Wolfgang Anderhuber

The minimally invasive approach to olfactory neuroblastoma: combined endoscopic and stereotactic treatment.

Objectives To describe a new treatment modality of olfactory neuroblastoma consisting of endoscopic nasal and paranasal sinus surgery and stereotactic radiosurgery.

Cystic lymph node metastases of squamous cell carcinoma of Waldeyer's ring origin

SummaryWe analysed in a retrospective study the frequency of cystic lymph node (LN) metastases in neck dissection specimens of 123 patients with primary squamous cell carcinoma (SCC) arising in the palatine tonsils (62 M/14 F), the base of the tongue (38 M/5 F) and the nasopharynx (2 M/2 F). Eighty-two per cent of patients had metastases (64 tonsillar SCC, 33 base of tongue SCC and all four nasopharynx SCC) in 368 LN of a total 2298 sampled LN. Thirty-nine per cent of patients had exclusively solid metastases and 37% of patients had exclusively cystic metastases. A total of 62 patients had some signs of cyst formation in one or more metastatically affected LN (27 with only histological evidence of cyst formation with luminal diameters < 5 mm, 35 with clinically detectable cyst with luminal diameter > 5 mm). Cystic metastases were more common in patients with SCC of the base of the tongue (P = 0.005), while solitary clinically evident cystic metastasis with lumina > 5 mm were found exclusively in tonsillar carcinoma (P = 0.024). In comparison with solid metastases, cyst formation was associated with N-categories (N2b and N3, P = 0.005) in SCC of the base of the tongue origin. No such association was observed for tonsillar SCC (P = 0.65). The primary mechanism of cyst formation was cystic degeneration.

Plasma Adrenaline Concentrations During Functional Endoscopic Sinus Surgery

Objectives/Hypothesis: Vasoconstrictors (i.e., epinephrine) are routinely applied before functional endoscopic sinus surgery (FESS) but may have significant cardiac side effects. The controversy concerning clinical application of adrenaline is discussed. Study Design: In a prospectively controlled study of 51 patients undergoing FESS we evaluated the absorption of adrenaline from standard cotton pledgets and submucous infiltration and the incidence of related side effects during surgery. Additionally, a control group of 12 patients undergoing tonsillectomy was investigated. Methods: Plasma adrenaline concentrations were measured 1) before anesthesia, 2) after intubation, 3) after nasal packing with adrenaline soaked pledgets (adrenaline 1:1000) and submucous infiltration with 2 mL lidocaine with adrenaline 1:100,000 in each side, and 4) at end of surgery. The catecholamines were determined with a Merck‐Hitachi Catecholamine Analyzer, model II (Merck, Darmstadt, Germany). Pulse, electrocardiogram (ECG), and blood pressure were monitored. Results: In the FESS group, we found a remarkable decrease in systolic (S) as well as diastolic blood pressure (D) (P < .001), whereas the heart frequency was unaffected during surgery. All patients in the adrenaline group showed significant increase in plasma adrenaline (AD) concentrations in the third and fourth sample (P < .001). The control group, however, showed a significant rise in blood pressure only at beginning of surgery (P < .001) with cardiac pulse and plasma adrenaline concentrations unaffected by surgery or anesthesia. The often described severe side effects of adrenaline in combination with general anesthesia were not seen in any of our patients. Conclusions: Although systemic absorption of locally injected vasoconstrictors occurs, adrenaline‐related side effects during FESS are extremely rare when the patient is monitored exactly.

Bilateral sensorineural hearing disorders in children: etiology of deafness and evaluation of hearing tests.

OBJECTIVE The purpose of this study was to determine the etiology of bilateral sensorineural hearing disorders in children and to evaluate the performed hearing tests by comparison of the results of the objective and subjective tests. METHODS The medical history and the hearing tests (behavioral observation audiometry, acoustic evoked potentials and pure tone audiometry) of 106 bilaterally hearing impaired children were analyzed in a retrospective follow-up study. RESULTS The total group included 52 males and 54 females. The ages at first diagnosis ranged from 4 months to 11 years with a mean age of 42 months and a median of 33 months. The degree of hearing loss for the better hearing ear was mild in one child, moderate in 28 children, severe in 29 children, profound in 32 children and total in 16 children. The delay between the first examination and diagnosis ranged from 0 to 597 days with a mean of 83 days and a median of 28 days. In 47 children (44%) no cause of hearing impairment could be determined. Nineteen children (18%) had a history of familial hearing loss, 40 (38%) suffered from acquired hearing loss (seven children had prenatal causes, 21 perinatal and 12 postnatal). A comparison between behavioral observation audiometry and brainstem evoked response audiometry revealed a statistically good agreement. Twenty-nine children (32%) showed progressive hearing loss, which was defined as a threshold shift of +10 dB or more in the pure tone average in at least one ear. CONCLUSIONS In a significant number of children with early hearing impairments the etiology still remains uncertain. Further research in the field of genetic disorders will diminish this number. Evaluation of hearing tests showed that behavioral observation audiometry still is an excellent tool in the hands of an experienced examiner. The age at identification of hearing disorders in industrialized countries still is unacceptably high. To obtain ideal care of hearing impaired children, universal neonatal hearing screening programs are mandatory.

Primary mucosal melanomas of the nasal cavity and paranasal sinuses

We present 14 patients with primary sinonasal melanomas (SM) identified from 1984–1997 in our archives (11/14 lateral nose, 1/14 nasal septum, 2/14 paranasal sinuses; 8M/6F, mean age 67.7 years, range 39–88 years). Survival was poor (median 9 months) with death related to extensive local disease and/or widespread hematogenous metastases. The following histological subtypes were identified in descending order: amelanotic small blue cell, pleomorphic, epithelioid, spindle cell and myxoid. High mitotic rate and vascular invasion, absence of tumor‐infiltrating lymphocytes and regression were features shared by all SM. Negative staining of B‐ and T‐cell markers, LCA, neuroendocrine markers such as NSE, chromogranin and synaptophysin, and CK‐negativity excluded olfactory neuroblastoma, small cell undifferentiated carcinoma, and lymphoma. S‐100 protein was expressed in all SM, but demonstrated variable staining intensity with areas of complete negativity. HMB45 was strongly and uniformly (>80%) expressed in all undifferentiated small blue cell SM. The pigmented SM were predominantly HMB45‐negative. The strong HMB45 staining in amelanotic small blue cell SM is explained by the reaction of HMB45 antibody with an oncofetal antigen found in immature melanosomes. In these poorly differentiated amelanotic malignant melanomas, antibody to HMB45 proved to be a superb diagnostic marker. We therefore strongly advocate the inclusion of HMB45 antibody in the panel of antibodies for initial work‐up of undifferentiated mucosal neoplasms, since a negative S‐100 stain in small biopsy material may result in incorrect classification of these neoplasms.

Induction chemotherapy with docetaxel, cisplatin and 5-fluorouracil followed by radiotherapy with cetuximab for locally advanced squamous cell carcinoma of the head and neck☆

PURPOSE To determine the efficacy and feasibility of induction chemotherapy (ICT) with docetaxel, cisplatin and 5-fluorouracil followed by radiotherapy and cetuximab (C) in patients with locally advanced head and neck cancer. PATIENTS AND METHODS Forty-nine previously untreated patients with local advanced stage III and IV squamous cell carcinoma of the head and neck (SCCHN) received three courses of ICT consisting of docetaxel 75mg/m(2) day 1, cisplatin 75mg/m(2) day 1 and infusional 5-fluorouracil 750mg/m(2)/day on days 1-5 followed by radiotherapy plus C at 250mg/m(2)/week (after an initial loading dose of 400mg/m(2)). RESULTS After completion of ICT 44 of 49 patients received radiotherapy plus C. Three months after therapy completion tumour response was observed in 33 patients and after two years, 25 patients were in complete remission (CR). The most common grade 4 toxicity during the whole treatment period was dermatitis (30%), followed by mucositis (27%) and neutropenia (17%) without fever. One toxic related death was observed during ICT. Two-year progression-free survival (PFS) rate was 59% and two-year overall survival (OS) rate was 63%, respectively. CONCLUSION Concurrent radiotherapy plus C after three courses of ICT was feasible and was associated with promising CR, PFS and OS rates. Further optimisation of dose and sequence is warranted.

Case report of bilateral cervical chondrocutaneous branchial remnants

Cervical chondrocutaneous branchial remnants are rare and not well known lesions. Histologically the lesion per definition presents as a Choristoma. Choristoma is the pathohistological term for a developmental tumor-like anomaly consisting of tissues foreign to the site at which it is located. Treatment is complete surgical removal as promptly as possible in order to get an exact histopathological diagnosis. A case of a 4-month-old boy with cervical chondrocutaneous branchial remnants anterior to the sternocleidomastoid muscles on both sides is presented. According to literature search this appears to be the second case published on such a bilateral lesion.

Cavernous haemangioma in the infraorbital nerve canal : an unusual expansion in the maxillary sinus

A patient with a four-week history of hypaesthesia and recurrent swelling of the cheek in the left infraorbital region presented with a computed tomography (CT) scan demonstrating an expansion in the infraorbital nerve canal, thought to be a neuroma. The tumour was surgically removed without complications and no bleeding. Histopathological investigation showed a partially thrombosed cavernous haemangioma. To our knowledge, after reviewing the literature, this is the first report of a cavernous haemangioma in the infraorbital nerve canal.

Simultaneous occurrence of metastatic tonsillar squamous cell carcinoma and angioimmunoblastic T-cell lymphoma in a cervical lymph node.

Non-Hodgkins lymphoma (NHL) is a frequent head and neck malignancy. Squamous cell carcinoma of the tonsil is the second most common head and neck carcinoma. We report a case of a tonsillar carcinoma metastasis in an angioimmunoblastic-transformedlymph node. To our knowledge this is the first description and histopathological documentation of such a case in the literature.

Retro- and para-pharyngeal ganglioneuroma

A patient with slight dysphagia and dyspnoea on exertion was referred to us. We diagnosed a large retro- and para-pharyngeal ganglioneuroma. The mass was surgically removed in toto. The case is presented and the features are discussed.