Jonathan Trites

Complete spontaneous regression of metastatic merkel cell carcinoma: a case report and review of the literature.

Merkel cell carcinoma (MCC) is a rare aggressive primary cutaneous neuroendocrine neoplasm with a high rate of recurrence and metastasis. We report a case of a 94-year-old woman who experienced complete spontaneous regression of metastatic MCC. Nine months after complete excision of the primary MCC on her left eyebrow, metastatic MCC was confirmed with a fine-needle aspiration of a 4-cm mass on the left side of her neck. Three months later the mass had reduced in size to 2 cm and a neck dissection was performed. Her submandibular gland, thoracic duct and 25 lymph nodes were negative for MCC. Two of the lymph nodes, the larger measuring 1.3 cm, contained extensive amounts of fibrosis, with accumulation of macrophages and other chronic inflammatory cells. The literature documents 6 similar cases of complete spontaneous regression of metastatic MCC. The mechanism for regression is not well understood and is thought to involve T-cell-mediated immune response and apoptosis.

Transoral laser microsurgery versus radiation therapy for early glottic cancer in Canada: Cost analysis

OBJECTIVE There is debate over whether radiation therapy or transoral laser microsurgery (TLM) is the superior treatment for early glottic cancer. Both offer similar cure rates and posttherapy quality of life. One factor that could decide the optimum therapy is cost. Several studies in Europe and the United States show that TLM is the most cost-effective treatment. The goal of this study was to conduct the first cost analysis in Canada on the treatment of early glottic cancer comparing radiation therapy and TLM. DESIGN AND METHODS The study was conducted retrospectively. TLM and radiation therapy were broken down into individual components, and then the price for each component was summed. SETTING The study was conducted at the Queen Elizabeth II Health Science Centre in Halifax, Nova Scotia. MAIN OUTCOME MEASURES The main outcome measure was total cost. RESULTS It was found that radiation therapy was approximately four times more expensive than TLM. CONCLUSIONS This study suggests that TLM should be the preferred treatment option for treating early glottic cancer in Canada as it is the most economical and has been shown in previous studies to be as effective as radiation therapy in both cure rates and quality of life.

Is preoperative ultrasonography accurate in measuring tumor thickness and predicting the incidence of cervical metastasis in oral cancer

The need for elective neck dissection in patients with early stage oral cancer is controversial. A preoperative predictor of the risk of subclinical nodal metastasis would be useful. Studies have shown a strong correlation between histological tumor depth and the risk of nodal metastasis. To determine if preoperative ultrasonography is an accurate measure of tumor depth in oral carcinoma. To assess if preoperatively measured tumor depth predicts an increased risk of subclinical metastatic neck disease and thus the need for elective neck dissection. Twenty one consecutive patients with biopsy proven squamous cell carcinoma of the tongue/floor of mouth were analyzed prospectively. Each patient received a preoperative ultrasonography to assess tumor depth which was compared to histological measures. Univariate analysis was used to correlate tumor thickness and T stage with neck metastasis. There was a significant correlation between the preoperative ultrasonography and histological measures of tumor depth (correlation coefficient 0.981, P<0.001). The overall rate of lymph node metastasis was 52%. The rate of metastasis was 33% in N0 necks. In the group with tumors<5mm in depth, the neck metastatic rate was 0%, as compared with 65% in the group 5mm. Using univariate analysis tumor depth and T stage were significant predictors of cervical metastasis (P=0.0351 and P=0.0300, respectively). Preoperative ultrasonography is an accurate measure of tumor depth in oral carcinoma. Tumor thickness is a significant predictor of nodal metastasis and elective neck dissection should be considered when this thickness is 5mm.

Hyperparathyroidism–jaw tumor syndrome

Hyperparathyroidism–jaw tumor (HPT‐JT) syndrome is a rare autosomal dominant multiple tumor syndrome characterized by hyperparathyroidism due to single or multiple‐gland parathyroid tumor(s). Since it was first described in 1990, the genetics underlying the syndrome have been elucidated and typical clinical presentations are becoming clarified as literature describing this rare entity amasses.

Lateral Ectopic Thyroid Goiter with a Normally Located Thyroid

BACKGROUND Midline ectopic thyroid tissue is a common pathological entity. In contrast, laterally located ectopic thyroid tissue with a normally located thyroid gland is a very rare condition in head and neck surgery. SUMMARY We report the association of laterally located multinodular thyroid tissue and a normally located multinodular goiter. A woman was seen in the otolaryngology clinic with a right submandibular mass. Clinical examination and investigations confirmed the presence of a multinodular goiter in an ectopic thyroid gland. CONCLUSION Laterally located ectopic thyroid tissue is a very rare condition. Ectopic thyroid tissues can undergo the same pathological changes as a normally located thyroid gland. Ectopic thyroid goiter together with a normally located multinodular goiter is a rare entity, and this is the first to be reported in North America.

Serum microRNA profiling to distinguish papillary thyroid cancer from benign thyroid masses

ObjectivesPapillary thyroid cancer (PTC) is increasing in incidence. Fine needle aspiration is the gold standard for diagnosis, but results can be indeterminate. Identifying tissue and serum biomarkers, like microRNA, is therefore desirable. We sought to identify miRNA that is differentially expressed in the serum of patients with PTC.MethodsSerum miRNA was quantified in 31 female thyroidectomy patients: 13 with benign disease and 18 with PTC. qPCR results were compared for significant fold-changes in 175 miRNAs, against a pooled control.Results128 miRNA qualified for analysis. There were identifiable fold-changes in miRNA levels between benign and control, and between PTC and control. There were statistically significant fold changes in the level of four miRNAs between benign and PTC: hsa-miR-146a-5p and hsa-miR-199b-3p were down-regulated, while hsa-let7b-5p and hsa-miR-10a-5p were up-regulated.ConclusionsMicroRNA is differentially expressed in the serum of patients with PTC. Serum miRNA has the potential to aid in thyroid cancer diagnosis.

Rates of thyroid malignancy by FNA diagnostic category.

BackgroundFine needle aspiration (FNA) of thyroid nodules is a cornerstone of surgical decision making in thyroid cancer. The most widely utilized system for reporting thyroid FNA results is the Bethesda System, which includes predicted malignancy rates for each FNA category. To date there have been few studies to determine whether these predictions are widely applicable.MethodsAll thyroid FNA results at the Queen Elizabeth II Health Science Centre from 2006–2010 were included in this study. The results were tabulated by FNA category and the health records were reviewed to determine whether the patient went on to have surgery and the result of surgical histopathology. Rates of malignancy were calculated and compared to published values.ResultsA total of 1491 thyroid FNAs were included in the study, representing 1117 individual patients with available health records. The majority of these FNAs were Benign, but the proportion of Unsatisfactory FNAs was higher than predicted while Malignant and Suspicious for Malignancy were lower than predicted. Surgery was performed on 388 patients and 110 were positive for malignancy (28%). The malignancy rate for each FNA category was higher than predicted based on literature values.ConclusionsThe proportions of FNA diagnoses and the rates of malignancy for each FNA category at our institution were not consistent with predicted values. It is important for clinicians to base their surgical recommendations on institution specific malignancy rates, not solely on literature values.

Serum biomarkers of papillary thyroid cancer

ObjectiveTo identify serum biomarkers of papillary thyroid cancer.MethodsProspective analysis was performed of banked tumor and serum specimens from 99 patients with thyroid masses. Enzyme-linked immunosorbent assay (ELISA) was employed to measure levels of five serum proteins previously demonstrated to be up-regulated in papillary thyroid cancer (PTC): angiopoietin-1 (Ang-1), cytokeratin 19 (CK-19), tissue inhibitor of metalloproteinase-1 (TIMP-1), chitinase 3 like-1 (YKL-40), and galectin-3 (GAL-3). Serum levels were compared between patients with PTC and those with benign tumors.ResultsA total of 99 patients were enrolled in the study (27 men, 72 women), with a median age of 54 years. Forty-three patients had PTC and 58 cases were benign tumors. There were no statistically significant differences when comparing all five different biomarkers between PTC and other benign thyroid tumors. The p-values were 0.94, 0.48, 0.72, 0.48, and 0.90 for YKL-40, Gal-3, CK19, TIMP-1, and Ang-1, respectively.ConclusionSerum levels of four of the five proteins were elevated in patients with thyroid masses relative to normal values. However, the difference between benign and PTC was not significant. Two of the markers (Gal-3 & TIMP-1) displayed a greater potential difference, which may warrant further investigation. This study suggests that other serum markers should be sought. This is the first study to investigate potential serum biomarkers based on over-expressed proteins in thyroid cancer versus benign pathology.

Outcomes of transoral laser microsurgery for recurrent head and neck cancer.

OBJECTIVE To report our outcomes with salvage CO2 laser surgery following recurrence of laryngeal and oropharyngeal cancer after radiotherapy. METHOD This study entailed a prospective review of patients treated with transoral laser microsurgery for recurrent laryngeal and oropharyngeal cancer between 2002 and 2010 at the Queen Elizabeth II Health Science Centre in Canada. RESULTS Sixteen patients were identified, with a mean follow up of 30.6 months. Five patients died of recurrence. Complications were common in patients with oropharyngeal cancer. The overall survival and disease-free survival rates at an average of 29.8 months follow up were 50 per cent and 68.8 per cent respectively. CONCLUSION Salvage surgery using transoral laser microsurgery should be considered in the management of patients with recurrent laryngeal and oropharyngeal cancer. This technique offers acceptable salvage rates with less comorbidity than other treatments.

Nodular fasciitis of the zygoma: A case report

Nodular fasciitis (NF), a benign proliferation of fibroblasts, commonly presents as a solitary, well-circumscribed, rapidly growing soft tissue mass. It is most commonly located in the upper extremities, particularly on the volar aspect of the elbow, and on the chest and trunk. In adults, NF is rarely found in the head and neck region. Although benign, it can often be confused with a more malignant process and therefore must be properly diagnosed histologically. The cause of NF is unknown but an association with trauma may be present. Treatment is most commonly by local surgical excision, and recurrence is rare. A case of NF over the zygoma in a 60-year-old man not associated with trauma is presented.