Shogo Shinohara

Implantation metastasis of head and neck cancer after fine needle aspiration biopsy.

One possible complication of the aspiration biopsy of malignant tumors is dissemination of tumor cells along the needle track. However, a search of the literature revealed few definite reports of implantation metastases of head and neck tumors after fine needle aspiration biopsy (FNAB). Here we report two cases of skin metastasis of head and neck cancer after FNAB, including a patient with papillary adenocarcinoma of the thyroid and one with adenoid cystic carcinoma of the submandibular gland. Surgical treatment prevented the spread of the tumor in both cases and there have been no evidence of recurrence to date. This report should alert head and neck surgeons to the possibility of implantation metastasis after FNAB.

Clinical features of sudden hearing loss associated with a high signal in the labyrinth on unenhanced T1-weighted magnetic resonance imaging

Abstract We report on five patients with high signals in the labyrinth on unenhanced magnetic resonance imaging who developed sudden hearing loss and vertigo. Weissman et al. (1992) suggested the possibility that such high signals were caused by hemorrhage. We assessed these patients using audiograms, caloric tests, and auditory brainstem responses to investigate the possibility of inner ear hemorrhage. Most of the patients were found to have severe and irreversible impairment of both cochlear and vestibular function. These findings were consistent with the hypothesis that their symptoms were caused by inner ear hemorrhage.

Reduction of [(18)F]fluoromisonidazole uptake after neoadjuvant chemotherapy for head and neck squamous cell carcinoma.

PurposeThe purpose of this study was to investigate the changes of tumor hypoxia as a result of neoadjuvant chemotherapy (NAC) by measuring the changes of [18F]fluoromisonidazole ([18F]FMISO) positron emission tomography (PET) uptake, as well as to look into the ability of [18F]FMISO PET to predict the NAC result.ProceduresA total of 13 patients with locally advanced head and neck squamous cell carcinoma underwent [18F]FMISO PET scans before and after NAC. For analysis of PET index, maximum standardized uptake value, tumor-to-muscle ratio, and hypoxic volume (HV) were measured.ResultsAll PET indexes of [18F]FMISO significantly decreased after NAC. Although HV in primary tumor and a few indexes before NAC in responder was lower than that in nonresponder, none of the indexes were statistically significant.ConclusionsPretreatment [18F]FMISO could not predict NAC outcome in this study. However, [18F]FMISO uptake significantly decreased after NAC, and [18F]FMISO PET seemed to be a useful noninvasive tool for detecting hypoxia reduction after NAC.

Sequential FDG-PET/CT after Neoadjuvant Chemotherapy is a Predictor of Histopathologic Response in Patients with Head and Neck Squamous Cell Carcinoma

PurposeTo evaluate whether 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) more accurately predicts the histopathologic response to neoadjuvant chemotherapy (NAC) than magnetic resonance imaging (MRI) in patients with head and neck squamous cell carcinoma (HNSCC).ProceduresSixteen patients with HNSCC underwent FDG-PET/CT and MRI scans before and after one cycle of NAC, followed by surgical resection. The 26 surgically resected specimens of the 16 patients were analyzed. Decreases in maximum standardized uptake value (SUVmax) or in tumor maximum size (diametermax) were calculated, and their accuracies for the prediction of histopathologic response were evaluated.ResultsIn histopathologic responders (n = 7), percent decreases in SUVmax were significantly higher (P < 0.001) than in non-responders (n = 19). Applying a cut-off point of 55.5%, the histopathologic response could be predicted with a sensitivity and specificity of 86% and 95%, respectively.ConclusionFDG-PET/CT can predict histopathologic NAC responses with higher accuracy than MRI in HNSCC patients.

Prognostic value of pretreatment 18F-fluorodeoxyglucose positron emission tomography/CT volume-based parameters in patients with oropharyngeal squamous cell carcinoma with known p16 and p53 status

The purpose of this study was to determine whether pretreatment 18F‐fluorodeoxyglucose‐positron emission tomography (18F‐FDG PET/CT) volume‐based parameters, such as metabolic tumor volume and total lesion glycolysis, add more prognostic information in patients with oropharyngeal squamous cell carcinoma (SCC).

Cortical activation during optokinetic stimulation - an fMRI study.

Conclusion: Activation of cortical areas related to visual motion processing and control of eye movement, and deactivation of parieto-insular vestibular cortices (PIVC) were revealed by functional magnetic resonance imaging (fMRI) with small-field optokinetic stimulation (OKS). The results agreed well with those of previous studies, which indicates that the current protocol is reliable enough to be used as a clinical examination. Objectives: To propose an fMRI set-up with OKS that is reliable and simple enough to be performed as a clinical test. Subjects and methods: Ten right-handed healthy volunteers participated in this study. fMRI was used to measure blood oxygen level-dependent (BOLD) signal increases (contrast: OKS – rest) and decreases (contrast: rest – OKS) during small-field OKS. Functional images were acquired using a standard clinical scanner operating at a magnetic field strength of 1.5 T. The data were analyzed by statistical parametric mapping (SPM2), and the significance level was set at p<0.001, uncorrected. Results: BOLD signal increases were observed in the visual association area of both hemispheres (BA19) (MT/V5), primary visual cortex (BA17) of the right hemisphere, bilateral superior parietal lobules (BA7), and bilateral frontal eye fields (BA6). Decreases of BOLD signals were observed in the PIVC bilaterally.

Suture granuloma showing false-positive finding on PET/CT after head and neck cancer surgery

We report herein two cases of suture granuloma showing focal intense 2-deoxy-2-[(18)F]fluoro-d-glucose (FDG)-uptake in positron emission tomography (PET). Follow-up FDG-PET after surgical intervention for head and neck cancer revealed lesions with high FDG-uptake, which were highly suspected of being a recurrent tumor. The lesions were subjected to excisional biopsy for definitive diagnosis. Histopathological examination proved them to be suture granulomas caused by non-absorbable silk sutures. It should be emphasized that suture granulomas can show false-positive findings on FDG-PET, thus requiring differential diagnosis from recurrent tumors.

Brain metabolism of children with profound deafness: a visual language activation study by 18F-fluorodeoxyglucose positron emission tomography.

Conclusion. The use of fluorodeoxyglucose positron emission tomography (FDG-PET) with a visual language task provided objective information on the development and plasticity of cortical language networks. This approach could help individuals involved in the habilitation and education of prelingually deafened children to decide upon the appropriate mode of communication. Objectives. To investigate the cortical processing of the visual component of language and the effect of deafness upon this activity. Subjects and methods. Six prelingually deafened children participated in this study. The subjects were numbered 1–6 in the order of their spoken communication skills. In the time period between an intravenous injection of 370 MBq 18F-FDG and PET scanning of the brain, each subject was instructed to watch a video of the face of a speaking person. The cortical radioactivity of each deaf child was compared with that of a group of normal- hearing adults using a t test in a basic SPM2 model. Results. The widest bilaterally activated cortical area was detected in subject 1, who was the worst user of spoken language. By contrast, there was no significant difference between subject 6, who was the best user of spoken language with a hearing aid, and the normal hearing group.

Osteoradionecrosis of the cervical vertebrae in patients irradiated for head and neck cancers

Osteoradionecrosis (ORN) is one of the common late adverse effects that follow radiation therapy for head and neck cancers. ORN usually develops on the mandible and less frequently on the maxilla. We present three cases of ORN of the cervical vertebrae, which is rarely reported. Two patients suffered from secondary osteomyelitis after neoadjuvant chemotherapy followed by definitive concurrent chemoradiation therapy with a hyperfractionated and an accelerated hyperfractionated regimen, respectively. For these patients, the high intensity of treatment was considered the cause of ORN. The third patient underwent concurrent chemoradiation therapy for upper thoracic esophageal cancer and subsequently underwent endoscopic laser resection and radiation therapy for hypopharyngeal cancer. ORN developed in the area of reirradiation. In this case, an excessive radiation dose was considered the cause. ORN of cervical vertebrae, different from that of the mandible and maxilla, has a risk of radiculopathy and myelopathy. In the future, ORN of cervical vertebrae will increase because metachronous double cancers will increase and opportunities for reirradiation, in turn, will increase. To prevent this, it is necessary to optimize the treatment schedule for radiation therapy, including the total dose, fractionation, and concurrent chemotherapy, and to decrease the volume of cervical vertebrae within the irradiation field.

Successful treatment of locally advanced anaplastic thyroid carcinoma by chemotherapy and hyperfractionated radiotherapy

The authors report a case of anaplastic thyroid carcinoma which was treated with chemotherapy and radiotherapy and proved to achieve pathological CR (complete response) after a radical operation. A 53-year-old female presented with a mass of about 4 cm in diameter arising from the left lobe of her thyroid and surrounding her cervical esophagus. Pre-operative aspiration cytology and open biopsy revealed the tumor was a giant cell anaplastic carcinoma. There was no sign of distant metastasis. Two cycles of chemotherapy were very effective in treating the tumor but regrowth appeared to occur during hyperfractionated radiotherapy. A radical operation, including a resection of the larynx, cervical trachea and esophagus, was successfully performed and no living cancer cells, only granulation and necrosis, were observed in the operation specimen. The patient has been alive for over 2 years since without any evidence of recurrence.