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And Neck Lesions (and + neck_lesion)
Kinds of And Neck Lesions Selected AbstractsLymphatic Mapping and Sentinel Lymphadenectomy for 106 Head and Neck Lesions: Contrasts Between Oral Cavity and Cutaneous Malignancy,THE LARYNGOSCOPE, Issue S109 2006FACS, Francisco J. Civantos MD Abstract Objectives: The objectives of this prospective series were to present our results in 106 sequential cases of lymphatic mapping and sentinel lymph node biopsy (SLNB) in the head and neck region and contrast the experience in oral cancer with that for cutaneous lesions. Hypotheses: SLNB has an acceptably low complication rate in the head and neck. Lymphatic mapping and gamma probe-guided lymphadenectomy can improve the management of malignancies of the head and neck by more accurate identification of the nodal basins at risk and more accurate staging of the lymphatics. For appropriately selected patients, radionuclide lymphatic mapping may safely allow for minimally invasive sentinel lymphadenectomy without formal completion selective lymphadenectomy. Methods: One hundred six patients underwent intralesional radionuclide injection and radiologic lymphoscintigraphy (LS) on Institutional Review Board-approved protocols and 103 of these underwent successful SLNB. These included 35 patients with malignant melanoma, 10 cutaneous squamous cell carcinomas, four lip cancers, eight Merkel cell carcinomas, two rare cutaneous lesions, and 43 oral cancers. Mean follow up was 24 months. Patients with oral cavity malignancy underwent concurrent selective neck dissection after narrow-exposure sentinel lymph node excision. In this group, the SLNB histopathology could be correlated with the completion neck specimen histopathology. Patients with cutaneous malignancy underwent SLNB alone and only received regional lymphadenectomy based on positive histology or clinical indications. Data were tabulated for anatomic drainage patterns, complications, histopathology, and patterns of cancer recurrence. Results: Surgical complications were rare. No temporary or permanent dysfunction of facial or spinal accessory nerves occurred with sentinel node biopsy. Lymphatic drainage to areas dramatically outside of the expected lymphatic basins occurred in 13.6%. Predictive value of a negative sentinel node was 98.2% for cutaneous malignancies (based on regional recurrence) and 92% with oral cancer (based on pathologic correlation). Gross tumor replacement of lymph nodes and redirection of lymphatic flow represented a significant technical issue in oral squamous cell carcinoma. Sixteen percent of patients with oral cancer were upstaged from N0 to N1 after extended sectioning and immunohistochemistry of the sentinel node. Conclusions: LS and SLNB can be performed with technical success in the head and neck region. Complications are minimal. More accurate staging and mapping of lymphatic drainage may improve the quality of standard lymphadenectomy. The potential for minimally invasive surgery based on this technology exists, but there is a small risk of missing positive disease. Whether the failure rate is greater than that of standard lymphadenectomy without gamma probe guidance is not known. New studies need to focus on refinements of technique and validation of accuracy as well as biologic correlates for the prediction of metastases. [source] Mycobacterium avium complex infection in a neck abscess: A diagnostic pitfall in fine-needle aspiration biopsy of head and neck lesionsDIAGNOSTIC CYTOPATHOLOGY, Issue 7 2009Valerie A. Fitzhugh M.D. Abstract Fine-needle aspiration biopsy (FNAB) is a useful tool in the diagnosis of mycobacterial disease, especially Mycobacterium tuberculosis. However, nontuberculous mycobacterial infection diagnosed with FNAB material is much rarer, with Mycobacterium avium complex being the most common. In this report, we present the case of a 21-year-old HIV positive man, who presented with a unilateral, tender, enlarging cervical neck mass. FNAB had revealed acute inflammation. Mycobacterium avium complex grew in culture from the material that was aspirated and was confirmed by DNA probe. Because of the paucity of articles on this subject in the cytology literature, it is important to reiterate the value of the material aspirated at the bedside and the clinic in the diagnosis of infectious disease. When faced with antibiotic-resistant cellulitis and abscesses, the FNAB material must be sent for acid fast bacteria smears and culture. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source] Cytohistologic correlations in schwannomas (neurilemmomas), including "ancient," cellular, and epithelioid variantsDIAGNOSTIC CYTOPATHOLOGY, Issue 8 2006Jerzy Klijanienko M.D. Abstract Schwannoma accounts for one of the most common benign mesenchymal neoplasms of soft tissues. Although it is well defined in the cytology literature, particular histologic subtypes such as "ancient," cellular and epitheliod variants could be a source of diagnostic difficulties. We have reviewed cytology aspirates and corresponding histologic sections from 34 schwannomas diagnosed at Institut Curie. Histologically, 24 cases were classic, 5 were "ancient," 4 were cellular, and 1 was epithelioid schwannomas. No example of melanotic schwannoma was recorded. Original cytologic diagnosis was schwannoma in 13 (38.2%) cases, benign soft tissue tumor in 11 (32.4%), pleomorphic adenoma in 2 (6%) cases, angioma in 1 (2.9%) case, nodular fasciitis in 1 (2.9%) case, suspicious in 3 (8.8%) cases, and not satisfactory in 3 (8.8%) cases. There were no major differences between classical, "ancient," cellular, and epithelioid variants on cytology smears. Myxoid stroma, mast cells, and intranuclear inclusions were limited to classical subtype. Similarly, cyto-nuclear atypia was more frequent in classical subtype than in other subtypes. Schwannoma should be differentiated from well-differentiated malignant peripheral nerve sheath tumor, neurofibroma, and pleomorphic adenoma, in the last instance particularly for head and neck lesions. Diagn. Cytopathol. 2006;34:517,522. © 2006 Wiley-Liss, Inc. [source] MYC gene amplification reveals clinical association with head and neck squamous cell carcinoma in Indian patientsJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 10 2009N. Bhattacharya Background:, Amplification of the MYC gene is reported to be associated with the development of head and neck squamous cell carcinoma (HNSCC). This study is focused to analyze the correlation between MYC gene amplification and various clinicopathological features and outcome in a cohort of 49 dysplastic and 187 primary head and neck lesions. Methods:,MYC gene amplification was assessed by differential polymerase chain reaction using primer sets from the MYC gene as target locus and DRD2 gene as the control locus. Result:, The MYC gene amplification was detected in a total of 23.7% (56/236) head and neck lesions comprising 14.2% (7/49) dysplastic lesions and 26% (49/187) HNSCC samples. The clinicopathological association study between MYC gene amplification with the different clinical parameters like sex, tumor stage, tumor differentiation, lymph node status, tobacco habit and HPV 16/18 status determined significant association of MYC amplification with tumor progression (P = 0.009). Kaplan Meier analysis revealed MYC gene has no prognostic significance on survival in HNSCC. Conclusion: , In conclusion, our results suggest that MYC gene amplification is associated with tumor progression in HNSCC. [source] Argon Plasma Coagulation (APC) in Palliative Surgery of Head and Neck MalignanciesTHE LARYNGOSCOPE, Issue 7 2002Ulrich Hauser MD Abstract Objectives Surgical reduction of bulky disease is an important treatment option in patients with incurable head and neck malignancies. In general, conventional tumor ablation is associated with significant hemorrhage, and the resulting tumorous wound surface entails aftercare problems. Argon plasma coagulation (APC) represents a novel technique providing effective hemostasis and wound sealing. Thus, APC features requirements of particular interest in palliative surgery of the head and neck. Study Design Using APC, we performed 18 palliative tumor resections in a series of 8 consecutive patients with recurrent head and neck lesions. Five patients received repeated APC treatment up to five times. Methods APC as non-contact, high-frequency electrosurgery under inert argon plasma atmosphere allows dissection, hemostasis, and desiccation of tumor tissue in a one-step procedure. In consideration of the limited and heterogeneous group of patients, results are interpreted descriptively. Results In every case of palliative surgery, APC caused efficient hemostasis, which helped significantly to reduce both time exposure of the operation and intraoperative loss of blood. Only one APC-unrelated complication occurred (transient rhino-liquorrhea), and none of the patients developed postoperative hemorrhage. Finally, APC produced dry and clean wound surfaces facilitating surgical aftercare. The achieved esthetic and functional improvements strengthened the patient's autonomy and social acceptance. Conclusion APC is highly recommended for palliative surgery of head and neck malignancies. [source] Low recurrence rate after surgery for dermatofibrosarcoma protuberansCANCER, Issue 5 2004A multidisciplinary approach from a single institution Abstract BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare sarcoma with a propensity for local recurrence. Treatments with wide excision, Mohs surgery, and other approaches have been reported with widely variable local control rates. The objective of this study was to review the experience with a multidisciplinary approach employing wide excision and Mohs surgery selectively in the treatment of patients with DFSP at a single academic institution over the past 10 years. METHODS The records of 62 patients with 63 DFSP tumors who underwent wide excision, Mohs surgery, or a multidisciplinary combination approach from January 1991 to December 2000 were reviewed retrospectively. Primary endpoints included the ability to extirpate the DFSP lesion completely, the tumor recurrence rate, and the need for skin grafts or local tissue flaps. Additional objectives included defining surgical practice patterns at the authors' institution. RESULTS Sixty-three DFSP lesions were removed from 62 patients. At a median follow-up of 4.4 years, no local or distant recurrences were detected in any patient. Forty-three lesions were treated with wide local excision, 11 lesions were treated with Mohs surgery, and 9 lesions were treated with a combination approach. Ninety-five percent of lesions that were approached initially with wide local excision were cleared histologically. Two patients (5%) received postoperative radiation for positive margins after undergoing maximal excision. Eighty-five percent of lesions that were approached initially with Mohs surgery were cleared histologically. The remaining 15% of lesions subsequently were cleared surgically with a wide excision. DFSP lesions that were approached initially with Mohs surgery tended to be smaller. Patients with head and neck lesions most often underwent Mohs surgery or were treated with a multidisciplinary combination approach (87%). CONCLUSIONS Wide local excision with careful pathologic analysis of margins was found to have a very low recurrence rate and was used for the majority of patients with DFSP lesions at the authors' institution. Wide local excision, Mohs surgery, and a multidisciplinary combination approach, selected based on both tumor and patient factors, were capable of achieving very high local control rates in the treatment of DFSP. The evolution of a multidisciplinary approach has provided a level of expertise that no single individual could achieve for the treatment of the full spectrum of DFSP lesions at the authors' institution. Cancer 2004;100:1008,16. © 2004 American Cancer Society. [source] | ||||||||||