Stanisław Żyłka

Nowotwory złośliwe jam nosa i zatok przynosowych w materiale własnym – charakterystyka epidemiologiczna i kliniczna ☆

Summary Introduction Sinonasal malignances (SNM) usually present as a difficult diagnostic and therapeutic problem. In the paper presented, the epidemiological and clinical characteristics of SNM, diagnosed in Holy Cross Cancer Center in Kielce (Dept. of Otolaryngology, Head and Neck Surgery), from 2001 to 2007, as well as a calculated survival rates are discussed. Material and methods From the hospital data and current clinical observations of 87 patients with SNM the age, sex, localization, stage of the disease, pathology and treatment applied, was taken for analysis. In cases with at least 3 year observation, the Kaplan-Meier survival curves were calculated. Results In the analyzed group of 87 cases, ranging from 8 to 82 years of age (average 62,3 years), there was 48 male, and 39 female patients (M : F = 1,2 : 1). 59,8% of all group was in the age above 60 years, with the most common age group 71–80 years (33,3%). The most common defined localization was a maxillary sinus (33,3%), but due to very advanced stage at time of diagnosis in 37,9% of cases, the precise localization within the region was not possible to define. The primary epithelial tumors were diagnosed in 52,9% (n = 46), of all SNM, the non epithelial malignant tumors in 42,5% (n = 37), and metastatic tumors to the nose and paranasal sinuses in 4,6% (n = 4). In the group of epithelial SNM the Squamous cell carcinoma dominated (26/46–56,5%), and in the non epithelial SNM the most common group was a malignant lymphoma (10/37–27,0%). At time of diagnosis the majority of patients with epithelial SNM (80,4%) presented with advanced local stage of the disease (T3 + T4a + T4b). The combined modality treatment was applied in the most of patients in the analyzed group (79,3%). The probability of 3 years disease free survival, calculated with Kaplan-Meier method was 64,0%, and 5-years survival – 45,0%. Conclusions 1. The SNM present as a very heterogeneous group of tumors 2. The most common SNM are a Squamous cell carcinoma, and malignant lymphoma. 3. The majority of SNM are diagnosed at then advanced stage of local disease. 4. The calculated probability of 3-years survival was 64,0%, and 5-years survival 45,0%. 5. The diagnostic, as well as therapeutic approach to SNM requires a multidisciplinary cooperation.INTRODUCTION Sinonasal malignances (SNM) usually present as a difficult diagnostic and therapeutic problem. In the paper presented, the epidemiological and clinical characteristics of SNM, diagnosed in Holy Cross Cancer Center in Kielce (Dept. of Otolaryngology, Head and Neck Surgery), from 2001 to 2007, as well as a calculated survival rates are discussed. MATERIAL AND METHODS From the hospital data and current clinical observations of 87 patients with SNM the age, sex, localization, stage of the disease, pathology and treatment applied, was taken for analysis. In cases with at least 3 year observation, the Kaplan-Meier survival curves were calculated. Results. In the analyzed group of 87 cases, ranging from 8 to 82 years of age (average 62.3 years), there was 48 male, and 39 female patients (M:F = 1.2:1). 59.8% of all group was in the age above 60 years, with the most common age group 71-80 years (33.3%). The most common defined localization was a maxillary sinus (33.3%), but due to very advanced stage at time of diagnosis in 37.9% of cases, the precise localization within the region was not possible to define. The primary epithelial tumors were diagnosed in 52.9% (n=46), of all SNM, the non epithelial malignant tumors in 42.5% (n=37), and metastatic tumors to the nose and paranasal sinuses in 4.6% (n=4). In the group of epithelial SNM the Squamous cell carcinoma dominated (26/46-56.5%), and in the non epithelial SNM the most common group was a malignant lymphoma (10/37-27.0%). At time of diagnosis the majority of patients with epithelial SNM (80.4%) presented with advanced local stage of the disease (T3+T4a+T4b). The combined modality treatment was applied in the most of patients in the analyzed group (79.3%). The probability of 3 years disease free survival, calculated with Kaplan-Meier method was 64.0%, and 5-years survival--45.0%. CONCLUSIONS (1) The SNM present as a very heterogeneous group of tumors. (2) The most common SNM are a Squamous cell carcinoma, and malignant lymphoma. (3) The majority of SNM are diagnosed at then advanced stage of local disease. (4) The calculated probability of 3-years survival was 64.0%, and 5-years survival 45.0%. (5) The diagnostic, as well as therapeutic approach to SNM requires a multidisciplinary cooperation.

Obraz epidemiologiczny i kliniczny czerniaka złośliwego jam nosa i zatok przynosowych – analiza 6 przypadków

Summary Introduction The mucosal malignant melanoma (MM), represent a rare group of tumors (0,2%–8% of all MM), with predominant localization on the mucosal surface of head and neck region, where the localization on the mucosa of nasal cavity, paranasal sinuses and oral cavity are the most common. The mucosal MM within the nose and paranasal sinuses represent approximately 4% of all malignant tumors in these localizations, affecting predominantly the age group over 60-es, equally in both sexes. The treatment of choice in mucosal MM is surgery followed by Rtg-therapy in cases of small or doubtful margins of resection. The prognosis of mucosal MM is poor with 8% to 30% of 5-years survival. Materials and methods 6 cases of mucosal MM, selected from 72 of all MM in the head and neck region, diagnosed and treated from 2001 to 2007 in Dept. of ORL HN lateral wall of nasal cavity – 2; and paranasal sinuses – 2. In 1 case an extremely rare pathologic form of amelanotic MM was diagnosed. The surgical resection of tumor followed by Rtg-therapy was performer in 4 cases. In 1 case, the radical surgery was the only method of treatment, and in 1 case the palliative Rtg-therapy was only applied. Within the observation period (4–96 months) 3 patients died, all due to the fatal progression of the MM. Conclusions 1. Mucosal MM localized in the nasal cavity and paranasal sinuses, present a very rare, but highly diversified group of malignant tumors. 2. The surgery, followed by Rtg-therapy is still the treatment method of choice. 3. The prognosis of mucosal MM in the nose and paranasal sinuses is bad.INTRODUCTION The mucosal malignant melanoma (MM), represent a rare group of tumors (0.2%--8% of all MM), with predominant localization on the mucosal surface of head and neck region, where the localization on the mucosa of nasal cavity, paranasal sinuses and oral cavity are the most common. The mucosal MM within the nose and paranasal sinuses represent approximately 4% of all malignant tumors in these localizations, affecting predominantly the age group over 60-es, equally in both sexes. The treatment of choice in mucosal MM is surgery followed by Rtg-therapy in cases of small or doubtful margins of resection. The prognosis of mucosal MM is poor with 8% to 30% of 5-years survival. MATERIALS AND METHODS 6 cases of mucosal MM, selected from 72 of all MM in the head and neck region, diagnosed and treated from 2001 to 2007 in Dept. of ORL H&N Surgery, Holy Cross Cancer Center in Kielce. RESULTS In group of mucosal MM which was taken to analysis there was 5 female and 1 male patient, with range of age from 55 to 80 (mean--69.4) with following localization: nasal septum--2 cases; lateral wall of nasal cavity--2; and paranasal sinuses--2. In 1 case an extremely rare pathologic form of amelanotic MM was diagnosed. The surgical resection of tumor followed by Rtg-therapy was performer in 4 cases. In 1 case, the radical surgery was the only method of treatment, and in 1 case the palliative Rtg-therapy was only applied. Within the observation period (4-96 months) 3 patients died, all due to the fatal progression of the MM. CONCLUSIONS (1) Mucosal MM localized in the nasal cavity and paranasal sinuses, present a very rare, but highly diversified group of malignant tumors. (2) The surgery, followed by Rtg-therapy is still the treatment method of choice. (3) The prognosis of mucosal MM in the nose and paranasal sinuses is bad.

Przerzuty nowotworów złośliwych do ślinianki przyusznej i regionu przyusznicy

Summary Introduction Among the malignant tumors found within the parotid gland, the primary tumors, as well as a metastatic tumors may be found. Aim Epidemiological and clinical characteristic, and preliminary assessment of treatment results of metastatic tumors to the parotid gland and the parotid region. Material and methods The retrospective analysis of 60 cases with metastatic tumors to the parotid gland and parotid region, selected from the material of Dept. ORL HN Malignant Melanoma 25,0%). The therapy with radical intention was applied in 75,0% of patients treated, mostly combined surgery and radiotherapy. 25,0% of patients received symptomatic and palliative treatment only. In the group with 3 (17 cases) and 5 years (6 cases) of observation accordingly, 53,1% and 33,3% total survival was achieved. Conclusions The most common primary localization of metastases to the parotid region are Squamous Cell Carcinoma and Malignant Melanoma of the head and neck skin. Metastases to the parotid gland and region are usually diagnosed in the advanced local stage of the disease. The treatment of choice in mentioned above metastases are surgery followed by radiotherapy. The unfavorable prognosis of metastatic tumors to the parotid gland and parotid region may be improved, with systematic follow up of the patients with the skin cancer.

Wznowy po leczeniu raka masywu szczękowo-sitowego – ocena uwarunkowań i wyników leczenia ratunkowego

THE AIM OF THIS STUDY is to demonstrate epidemiological and clinical parameters of the group of patients with sinonasal malignancies and to analyze its impact on development of recurrences after primary surgical treatment conducted in Head and Neck Surgery Department of Holly Cross Cancer Center Kielce during 7-years period 2001-2007. The retrospective analysis of the group of 42 patients with sinonasal malignancies was made, based on medical record and outpatient follow-up, considering: age, sex, primary focus, histological outcome, local and clinical stage and methods of the therapy. In the group of patients with at least 3-years period of follow-up (n=42) the dependence the rate of oncological failures such as local recurrence, nodal metastases, distant metastases or the second primary focus on clinical and epidemiological factors was analyzed. The probability of survival rate was also estimated. The studied group consists of 42 patients (27M, 15K, M:K = 1.8:1). Age ranged from 28 to 87. The most common localization was maxillary sinus--59.5%. Patients with high local (T3, T4) and clinical (III, IV) stage constitute 77.5% of the studied group. In 66.7% cases the radiation therapy had to follow the surgery. In the group of 42 patients with at least 3-years period of follow-up the oncological failure appeared in 17 cases (40.5%): local recurrence (8), nodal metastases (7), distant metastases (1) and all of them in 1 case. The treatment was performed through: local recurrence (surgery in 2 cases, CHTH--3, symptomatic treatment--3), nodal metastases (RND--3, SND--4, supplementary radiotherapy--7), distant metastases--CHTH--2 cases. Thanks to these procedures the 5-year survival rate is 23.1% and the 3-year survival rate is 29.4%. CONCLUSIONS (1) The oncological failure after primary surgical treatment in the group of patients with sinonasal malignancies developed in 40.5% cases, mainly as local recurrence or nodal metastases. (2) Primary localization and sex have no impact on the rate of the recurrence. (3) The oncological failures significantly more often relate to young patients with high local, clinical stage and low grade of malignancies. (4) The recurrence after primary surgical treatment in the group of patients with sinonasal malignancies substantially reduces 3- and 5-year survival rate (29.4%; 23.1%) compared with the entire studied group--54.8%; 40.0%.Summary The aim of this study is to demonstrate epidemiological and clinical parameters of the group of patients with sinonasal malignancies and to analyze its impact on development of recurrences after primary surgical treatment conducted in Head and Neck Surgery Department of Holly Cross Cancer Center Kielce during 7-years period 2001–2007. The retrospective analysis of the group of 42 patients with sinonasal malignancies was made, based on medical record and outpatient follow-up, considering: age, sex, primary focus, histological outcome, local and clinical stage and methods of the therapy. In the group of patients with at least 3-years period of follow-up (n = 42) the dependence the rate of oncological failures such as local recurrence, nodal metastases, distant metastases or the second primary focus on clinical and epidemiological factors was analyzed. The probability of survival rate was also estimated. The studied group consists of 42 patients (27M, 15K, M:K = 1.8:1). Age ranged from 28 to 87. The most common localization was maxillary sinus – 59.5%. Patients with high local (T3, T4) and clinical (III, IV) stage constitute 77,5% of the studied group. In 66.7% cases the radiation therapy had to follow the surgery. In the group of 42 patients with at least 3-years period of follow-up the oncological failure appeared in 17 cases (40.5%): local recurrence (8), nodal metastases (7), distant metastases (1) and all of them in 1 case. The treatment was performed through: local recurrence (surgery in 2 cases, CHTH – 3, symptomatic treatment – 3), nodal metastases (RND – 3, SND – 4, supplementary radiotherapy – 7), distant metastases – CHTH – 2 cases. Thanks to these procedures the 5-year survival rate is 23.1% and the 3-year survival rate is 29.4%. Conclusions 1. The oncological failure after primary surgical treatment in the group of patients with sinonasal malignancies developed in 40.5% cases, mainly as local recurrence or nodal metastases. 2. Primary localization and sex have no impact on the rate of the recurrence. 3. The oncological failures significantly more often relate to young patients with high local, clinical stage and low grade of malignancies. 4. The recurrence after primary surgical treatment in the group of patients with sinonasal malignancies substantially reduces 3- and 5-year survival rate (29.4%; 23.1%) compared with the entire studied group – 54.8%; 40.0%.

Rak brodawkowaty tarczycy w torbieli przewodu tarczowo-językowego

Summary Introduction Thyroglossal duct cyst is one of the most common congenital malformation in the neck area, but malignant neoplasms of the thyroglossal duct cyst are rare, about 1–1,5% cases of TDC. The papillary thyroid carcinoma is the most frequent malignant neoplasm of thyroglossal duct cyst. The recommended treatment is surgery, including excision of not only TDC, but also thyroid gland, with subsequent J131 ablation and suppressant dose of thyroxine. Aim of study Review of literature and presentation of 3 cases of papillary thyroid carcinoma in thyroglossal duct cyst. Material and methods Analysis of clinical records and current observation of patients treated in Department of Otolaryngology Head and Neck Surgery, Holy Cross Cancer Center in Kielce. Conclusion Clinical pattern of thyroglossal duct carcinoma and diagnostic process (USG + BAC) do not indicate the presence of neoplasms commonly. The diagnosis is established just after histopathological examination of a resected cyst, what requires a consecutive steps of treatment.

Nowotwory przerzutowe w śliniance przyusznej

Summary Not only primary malignancies but also metastatic tumors may be found within the parotid gland. Aim Epidemiological and clinical characteristic, and preliminary assessment of treatment results. Material and methods The retrospective analysis of 95 cases with metastatic tumors to the parotid gland, selected from the material of HN Malignant Melanoma 28.4%). 81% of patients underwent radical therapy intentionally – mostly combined surgery and radiotherapy. 19.0% of patients received symptomatic and palliative treatment only. In the group with 3 and 5 years of observation accordingly, 51.7% and 34.0% total survival was achieved. Conclusions 1. Squamous Cell Carcinoma and Malignant Melanoma of the head and neck skin are the most common origin of metastases to the parotid gland. 2. This kind of metastases are usually diagnosed in the advanced local stage of the disease. 3. The treatment of choice is surgery followed by radiotherapy. 4. Systematic follow-up can probably improve survival prognosis.

Mięsak gładkokomórkowy – niezwykle rzadki nowotwór złośliwy części nosowej gardła☆☆☆

Summary Malignant nasopharygeal neoplasms are relatively rare. Anaplastic nasopharyngeal carcinoma is the most common and the most malignant one. In this paper, we present a case of 56-year old patient with high-grade leiomyosarcoma of nasopharynx. The final diagnosis was achieved by using immunohistochemical methods – SMA (+), Caldesmon (+/−), Desmin (+/−), bcl 2 (+/−), EMA (−), S-100 (−), CD 34 (−), MIB 1 – 70% cells. The patient was successfully treated with radical radiotherapy IMRT technique (total dose 7000 cGy in 7 weeks). Currently, the patient has no symptoms and signs of the disease (oncological follow-up; CT imaging, PET-CT). This case is the first nasopharyngeal leiomyosarcoma reported in Poland, and probably the second one in the world.

Przerzuty nowotworów złośliwych do ślinianki przyusznej i regionu przyusznicyMetastases to the parotid gland and parotid region

Summary Introduction Among the malignant tumors found within the parotid gland, the primary tumors, as well as a metastatic tumors may be found. Aim Epidemiological and clinical characteristic, and preliminary assessment of treatment results of metastatic tumors to the parotid gland and the parotid region. Material and methods The retrospective analysis of 60 cases with metastatic tumors to the parotid gland and parotid region, selected from the material of Dept. ORL HN Malignant Melanoma 25,0%). The therapy with radical intention was applied in 75,0% of patients treated, mostly combined surgery and radiotherapy. 25,0% of patients received symptomatic and palliative treatment only. In the group with 3 (17 cases) and 5 years (6 cases) of observation accordingly, 53,1% and 33,3% total survival was achieved. Conclusions The most common primary localization of metastases to the parotid region are Squamous Cell Carcinoma and Malignant Melanoma of the head and neck skin. Metastases to the parotid gland and region are usually diagnosed in the advanced local stage of the disease. The treatment of choice in mentioned above metastases are surgery followed by radiotherapy. The unfavorable prognosis of metastatic tumors to the parotid gland and parotid region may be improved, with systematic follow up of the patients with the skin cancer.