Valentina Manciocco

CO2 laser cordectomy for early-stage Glottic carcinoma: A long-term follow-up of 156 cases

Objectives To define when laser resection of early‐stage glottic carcinoma is indicated and to compare the results obtained by laser surgery with other therapeutic options.

Ectopic Lingual Thyroid as Unusual Cause of Severe Dysphagia

Ectopic lingual thyroid is an uncommon embryological aberration characterized by the presence of thyroid tissue located in a site different from the pretracheal region as in the normal. Lingual thyroid is the most frequent ectopic location of the thyroid gland, although its clinical incidence varies between 1:3000 and 1:10,000. We present the case of a 26-year-old woman who presented severe dysphagia caused by a mass located on the base of the tongue in the midline. An endoscopic partial removal of the ectopic tissue allowed her to rapidly regain her swallowing capacity. The literature regarding the incidence and diagnosis of lingual thyroid is reviewed and the possibilities of treatment discussed.

Treatment and outcome of advanced external auditory canal and middle ear squamous cell carcinoma.

This is a retrospective study to evaluate the outcomes and complications of combined treatment, surgery with or without adjunctive intraoperative radiotherapy, of locally advanced temporal bone squamous cell carcinoma. A series of 17 patients with locally advanced squamous cell carcinoma of the temporal bone were treated between September 2002 and February 2007. Eleven patients had primary tumors, and 6 patients had recurrences. According to the University of Pittsburgh staging system, 5 patients were stage II (T2 N0), 6 patients were stage III (5, T3 N0 and 1, T1 N1), and 6 patients were stage IV (5, T3 N2b and 1, T4 N0). All patients underwent lateral temporal bone resection and pedicle flap reconstruction. Eight patients received intraoperative and postoperative radiotherapies, 4 patients underwent postoperative radiation alone, whereas 5 patients did not receive any adjunctive treatment. Median follow-up was 29.5 months. No major complications were observed. No patients were found to have residual gross tumor. Disease-free survival was 73.3%, and overall survival was 75.6%. Radical external auditory canal and/or middle ear canal resection is of utmost importance to obtain a good surgical outcome. Postoperative radiotherapy is necessary to obtain good local control; no major adverse effects were observed in the intraoperative radiotherapy patients. The incidence of major complication is minimal after pedicle flap reconstruction.

Swallowing ability and chronic aspiration after supracricoid partial laryngectomy

Objective: Sporadic episodes of aspiration may occur after supracricoid partial laryngectomy. To prevent risks of pulmonary consequences, a limitation of oral intake of food or a “nothing by mouth” regimen has been suggested. The objective of this study was to evaluate the long-term swallowing and pulmonary status of patients after supracricoid partial laryngectomy. Study Design: Case series with chart review. Setting: Tertiary University Hospital Policlinico “Umberto I” and Santa Lucia Foundation, Rome, Italy. Subjects and Methods: The swallowing status of a selected group of 116 patients who recovered functional deglutition after supracricoid partial laryngectomy was analyzed during follow-up consultation. Swallowing evaluation included clinical observation, fiberoptic endoscopic evaluation of swallowing, and a videofluoroscopy. When aspiration was confirmed by videofluoroscopy, a high-resolution computed tomography (CT) of the chest was performed in order to assess the radiological manifestations of aspiration. A group of 45 patients with chronic obstructive pulmonary disease and normal deglutition was used as a control. Results: Seventy-nine patients out of 116 showed a fiberoptic endoscopic evaluation of swallowing suggestive for aspiration; only 45 patients had aspiration confirmed by videofluoroscopy. No significant differences in radiological findings were noted in the patients affected by postoperative chronic aspiration compared to the control group. Conclusion: Patients with functional deglutition after supracricoid partial laryngectomy show a mild and well-tolerated degree of chronic aspiration and do not require a limitation of oral intake of food.

Prognostic value of resection margins in supracricoid laryngectomy

Objectives The objective was to assess the prognostic value of surgical margin involvement in patients treated for squamous cell carcinoma of the larynx.

Rhabdomyoma of the Parapharyngeal Space Presenting with Dysphagia

Rhabdomyoma is an exceedingly rare soft tissue benign tumor of skeletal muscle origin classified into cardiac and extracardiac types based on location. Extracardiac rhabdomyoma is further classified into adult, genital, and fetal type depending on the degree of differentiation. Adult rhabdomyomas are rare, but morphologically characteristic, benign mesenchymal tumors with mature skeletal muscle differentiation that in 90% of cases arise in the head and neck region, mainly in the mucosa of the oropharynx, nasopharynx, and larynx, from the branchial musculature of third and fourth branchial arches. Most patients are between 40 and 70 years old, with a mean age of 60 years with a male predominance. Usually presenting symptoms include upper airway obstruction, Eustachian tube dysfunction, and mucosal or neck mass, but rarely does it arise as pure dysphagia. This article presents a case of parapharyngeal rhabdomyoma presenting with only progressive dysphagia.

MicroRNA expression as predictor of local recurrence risk in oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) is the sixth most common cancer worldwide with a high rate of recurrence. MicroRNAs (miRNAs) are gene regulators playing an important role in oral carcinogenesis. The purpose of this study was for us to identify and functionally characterize miRNAs that predict recurrence in OSCC.

Allelic Expression Imbalance of TP53 Mutated and Polymorphic Alleles in Head and Neck Tumors

TP53 is the most widely mutated gene across all cancer types. In head and neck cancer, approximately half of the tumors are found to contain TP53 mutations, which are correlated to an increased risk for locoregional recurrence and poor outcomes. In this study a mutational profiling of TP53 exons 5-8 was performed on tumor, peritumor and normal tissues from 57 HNSCC patients by direct sequencing of genomic DNA and cDNA. Cloning/sequencing in tumors carrying multiple TP53 mutations and semiquantitative SNaPShot mutation assay was performed in order to assess eventual allelic expression imbalances (AEI). We identified 24 out of 57 HNSCC patients (42%) carrying TP53 mutations and 5 patients carrying the R213R polymorphism. Cloning of the genomic DNA encompassing TP53 exons 5-8 from tumors with multiple TP53 mutations revealed that alleles carrying different types of TP53 mutations are present in these tumors. TP53 missense and nonsense mutations exhibit higher and lower TP53 transcript abundance compared to wild-type TP53 allele, respectively. Interestingly, three out of four patients with the R213R polymorphism analyzed were found positive for TP53 loss of heterozygosity (LOH) and also presented higher transcript abundance than the wild-type counterpart, specifically, in the tumor tissue and not in peritumor or normal tissues. HNSCC tumors present heterogenic cell populations carrying different TP53 mutations. All HNSCC samples analyzed show an alteration in the expression of mutated TP53 mRNA compared to the wild-type allele, most likely independently from the TP53 hemizygous status. The higher expression of R213R TP53 polymorphic allele in cancer tissue compared to normal tissue demonstrates a noninherited variation in allelic expression, independently from its mutation status for exons 5-8, suggesting a potential contribution to TP53 expression in HNSCC disease.

Planned neck dissection after chemoradiotherapy in advanced oropharyngeal squamous cell cancer: the role of US, MRI and FDG-PET/TC scans to assess residual neck disease.

OBJECTIVE To investigate the ability of neck ultrasounds (US), magnetic resonance imaging (MRI) and positron emission tomography (FDG-PET/TC) in detecting residual nodal disease after chemoradiotherapy in patients with advanced oropharyngeal squamous cell carcinoma (OPSCC). METHODS From 2006 to 2009, 36 consecutive patients affected by OPSCC with bulky nodal disease (>3 cm), treated with primary concurrent chemoradiotherapy, were enrolled prospectively. Nodal response to treatment was assessed by using US, MRI and FDG-PET/CT. Planned neck dissection (ND) was performed in all the patients, and the histopathological node status was compared to the imaging findings in order to establish sensitivity, specificity, accuracy and predictive values of each technique. RESULTS Metastatic disease was assessed in 18/37 (48.6%) hemi-necks, always localized in levels II-IV. US showed greater sensitivity (77.8%) and, combined with FDG-PET/TC, produced the highest negative predictive value (93.3%). US, MRI and FDG-PET/TC scans showed the highest specificity (100%), accuracy (93.8%) and positive predictive values (100%). CONCLUSIONS In the presence of advanced OPSCC with bulky nodal disease, US combined with FDG-PET/TC could be a reliable and cost-effective strategy to identify patients with complete nodal response to chemoradiotherapy that might not require post-treatment ND but only observation. When residual disease in the neck was detected, selective ND was recommended.

Pectoralis major myocutaneous flap for hypopharyngeal reconstruction: long-term results.

Surgical treatment of hypopharyngeal cancer is indicated in advanced stages and recurrent/persistent disease after conservative regimens. As of today, no criterion standard treatment is applicable to all cases. Comparing functional results, complication rates and feasibility of different techniques proposed (free flaps, gastric pull-up, etc), and poor outcome in disease-free survival and in overall survival are more related to the tumor stage rather than the reconstruction technique. The authors discuss reconstructive surgery performed in 52 patients using a pectoralis major myocutaneous flap, according to a technique proposed by Spriano et al in 2001, after total circular partial/total hypopharyngectomy and total laryngectomy from January 1993 to 2008. Primary surgical treatment was performed in 38 patients. Surgery after radiotherapy/chemotherapy failure was performed in 8 patients. Surgery after chemotherapy was performed in 6 patients. Postoperative radiation treatment was administered in 35 patients. Two patients did not receive complementary radiotherapy: 1 patient died perioperatively and 1 had previous radiation treatment in 2002 for oropharyngeal cancer. Follow-up period ranged from a minimum of 7 months to a maximum of 15 years. Overall survival was 19.6%. To date, disease-free survival is 9 (17.3%) of 52 patients. Long-term follow-up shows that late complications are low or absent. For this reason, we consider this procedure to be time-sparing and safe, especially in this category of patients commonly affected by malnutrition and other long-term diseases.