Fumiyuki Shimada

Differential diagnosis of cervical lymph nodes in head and neck cancer by ultrasonography

OBJECTIVE Determination of whether an enlarged cervical lymph node is metastatic or not is clinically important in head and neck oncology. Differential diagnosis of the lymph node, however, is still a diagnostic problem. The purpose of this study is to clarify the ultrasonographic findings of the metastatic lymph nodes of head and neck squamous cell carcinoma and to establish the criteria. METHODS We investigated 36 metastatic lymph nodes in head and neck squamous cell carcinoma and 24 non-metastatic nodes in benign disease with a 10-MHz transducer. We examined the size, shape, and internal echo (echo level, punctate bright echogenic spots, hilus echogenic line, cystic pattern) of these nodes. Based on this investigation, we evaluated 70 lymph nodes from 25 other patients by ultrasonography. RESULTS The short axis diameter and shape of metastatic nodes were larger and rounder than those of non-metastatic ones. Of the metastatic nodes, 69% showed hypoechoic and 31% isoechoic levels, and 78% exhibited punctate bright echogenic spots. Of the non-metastatic nodes, 92% showed hypoechoic and 8% isoechoic levels, and none of them showed the spots. The hilus echogenic line was not present in any metastatic node, but it was seen in 58% of non-metastatic ones. Of the metastatic nodes, 19% exhibited a cystic pattern; none of the non-metastatic nodes showed the pattern. According to our criteria based on these results, the accuracy rate was 98.6% (69/70). The sensitivity and specificity were 97.2% (35/36) and 100% (34/34), respectively. The false positive rate and the false negative rate were 0% (0/70) and 1.4% (1/70), respectively. CONCLUSION Internal echo findings and shape of lymph nodes can be an important diagnostic tool, and our ultrasonographical criteria of the lymph nodes are very useful for the differential diagnosis of the cervical lymph nodes.

Visualization of nasopharyngeal carcinoma with Tl-201 chloride and a three-head rotating gamma camera SPECT system

Tl-201 SPECT was performed on 12 patients with Nasopharyngeal carcinoma (NPC) by means of a three-head rotating gamma camera to evaluate whether or not Tl-201 SPECT was useful and reliable for assessing the tumor viability of NPC. Tl-201 clearly accumulated in the tumor in 3 patients before radiation treatment and increased Tl-201 uptake by the lesion ceased after the treatment. Three of 9 patients who were followed up after radiotherapy developed apparent local recurrence and Tl-201 SPECT clearly visualized these recurrent lesions. Tl-201 SPECT was very useful for assessing the tumor response to irradiation and for detecting local recurrent tumor. A High resolution SPECT system employing Tl-201 chloride is a new reliable and accurate diagnostic tool for the assessment of NPC.

Thallium-201 single-photon emission tomography in the treatment follow-up of nasopharyngeal carcinoma

In order to assess the usefulness of thallium-201 single-photon emission tomography (SPET) in the treatment follow-up of nasopharyngeal carcinoma (NPC), a total of 75201Tl SPET studies were performed in 18 patients with histologically proven NPC. The findings were compared with those of magnetic resonance imaging (MRI) before and after therapy. Four patients received radiotherapy alone while the other 14 received concurrent chemo-radiotherapy. Treatment response was classified as complete (CR) or partial (PR) based on the findings of MRI and201Tl SPET. Intense201Tl uptake by the tumour was seen in all 18 patients before treatment. After treatment, MRI showed seven CRs and 11 PRs, whereas201Tl SPET showed 13 CRs and five PRs. In 12 patients, the results of201Tl SPET were in agreement with those of MRI. In six patients MRI showed PR but201Tl showed CR. Follow-up (mean 10.6 months) MRI and201Tl SPET studies of these six patients revealed that tumour gradually decreased and finally vanished in three patients. This preliminary study indicates that201Tl SPET has potential in the assessment of early response to treatment of patients with NPC when compared with MRI.

A Case of Nodular Fasciitis Arising in the Auricle

Nudular fasciitis is an uncommon benign proliferative lesion in the head and neck, and is extremely rare in the auricle. A case of nodular fasciitis arising in the auricle of 53-year-old man is reported by immunohistochemical and electron microscopical studies. Initially, he had noticed a small painless nodule on the posterior side of right auricle, and it grew up rapidly in size over 2 months. A biopsy revealed nodular fasciitis. This lesion was resected totally with the auricular cartilage. Histological examination revealed proliferation of spindle-shaped cells and immunohistochemical-positive staining was observed with actin, and focally positive staining was seen with vimentin. Electron microscopically some tumor cells contained dilated rough endoplasmic reticulum and myofilament-like bundles in cytoplasm.

Voice Preservation Technique in the Surgical Treatment of Postcricoid Cancer

In patients with freedom from invasion to anterior half of the larynx in postcricoid and cervical esophageal cancer, reconstruction of vocal tract with preservation of the anterior half of the larynx is applied with oncologic rationality and we performed the procedure in three cases of T2N1. At neck dissection bilateral superior thyroid neurovascular pedicles and unilateral inferior thyroid vessels were preserved. The larynx and upper part of the trachea were devided on the frontal plane and the posterior half with the hypopharynx and cervical esophagus was removed. The anterior half of the part was preserved and the mucosal edges of the cut surface extending from the appropriate margin of membranous portion of the trachea to the aryepiglottic folds were longitudinally approximated to reconstruct a thin tube to rehabilitate the voice. The pharyngoesophagus was replaced by either deltopectoral flap or forearm flap. Postoperative aspiration was minimal and voice rehabilitation was satisfactory.

Ein Fall des Multiplen Chemodektoms

Zusammenfassung Klinisch und elektronenmikroskopisch untersuchten wir einen Fall, bei welchem der Kranke mit dem Karotisdrusentumor links und dem Tumor des Glomus jugularis sinistra 18 jahrig war, was sich durch die Angiographie der Karotis und die retrograde Venographie der Vena jugularis interna bestatigt wurde. Feinstrukturell hinsichtlich der Tumorzellen konnten zwei Type identifiziert werden, deren beiden Cytoplasmen die durchmesserlich 150–250 A betragene Neurosekretionsgranula nach Art von Katecholamine enthalten. Auserdem konnten wir zufallig zwischen der soliden Gruppierung der Tumorzellen im Karotisdrusentumor die Nervenendigung untersuchen.

Ein Fall des Multiplen Chemodektoms: Klinische und elektronenmikroskopische Untersuchungen***

We observed electronmicroscopically and clinically a case of multiple chemodectoma, which has occurred from glomus caroticum sinistra and glomus jugularis sinistra of a 18 year old boy. The diagnosis was especially made by an angiography of the left common carotid artery and by a retrograde venography of the left internal jugular vein. Electronmicroscopically two kinds of tumor cells in this chemodectoma were identified. These cytoplasmas showed cored neurosecretory granules measured 125 to 250 A in diameter markedly increasing in number. Moreover in the island of the tumor cells of the carotid body tumor we happened to observe the nerve ending.