Qingang Hu

The treatment of sublingual gland tumours

This study assessed the clinical and histological features and therapeutic efficacy of 25 cases of sublingual gland tumours from 1998 to 2008. There were 17 female patients and 8 male, the ratio of females to males was 2.1:1. The mean age was 48.6 years. 4 cases were benign tumours (16%). 21 cases were malignant sublingual gland tumours (84%) and of these, 18 were adenoid cystic carcinoma (86%). Adenoid cystic carcinoma was mainly of the histological type, and the other histological classifications included mucoepidermoid carcinoma, pleomorphic adenoma, myoepithelioma, oncocytoma and polymorphous low-grade adenocarcinoma. Sublingual gland tumours are rare and most are malignant. For malignant sublingual gland tumours, early diagnosis and aggressive surgical treatment, especially for tumours with nerve involvement, is the key to improving prognosis. Free radial forearm flap or pectoralis major myocutaneous flap are appropriate methods for mouth floor reconstruction. For benign sublingual gland tumours, the resection of tumour and sublingual gland is the preferred treatment.

Palatomaxillary reconstruction with titanium mesh and radial forearm flap

OBJECTIVE The purpose of this study was to assess the treatment and prognosis of the palatomaxillary reconstruction with titanium mesh and the free radial forearm flap. STUDY DESIGN This is a retrospective study of 19 patients with palatomaxillary defects who underwent immediate reconstruction using titanium mesh and a radial forearm flap during the 4-year period from 2004 to 2008. Intraoperatively, the titanium mesh was fixed to the residual bones for the reconstruction of hard-tissue defect after the tumor resection; then the free radial forearm flap was harvested to repair the soft-tissue defect, serving as the intraoral lining and titanium mesh covering. RESULTS Postoperative esthetic appearance and function were followed-up. All of the patients achieved a satisfactory facial appearance. The speech assessment was good, and the oronasal reflux did not occur in all patients. Only 3 patients had titanium mesh exposure during the follow-up period. CONCLUSION The free radial forearm flap with folded titanium mesh is a reliable option for reconstruction of palatomaxillary defects. It is highly effective for swallowing and speech rehabilitation as well as esthetic reconstruction.

The variability and complexity of ameloblastoma: Carcinoma ex ameloblastoma or primary ameloblastic carcinoma

Ameloblastoma is characterized by slow-growing, local invasiveness and high incidence of local recurrence. It usually presents with a benign histological appearance. However, ameloblastoma occasionally demonstrates a clinical course that is characteristic of malignant transformation. Here, we present a case of ameloblastoma with an aggressive clinical course, including multiple recurrences, a short disease-free interval, pulmonary metastasis and extensive skull-base infiltration. With a careful re-evaluation of the histology and cytology of the specimens of primary and recurrent ameloblastoma in 2006 and 2007, malignant transformation was observed and carcinoma ex ameloblastoma was ultimately diagnosed.

Surgical management of maxillofacial fibrous dysplasia under navigational guidance.

Fibrous dysplasia is a benign and slowly progressive disorder of bone in which normal cancellous bone is replaced by immature woven bone and fibrous tissue. Precise excision of the lesion is crucial to restore function and aesthetics. We present our experience using surgical navigation technology for the recontouring of the faces of 8 patients with maxillofacial fibrous dysplasia who were treated from 2012-2013, all of whom were thought suitable for surgical recontouring. Preoperative computed tomography (CT) scans were used to make a virtual plan based on the patients mirrored anatomy. During the operation we fixed a rigid digital reference frame to the patients forehead or mandible, depending on the site of the lesion. The patient and the virtual image were matched through an individual recording technique. A pointing device was in constant use to find out whether the extent of resection was consistent with the preoperative design, and we assessed the surgical outcome by fusion of the preoperative planning and postoperative CT reconstruction images. The acquisition of the data sets was uncomplicated, and the use of surgical navigation improved the safety and the accuracy of the recontouring. There were no complications during 1-2 years follow up. Navigational guidance based on a virtual plan is safe and accurate, and is of value in the management of maxillofacial fibrous dysplasia.

The influence of mild dysplasia at the surgical margin on the prognosis of oral squamous cell carcinoma.

The purpose of this study was to evaluate the clinical relevance between different margin statuses and local recurrence rate in patients undergoing primary surgical treatment for oral squamous cell carcinoma (OSCC). Five hundred and thirty-nine patients with T1-4N0M0 OSCC, who underwent surgery alone at a stomatology hospital in Nanjing, China during the years 2005-2014, were included. Tumour and margin status were assessed. Overall survival (OS), disease-free survival (DFS), and recurrence-free survival (RFS) were calculated by Kaplan-Meier method. Predictors of RFS, OS, and DFS were analysed. Positive or dysplastic margins were found in the initial specimen in 20.0% of the cases. On multivariate analysis, there was no significant difference between RFS (hazard ratio (HR) 1.379, P=0.361) or DFS (HR 1.452, P=0.183) of those with mild dysplasia and those with negative margins. However, patients with mild dysplasia who did not undergo re-excision demonstrated significantly worse RFS (HR 2.286, P=0.010) and DFS (HR 2.070, P=0.014) than those with negative margins. It is concluded that there appears to be a correlation between initial mild dysplastic margins that are not subjected to re-excision and inferior RFS and DFS. Additional attention should be drawn to mild dysplasia at the initial margin in OSCC, and extended excision is suggested.

Keratocystoma of the parotid gland: a clinicopathological study and literature review §

The authors investigated the clinicopathological characteristics of keratocystoma of the parotid gland. Two cases of parotid gland keratocystoma in the files of Nanjing Stomatological Hospital were analysed. These slowly growing parotid gland tumours occurred in two women aged 29 and 49 years. The cut surface showed multilocular cystic lesions filled with keratin materials. Histologically, there were multi-cystic spaces and solid epithelium islands, containing keratinized lamellae. Without cytological atypia, the lining stratified squamous epithelium showed apparent keratinization through an orthokeratotic or parakeratotic pathway. No skin appendage formation was observed. Both cases immunoreactively stained positively for AE1/AE3 and CK5/6 but negatively for CK8/18, S-100 and Calponin. There was no evidence of recurrence 3 or 4 years after superficial parotidectomy. The data from these two cases and cases previously published suggest that keratocystoma of the parotid gland is a benign cystic neoplasm. Surgical resection is apparently sufficient for cure.

Peripheral blood dendritic cells and vascular endothelial growth factor in oral squamous cell carcinoma: correlation analysis and in vitro study.

Vascular endothelial growth factor (VEGF) may cause functional deficiency in dendritic cells (DCs) in vitro. The roles of peripheral blood dendritic cells (PBDCs) and VEGF in patients with oral squamous cell carcinoma (OSCC) are not well understood. The authors analysed the correlation between VEGF and PBDC in 81 OSCC patients. They assessed the effect of VEGF on DC function in vitro. VEGF levels were significantly increased in OSCC patients compared with control subjects (P < 0.05), but PBDC levels were significantly lower (P < 0.05). VEGF expression in TNM I-II (67%) and T1-T2 (74%) was significantly lower, compared with TNM III-IV (88%, P < 0.05) and T3-T4 (89%, P < 0.05). Increased VEGF expression in primary tumours was significantly correlated with elevated serum VEGF levels, but reduced PBDC levels. In vitro cultured DC exposed to VEGF showed significantly decreased expression of functional proteins, enhanced endocytosis activity, and elicited weaker proliferation of T cells, compared with that of free VEGF (P < 0.01). These findings suggest that decreased PBDC and elevated VEGF occur in OSCC patients. Higher VEGF levels may affect precursor cells, resulting in decreased numbers of functional DC.

Functional assessment: Free thin anterolateral thigh flap versus free radial forearm reconstruction for hemiglossectomy defects

Background To compare free thin anterolateral thigh (ALT) flap with free radial forearm (FRF) flap in the reconstruction of hemiglossectomy defects, and to introduce our methods and experience in the tongue reconstruction with free thin ALT flap. Material and Methods The clinicopathologic data of 46 tongue carcinoma cases hospitalized from December 2009 to April 2014 were obtained from Nangjing Stomatological Hospital, Medical School of Nanjing University. All the subjects were evaluated for the articulation and the swallowing function 3 months after the surgery. Results Among these 46 patients, 12 patients underwent tongue reconstruction after hemiglossectomy with ALT flap; 34 patients underwent tongue reconstruction with FRF flap. The differences in the incidence of vascular crisis, the speech and the swallowing function between two groups were not significant (P>0.05). Conclusions Thin ALT flap could be one of the ideal flaps for hemiglossectomy defect reconstruction with its versatility in design, long pedicle with a suitable vessel diameter, and the neglectable donor site morbidity. Key words:Free thin anterolateral thigh flap, free radial forearm flap, hemiglossectomy, reconstruction, morbidity.

Hyalinizing clear cell carcinoma of salivary gland origin in the head and neck: clinical and histopathological analysis

Hyalinizing clear cell carcinoma (HCCC) is an extremely rare neoplasm of salivary gland origin with a low-grade indolent nature. It is difficult to distinguish from other malignant salivary gland tumours. Clinical outcomes following surgery are generally reported as good. The aim of this study was to further determine the features of HCCC. This study was approved by Medical ethics review of affiliated hospital of jiangsu university. Fourteen new cases of HCCC are reported. The clinical and histopathological data of these 14 cases were analysed alongside those of 141 cases identified in a systematic review of the literature (up to 2016). Demographic data, histopathological findings, clinical presentation, primary treatment, and outcomes were extracted. Histologically, HCCC tumour cells had a clear cell morphology with hyalinized stroma. Immunohistochemical results were positive for cytokeratins and EMA, but negative for SMA, S100, vimentin, and calponin. Twelve of the 14 patients showed EWSR1 translocation. Local nodal metastasis on presentation was present in 17.3% and the overall recurrence rate was 17.7% in the total population (N=155), compared with 35.7% and 21.4%, respectively, in the new cases alone. Focal necrosis and local metastasis were identified as possibly associated with recurrence. The overall prognosis was good: only 3.8% of patients died of the disease. HCCC is less indolent than was previously thought, but overall the prognosis is good. Risk factors for recurrence may include focal necrosis and local metastasis at presentation. The best treatment for patients with HCCC is wide local excision combined with regional lymph node dissection.

Soft tissue recurrent ameloblastomas also show some malignant features: a clinicopathological study of a 15-year database

Background To investigate the clinicopathological features of six cases of soft tissue recurrent ameloblastoma and explore the role of increased aggressive biological behavior in the recurrences and treatment of this type of ameloblastomas. Material and Methods In this study, we retrospectively reviewed recurrent ameloblastomas during a 15-year period; six cases were diagnosed as soft tissue recurrent ameloblastoma. The clinical, radiographic, cytological and immunohistochemical records of these six cases were investigated and analyzed. Results All the six soft tissue recurrent ameloblastomas occurred after radical bone resection, and were located in the adjacent soft tissues around the osteotomy regions. In Case 4, the patient developed pulmonary metastasis, extensive skull-base infiltration and cytological malignancy after multiple recurrences and malignant transformation was diagnosed. In the other five cases, although there were no cytological signs are sufficient to justify an ameloblastoma as malignant, some malignant features were observed. In Case 1, the tumor showed moderate atypical hyperplasia and the Ki-67 staining percentage was 40% positive, which are strongly suggestive of potential malignance. In Case 5, the patient developed a second soft tissue recurrence in the parapharyngeal region and later died of tumor-related complications. All the remaining three patients showed cytology atypia of varying degrees and high expression of PCNA or Ki-67, which confirmed active cell proliferation. Conclusions Increased aggressiveness is an important factor of soft tissue recurrence. An intraoperative rapid pathological examination and more radical treatment are suggested for these cases. Key words: Ameloblastoma, soft tissue recurrence, aggressive biological behaviour.