Kunitoshi Yoshino

Multiple primary tumours in laryngeal cancer.

All 748 patients with squamous cell carcinomas of the larynx treated in the Free University Hospital, Amsterdam, between 1964 and 1983 were analysed retrospectively with regards to the occurrence of multiple primary tumours. One hundred and four (14 per cent) second primary tumours were reported. Seventy-three (10 per cent) were situated in the respiratory tract and upper digestive tract. Of these 73, 64 were localized in the lung. No esophageal carcinomas were reported. Male patients, with a glottic carcinoma had a statistically higher change of developing a second primary than female patients (14.5 per cent versus 0 per cent). In both sexes more multiple primary tumours occurred in supraglottic than in glottic cancers. Only in female patients was the difference statistically significant. Because of the high rate of lung carcinomas, and since most tumours are metachronous, bronchoscopy is justified at the initial work-up and is also to be considered at regular intervals during the follow-up period.

Radiation-induced cancers of the head and neck region.

A total of 65 patients with radiation-induced cancers of the head and neck region were treated and evaluated. The primary disease for which the radiotherapy had been applied was benign disease in 48 patients (including tuberculous lymphadenitis in 39 patients), and malignant tumors in 17 patients (including 9 laryngeal cancers and 5 thyroid cancers). The radiation-induced cancers included 35 cases of hypopharyngeal cancer, 15 of thyroid cancer, and 13 of cervical esophageal cancer. The mean duration from radiotherapy until the diagnosis of cancer was 12.8 years in the patients with malignant primary tumor and 32.9 years in those with benign primary diseases. Most of the patients underwent surgery for their cancer. The clinical course was poor and the outcome extremely poor, especially in those patients with field carcinogenesis. It is emphasized that excessively high dosage and wide radiation field should be avoided, and that radiotherapy for young patients with malignancies requires extremely careful management.

Expression of Epstein-Barr virus in mesopharyngeal and hypopharyngeal carcinomas

Epstein-Barr virus (EBV) causes various tumors, including nasopharyngeal carcinoma (NPC). There have been no reports as to whether the carcinogenicity of EBV is restricted to the nasopharynx or extends into the mesopharynx and hypopharynx. We attempted to ascertain the relation between EBV and mesopharyngeal (MPC) and hypopharyngeal carcinomas (HPC). Messenger RNA in situ hybridization showed that all 29 cases of MPC and 5 of 12 HPC expressed EBV mRNA. For further analysis, we established 7 cell lines from 5 MPC and 2 HPC. All cell lines and 5 tumors formed by these cultured cells in nude mice expressed EBV transcripts. Moreover, immunofluorescence staining showed expression of EBV-related nuclear antigen-2 and latent membrane protein-1 (LMP1) in the original tumors and the cell lines, as well as in nude mouse tumors. Study by reverse transcription polymerase chain reaction (RT-PCR) also showed EBER1 and LMP1 expression. Furthermore, lytic-cycle antigens of EBV were detectable in most cell lines. Nested PCR showed the EBV genome in 3 cases of MPC and 4 cases of HPC. These results suggest that EBV plays an important role in the development of MPC and HPC as well as in NPC.

Significance of Endoscopic Screening and Endoscopic Resection for Esophageal Cancer in Patients with Hypopharyngeal Cancer

OBJECTIVE The efficacy of endoscopic screening for esophageal cancer in patients with hypopharyngeal cancer remains controversial and its impact on prognosis has not been adequately discussed. We studied the use of endoscopic screening to detect esophageal cancer in hypopharyngeal cancer patients by analyzing the incidence, stage and prognosis. METHODS We included 64 patients with hypopharyngeal cancer who received radical radiotherapy at our institute. Chromoendoscopic esophageal examinations with Lugol dye solution were routinely performed at and after treatment for hypopharyngeal cancer. RESULTS Twenty-eight esophageal cancers were detected in 28 (41%) patients (18 synchronous and 10 metachronous cancers). Of the 28 cancers, 23 were stage 0 or I cancer and 15 of these were treated with endoscopic resection. Local control was achieved in all of these 23 stage 0 or I cancers. The 5-year overall survival rates with esophageal cancer were 83% in stage 0, 47% in stage I and 0% in stage IIA-IVB. CONCLUSIONS This study showed a strikingly high incidence of esophageal cancer in hypopharyngeal cancer patients. We suppose that the combination of early detection by chromoendoscopic examination and endoscopic resection for associated esophageal cancer in hypopharyngeal cancer patients improve prognosis and maintain quality of life.

Clinical outcomes of endoscopic mucosal resection and endoscopic submucosal dissection as a transoral treatment for superficial pharyngeal cancer.

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been introduced for the treatment of superficial pharyngeal cancer.

Definitive Radiotherapy for T1–2 Hypopharyngeal Cancer: A Single-Institution Experience

PURPOSE To analyze the outcome in T1-2 hypopharyngeal cancer (HPC) patients treated with definitive radiotherapy (RT). PATIENTS AND METHODS A total of 103 patients with T1-2 hypopharyngeal squamous cell carcinoma treated with radical RT between March 2000 and June 2008 at our institution were analyzed. Pre-RT neck dissection (ND) was performed in 26 patients with advanced neck disease. Chemotherapy was used concurrently with RT in 14 patients. Sixty patients were associated with synchronous or metachronous malignancies. The median follow-up for surviving patients was 41 months. RESULTS The 3-year overall and cause-specific survival rates were 70% and 79%, respectively. The 3-year local control rates were 87% for T1 and 83% for T2 disease. The ultimate local control rate was 89%, including 7 patients in whom salvage was successful. The ultimate local control rate with laryngeal preservation was 82%. Tumors of the medial wall of the pyriform sinus tended to have lower control rates compared with tumors of the lateral or posterior pharyngeal wall. Among patients with N2b-3 disease, the 3-year regional control rates were 74% for patients with pre-RT ND and 40% for patients without ND. The 3-year locoregional control rates were as follows: Stage I, 100%; Stage II, 84%; Stage III, 67%; Stage IVA, 43%; Stage IVB, 67%. Forty-two patients developed disease recurrence, with 29 (70%) patients developing recurrence within the first year. Of the 103 patients, 6 developed late complications higher than or equal to Grade 3. CONCLUSIONS Definitive RT accomplished a satisfactory local control rate and contributed to organ preservation.

Neurofibroma of the hypopharynx a case report

A 45-year-old female patient with a neurofibroma of the hypopharynx is reported. She had complained of swallowing discomfort for 3 months. Indirect laryngoscopy showed an oval tumor with a smooth surface in the posterior wall of the hypopharynx. Xeroradiography was effective for defining the tumor. Removal of the tumor was performed by an infrahyoid horizontal pharyngotomy under general anesthesia. The tumor had an indistinct capsule. The nerve from which the tumor originated was not clear. Histologically, the tumor was diagnosed as neurofibroma. The patient had no other neurogenic tumor and has been well without recurrence after the surgery.

Antibody response against the epstein-barr virus-coded nuclear antigen2 (EBNA2) in nasopharyngeal carcinoma

Specific antibody responses against the Epstein‐Barr virus‐coded nuclear antigen2 (EBNA2) were evaluated. Thirty‐five sera from pretreatment patients of nasopharyngeal carcinoma (NPC) and 12 from healthy adults were tested. Although the anti‐EBNA2 response did not show any correlation with T stage, overall stage, or histopathology, it showed a correlation with the N stage of the disease. In a se‐rological follow‐up study, 17 (85%) of 20 patients showed a correlation on the change of antibody levels to EBNA2 and clinical progression. This suggests that EBNA2 serology might represent a useful marker relative to tumor status.

Multiple Primary Tumors in Patients With Head and Neck Cancer

From July 1978 to June 1984, 851 new cases of malignancies in the head and neck were registered in our hospital. Ninety-three patients with multiple primary tumors were observed. Triplicated malignancies were observed in three cases, i.e., larynx, thyroid, skin; stomach, tongue, larynx; and larynx, sarcoma, mesopharynx. The incidence rate was a high 30% in cancer of the mesopharynx (14/46), 14% in cancer of the larynx (55/392), and 7% in cancer of the hypopharynx. Additional primary malignancies occurred in the head and neck regions (25 cases), the digestive system (10 cases), the uro-reproductive system (18 cases), and others. Cancers of the stomach, lung, esophagus, and thyroid were predominant. Thirty-one cases (32.2%) were detected simultaneously and others were detected synchronously. We discuss the increased incidence rate of multiple primary tumors and the factors attributable to multiple primary tumors and stress the usefulness of systematic investigations.

A case of myxofibrosarcoma of the maxilla with difficulty in preoperative diagnosis

Myxofibrosarcoma (MFS) is a very rare fibroblast-derived sarcoma that occurs in the head and neck region. Here, we report the case of a 52-year-old man in whom MFS generated from the maxilla and whose beginning of treatment was considerably delayed because he was initially diagnosed as having a benign inflammatory lesion. Because a definite diagnosis was not obtained via 2 independent biopsies, total maxillectomy was used for both diagnosis and treatment. Histopathological and immunohistochemical analyses suggested that the tumor was a low-grade MFS. Because soft tissue tumors in the head and neck region are rare and a definite diagnosis is relatively difficult, surgical excision is indispensable if malignancy of the tumor is suspected.