Tsuyoshi Morisaki

Adipose‐derived mesenchymal stromal cells prevented rat vocal fold scarring

This study aimed to reveal the effects of adipose‐derived mesenchymal stromal cells (ASCs) on prevention of vocal fold scarring by investigating how the immediate ASCs transplantation into the injured rat vocal fold affect the levels of gene transcription and translation.

Lenvatinib for Anaplastic Thyroid Cancer and Lenvatinib-Induced Thyroid Dysfunction

Background: Lenvatinib is an oral multitargeted tyrosine kinase inhibitor that has an anticancer action in patients with differentiated thyroid cancer that is refractory to radioiodine. Knowledge of the efficacy and safety of lenvatinib in patients with anaplastic thyroid cancer (ATC) is limited. Tyrosine kinase inhibitors frequently cause hypothyroidism, but the incidence of hypothyroidism with lenvatinib is unclear. Objectives: We conducted a retrospective study to investigate the efficacy and safety of lenvatinib in ATC. Methods: Five patients with unresectable ATC were enrolled. Lenvatinib 24 mg once daily was administered until disease progression, unmanageable toxicity, withdrawal, or death occurred. We retrospectively analyzed the objective response rate (ORR), time to progression (TTP), overall survival, and safety. Results: Three of the 5 patients (60%) had a partial response, and 5 (40%) had stable disease. The ORR was 60%. Median TTP was 88 days, and overall survival was 165 days. Hypothyroidism was a common treatment-related adverse effect; 4 patients (80%) had hypothyroidism of any grade. These 4 patients had not undergone total thyroidectomy prior to lenvatinib administration, and the other patient had undergone total thyroidectomy. Treatment-related adverse effects of any grade were hypertension in 80% of patients, diarrhea in 40%, fatigue in 80%, and decreased appetite in 80%. Conclusions: Lenvatinib is an effective treatment and may improve the prognosis of unresectable ATC. Four of the 5 patients had hypothyroidism, which may have been associated with treatment-induced injury of the thyroid gland. There were many treatment-related adverse effects, most of which were manageable by dose modification and medical therapy.

Mucinous carcinoma occurring in the ceruminous gland

To the Editor: Malignant tumors occurring in the external auditory canal are rare, representing less than 0.2 % of all head and neck cancers. Squamous cell carcinoma is the most common histological subtype, and the occurrence of adenoid cystic carcinoma has also been reported. The external auditory canal contains both sebaceous and ceruminous glands, which are modified apocrine glands. Albeit rare, benign and malignant tumors can occur in the ceruminous gland. Benign ceruminous gland neoplasms can contain ceruminous adenoma, pleomorphic adenoma, and syringocystadenoma papilliferum. Malignant ceruminous gland tumors were found to represent 0.00025 % of all neoplastic lesions in one series, and 2.4 % of all ear neoplasms, and contain adenocarcinoma not otherwise specified, adenoid cystic carcinoma, and mucoepidermoid carcinoma. Mucinous carcinoma can occur in various organs, including the gastrointestinal tract and breast, as well as the skin and salivary gland albeit rare. Herein, we report the first documented case of mucinous carcinoma occurring in the ceruminous gland. A 73-year-old Japanese male without any history of malignant neoplasms presented with a gradually enlarged tumor in his left external auditory canal. Physical examination revealed that a soft sessile tumor with hemorrhagic tendency was present in the posterior wall of the left external auditory canal. Laboratory test showed a slight elevation of serum carcinoembryonic antigen (6.2 mg/ml (range < 6.0)), but the CA19–9 levelwaswithinnormal range (16.1U/mL (range< 37.0)). Biopsy of the tumor revealed mucinous carcinoma. Computed tomography and magnetic resonance imaging revealed no tumorous lesions other than the one in the left external auditory canal, and gastroduodenal endoscopic and colonoscopic examinations also failed to demonstrate presence of other tumorous lesions. Subsequently, resection of the external auditory canal tumor was performed. The post-operative course was uneventful, and the patient has been free from tumor recurrence and metastasis during four months of medical follow-up. Microscopic examination of the resected tumor demonstrated a relatively well-circumscribed nodular lesion within the ceruminous gland (Fig. 1a). Clusters of relatively uniform neoplastic cells with slightly enlarged round nuclei containing small nucleoli and eosinophilic cytoplasm were observed within rich mucinous material (Fig. 1a,b). No mitotic figures were present. The tumor had invaded into the surrounding cartilage, although lymphovascular invasion was not observed. No conventional adenocarcinoma component was present. The ceruminous glands surrounding the tumor were hyperplastic and dilated, however, no nuclear atypia was observed (Fig. 1a). The neoplastic cells were diffusely positive for cytokeratin 7, but negative for cytokeratin 20 (Table S1). Gross cystic disease

Submucosal Abscess of the Esophagus Caused by Piriform Sinus Fistula Treated with Transoral Video Laryngoscopic Surgery

Piriform sinus fistula (PSF) is a rare branchial anomaly that causes repetitive acute suppurative thyroiditis or deep neck abscess. The definitive treatment of PSF is open neck surgery. However, such surgery has a cosmetic problem and a high risk of recurrence. Furthermore, identifying the fistula is difficult due to previous repetitive infections. We report a case of esophageal submucosal abscess caused by PSF treated with endoscopic mucosal incision. The patient underwent transoral video laryngoscopic surgery (TOVS), and endoscopy as well as fluoroscopy revealed complete closure of PSF without any complication. TOVS is a novel surgical technique for the definitive treatment of PSF with esophageal submucosal abscess.

Immunohistochemical Features of Primary Pure Squamous Cell Carcinoma in the Thyroid: An Autopsy Case

Primary squamous cell carcinoma (SCC) in the thyroid is extremely rare and has been reported in < 1% of all thyroid cancer cases. Primary SCC in the thyroid was thought to be a transitional form derived from adenocarcinomas; therefore, the majority of reported cases have focused on the conjunction with other histological adenocarcinomas. A 73-year-old male presented to our hospital with bilateral vocal fold palsy and an anterior neck mass. Ultrasound sonography revealed a bulky tumor in the thyroid and bilateral cervical lymphadenopathy. We performed fine-needle aspiration cytology from the thyroid tumor, which revealed SCC. Positron emission tomography/computed tomography showed distant metastases in the lungs, mediastinal lymph nodes, and vertebra. We diagnosed the patient as having stage IVC SCC in the thyroid and administered weekly paclitaxel. Four and a half months after treatment initiation, the tumor progression resulted in aspiration pneumonia, which proved fatal. We performed an autopsy in accordance with the patient’s wishes. Pathological findings revealed that all carcinomas in the thyroid, cervical lymph nodes, and lungs were pure SCCs. Immunohistochemical examinations for PAX8, thyroglobulin, and TTF-1 were all negative. Differentiated thyroid carcinomas have 3 major positive markers – PAX8, thyroglobulin, and TTF-1 –, and PAX8 is also sometimes positive for SCC in the thyroid. PAX8 positivity of SCC in the thyroid might, however, be associated with conjunction with other histological adenocarcinomas such as papillary or follicular thyroid carcinoma; therefore, pure SCC in the thyroid might be negative for PAX8.

Thyrolipomatosis: A case report with review of the literature

Fatty tissue is not usually present within the thyroid gland. Only a few fat-containing thyroid lesions have been reported to date, and thyrolipoma is the most common fat-containing lesion of the thyroid gland. Thyrolipomatosis is a condition characterized by diffuse mature adipose cell infiltration of the normal thyroid gland. In this report, we describe what is, to the best of our knowledge, the 12th documented case of thyrolipomatosis, and review the fat-containing lesions of the thyroid gland. A 68-year-old Japanese woman presented with a neck mass that had first been noticed ~7 years earlier. A computed tomography scan revealed diffuse thyroid gland enlargement and total thyroidectomy was performed. The histopathological examination revealed that mature fatty tissue was diffusely distributed throughout the thyroid gland, as well as among the hyperplastic follicles. Capsular formation or amyloid deposition were not observed. Nuclear grooves or intranuclear cytoplasmic inclusions were not observed. Accordingly, thyrolipomatosis was diagnosed. Albeit rare, various neoplastic and non-neoplastic thyroid lesions may contain mature fatty tissue. Therefore, thyrolipomatosis must be included in the differential diagnostic consideration of fat-containing lesions of the thyroid gland.

Basaloid squamous cell carcinoma arising in an inverted papilloma in the nasal cavity: A case report and review

Basaloid squamous cell carcinoma (BSCC) is a histologically distinctive variant of squamous cell carcinoma comprising basal cell carcinoma and squamous cell carcinoma. BSCC is aggressive and shows a poor prognosis because of frequent lymph node invasion and distant metastases. BSCC preferentially occurs in the cervix, thymus, and esophagus and is uncommonly found in the head and neck region. BSCC in the nasal cavity or paranasal sinus is particularly rare. Inverted papilloma is an uncommon, benign tumor with a propensity to be associated with malignancy; however, BSCC arising in an inverted papilloma has never been reported. Here we report a case of a 56-year-old woman with BSCC arising in an inverted papilloma in the nasal cavity. The woman was referred to our hospital for epistaxis, nasal congestion, and dysphagia. A tumor was observed to completely occupy the left nasal cavity. The biopsy specimen was histologically diagnosed as papilloma. Computed tomography demonstrated a tumor with heterogeneous contrast effect occupying the left nasal cavity; however, extra-nasal tract extension was not observed. We performed endoscopic excision of the tumor. Microscopic findings confirmed the diagnosis of BSCC arising from an inverted papilloma. No tumor recurrence has been observed for 13 months after surgery.