Harun Cansiz

Management of paragangliomas in otolaryngology practice: review of a 7-year experience.

Background and Aims:Paragangliomas of the head and neck are highly vascular lesions originating from paraganglionic tissue located at the carotid bifurcation (carotid body tumors), along the vagus nerve (vagal paragangliomas), and in the jugular fossa and tympanic cavity (jugulotympanic paragangliomas) and should be considered in the evaluation of all lateral neck masses. The aim of this study is to review an institutional experience in the management of these tumors. Materials and Methods:Twenty-six patients with 27 paragangliomas were treated in our institution during a period of 7 years (2000-2007). There were 15 women (57.6%) and 11 men (42.4%) with a mean age of 33.5 years. A painless lateral neck mass was the main finding in 16 patients (61.5%). There was no evidence of a functional tumor. Carotid angiography was performed on all of our patients (100%) to define the vascular anatomy of the lesion. Twenty-two paragangliomas (of the 25 operated paragangliomas; 88%) underwent selective embolization of the major feeding arteries. We performed surgery on 24 (92.3%) patients. Two patients were treated with radiotherapy. Results:Most lesions were paragangliomas of the carotid bifurcation (n = 14 [51.8%]), whereas 6 patients were diagnosed with jugular (22.2%), 1 with a vagal (3.7%), 1 with a tympanic paraganglioma (3.7%), 2 with jugulotympanic paraganglioma (7.4%), and 1 with laryngeal paraganglioma (3.7%). In 1 patient (3.8%), bilateral paragangliomas in the carotid bifurcation were detected. There was an evidence of malignancy in all cases (3.8%). Preoperative embolization has proven successful in reducing tumor vascularity in approximately 22 (of 25 who accepted surgery; 88%) paraganglioma patients. The common preoperative complication was vascular injury, which occurred in 6 (23%) of 26 patients; the main postoperative complication was transient cranial nerve deficit in 4 (15.3%) of 26 patients; and a permanent Horner syndrome was documented in 2 patients (7.6%). Cerebrospinal fluid leak occurred in 1 patient (3.7%). Postoperatively, stroke was occurred in 1 patient (3.7%). Two patients with jugular paraganglioma were treated with irradiation because of skull base extension with significant symptomatic relief. Conclusions:The primary therapeutic option for paragangliomas is complete excision of tumor with preservation of vital neurovascular structures. Combined therapeutic approach with preoperative selective embolization followed by surgical resection is the safe and the effective method for complete excision of the tumors with a reduced morbidity rate.

Aneurysmal Bone Cyst of the Sphenoid Bone

Aneurysmal bone cyst (ABC) is an uncommon benign lesion that rarely presents in the craniofacial region. Aneurysmal bone cysts represent nearly 1.4% of all bone tumors, and among those, only 3% are located in the cranium. In this study, we report on an ABC located in the sphenoid bone with superior nasal cavity and ethmoid extension. The presenting symptom of our patient was headache, followed by diplopia, loss of visual accuracy, and abduction restriction. We successfully resected the lesion by a combined subcranial-midfacial degloving approach without any complications or recurrence.

Role of miR‐145 in human laryngeal squamous cell carcinoma

Laryngeal squamous cell carcinoma (SCC), being an aggressive malignancy, is one of the most commonly diagnosed malignant types of head and neck SCC worldwide. Incidences of laryngeal SCC have been reported to increase recently. In this study, we aimed to explore the biological effects of miR‐145 on laryngeal cancer cells.

Primary Tuberculosis Involving Epiglottis: A Rare Case Report

The case of a 29-year-old patient with active laryngeal tuberculosis predominantly involving the epiglottis, without pulmonary disease, is presented. The predominant symptoms are dysphagia, odynophagia, and hoarseness. Laryngeal carcinoma, which shares almost the same symptoms and signs, should be ruled out immediately. Laryngeal tuberculosis is discussed with a brief literature review.

Head and neck hemangiopericytomas: diagnostic contradictions.

Purpose: To identify misdiagnostic points of hemangiopericytomas (HPs) of the head and neck. Patients and Methods: We reviewed our clinical records from 2000 to 2007 retrospectively and identified 5 patients with HP of the head and neck. The records of each patient with head and neck HP were evaluated for age, sex, location of primary, clinical course, treatment, and tumor embolization (if performed). Pathologic slides of all patients were reviewed to identify histologic features and correlation with the clinical course and outcome for each lesion. Results: Five patients with HP that arose from head and neck sites were identified. Five patients included 3 women and 2 men aged 9 to 52 years, with an average of 33.2 years. Each lesion of the patients derived from different parts of the head and neck. The most common complaints were painless mass (3 of 5) and nasal airway obstruction (3of 5). Magnetic resonance imaging of the 3 patients reflected hyperintense on T2-weighted imaging and hypointense on T1-weighted imaging with diffuse enhancement after intravenous administration of gadolinium. Angiography was performed to all these 3 patients, and only 1 patient with cranial HP involvement did not show significant vascularity. Two patients had preoperative histopathologic results. All patients were operated on with appropriate approach. Pathologic slides of all patients were investigated and graded according to the tumor diameter, cellularity, mitotic rate, and necrosis. Conclusion: Differential diagnosis of clinical features and radiologic and pathologic aspects must be managed more carefully. Diagnostic way of these tumors has different pitfalls for the clinician.

Tracheal reconstruction with autogenous composite nasal septal graft.

We describe lateral resection of tracheal tumors and repair of the defect with a composite graft of nasal septal mucosa and cartilage. The preliminary experience with this technique in 3 patients was satisfactory. The procedure can be used for patients who are not candidates for standard resection and end-to-end anastomosis.

Characterization of Stem-Like Cells Directly Isolated from Freshly Resected Laryngeal Squamous Cell Carcinoma Specimens

Larynx cancer (LCa) is an aggressive malignancy, which is the second most common malignant neoplasm of head and neck squamous cell carcinoma. Its incidences have been reported to increase and therapeutic options mostly fail to give positive clinical response especially for the advanced LCa cases. In this study we aimed to isolate stem-like cells from freshly resected LCa tumor specimens and characterize them by quantitative real time PCR (qRT-PCR) for expression of cancer stem cell markers including SOX2, OCT4, KLF4, ABCG2, CXCR4 and CD44. Our results showed that CD133(high) cells directly isolated from freshly resected tumor specimens exhibit elevated levels of SOX2, OCT4 and KLF4, and have increased expression levels of ABCG2 and CXCR4, which were associated with resistance of tumors to regular chemotherapeutic reagents. In conclusion, this study offers a useful approach utilizing CD133 to isolate stem cells directly from fresh tissues, which gives the opportunity to develop novel therapeutic tools specifically targeting these cells through their further characterization.

Hypoglossal schwannoma presenting only with headache.

Hypoglossal schwannoma is a rarely encountered skull base lesion that has generally both intracranial and extracranial parts. This article reports a case of hypoglossal schwannoma that is purely extracranial and presents itself only with persistent headache. Magnetic resonance imaging delineated a mass at the skull base that consisted of both cystic and solid components, consistent with a nerve sheath tumor. Cervical approach was chosen, and the mass was completely removed. Postoperatively, the patient developed hypoglossal nerve palsy because the hypoglossal nerve was sacrificed. Hypoglossal schwannomas are briefly discussed with a literature review.

Hemangioendothelioma of the frontal bone in a child.

Hemangioendothelioma is a vascular tumor of endothelial cell origin. It may involve bone or soft tissues and can behave like a benign or malignant tumor. In the literature, there are several case reports on the involvement of the head and neck region, but involvement of the frontal bone is extremely rare. This report presents the case of a 4-year-old boy with the diagnosis of spindle cell hemangioendothelioma of the frontal bone, who was treated by wide surgical resection.

Primary malignant melanoma of the pharynx

Primary mucosal malignant melanomas are rare. They appear late in life and their prognosis is grave. Although there is no consensus on therapy, wide surgical resection followed by radiotherapy, chemotherapy and immunotherapy are treatment modalities. In this report we present a case of widespread primary mucosal malignant melanoma located in the pharynx. After immunotherapy (four cycles of interleukin-2 and interferon-alpha) and chemotherapy (four cycles of cisplatin and dacarbazine) has been applied as primary therapy for suppression of the mass, transoral total pharyngeal resection was performed. After surgery three cycles of immunotherapy and three cycles of chemotherapy were administered followed by radiotherapy (total dose of 6600 cGy). An additional three cycles of immunotherapy and chemotherapy were administered. Although no local recurrence was observed during the 14 months of follow-up after the completion of radiotherapy, cranial and lung metastasis were detected in the 12th month.