Hisanobu Tamaki

Destiny of autologous bone marrow-derived stromal cells implanted in the vocal fold.

Objectives: The aim of this study was to investigate the destiny of implanted autologous bone marrow–derived stromal cells (BSCs) containing mesenchymal stem cells. We previously reported the successful regeneration of an injured vocal fold through implantation of BSCs in a canine model. However, the fate of the implanted BSCs was not examined. In this study, implanted BSCs were traced in order to determine the type of tissues resulting at the injected site of the vocal fold. Methods: After harvest of bone marrow from the femurs of green fluorescent transgenic mice, adherent cells were cultured and selectively amplified. By means of a fluorescence-activated cell sorter, it was confirmed that some cells were strongly positive for mesenchymal stem cell markers, including CD29, CD44, CD49e, and Sca-1. These cells were then injected into the injured vocal fold of a nude rat. Immunohistologic examination of the resected vocal folds was performed 8 weeks after treatment. Results: The implanted cells were alive in the host tissues and showed positive expression for keratin and desmin, markers for epithelial tissue and muscle, respectively. The implanted BSCs differentiated into more than one tissue type in vivo. Conclusions: Cell-based tissue engineering using BSCs may improve the quality of the healing process in vocal fold injuries.

Tracheal Regeneration After Partial Resection: A Tissue Engineering Approach

Objectives: The aims of this study are to investigate the efficiency of a tissue engineering approach to partial tracheal reconstruction and to improve epithelialization of the reconstructed trachea. The trachea must be resected in some cases of cancer or trauma. Various restructuring techniques are used, with no consensus on the best approach. Two problems that arise when treating tracheal defects by conventional techniques are an inability to regenerate ciliated epithelium at the reconstructed site and having to perform multiple procedures to achieve the desired repair. This study is designed to address these problems.

Therapeutic outcomes of laryngeal cancer at Kyoto University Hospital for 10 years.

Conclusion: It is important to prevent regional lymph node recurrence and distant metastasis to achieve better survival of laryngeal cancer. Objective: Therapeutic outcomes of 130 cases with laryngeal cancer treated at Kyoto University Hospital between 1995 and 2004 were reviewed. Patients and methods: In all, 121 males and 9 females were involved. Their ages ranged from 40 years to 92 years (average 66 years). All tumors were squamous cell carcinoma – arising at the glottis in 111 cases, the supraglottis in 18, and the subglottis in 1 case. Most glottic cancers (77.5%) were classified as stage I or II, while most supraglottic cancers (77.8%) were at stage III or IV. Stage I/II cancers were basically treated by conventional radiotherapy (60–66 Gy) and twice-daily hyperfractionated radiotherapy (70–74 Gy), respectively, attempting to preserve the larynx. Total laryngectomy with neck dissection was performed in the treatment of stage III/IV cases. Results: Five-year disease-specific survival rates were 100%, 96%, 100%, and 68% for stage I, II, III, and IV, respectively. Five-year laryngeal preservation rates were 98%, 100%, 86%, 0%, and 0% for T1a, T1b, T2, T3, and T4 of glottic cancer, respectively. Local recurrence occurred in five cases of stage I/II glottic cancer, which was successfully salvaged. Regional lymph node recurrence occurred in five cases including four patients with glottic cancer and one with supraglottic cancer. Two of them died of disease despite undergoing salvage therapy. Distant metastasis occurred in the lung in four cases including one glottic and three supraglottic cancer patients after initial treatment.

Cranial bone regeneration using a composite scaffold of Beta-tricalcium phosphate, collagen, and autologous bone fragments.

Objective: The aim of our study was to examine the tissue response and new bone formation induced by β‐tricalcium phosphate (β‐TCP), collagen, and autologous bone fragments with fibrin glue implanted into a cranial bone defect.

A rare case of hyperfunctioning papillary carcinoma of the thyroid gland

We report a rare case of hyperfunctioning papillary carcinoma of the thyroid. A 32-year-old man was referred to our hospital for the treatment of a painless mass in the left neck, which had been detected on routine physical check-up. Cervical ultrasonography and computed tomography showed a solid tumor with calcification in the left lobe of the thyroid gland. Serum examinations demonstrated hyperthyroidism with a high level of thyroglobulin. Fine needle aspiration biopsy revealed a cytological diagnosis of class II. Tc-99m scintigraphy showed a hot nodule in the left lobe, which implied that the tumor was a hyperfunctioning thyroid tumor. Left lobectomy of the thyroid gland was performed to treat the hyperfunctioning tumor. Postoperative pathological examinations revealed a follicular variant papillary carcinoma. Postoperative thyroid function became within the normal range. Although hyperfunctioning thyroid carcinomas are rare, it is important to correctly diagnose them and to perform appropriate surgical interventions.

Granular cell tumor of hypopharynx : report of a rare case

Granular cell tumor is a rare tumor, probably of Schwann cell origin. The head and neck are most frequently affected, but hypopharyngeal lesion is extremely rare. We report the seventh case of hypopharyngeal granular cell tumor. Immunohistochemical staining for S100 protein is helpful for the correct diagnosis. There is some possibility of malignancy despite absence of histological evidence, thus the treatment is exclusively surgical resection. The microlaryngoscopic approach is feasible for hypopharyngeal lesions in most cases. Recurrence can occur even after appropriate resection.

Survival in patients with parotid gland carcinoma – Results of a multi-center study

BACKGROUND Parotid gland carcinoma is a rare malignancy, comprising only 1-4% of head and neck carcinomas; therefore, it is difficult for a single institution to perform meaningful analysis on its clinical characteristics. The aim of this study was to update the clinical knowledge of this rare disease by a multi-center approach. METHODS The study was conducted by the Kyoto University Hospital and Affiliated Facilities Head and Neck Clinical Oncology Group (Kyoto-HNOG). A total of 195 patients with parotid gland carcinoma who had been surgically treated with curative intent between 2006 and 2015 were retrospectively reviewed. Clinical results including overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), local control rate (LCR), regional control rate (RCR), and distant metastasis-free survival (DMFS) were estimated. Univariate and multivariate analyses were performed to identify prognostic factors. RESULTS The median patient age was 63years old (range 9-93years), and the median observation period was 39months. The OS, DFS, DSS, LCR, RCR, and DMFS at 3years were 85%, 74%, 89%, 92%, 88%, and 87%, respectively. Univariate analysis showed age over 74, T4, N+, preoperative facial palsy, high grade histology, perineural invasion, and vascular invasion were associated with poor OS. N+ and high grade histology were independent factors in multivariate analysis. In subgroup analysis, postoperative radiotherapy was associated with better OS in high risk patients. CONCLUSION Nodal metastases and high grade histology are important negative prognostic factors for OS. Postoperative radiotherapy is recommended in patients with advanced high grade carcinoma.

Adenoid cystic carcinoma of the head and neck: a retrospective multicenter study

Abstract Background: Adenoid cystic carcinoma of the head and neck (ACCHN) is rare and difficult to study effective treatment at one institute. Our aim is to identify prognostic factors for this disease by conducting a multicenter study at 11 institutions in Japan. Methods: A retrospective multicenter study of ACCHN was performed. One hundred and three patients were identified between 2006 and 2015. The overall survival (OS) rate for all patients was calculated, and OS, locoregional control (LRC) rate, or no distant metastasis (NDM) rate was calculated for patients in that the surgery was performed without distant metastasis (DM). Statistical analyses were performed. Results: A significant difference with multivariate analysis was observed in patients in sublingual glands, stage IV and the use of radiation therapy ≥60Gy (sufficient RT) in OS for all patients. A significant difference was observed in the use of sufficient postoperative RT in the OS and the LRC rate, and in pathological surgical margins in the NDM rate. Conclusion: Sublingual glands or stage IV was a poorer, and sufficient RT was a better prognostic factor for ACCHN. Sufficient RT was effective to prevent local recurrence after surgical resection. Positive surgical margins caused an increase in DM.

Therapeutic outcomes of oral cancers at Kyoto university hospital

Conclusion: The results suggest that early diagnosis and treatment are the most important factors to improve the prognosis in oral cancer patients. Objective: In this retrospective study we analyzed the therapeutic outcome of oral cancers at out institute. Patients and methods: Thirty-one patients with oral cancers were treated between January 2000 and December 2004 at the Department of Otolaryngology–Head and Neck Surgery, Kyoto University Hospital. Transoral resection of tumor with or without neck dissection was performed for early oral cancers (stage I and II), while more extensive resection and radical neck dissection followed by postoperative radiotherapy was performed for advanced cases (stage IIII and IV). In the treatment of early tongue cancer, either partial glossectomy or brachytherapy was selected. The 3-year disease-specific survival rates of all patients, early-staged, and advanced-staged patients were 82.2%, 92.9%, and 63.5%, respectively. The prognosis was significantly related to the clinical stage of the tumor.

Clinical features of nasal and sinonasal inverted papilloma associated with malignancy

OBJECTIVE Nasal and sinonasal inverted papilloma (IP) are rare benign tumors and have the potential to exhibit malignancy in approximately 10% of cases. This study aimed to analyze the clinical features of IP associated with malignancy. Furthermore, we reviewed our therapeutic strategy and the clinical course of malignant IP. METHODS Overall, 70 patients with IP at our institution were retrospectively analyzed from April 2006 to December 2015; of these, six (9%) had associated malignancy. Data was collected on sex, age, presenting symptoms (nasal bleeding, rhinorrhea, facial or cheek pain, and nasal obstruction), bone destruction, and extent of disease on CT and MRI. Categorical data of patients with and without malignancy were compared using the chi-square test. A p value of <0.05 was considered statistically significant. Our therapeutic strategy for IP with malignancy, particularly the surgical procedure, i.e., the external incision or the endoscopic nasal approach, varied based on when the carcinoma was detected. In addition, we considered postoperative radiation therapy depending on histological examination. RESULTS Nasal bleeding (p<0.001), pain (p=0.040), bone destruction (p<0.001), and extent of disease (p=0.026) on CT and MRI findings were significantly associated with malignancy. Carcinoma was diagnosed preoperatively in two (33%) and postoperatively in four patients (67%). We operated five patients (one case was not treated because of end-stage pancreatic cancer). Two patients underwent endoscopic sinus surgery (ESS) alone, two ESS plus Denkers method, and one ESS plus anterior craniotomy. Three patients underwent surgery only, and two patients received postoperative radiotherapy. The median follow-up period was 69.3 months. One patient died of the disease and the remaining patients are alive without recurrence. CONCLUSION For IP patients exhibiting these clinical findings preoperatively, we should suspect complication with malignancy and plan a treatment. Even if postoperative histology does not confirm malignancy, we should ensure careful observation because of metachronous malignant transformation or the possibility to overlook small malignant lesions. Our result suggests that our strategy for malignant IP could be a reasonable option.