Grégoire B. Morand

Outcome in squamous cell carcinoma of the nasal vestibule: A single center experience

The purpose of this study was to analyze the outcome of squamous cell carcinomas (SCCs) of the nasal vestibule and to identify factors predicting recurrence.

Helicobacter pylori detected in pharyngeal and laryngeal pathologies in patients with proven gastric colonization

Helicobacter pylori is known to cause gastric cancer. Presence and carcinogenicity in the upper aerodigestive system is doubtful. This study examined the prevalence of Helicobacter pylori and related factors in biopsies from the upper aerodigestive tract (UADT) in patients with gastric colonization by Helicobacter pylori.

Outcome by treatment modality in sinonasal undifferentiated carcinoma (SNUC): A case-series, systematic review and meta-analysis

OBJECTIVEnSinonasal undifferentiated carcinoma (SNUC) is an aggressive malignancy first described by Frierson et al. in 1986. As the tumor is very rare, current treatment recommendations are based on institutional case reports. We thus felt the need to perform a comprehensive systematic review and meta-analysis to investigate how treatment modalities are associated with survival.nnnDESIGNnCase-series, systematic review and meta-analysis METHODS: We searched the OvidMedline, OvidEmbase, Web of Science, Biosis, Scopus and the Cochrane Library database libraries. We extracted aggregate and individual patient data for statistical analysis. To study the association between treatment modalities and survival, we used random-effects meta-regression for the aggregate- and cox mixed-effects models.nnnRESULTSn379 citations were found; 29 case series could be included in the final analysis, including a total number of 390 single patients (34.6% female). Median age at diagnosis was 52 years. 80.9% of patients presented with a T4 tumor and 16.0% with nodal metastasis at diagnosis. In individual patient data (IPD) meta-analysis, single modality (surgery alone or radiation alone) treatment was associated with reduced survival compared to double modality (surgery & radiation or chemoradiation) treatment (adjusted Hazard Ratio [aHR] 2.97, 95% ConfidenceInterval [1.41-6.27]) and compared to triple modality (surgery & radiation & chemotherapy) treatment (aHR 2.80 95%-CI 1.29-6.05 for triple vs. single modality). Triple modality treatment was not superior to double modality treatment. (aHR 1.06, 95%-CI 0.59-1.92).nnnCONCLUSIONnDouble and triple modality treatment are associated with improved survival over single modality but there is no evidence that triple modality is superior to double modality treatment.

Delayed granulomatous reaction to hyaluronic acid gel injection

Injectable hyaluronic acid (HA) derivatives are the most used resorbable dermal fillers used for soft tissue augmentation. While their use is considered safe, there have been reports of cutaneous granulomatous reactions. We describe the clinical, radiological, and cytological findings in a patient who presented a full year after cosmetic treatment with HA injections and discuss the various treatment options.Level of Evidence: Level V, therapeutic study.

Maximum Standardized Uptake Value (SUV max ) of Primary Tumor Predicts Occult Neck Metastasis in Oral Cancer

The aim of this study was to investigate the predictability of occult lymph node metastasis using maximum standardized uptake value (SUVmax) in the primary tumor on pre-treatment 18-fluorodeoxyglucose positron emission tomography FDG-PET in oral squamous cell carcinoma (OSCC) patients who were clinically node negative (cN0) before surgery. A retrospective analysis of all patients treated at the University Hospital Zurich from 2007 to 2016 for OSCC with available pre-therapeutic FDG-PET was performed. We assessed the correlation of SUVmax of the primary tumors with the presence of occult nodal disease in the neck dissection specimen (pN+). The study included a total of 71 patients. In the nodal negative group (cN0/pN0), the median SUVmax of primary tumors was 9.0 (interquartile range (IQR) 7.4–13.9), while it was 11.4 (IQR 9.9–15.7) in the occult metastatic group (cN0/pN+). The difference was statistically significant (independent samples median test, Pu2009=u20090.037). In a multivariable model, the only independent predictor of occult metastatic disease for cN0 patients was a SUVmaxu2009≥u20099.5 (Pu2009=u20090.028). Further, primary tumors with SUVmaxu2009≥u20099.5 had a significantly higher risk of local recurrence (Log rank test, Pu2009=u20090.020). In conclusion, we showed that higher SUVmax (≥9.5) of the primary tumor is associated with higher occurrence of occult metastatic nodal disease and worse local survival. High SUVmax of the primary tumor may encourage clinicians towards more aggressive treatment.

Kaposi Sarcoma of the Ear in HIV-Negative Patients

With great interest we have read the article from Agaimy et al. describing 11 cases of Kaposi sarcoma in the head and neck area [1]. Special attention was elicited by two cases from the ear in HIV-negative patients. We recently encountered a similar case in a 79-years old male with a solitary nodule on the left ear’s concha. The patient underwent surgical tumor resection. Intraoperative frozen section analysis revealed atypical spindle cell proliferation. On formalin-fixed paraffin-embedded sectioning, the lesion showed a lobulated, but relatively circumscribed spindle cell proliferation with some atypical, hyperchrome cells and increased mitotic activity, but without morphologically obvious endothelial differentiation (Fig. 1a, b). No significant actinic damage was noted. Immunohistochemistry demonstrated strong positivity for CD34, at least partial expression of ERG (Fig. 1c, d), and strong nuclear positivity for HHV8 (Fig. 1e). Therefore, an unusual Kaposi sarcoma of the concha was diagnosed. HIV testing was negative and positron emission tomography with computed tomography (PET/CT) excluded presence of regional and distant disease. The patient was presented at the local head and neck and sarcoma tumor boards and local external beam radiotherapy with 20 × 2 Gy = 40 Gy was given postoperatively. The patient remains free of disease after 15 months of clinical and radiological follow-up. While the exact pathogenesis of Kaposi sarcoma in HIVnegative patients remains largely unelucidated, a lessening of the immunosurveillance abilities of the patient seems to be critical. Interestingly, our patient suffers from a low-grade non-Hodgkin lymphoma (currently not under therapy). This could be, along with immunosenescence, a possible clinical hint for some degree of immunosuppression. In summary, we think this case corroborates the fact, that the ear/concha of the ear seems to be, for unknown reasons, a predilection site for Kaposi sarcoma in HIV-negative patients. This should be kept in mind, especially when dealing with sarcomatoid tumors of the ear.

Early Timing of Thyroidectomy for Hyperthyroidism in Graves’ Disease Improves Biochemical Recovery

BackgroundThe role of thyroidectomy as an early treatment for hyperthyroidism has been poorly investigated. Our aim was to examine its success rates, particularly focusing on thyroidectomy as an early treatment.MethodsPatients with thyroidectomy for hyperthyroidism between February 2008 and October 2014 were included. They were divided into two groups (early and delayed thyroidectomy), and patient characteristics, treatment indications, complications and time to biochemical recovery were analyzed.ResultsNinety-nine patients met the inclusion criteria, of whom 65 (66%) suffered from Graves’ disease, 25 (25%) from toxic goiters and 9 (9%) from amiodarone-induced hyperthyroidism. Structural abnormalities of the thyroid (39 patients, 39%) represented the most frequent indications for thyroidectomy. Forty-six patients (46%) underwent an early and 53 (54%) a delayed surgical approach. Patients with Graves’ disease undergoing early thyroidectomy did not suffer more often from complications but had a significantly faster biochemical recovery after surgery than those with a delayed thyroidectomy, as judged by a shorter time to reach TSH (121xa0±xa024 vs. 240xa0±xa031xa0days, pxa0=xa00.007) and fT4 (91xa0±xa029 vs. 183xa0±xa031xa0days pxa0=xa00.015) levels in the normal range. As expected, there were no recurrences of hyperthyroidism.ConclusionsEarly thyroidectomy was neither associated with permanent complications nor thyroid storm, but with a significantly improved biochemical recovery and therefore has toxa0be recommended early in patients with Graves’ disease.

Congenital pharyngeal webs: Treatment of a rare clinical entity by endoscopic CO 2 laser approach

IMPORTANCEnOesophageal inlet stenosis can promote dysphagia and aspiration. We report the cases of syndromic children with congenital pharyngeal webs successfully treated with endoscopic CO2 laser.nnnOBSERVATIONSnPharyngeal webs were excised with CO2 laser (Ultrapulse mode) and resurfaced using mucosal advancement flaps to avoid restenosis and/or formation of secondary synechia. This led to a significant enlargement of the oesophageal inlet, which was documented immediately postoperatively and the clinical improvement of dysphagia and decreased aspiration persisted at distant follow-up.nnnCONCLUSION AND RELEVANCEnPharyngeal webs are congenital anomalies that can be safely and effectively corrected with endoscopic treatment.

Detection of Helicobacter pylori in patients with head and neck cancer: Results from a prospective comparative study combining serology, polymerase chain reaction, and rapid urease test

The purpose of this study was to evaluate prospectively the presence and impact of the gastric carcinogen Helicobacter pylori (H. pylori) in the upper aerodigestive tract. Previous studies suggested it could represent a risk factor for head and neck squamous cell carcinoma (HNSCC).