Naoki Matsushita

Anatomic distribution of hematolymphoid malignancies in the head and neck: 7 years of experience with 122 patients in a single institution

Abstract Conclusion: Most hematolymphoid malignancies in the head and neck were malignant lymphomas that most often occurred in sexagenarian men. Approximately 80% of them were B-cell lymphomas with a predominance of diffuse large B-cell lymphoma (DLBCL) in both nodal and extranodal sites. Our results were compatible with those in a previous study that was conducted in the central part of Japan. Objectives: This analysis was performed to describe the anatomic distribution of hematolymphoid malignancies that were diagnosed by biopsy in our department. Methods: Clinical medical records of 122 patients with hematolymphoid malignancies in the head and neck from January 2004 to December 2010 were retrospectively reviewed. The anatomic site of origin according to the histopathology of each malignancy was analyzed. Results: The incidence ratio of hematolymphoid malignancies was 15.1%. The male:female ratio was 2.3:1. Ages ranged from 17 to 89 years (median, 66). Of the 122 cases, 121 were lymphoid neoplasms (4 cases of Hodgkin lymphoma and 117 cases of non-Hodgkin lymphoma) and the remaining 1 was myeloid. The most common histopathology was DLBCL (54.9%), followed by follicular lymphoma (8.2%), and peripheral T-cell lymphoma (8.2%). Most commonly, the oropharynx (36.1%) and the cervical lymph node (34.4%) were affected.

Three-dimensional cone beam computed tomography imaging of the membranous labyrinth in patients with Meniere’s disease

Abstract Conclusion: Three-dimensional cone beam computed tomography (3DCT) images revealed characteristic malformations of the membranous labyrinth of the inner ear in Meniere’s disease (MD). The morphology of the membranous region between the vestibular cecum of the cochlea and the saccule of ears with MD was compared to that of healthy ears. The present study supports the hypothesis proposed earlier that reuniting duct blockade is a result of the dislodgement of saccular otoconia. Objective: To visualize the membranous labyrinth using 3DCT and to investigate the pathology of MD. Methods: A preparatory study was conducted to determine the optimal 3DCT window settings for the detection of water, muscle, calcium carbonate (CaCO3), and bone. Based on this preparatory study, the ears of 13 healthy volunteers and 25 MD patients definitely diagnosed according to the criteria issued by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology, Head and Neck Surgery (AAO-HNS), were visualized. Results: The differences in the membranous labyrinth between MD ears and healthy ears could be visualized using 3DCT. The images were classified into three types based on their morphological pattern. The ears of patients with MD were different from normal ears in terms of this classification.

Practical 3DCT imaging of the vestibular aqueduct for Meniere's disease

Abstract Conclusion: Radiographic visualization of the vestibular aqueduct (VA) from a lateral inside view was effective in assessing patients with Meniere’s disease (MD). There were no VA shapes specific to MD on radiography, except for an obliterated VA. This technique could yield more accurate images and functional assessment of the VA for MD evaluation in a clinically useful and convenient manner, without requiring morphologic measurement. Objective: To visualize the detailed images of the VA using three-dimensional (3D) computed tomography (CT) and discuss its clinical utility in assessing MD. Subjects and methods: The VAs in 13 healthy subjects and 25 MD patients, who were definitely diagnosed according to criteria described by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology, Head and Neck Surgery (AAO-HNS), were imaged from the medial and lateral sides using 3DCT and compared to conventional CT images. Results: Examination of the VA from both the lateral outside and inside views on 3DCT yielded more precise images than generated by conventional CT and could be useful to estimate the VA function. The estimated VA function in the MD ears was significantly abnormal compared to the function in healthy ears. An obliterated VA was characteristic of affected MD ears.

Site-specific analysis of B-cell non-Hodgkin’s lymphomas of the head and neck: A retrospective 10-year observation

Abstract Conclusion: B-cell non-Hodgkin’s lymphoma (B-NHL) in the head and neck most commonly affected the oropharynx and the cervical lymph node in sexagenarian patients, with more than 70% of these cases being diffuse large B-cell lymphoma (DLBCL). Accordingly, B-NHL should be considered one of the most important differential diagnoses of head and neck malignancies. Objectives: It has previously been reported that the majority of head and neck malignant lymphomas are B-NHLs. This analysis aimed to assess the site-specific profiles of B-NHL of the head and neck. Methods: The medical records of patients with B-NHL of the head and neck diagnosed between January 2004 and December 2013 were retrospectively reviewed. The clinical parameters of these patients, including age, sex, site distribution, and histopathologic sub-type, were analyzed. Results: A total of 153 cases (95 males; 58 females) were included in this analysis (male-to-female ratio = 1.64:1). The patient age at the time of diagnosis ranged from 30–92 years (median = 68 years). The oropharynx was the most commonly affected site (40.5%), followed by the cervical lymph nodes (33.3%). The most common histopathologic sub-type was DLBCL (71.9%), followed by follicular lymphoma (11.1%), and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (9.2%).

Twelve-year-old girl with intracranial epidural abscess and sphenoiditis

We report the case of a 12-year-old girl with an intracranial epidural abscess and sphenoiditis. Although she had no history of sinusitis, she developed acute severe headache, fever, and vomiting. Emergent CT and MRI showed a spherical space-occupying lesion of diameter 3 cm in the right cranial fossa with rim enhancement. The lesion was thought to be an epidural abscess adjacent to the right sphenoiditis. On the basis of the MRI findings, we performed emergent surgery to drain the abscess and sinusitis because of severe and rapidly worsening headaches. The patient showed great improvement the day after the operation. Intravenous antibiotics were administered for 8 days. She has completely recovered, with neither sequelae nor recurrence at 7 months after the operation. We believe that this report will be a useful reference for cases of acute onset headache and may be helpful in diagnosis and treatment decisions for severe sinusitis-related intracranial abscess in childhood.

Clinical analysis of 21 cases of cervical tuberculous lymphadenitis without active pulmonary lesion

Abstract Conclusion: The necessity of considering cervical tuberculous lymphadenitis (CTL) should be emphasized even today for the differential diagnosis of cervical lymphadenopathy, particularly when it is located in the posterior triangle and supraclavicular regions even in patients without active pulmonary tuberculosis (PTB). Objective: This study was conducted to highlight the characteristics of patients with CTL without active PTB who were treated in our department. Methods: Between 2004 and 2011, 21 cases of CTL without active PTB were included in this retrospective study. Histological examination after excisional biopsy of the affected lymph node was performed in 18 patients using hematoxylin and eosin staining and Ziehl-Neelsen (Z-N) staining for acid-fast bacilli (AFB) identification. Growth of Mycobacterium tuberculosis was detected by culturing and/or nucleic acid amplification tests including polymerase chain reaction (PCR) and transcription-mediated amplification (Mycobacterium Tuberculosis Direct: MTD). Results: The male to female ratio was 1:1.3. Patient ages ranged from 22 to 89 years. Eighteen patients (85.7%) complained of indolent unilateral cervical lymphadenopathy in the posterior triangle (26.5%), internal jugular (24.5%), or supraclavicular nodes (18.4%). Positive rates of AFB according to Z-N staining and culturing of M. tuberculosis and/or PCR or MTD were 33.3% (6/18) and 72.2% (13/18), respectively.

Evaluation of usefulness of fine-needle aspiration cytology in the diagnosis of tumours of the accessory parotid gland: a preliminary analysis of a case series in Japan.

Abstract Conclusion: The accuracy and sensitivity of fine-needle aspiration cytology (FNAC) in this analysis were not satisfactory, and the false-negative rate seemed to be higher than for parotid tumours. The possibility of low-grade malignancy should be considered in the surgical treatment of accessory parotid gland (APG) tumours, even if the preoperative results of FNAC suggest that the tumour is benign. Objectives: Little is known about the usefulness of FNAC in the preoperative evaluation of APG tumours, probably due to the paucity of APG tumour cases. We examined the usefulness of FNAC in the detection of malignant APG tumours. Methods: We conducted a retrospective analysis of 3 cases from our hospital, along with 18 previously reported Japanese cases. We compared the preoperative FNAC results with postoperative histopathological diagnoses of APG tumours and evaluated the accuracy, sensitivity, specificity and false-negative rates of FNAC in detecting malignant APG tumours. Results: There were four false-negative cases (19.0%), three of mucoepidermoid carcinomas and one of malignant lymphoma. One false-positive result was noted in the case of a myoepithelioma, which was cytologically diagnosed as suspected adenoid cystic carcinoma. The accuracy, sensitivity and specificity of FNAC in detecting malignant tumours were 76.2%, 60.0% and 90.9%, respectively.

A clinical study of malignant tumors of Stensen’s duct

Abstract Conclusion: Malignant tumors of Stensen’s duct are often squamous cell carcinomas. Surgery is the treatment of choice, and maintaining an adequate safety margin and performing parotidectomy may help to reduce postoperative recurrence. Objectives: Since malignant tumors of Stensen’s duct are extremely rare, the number of cases is limited in single-facility studies, making it difficult to perform a sufficient number of clinical examinations. Therefore, we reviewed 26 cases with Stensen’s duct malignancies to examine their clinical features. Methods: We conducted a retrospective study of 26 cases with Stensen’s duct malignancies, including 1 patient whom we treated and 25 cases previously reported in the English literature, and analyzed their clinical parameters, including age, sex, affected side, chief complaint, tumor size, histopathology, treatment method, and treatment outcome. Results: Most cases were diagnosed in patients between 40 and 69 years of age. The chief complaint was swelling in the cheek in 24 patients, in 14 of whom the swelling was painful. The most common tumor diameter range was 10–19 mm. Squamous cell carcinoma was the most frequent histopathology. The recurrence rate in surgical patients who did not undergo parotidectomy was 60%, whereas in patients who underwent parotidectomy, the recurrence rate was only 7%.

Efficacy and toxicity profiles of two chemoradiotherapies for stage II laryngeal cancer – a comparison between late course accelerated hyperfractionation (LCAHF) and conventional fractionation (CF)

Abstract Objective: To evaluate the treatment results of late course accelerated hyperfractionation (LCAHF) compared with conventional fractionation (CF) for stage II laryngeal cancer. Methods: Fifty-nine consecutive patients treated for stage II laryngeal cancer were retrospectively reviewed. Thirty-two patients underwent LCAHF, twice-daily fractions during the latter half with a total dose of 69 Gy. Twenty-seven patients received CF of 70 Gy. Results: The local control rates (LCRs), overall survival (OS), and disease-specific survival (DSS) at 5 years were 80.6%, 74.0%, and 90.4%, respectively, after LCAHF and 64.7%, 68.2%, and 90.5%, respectively, after CF. There were no significant differences in LCR, OS, and DSS (p = .11, 0.68, and 0.69, respectively). In a small number of patients with supraglottic cancer, LCAHF was associated with a significantly higher LCR at 5 years compared with CF (100% vs. 41.7%; p = .02). Conclusions: This is the first report that compared the results of LCAHF and CF for stage II laryngeal cancer. We could not find significant differences in LCR, DSS, and OS rates between LCAHF and CF groups. Although in a small number of patients with supraglottic cancer, LCAHF may improve the LCR compared with CF.

A case of piriform sinus fistula treated with fistulectomy at a relatively early phase after drainage

Piriform sinus fistula is a relatively rare congenital condition that often causes acute suppurative thyroiditis and neck abscess among young people. The radical treatment for this condition includes a fistulectomy using a cervical approach or, recently, chemocauterization of the internal opening of the fistula by direct endoscopy. In general, radical treatment can be performed only at a certain interval after reduction of inflammation. A 9-year-old boy suffering from swelling and tenderness of the anterior neck was referred to our hospital. Two weeks after reduction of inflammation by incising the neck to drain the abscess, we performed a fistulectomy. Identification of the fistula is the most important step in obtaining a successful surgical result. We were not able to confirm the fistula in the operating field by staining. However, insertion of a wire probe into the fistula allowed detection of the fistula and facilitated the fistulectomy. This method is supposed to be very effective to identify a piriform sinus fistula in the inflammatory tissue.