Bor-Hwang Kang

Epidemiology of Oral Cavity Cancer in Taiwan with Emphasis on the Role of Betel Nut Chewing

This article reports the epidemiological characteristics and the possible contributing etiology of oral cavity cancer in Taiwan. Data on oral cavity cancer from the period between 1986 and 1997 were compiled from the Taiwan Cancer Registry Annual Report. The amount of average annual consumption per person of cigarettes, alcohol and betel nut were extracted from the Annual Report of Taiwan Tobacco and Wine Monopoly Bureau and the Agriculture Counsel of Taiwan. The incidence of oral cavity cancer increased annually. Both the total and male incidence have increased substantially since 1993. Regarding the peak incidence, most cases were seen in the sixth to eighth decades of life. Multiple regression models indicated that 86.2% variation in the incidence of oral cavity cancer was explained by the annual average betel nut consumption per person. These results imply that those who chew betel nut belong to a high-risk group and require special consideration and attention regarding health education and health promotion.

Middle turbinate osteoma presenting with ipsilateral facial pain, epiphora, and nasal obstruction

Nasal osteomas are benign tumors of the bone of the nose and paranasal sinus that are capable of extending to surrounding structures, which may result in severe complications such as orbital involvement or intracranial invasion. They most commonly occur in the frontal sinus, followed by the ethmoidal and maxillary sinuses. Occurrence in the sphenoidal sinus is very rare.1 It is also rare that an osteoma occurs in the nasal cavity. An extensive literature search revealed only one case, reported by Whittet and Quiney2 in 1988. In the current report, we present the case of a patient with middle turbinate osteoma accompanied by ipsilateral facial pain, epiphora, and nasal obstruction.

Comparison of therapeutic results in sudden sensorineural hearing loss with/without additional hyperbaric oxygen therapy: a retrospective review of 465 audiologically controlled cases: Sudden sensorineural hearing loss and hyperbaric oxygen therapy

Clin. Otolaryngol. 2011, 36, 121–128

Adenoid cystic carcinoma of the external auditory canal

Primary cancers of the external auditory canal (EAC) are rare and most are squamous cell carcinomas. We report the case of a 78-year-old man who visited our institution with a 5-month history of right-side intermittent otalgia and ear fullness. Otoscopic examination showed a bulging mass arising from the superior and posterior aspects of the right EAC, and incision biopsy confirmed the lesion as adenoid cystic carcinoma (ACC). Lateral temporal bone resection in conjunction with total parotidectomy and neck dissection was subsequently performed. Postoperative adjuvant radiotherapy was administered and no recurrence was noted at a 26-month follow-up. We review the medical literature on the topic and suggest that early diagnosis is still the best option for successful treatment of this neoplasm. ACC arising in the EAC must be removed using radical procedures to increase the chance of local control. Subsequent metastasis that tends to develop in the lungs and regional lymph nodes is best evaluated regularly using computed tomography examination.

Neck mass as the first presentation of metastatic prostatic adenocarcinoma

Adenocarcinoma of the prostate (CAP) is a rare diagnosis in men younger than 50 years of age; this age group accounts for less than 0.1% of all patients with prostatic cancer. Left supraclavicular lymphadenopathy (LSCL) as the presenting symptom of metastatic CAP is even rarer. No cases of CAP presenting as LSCL in men younger than 45 years have been reported in the literature. Here we report a 42-year-old male with the uncommon presentation of CAP as LSCL. In adult males with persistent LSCL, even if younger than 45 years, measurement of serum prostate specific antigen is warranted at the time of initial presentation, and the lymph node biopsy should be subsequently stained for prostate specific antigen immunohistochemically. These examinations are crucial to establish a definitive diagnosis of CAP and, in turn, to institute appropriate management and achieve the best possible outcome.

Sarcoidal granuloma in cervical lymph nodes.

Sarcoidosis is a multiorgan granulomatous disease, the most common head and neck manifestation of which is cervical lymphadenopathy. Only the presentation of sarcoidal granuloma in cervical lymph nodes without typical manifestations of systemic sarcoidosis poses a diagnostic difficulty. We describe the case of a 39-year-old male who had a 2-month history of a progressively increasing mass with soreness in his right neck. The biopsy from the neck mass demonstrated non-caseating epithelioid cell granuloma of the lymph nodes. The differential diagnoses of mycobacterial or fungal infections were excluded. Thoracic evaluations, including chest X-ray and high-resolution computed tomography, revealed no abnormal findings. Treatment with systemic corticosteroids resulted in improved clinical symptoms. No recurrence of the neck mass or other signs of systemic sarcoidosis were noted during 1.5 years of follow-up. Although our patients definitive diagnosis could not be determined, the case highlights 2 important issues: sarcoidal granuloma in lymph nodes may be a precursor of sarcoidosis, even in the absence of pulmonary or other systemic involvement; and regular follow-up is recommended in such cases.

Vimentin is a potential prognostic factor for tongue squamous cell carcinoma among five epithelial–mesenchymal transition-related proteins

We aimed to investigate the association of the expression levels of five epithelial–mesenchymal transition (EMT)-related proteins (Snail, Twist, E-cadherin, N-cadherin, and Vimentin) with tumorigenesis, pathologic parameters and prognosis in tongue squamous cell carcinoma (TSCC) patients by immunohistochemistry of tissue microarray. The expression levels of Snail, E-cadherin, N-cadherin and Vimentin were significantly different between the tumor adjacent normal and tumor tissues. In tumor tissues, lower E-cadherin and higher N-cadherin levels were associated with a higher grade of cell differentiation, advanced stage of disease, and lymph node metastasis. However, higher Vimentin expression was associated with poor cell differentiation and lymph node metastasis. Patients with low E-cadherin expression had poor disease-specific survival (DSS). Conversely, positive N-cadherin and higher Vimentin expression levels were associated with poor DSS and disease-free survival. Notably, our multivariate Cox regression model indicated that high Vimentin expression was an adverse prognostic factor for DSS in TSCC patients, even after the adjustment for cell differentiation, pathological stage, and expression levels of Snail, Twist, E-cadherin, and N-cadherin. Snail, E-cadherin, N-cadherin, and Vimentin were associated with tumorigenesis and pathological outcomes. Among the five EMT-related proteins, Vimentin was a potential prognostic factor for TSCC patients.

Expression levels of cleaved caspase-3 and caspase-3 in tumorigenesis and prognosis of oral tongue squamous cell carcinoma

Apoptosis plays a dual role in cancer development and malignancy. The role of apoptosis-related caspases in cancer remains controversial, particularly in oral tongue squamous cell carcinoma (OTSCC). In this study, we examined the protein levels of cleaved caspase-3, caspase-3, caspase-8, and caspase-9 on tissue microarrays consisting of samples from 246 OTSCC patients by immunohistochemistry. Wilcoxon signed-rank test indicated that the protein levels of cleaved caspase-3, caspase-3, caspase-8, and caspase-9 in tumor tissues were significantly higher compared to those in adjacent normal tissues (all p<0.001). The expression level of caspase-8 in tumors was elevated in patients with lymph node invasion. Moreover, positive expression of cleaved caspase-3 was associated with shorter disease-free survival (DFS) in OTSCC patients with moderate differentiation and lymph node invasion. Combination of either positive cleaved caspase-3 or higher caspase-3 expression or both was associated with poor DFS. Interestingly, stratification analysis showed that co-expression levels of positive cleaved caspase-3 or/and higher caspase-3 were associated with better disease-specific survival in patients with advanced stages of the disease, such as large tumor size and lymph node invasion, whereas it was associated with poor DFS in OTSCC patients with moderate cell differentiation and small tumor size. Taken together, cleaved caspase-3 and caspase-3/8/9 could be biomarkers for tumorigenesis in OTSCC patients. The co-expression level of cleaved caspase-3 and caspase-3 might be a prognostic biomarker for OTSCC patients, particular in those patients with certain tumor stages and cell differentiation status.

Clinical photographGiant tonsillolith

A51-year-old Asian woman was referred to our institute due to 6-month history of odynophagia and left pharyngeal pain. She had no habit of smoking, drinking, or betel nut chewing, but had been diagnosed with type 2 diabetes mellitus that was controlled with regular medication. Clinical examination revealed a whitish and firm mass lesion that occupied the left tonsillar fossa. The left tonsil could not be seen (Fig 1A). A plain film of the neck showed a hyperdense lesion in the left posterior oral pharyngeal region that had a density similar to bone tissue. After diagnosis of chronic tonsillitis with tonsillolith, she underwent a left tonsillectomy while under general anesthesia. After removal of the stone, a decreased left tonsil was found in the tonsillar fossa. Histopathologic diagnosis included actinomycosis tonsillitis and a 2 2 cm tonsillolith (Fig 1B). The symptoms of the patient improved dramatically after surgery.

Unusual Origin of Pleomorphic Adenoma: Lateral Nasal Wall

Pleomorphic adenoma is the most common benign salivary glands tumor, but it rarely originates in the nose, and is especially rare in the lateral nasal wall. We present a case of intranasal pleomorphic adenoma arising from the lateral nasal wall and discuss the clinical presentation, diagnosis and treatment.