corti, and present only in the lower turn of the cochlea, which responds to high-frequency sound. Boettcher cells interdigitate with each other, and project microvilli into the intercellular space. Their structural specialization suggests that Boettcher cells may play a significant role in the function of the cochlea. Nitric oxide synthase (NOS) has previously been detected in substructures of the cochlea. In the cochlea, it is believed that nitric oxide plays an important role in neurotransmission, blood flow regulation, and induction of cytotoxicity under pathological conditions. Findings concerning detection of NOS on Boettcher cells are rare. We demonstrated here the localization of NOS on Boettcher cells of the rat by immunohistochemistry using polyclonal antibody to NOS. On observation with the light microscope using DAB staining, positive immunostaining to NOS was observed in Boettcher cells. In immunoelectron micrographs, NOS was detected abundantly in the cytoplasm of the interdigitations. This suggests that the interdigitations may play significant roles by using NOS. It follows from this that the nitric oxide (NO) on Boettcher cells may influences neighboring Boettcher cells. The ultrastructure of Boettcher cells suggests that they may be active cells, which perform both secretory and absorptive functions.

A case of simultaneous primary carcinomas of the tongue.

Reports of multiple primary cancers are increasing, but simultaneous primary cancers are not frequently reported especially originated in the same organ. We encountered a 71-year-old female who had two simultaneous carcinomas at both edges of the tongue. Histologically, the carcinoma of the right edge was a well-differentiated squamous cell carcinoma, while that on the left edge was a moderately-differentiated squamous cell carcinoma. No other tumors were detected on other examinations, including gallium-67 scintigraphy, CT scan of the chest, upper gastrointestinal fiberscopy and so on. She underwent surgical treatment without other induction treatments such as radiotherapy and chemotherapy. Her postoperative radiotherapy and chemotherapy were also uneventful because of her age. Fourteen-month follow-up revealed neither recurrence nor metastasis.