Kazunori Miyabe

FDG PET as a procedure for detecting simultaneous tumours in head and neck cancer patients.

AimThe presence of simultaneous primary tumours in other regions affects the prognosis and management decisions of head and neck cancer patients. Therefore, early detection of these tumours is necessary. Recent improvements in positron emission tomography (PET) have made it possible to examine the patients whole body. The present study was undertaken to evaluate the clinical contribution of whole-body PET using fluorodeoxyglucose (FDG) for head and neck cancer patients. MethodsFifty-three consecutive patients with previously untreated head and neck cancer were examined. Whole-body FDG PET imaging was performed at 1 h after injection of 18F-FDG. A 3-D acquisition was undertaken and iterative reconstruction was performed. The final diagnosis of simultaneous primary tumour was established by histological findings or clinical follow-up. ResultsOf 53 patients, six (11%) had evidence of simultaneous primary tumour. In five of these six patients, simultaneous primary tumours (two gastric cancer; one colon cancer; one pancreatic cancer; one thyroid cancer) were found by FDG PET. One more patient was found to have prostate cancer on the basis of blood test but this was not detected by FDG PET. In none of the remaining 47 patients, were additional simultaneous primary tumours found by FDG PET or any of the other routine examinations or during follow-up. ConclusionsThe results of this study show a high rate of simultaneous primary tumour in patients with primary head and neck cancer. FDG PET appears to be a promising imaging modality for the detection of simultaneous tumours in head and neck cancer patients.

Thermal burn of the pharynx and larynx after swallowing hot milk

Thermal burns of the larynx after swallowing hot beverages are extremely rare among adults. Most reported cases have occurred among young children. We report the case of a male adult who, upon swallowing hot milk from a bottle, experienced a burn of the larynx affecting the epiglottis and surrounding supraglottic structures. Since dyspnea usually occurs within hours of a burn of the larynx, the importance of airway management in this case is emphasized.

A case of ulcerative Warthin's tumor.

To the Editor: An 84-year-old Japanese woman was seen in May of 2001 with a left retroauricular skin tumor. The patient first noticed it about thirteen years earlier, but she had not sought medical attention. Her past history was only notable for complicated emphysema and chronic bronchitis due to her 60 year smoking habit. On physical examination, she had a painless, 4.7 × 3.5 cm mass with a 2.0 × 1.0 cm ulcer on its apex. The mass did not adhere to the overlying skin. Multiple reddish nodules were noted at the bottom of the ulcer (Fig. 1). A small amount of transparent yellowish exudate was also noted. No facial nerve weakness was found. Hematological and biochemical studies were all within normal limits. An MRI scan of the neck showed a heterogeneous mass in the left parotid gland (Fig. 2A), which was thought to be squamous cell carcinoma (SCC) on initial clinical impression. A biopsy of the granulomatous nodules on the ulcer revealed papillary epithelial elements embedded in lymphoid tissue, with no atypical cells (Fig. 2B), and a histological diagnosis of Warthin’s tumor (WT) was made. The patient was hospitalized for surgery. Because of its benign nature and her age, the ulcer margin was excised in a spindleshaped manner, and the skin was then sutured under local anesthesia to decrease the discharge from the exudates. She is now The Journal of Dermatology Vol. 31: 779–781, 2004

Superimposed dual-isotope SPECT using99mTc-hydroxymethylene diphosphonate and201Tl-chloride to assess cartilage invasion in laryngohypopharyngeal cancer

ObjectiveCartilage invasion in laryngohypopharyngeal cancer has a significant impact on the choice of treatment modality and outcome of the disease. We examined invasion of cartilage in laryngohypopharyngeal cancer by simultaneous bone and tumor dual-isotope SPECT using99mTc-hydroxymethylene diphosphonate and20lTl-chloride.MethodsEarly and delayed simultaneous bone and tumor dual-isotope SPECT were performed on 19 patients with laryngohypopharyngeal cancer. Dual-isotope SPECT images were superimposed to project tumor location from tumor SPECT onto the osseous structures shown by bone SPECT. The presence or absence of cartilage invasion was evaluated histopathologically or by radiological studies such as CT and/or MRI.ResultsHistopathological or radiological examination of the cartilage revealed invasion in 5 patients and no invasion in 14 patients. The results of both early and delayed dual-isotope SPECT were exactly the same. Using dual-isotope SPECT, the sensitivity, specificity, and accuracy in detecting cartilage invasion by laryngohypopharyngeal cancer were: 80% (4/5), 92.9% (13/14), and 89.5% (17/19), respectively.ConclusionsResults of the present study suggest that superimposed early bone and tumor dual-isotope SPECT images may be sufficient for the diagnostic evaluation of cartilage invasion by laryngohypopharyngeal cancer. Superimposed dual-isotope SPECT imaging is a useful technique in the evaluation of cartilage invasion in laryngohypopharyngeal cancer.

A Case of Invasive Paranasal-Skull Base Mycosis

Paranasal mycosis is divided into non-invasive and invasive types. The invasive type is rare, but sometimes fatal; it can extend up to the skull base and affect the orbital cavity with bone destruction. We encountered a case of invasive paranasal-skull base mycosis resistant to surgical and pharmacological treatments. A 78-year-old man developed persistent headache and retro-ocular pain in June, 2004, and consulted the Department of Neurosurgery and Otorhinolaryngology, Ritsurin Hospital on July 20. CT scan demonstrated a soft tissue shadow in the ethmoid and sphenoid sinus with bone destruction of the skull base. We performed endonasal endoscopic biopsy on July 30, but we could not open the sphenoid sinus because of bleeding. Therefore, we only opened the bilateral ethmoid sinuses. The result of biopsy showed granulation tissue. On August 11, endonasal endoscopic surgery was performed to obtain biopsy and culture as well as to drain the sphenoid sinus. The second histopathological examination demonstrated a fungus ball. Culture of this fungus ball demonstrated Aspergillus fumigatus. Post-operative CT scan showed the persistent residue of a soft tissue shadow and expansion of a bone defect of the skull base. The patient was referred to Kagawa University for further treatment. Endonasal endoscopic surgery was performed again to remove residual fungus on August 20. Antifungal drug therapies had been administered throughout the treatment period, but we failed to control the fungal disease. The patient died on September 21.

Long-term Middle Ear Ventilation Tube (Paparella type II) for Otitis Media with Effusion.

The use of long-term middle ear ventilation tubes (Paparella type II) was retrospectively analyzed in 66 ears with otitis media with effusion, in children treated at Kagawa Medical University Hospital between January 1990 and March 1998. The average intubation period was 23.9 months. The average pure tone air conduction threshold showed a remarkable improvement of between 32.7dBHL and 16.9dBHL. Otorrhea was observed in 25 ears (37.8%), obstruction in 2 ears (3.0%), granulation in 3 ears (4.5%) and permanent ear drum perforation in 11 ears (19.6%). No cholesteatma or adhesion of the ear drum was seen. Recurrence of otitis media with effusion was found in 9 of 45 ears (20.0%). In conclusion, Paparella type II tube can be placed for a long-term period and have a low rate of reccurence, but have a high rate of otorrhea and permanent ear drum perforation.