C. Timon

Expression microarray analysis of papillary thyroid carcinoma and benign thyroid tissue: emphasis on the follicular variant and potential markers of malignancy

The most common sub-variant of papillary thyroid carcinoma (PTC) is the so-called follicular variant (FVPTC), which is a particularly problematic lesion and can be challenging from a diagnostic viewpoint even in resected lesions. Although fine needle aspiration cytology is very useful in the diagnosis of PTC, its accuracy and utility would be greatly facilitated by the development of specific markers for PTC and its common variants. We used the recently developed Applied Biosystems 1700 microarray system to interrogate a series of 11 benign thyroid lesions and conditions and 14 samples of PTC (six with classic morphology and eight with follicular variant morphology). TaqMan® reverse transcriptase-polymerase chain reaction was used to validate the expression portfolios of 50 selected transcripts. Our data corroborates potential biomarkers previously identified in the literature, such as LGALS3, S100A11, LYN, BAX, and cluster of differentiation 44 (CD44). However, we have also identified numerous transcripts never previously implicated in thyroid carcinogenesis, and many of which are not represented on other microarray platforms. Diminished expression of metallothioneins featured strongly among these and suggests a possible role for this family as tumour suppressors in PTC. Fifteen transcripts were significantly associated with FVPTC morphology. Surprisingly, these genes were associated with an extremely narrow repertoire of functions, including the major histocompatibility complex and cathepsin families.

Parotid gland surgery: a retrospective review of 108 cases

One hundred and eight parotidectomies performed by a single consultant were reviewed. Eighty-five patients had primary parotid disease, 23 patients had extra-parotid primaries. Pleomorphic adenoma was the most common histological diagnosis. In patients with primary parotid disease, a post-operative temporary facial nerve palsy was noted in 15 patients, with a further four developing a permanent palsy. Patients with metastatic disease to the parotid had a poor prognosis.

Hemithyroidectomy for benign thyroid disease: who needs follow‐up for hypothyroidism?

Objective:  To identify the incidence and possible risk factors for the development of hypothyroidism following hemithyroidectomy and to determine a simple protocol for the post‐op monitoring of thyroid function.

Laryngeal tuberculosis: an important diagnosis.

The incidence of laryngeal tuberculosis is increasing worldwide. To ensure early diagnosis it is important for physicians and otolaryngologists to recognize its cardinal signs and symptoms. We present two recent cases of laryngeal tuberculosis that presented to our department. We outline potential pitfalls in diagnosis, and highlight the importance of obtaining a tissue diagnosis. The literature is reviewed, and the treatment options outlined.

Recurrent laryngeal nerve palsy secondary to benign thyroid disease

A recurrent nerve palsy occurring in the presence of a goitre is considered to be caused by thyroid malignancy until proven otherwise. Three cases are described in which benign thyroid disease resulted in recurrent laryngeal nerve paralysis. Recent haemorrhage was implicated histologically as the possible aetiology in all three cases. The importance of identifying and preserving the recurrent laryngeal nerve in the surgical management is highlighted.

Routine nasopharyngeal biopsy in adults presenting with isolated serous otitis media: is it justified?

Nasopharyngeal malignancy accounts for less than 2 per cent of all head and neck cancers. Serous otitis media (SOM) causing deafness is a recognized indicator of nasopharyngeal obstruction and the possibility of a nasopharyngeal malignancy must be considered in all adults. Examination under anaesthesia (EUA) and biopsy of the nasopharynx is routinely undertaken in many centres to rule out nasopharyngeal malignancy in adults with SOM. The purpose of this 10-year retrospective study was to evaluate the case records of all adult cases of SOM, including their presentation, clinical findings, management and nasopharyngeal biopsy results. Eighty-five patients were included in the study. Fifty-nine presented with unilateral SOM and 26 with bilateral SOM. The primary presenting complaint in all cases was hearing loss. A nasopharyngeal mass was documented in 55 patients (69 per cent). Four nasopharyngeal masses were noted to have irregular or exophytic mucosa on flexible nasendoscopy. All patients underwent a EUA of the ears and a nasopharyngeal biopsy. The four patients with suspicious-looking masses were all found to have malignancies (two squamous cell carcinomas, one B-cell non-Hodgkin lymphoma and one adenocarcinoma). Three of these patients presented with unilateral SOM and one with bilateral SOM. All other patients with masses were found to have benign lymphoid hyperplasia. In total, 4.7 per cent of the adults with conductive hearing loss secondary to SOM were found to have a malignancy on nasopharyngeal biopsy. We would advocate a high index of suspicion of a nasopharyngeal tumour in adults presenting with SOM. If a mass is found in the nasopharynx then it should be biopsied. If no mass is found then it is not necessary to biopsy; however, close follow up, with repeat fibre-optic nasendoscopy, is advised.

Glomangiopericytoma (sinonasal-type haemangiopericytoma).

BACKGROUND Glomangiopericytoma is a rare sinonasal tumour of perivascular myoid phenotype, which accounts for less than 1 per cent of all sinonasal tumours. OBJECTIVE Discussion of the clinical presentation, histopathological features and advances in the management of sinonasal and skull base glomangiopericytoma. CASE REPORT A 32-year-old woman presented with worsening nasal obstruction, anosmia, severe frontal headaches and right-sided proptosis. Radiographic and endoscopic examination revealed a right-sided, vascular mass involving the nasal cavity, paranasal sinuses and anterior skull base. Histopathological features were consistent with a glomangiopericytoma. Complete endoscopic resection with free margins was achieved. CONCLUSION Glomangiopericytomas are rare, vascular, sinonasal tumours. Successful management depends on complete resection, traditionally achieved via an open approach. However, recent advances in endoscopic surgical approaches have enabled complete endoscopic resection of these tumours, minimising morbidity and facilitating subsequent surveillance of the operative site.

Oncogenic impact of human papilloma virus in head and neck cancer

There is considerable debate within the literature about the significance of human papilloma virus in head and neck squamous cell carcinoma, and its potential influence on the prevention, diagnosis, grading, treatment and prognosis of these cancers. Cigarette smoking and alcohol consumption have traditionally been cited as the main risk factors for head and neck cancers. However, human papilloma virus, normally associated with cervical and other genital carcinomas, has emerged as a possible key aetiological factor in head and neck squamous cell carcinoma, especially oropharyngeal cancers. These cancers pose a significant financial burden on health resources and are increasing in incidence. The recent introduction of vaccines targeted against human papilloma virus types 16 and 18, to prevent cervical cancer, has highlighted the need for ongoing research into the importance of human papilloma virus in head and neck squamous cell carcinoma.

Treatment of combined subglottic and critically low tracheal stenoses secondary to burn inhalation injury

We report a case of combined severe subglottic and lower tracheobronchial stenoses after an inhalation burn injury. The patient was successfully treated by the insertion of a bifurcated silicone rubber stent. The proximal limb of the silicone tube was used to stent the subglottic stenosis after it had been resected, a treatment option not previously reported. It is speculated that the diffuse airway damage resulted from a combination of thermal injury, mechanical trauma and infection. The relatively late symptomatic presentation of the lower tracheal stricture is stressed and the treatment options discussed.

Ischaemic optic neuropathy following bilateral neck dissection.

Two cases of ischaemic optic neuropathy, which occurred as a complication of oncological neck surgery, are reported. These cases are submitted because of the apparent scarcity in the literature of this complication after head and neck surgery. They are also unusual because they presented with different clinical manifestations of ischaemic optic neuropathy after separate forms of bilateral neck dissection. A literature review identifies a small number of similar cases and risk factors and preventative measures are discussed.