Hideki Chijiwa

Clinical study of parapharyngeal space tumours

This study reviewed 24 cases of parapharyngeal space tumour treated at Kurume University Hospital between 1990 and 2007. Histological diagnoses were generally obtained from the excised tumour (22/24). Seventy-seven per cent of the parapharyngeal space tumours were benign and 23 per cent were malignant. Thirty-eight per cent (eight of 22) of these tumours were pleomorphic adenomas and 23 per cent (five of 22) were schwannomas. A transparotidectomy and transcervical approach were used in 88 per cent (15/17) of benign tumours. A mandibular swing approach was used for one malignant tumour. Post-operative complications were identified in 16 of 22 patients. The most common complication, facial nerve paralysis, was identified in eight patients, and seven of these patients demonstrated first bite syndrome. In consideration of the high incidence of post-operative complications, the surgical approach should therefore be carefully selected when treating patients with parapharyngeal space tumours.

Histopathological study of correlation between laryngeal space invasion and lymph node metastasis in glottic carcinoma.

OBJECTIVES The paraglottic space and cricoid area of the larynx are made up of loose, areolar tissue composed of loose elastic and collagenous fibres and adipose tissue. They contain the main blood vessels of the larynx. We examined the correlation between the histopathological extension of glottic carcinoma into the paraglottic space or cricoid area and the development of cervical lymph node metastasis. STUDY DESIGN We reviewed the medical charts of 45 patients (44 men and one woman) who had undergone total laryngectomy for squamous cell carcinoma of the glottis between 1991 and 2003. METHODS Macroscopic and microscopic study of the removed larynges of the same patients was performed, and the histopathological evidence for invasion of the paraglottic space or cricoid area was analysed. RESULTS Eight of the 24 patients (33 per cent) with invasion of the paraglottic space or cricoid area had cervical lymph node metastasis. In contrast, only one of the 21 patients (5 per cent) without any evidence of invasion of either space had lymph node metastasis. This difference was statistically significant (p < 0.05). In the 36 patients free of cervical lymph node metastasis, recurrence in the neck occurred in six (38 per cent) of the 16 patients with paraglottic space or cricoid area invasion, but in only one (5 per cent) of the 20 patients without paraglottic space or cricoid area invasion (p < 0.05). CONCLUSION In patients with glottic carcinoma, invasion of cancer into the paraglottic space or cricoid area is an important prognostic factor for the development of cervical lymph node metastasis.

Supraglottic carcinoma treatment results analysed by therapeutic approach

This study reviewed 161 patients with supraglottic squamous cell carcinoma who underwent radical therapy at Kurume University Hospital between 1989 and 2003. The five-year survival rate was 89 per cent in patients with stage III disease and 75 per cent in stage IV patients, thus demonstrating favourable results even for patients with advanced cancer. The five-year local control rate and the laryngeal preservation rate were poor in patients with T3 tumours (being 75 per cent for both), but the overall five-year local control rate for all patients was 86 per cent. Laser surgery plus chemo-radiotherapy was the most frequently used treatment. The local control rates and laryngeal preservation rates were poor in patients with tumour infiltration to the glottis and the laryngeal ventricle. In conclusion, the indications for combination laser therapy for supraglottic carcinoma should in future be extended, and the type and number of chemotherapy courses for this cancer should be further clarified.

Treatment of Subglottic Carcinoma

A retrospective review was performed on 12 patients (10 male and 2 female ; mean age of 62.1 years) with subglottic cancer who received initial treatment at Kurume University Hospital between 1979 and 2006. In T classification, there were 4 T2 cases and 8 T4 cases. In N classification, there were 8 NO cases, 3 N1 cases and 1 N2 case. 3 were at stage 2 and 9 were at stage 4a. The 3-year and 5-year survival rates as determined by the Kaplan-Meier method were 81.8% and 70.1% respectively. The 3-year and 5-year survival rates for cases at stage T2 were both 75%, whereas those at T4 were 83.3% and 62.5%. 6 patients died. 3 patients died of the primary disease (lymph node death : 1, distant metastasis death : 2) . Total laryngectomywith bilateral paratracheal neck dissection was performed in 9 cases. (3 T2 cases and 6 T4 cases) . Radiotherapy as additional treatment was performed on 4 out of 9 cases. Laryngeal preservation operations were performed in 3 cases (1 T2 cases and 2 T4 cases) . Radiotherapy and chemotherapy were performed in 2 cases while super-selective intra-arterial chemotherapywith radiotherapy was performed in 1 case. This particular patient did not experience recurrence. It is conceivable that super-selective intra-arterial chemotherapy with radiotherapy is one of the more effective treatments in laryngeal preservation.

Epithelioid sarcoma of the neck: case report

Epithelioid sarcoma is an aggressive, malignant tumour of the soft tissue which tends to arise in proximity to large tendons and aponeuroses. We report the case of a patient presenting with an epithelioid sarcoma arising in the neck. A 56-year-old man was referred with a three-year history of a sensory disorder as well as a slowly growing mass in his right neck. The patient underwent resection of the tumour by means of a conservative neck dissection. The final diagnosis, based on the histological and immunohistochemical findings, was epithelioid sarcoma. Radiotherapy was performed after the operation. The post-operative course was uneventful, and there was no local recurrence or distant metastasis.

Rapidly Progressive Angiosarcoma of the Neck: A Case Report

We encountered a case of rapidly growing angiosarcoma of the left neck. The patient was a 55-year-old male who consulted our clinic complaining of a left infraauricular mass with subcutaneous bleeding. Neck MRI demonstrated a large mass (49×37×23mm) with outapparent tumor capsule. The lesion was diagnosed as carcinoma of the left parotid gland. Based on the findings of fine needle aspiration biopsy, we performed surgical removal and postoperative diagnosis demonstrated angiosarcoma. However, there was a rapid regrowth of the tumor and the patient developed peritonitis due to metastasis to the liver and lung. He died of respiratory failure. As angiosarcoma is a severe disease with a poor prognosis, difinitive diagnosis followed by a multimodal regimen is required for adequate treatment.

Two Cases of Soft Tissue Tumor Arising in the Deep Neck

We encountered two rare cases of soft tissue tumor arising in the deep neck. The first case was a 29-year-old woman diagnosed as having pseudomalignant osseous tumor. At surgery, a circumscribed, hard mass was found in the deep portion and adhered to the cervical vertebra. The mass was extirpated together with a layer of the surrounding macroscopically intact tissue. The post-operative course was uneventful. The second case was a 59-year-old man diagnosed as having epithelioid sarcoma. At surgery, a circumscribed, invasive mass was found in the deep portion and adhered to the cervical vertebra. The mass was excised together with adjacent muscle tissue and fat tissue. The post-operative course was uneventful. Immunohistochemical evidence in these cases are also presented.