Katsuhiro Yoshimura

Indication for elective neck dissection for N0 carcinoma of the parotid gland: a single institution's 20-year experience

Conclusions: Elective neck dissection (END) may not be necessary in patients with low-grade malignancy. However, currently, END should be performed in all patients with parotid carcinoma because the preoperative diagnosis of lymph node metastasis is limited and the accuracy of preoperative grade diagnosis is low. Objective: Our aim was to examine the indication for END in N0 patients and the extent of dissection by investigating the accuracy of diagnosing the grade and lymph node metastasis of parotid carcinoma. Patients and methods: The subjects were 77 patients with parotid carcinoma. Among N0 patients, modified radical neck dissection (MRND) was conducted in those in whom the histological grade was evaluated as high, and selective neck dissection (SND) in other patients. Results: Lymph node metastasis was detected in 27 of 71 patients who underwent neck dissection. Node metastasis was detected in 19 (61.3%) of 31 patients in whom high-grade malignancy was suggested and in 8 (22.9%) of 35 patients in whom intermediate-grade malignancy was suggested preoperatively. There was no metastasis in any of the five patients in whom low-grade malignancy was suggested. Occult metastasis was noted in 8 of 51 patients. The rate at which the histological grade was accurately diagnosed before surgery was low, especially in patients with low-grade malignancy.

Basal cell adenoma of the parotid gland: a clinicopathological study of nine cases—basal cell adenoma versus pleomorphic adenoma and Warthin’s tumor

The aim of this study is to investigate the clinical and pathological characteristics of basal cell adenoma (BCA) and to compare the diagnosis/treatment of BCA with those of Warthin’s tumor (WT) and pleomorphic adenoma (PA). Among 192 patients with benign tumors of the parotid gland who underwent surgery, 9 had BCA. All of these tumors showed a benign pattern on computed tomography and magnetic resonance imaging. The accuracy of fine needle aspiration biopsy (FNAB) for diagnosis of BCA was slightly lower than for PA and WT. Most PA and BCA lesions developed in the upper part of the parotid gland. Considering the gender difference, tumor site, and age, it is necessary to differentiate BCA from PA rather than from WT. There were no significant differences in the duration of surgery, the blood loss, and the incidence of transient facial paralysis between surgical resection of BCA and surgery for PA or WT. BCA is the third most common of the benign parotid tumors, following WT and PA, although its incidence is low. When PA and WT are ruled out by FNAB after a tentative diagnosis of benign tumor has been based on imaging findings, BCA should be considered.

Diagnostic criteria of ultrasonographic examination for lateral node metastasis of papillary thyroid carcinoma

Conclusion: Considering the incidence of metastasis from papillary thyroid carcinoma (PTC) with respect to the lateral cervical regions and limited detection on preoperative ultrasonography (US), level II to IV dissection may be essential when lateral node metastasis (LNM) is detected on preoperative US. Objectives: LNM is frequent in patients with PTC. However, a consensus regarding its preoperative diagnosis and the indication/extent of lateral node dissection (LND) has not been reached. We prepared criteria for diagnosing LNM from PTC using US. Furthermore, we investigated the usefulness and limits of US and appropriate extent of dissection. Patients and methods: We conducted a retrospective study in 70 patients with PTC (80 sides) in whom LNM was detected preoperatively, and level II to V LND was performed. We compared the results of the preoperative diagnosis of LNM using US in accordance with the criteria with those of histopathological diagnosis after LND. Results: Diagnostic criteria for LNM were a minor axis of 6 mm or more and a minor/major axis ratio of 0.5 or more. Histopathologically, metastasis was detected in 467 lymph nodes. Of these, 199 (43%) were detected on US, and met the diagnostic criteria.

Ultrasonography for preoperative localization of enlarged parathyroid glands in secondary hyperparathyroidism

OBJECTIVE Parathyroidectomy (PTx) is sometimes performed to treat secondary hyperparathyroidism (2HPT) related to long-term dialysis. In this procedure, all four parathyroid glands should be resected. However, in patients with 2HPT, the four glands are not uniformly enlarged; therefore, preoperative diagnosis is difficult in comparison with primary hyperparathyroidism. We compared glands detected on preoperative ultrasonography (US) with those resected during PTx to examine the usefulness and limitations of US. METHODS The subjects were 44 patients with 2HPT who underwent PTx between December 2003 and November 2007. Surgery was indicated for patients meeting the following three conditions: a serum intact PTH (iPTH) level of 500 pg/ml or more; a maximum glandular volume of 500 mm3 or more; and increased bone metabolism. Before surgery, we detected the parathyroid glands using US, and three-dimensionally measured their sizes. PTx was performed based on US diagnosis, and resected glands were weighed. RESULTS Assuming that four parathyroid glands are present in each patient, the total number of glands in the 44 patients was 176. Of the 176 glands, 139 were detected on preoperative US. However, 27 could not be resected. Therefore, the detection rate on US was 63.6% (112/176). Of 37 glands that could not be detected on preoperative US, 30 were detected during surgery, and resected. There was a positive correlation between the glandular volume measured on US and isolated gland weight. However, there was no correlation between the preoperative serum iPTH level and the sum of the four isolated gland weights. CONCLUSION On preoperative US, approximately 80% of the glands were detected. However, the misdiagnosis rate was approximately 20%. The rate of accurate diagnosis was 63.6%. Even when glands were misdiagnosed or could not be confirmed on preoperative US, approximately 80% of them could be detected and resected during surgery. It may be impossible to estimate the glandular volume based on the preoperative serum iPTH level.

Novel differential diagnostic method for superficial/deep tumor of the parotid gland using ultrasonography

The purpose of this study was to prepare the ultrasonographic diagnostic criteria on parotid tumors for preoperative differentiation of superficial and deep tumors.

Kimura's disease of the epiglottis: resection by a lateral pharyngotomy approach.

Kimura’s disease is a chronic non-neoplastic entity first described by Kimura et al in 1948. It predominantly occurs in Asian males during the second and third decades of life. The major physical manifestation is slowly enlarging subcutaneous masses often found in the head and neck, especially in the salivary glands, usually in association with peripheral blood and tissue eosinophilia and a markedly increased serum IgE concentration. Although many cases have been reported, development in the larynx is very rare, possibly leading to difficulties in diagnosis. We report a case of Kimura’s disease presenting as an epiglottic mass, which was resected by a lateral pharyngotomy approach (LPA). A 52-year-old female presented to our department with a 10-month history of sensation of a foreign body in her pharynx. ENT examination revealed a 30-mm, well-defined, submucosal epiglottic mass (Fig 1). No enlarged lymph nodes were palpable in cervical regions, and there were no lesions in the salivary glands. MRI showed a diffuse enlargement of the epiglottis with a low-intensity signal in both T1and T2-weighted images. CT also showed an epiglottic mass with slight enhancement (Fig 2). These findings suggested a tumorous lesion in the epiglottis, such as malignant lymphoma. The white blood cell (WBC) count was 6800/mm, with 12.5 percent eosinophils. We did not measure serum IgE concentration. During direct laryngoscopy with the patient under general anesthesia, we detected a submucosal tumor covered with a normal mucous membrane in the epiglottis, making the laryngeal space at the epiglottic level very narrow. We incised the mucous membrane and took a biopsy sample from the mass. These findings suggested low-grade malignant lymphoma. The specimen was too small to make a definite diagnosis pathologically, so we performed an LPA to obtain a larger sample. The mass was found to be closely adhered to the epiglottis, so subtotal removal was performed. The mass was firm, reddish-white, and measured 4 3 3 cm. Histopathologically, multiple hyperplastic

Role of cytokines in lavage or drainage fluid after hemithyroidectomy in wound healing: Involvement of histamine in the acceleration and delay of wound healing

Wound healing is a sophisticated biologic process. In the case of hemithyroidectomy, the operation time is relatively short with small tissue damage and without skin excision, and bacterial contamination before, during, and after the operation is uncommon. Here, we explored which cytokine(s) affected the rates of healing of skin wounds after hemithyroidectomy of 29 patients. We assessed the amounts of cytokines (e.g., interleukin‐6, platelet‐derived growth factor, basic fibroblast growth factor, vascular endothelial growth factor, and tumor necrosis factor‐α) in either the preoperative or postoperative lavage fluids, or in the drainage fluids on postoperative days (PODs) 1–8. All of these cytokines showed a similar pattern; after reaching a peak on POD1, the production fell sharply on POD2–8, revealing that wound healing commenced on POD1. The rates of wound healing were inversely related to the levels of histamine in six patients (i.e., those with the three largest and those with the three smallest total volumes of drainage fluid on POD1): high (or low) levels of histamine in the postoperative lavage fluids with low (or high) levels in the drainage fluids on POD1 caused earlier (or the delay of) wound healing, suggesting involvement of histamine in the acceleration and delay of wound healing.

Late nodal metastasis of T2 oral cancer can be reduced by a combination of preoperative ultrasonographic examination and frozen section biopsy during supraomohyoid neck dissection.

Abstract Conclusion: The occult metastasis rate for T2 oral cancer can be reduced by ultrasonography (US). Also, the late metastasis rate is considered to be reduced by combining US with frozen section biopsy (FSB) during supraomohyoid neck dissection (SOHND). Objectives: Early oral cancer has been reported to show occult metastases in 15–53% of patients, but the criteria or methods for the diagnosis of cervical lymph node metastasis are unclear in many studies, and there is no clear definition of occult metastasis. In patients with T2 oral cancer, the diagnosis of lymph node metastasis by US and its pathological diagnosis (pN) after neck dissection were compared to evaluate the usefulness and limitations of US, occult metastasis rate, significance of SOHND as preventive neck dissection, and use of FSB. Methods: A total of 73 patients with T2 oral cancer were investigated retrospectively. Modified radical neck dissection (MRND) was performed in N+ patients, and SOHND was carried out in N0 patients. FSB was performed in all patients undergoing SOHND. US and pN diagnoses were compared. Results: The occult metastasis rate was 18% when occult metastases were limited to those detected by SOHND and 22% when late nodal recurrences were also included.

Recurrent Thyroid Cancer 25 Years after a First Operation

初回手術後25年を経て再手術を行った甲状腺乳頭癌症例を経験したので報告した。患者は56歳女性で，約3年前から左頸部腫瘤に気付くも放置していた。平成15年3月18日大阪府済生会吹田病院耳鼻咽喉科を受診，左側頸部に直径15 cm以上の巨大な易出血性の腫瘤を認めた。既往歴として約25年前に甲状腺癌で甲状腺亜全摘と左保存的頸部郭清術を受けていた。左頸部腫瘤は皮膚を一部付けて一塊として摘出できた。摘出した頸部腫瘤の重量は900 gであった。本例のように甲状腺乳頭癌は長期間経過したのち再発することがあり，注意深い長期の経過観察が必要である。

Bilateral Basal Cell Adenomas in the Parotid Glands Combined with Warthin's Tumor Unilaterally; A Case Report.

We treated an extremely rare case of bilateral basal cell adenomas combined with Warthins tumor in the left parotid gland. The patient was a 65-year-old male who complained of swelling in the bilateral parotid areas. We removed bilateral parotid masses. Histopathological examination demonstrated adenoma and Warthins tumor. The incidence of bilateral parotid tumors is rare, and synchronous tumors with different histopathological types in a single salivary gland are extremely rare.