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Adult rhabdomyoma is a rare, usually solitary, primary tumour of striated muscle origin that almost exclusively presents in the head and neck region with predilection for male. We herein present a rare case of a multifocal adult rhabdomyoma in a 72-year-old woman. The lesions were located, the first one in the area of the left aryepiglottic fold and the second one right cervical arising from oesophagus. The diagnosis of the cervical mass was obtained prior to resection through cytological examination (FNAC). We discuss the clinical, cytological and histological findings and we provide a brief review of the literature on this entity.

Background: Only very limited data are available in the literature on the incidence of childhood cancer of the head and neck worldwide., Methods: Based on data obtained from the national German Childhood Cancer Registry, a total of 370 malignancies of the head and neck in children under the age of 15 (199 boys and 171 girls), which were reported to this institution between 1994 and 2003, were analysed in this study., Results: The overall incidence of malignancies of specific sites of the head and neck in Germany is 4.48 per 100000 children. The most frequently observed entities, representing primary tumours, are soft tissue sarcomas (0.39/100000), lymphomas (0.09/100000) and thyroid carcinoma (0.07/100000). The most commonly affected organs are the thyroid (1.21/100000), orbita (0.91/100000), nasopharynx (0.66/100000), tonsils (0.43/100000) and paranasal sinuses (0.14/100000). Overall, boys are more frequently affected than girls; however, incidence increases in girls with age and exceeds that of boys in the age group between 10 and 14 years., Conclusions: This is a first statistical evaluation detailing cumulative incidences of various histologic types of malignancies of the head and neck including age and gender distribution as well as organ-specific localization in children below the age of 15 in Germany.

Sonography of the head-and-neck region is well established in the preoperative diagnostic process of tumorous lesions. Its intraoperative use to localise small tumours, however, has been rarely investigated to date. We applied intraoperative ultrasound to 19 patients who underwent parotid surgery and evaluated the following criteria: intraoperative tumour presentation, scan quality, comparison between sonographic visualisation and tumour detection by palpation, histological tumour borders as well as postoperative complications. All lesions were reproduceable by intraoperative ultrasound and could be demonstrated in sufficient quality. None of the 19 parotid tumours could be identified by palpation pre- and intraoperatively. All tumour capsules remained intact, the tumours were completely removed and no postoperative complications were observed. Problems of ultrasound application may arise due to significantly altered anatomic landmarks while surgical preparation proceeds. Intraoperative ultrasound is fast, dynamic and feasible under sterile conditions. Especially in parotid surgery with small, non-palpable tumours, intraoperative ultrasound supports minimal-invasive surgery.

Aim: Ultrasound (US) is a cost effective and time saving examination method for diseases of the neck,and can be used without any known side effects or limitations. US tied into modern navigation devices may significantly improve intraoperative orientation in regions with soft tissue characteristics., Methods: 22 patients with soft tissue tumours of the head and neck underwent surgical procedures assisted by CAS system LandmarX (Medtronic) in combination with the US system DynaVievP II (Aloka). Clinical feasibility of using intraoperative US in navigated surgical procedures has been investigated by paying particular attention to the surgical approach, possible interferences from surgical instruments and time consumption., Results: In the case of soft tissue shift, US can provide a sequence of a section of the operative field and, without delay, an instant comparison with the preoperative imaging data set. The feasibility of using this method is severely limited by the additional preparation required, the unfamiliar handling during surgery, and design-related matters., Conclusions: Integrating US into a navigation device could provide additional useful information for a more controlled resection of soft tissue disease of the neck and below the base of the skull.

Background: Adult rhabdomyoma is a rare mesenchymal tumor, which generally grows slowly and is mainly localized in the head and neck area., Patient and Methods: We report the extraordinary case of a rapidly growing adult rhabdomyoma in a 73-year-old man. The patient was treated for diffuse large B-cell non-Hodgkin's lymphoma with CHOP therapy (doxorubicin, cyclophosphamide, vincristine, and prednisone). Comparison of the respective computed tomography scans showed prominent enlargement of 35% in the tumor mass volume on the right side of the neck within 3 months. The tumor was highly suspicious for lymphoma. Surgical resection was performed., Results: Histological examination revealed a tumor which was composed of tightly packed polygonal cells with a PAS-positive granular or vacuolated cytoplasm, occasionally with cross-striations. Immunohistochemically, the cells were positive for desmin, myogenin, Myo-D1, but negative for S-100. Due to these characteristic morphologies, adult rhabdomyoma was diagnosed., Conclusion: This is the first report on an adult rhabdomyoma with a proven rapid enlargement. The possible pathomechanisms are discussed.

Objective: The cyclooxygenases (COX) 1 and 2 are the rate-limiting enzymes of prostaglandin E(2) (PGE(2)) synthesis, and the upregulation of COX-2 has been reported in tumors of different origins. The aim of our study was to quantify the PGE(2) expression in squamous cell carcinoma and surrounding mucosa, to analyze the potential of acetylsalicylic acid (ASA) for reducing PGE(2) levels in these tissues, and to improve our understanding of potential tumor-derived stimulation of surrounding mucosa by PGE(2)., Study Design and Setting: Intracellular PGE(2) levels in primary head and neck squamous cell carcinoma (HNSCC) and the surrounding mucosa at 1 and 2 cm distance were analyzed ex vivo by ELISA. Subsequently, we treated in vitro tumor and normal mucosal cells from turbinates with recombinant PGE(2) and ASA, and quantified intracellular PGE(2) levels., Results: We observed high PGE(2) levels in the tumor samples and in tumor-surrounding mucosa. The addition of PGE(2) and arachidonic acid to tumor cell cultures resulted in no further increase in intracellular PGE(2) levels, while ASA reduced PGE(2) levels by up to 40%. In normal epithelial cell cultures, less PGE(2) (6% of that found in the tumor cells) was expressed, but stimulation with PGE(2) resulted in levels comparable to those of the tumor samples., Conclusion and Significance: We conclude that HNSCC and the surrounding mucosa express high levels of PGE(2). This expression is reduced efficiently by ASA. We propose a stimulation of PGE(2) expression in the epithelium surrounding HNSCC by tumor-derived PGE(2) with a potential impact on tumor growth., (Copyright 2005 S. Karger AG, Basel.)

Background: Positron emission tomography (PET) offers an opportunity to examine noninvasively cellular functions with different tracers. [(18)F]Fluorodeoxyglucose (FDG) is most commonly used in identifying malignant tumors. Several tumor biologic characteristics (tumor cell viability, growth faction, treatment response to radiation, cell membrane dysfunction, recurrence rate) are suggested to be characterized by [(18)F]FDG PET. The aim of this study was to assess which other tumor biologic characteristics of squamous-cell carcinoma of the head and neck are correlated with [(18)F]FDG PET., Methods: [(18)F]FDG PET was performed in 14 patients with squamous-cell carcinomas of the upper digestive tract (TNM classification T(2)-T(4), N(1)-N(3)). After attenuation correction, predefined areas of the tumor were semiquantitatively analyzed by the technique of the region of interest and calculated as standard uptake values (SUV). Afterwards, 5 biopsies of different tumor regions were obtained during endoscopy in each patient under general anesthesia, and a correlation between SUV of [(18)F]FDG PET and tumor biologic parameters was attempted. These parameters included: quantitative DNA measurements (i.e. 2c deviation index, 5c exceeding rate), immunohistochemical assessment of growth fraction (i.e. Ki67-MIB-1, PCNA) along with morphological tumor front grading., Results: The results revealed a marked variation of proliferation and cellular differentiation in various regions of the tumor for all parameters examined. There was a close correlation between [(18)F]FDG uptake and growth fraction (r = 0.83 for Ki67-MIB-1 and r = 0.8 for PCNA). A poor correlation was found between DNA aneuploidy (r = 0.4) or tumor front grading (r = 0.12) and [(18)F]FDG uptake., Conclusions: Our results confirm previous clinical and histologic observations that squamous-cell carcinomas of the upper digestive tract are heterogeneous tumors. Ki67 antigen, which has been shown to be of predictive value for proliferation and individual prognosis, correlated with [(18)F]FDG uptake. Using [(18)F]FDG PET, the main proliferation centers of inhomogeneous squamous-cell carcinomas could be identified with possible clinical implications for patient management., (Copyright 2001 S. Karger AG, Basel)

Unlabelled: Sonography of the head and neck mainly focuses on tumours of the lateral neck. Even though most of these masses are enlarged lymph nodes, other tumors have to be considered., Aim: To determine whether different pathological cervical masses display a characteristic sonographic morphology., Method: On the basis of 530 sonographical findings in the neck, typical ultrasound characteristics either in B-scan or in colour coded sonography were demonstrated., Results: Apart from enlarged lymph nodes, it was possible to differentiate other occurrences such as branchial cysts, abscesses, laryngoceles, lipomas, neurinomas, glomus tumours, paragangliomas and also fibromas by their specific ultrasound appearance., Conclusion: Knowledge of characteristic ultrasound morphology allows the early detection of tumours and facilitates the distinction between benign and malignant lesions as well as malformations. Further diagnostic procedures and therapeutical strategies can therefore be planned more adequately.

We evaluated the use of a novel three-dimensional ultrasound imaging device in patients with various head and neck lesions. The investigated system was found to be a valuable adjunct to conventional ultrasound in head and neck evaluations. A disadvantage of the three-dimensional system was the need for expensive technical equipment.

The dynamic relationship of lymph node metastases to surrounding vascular structures in the neck is important for preoperative patient assessment. When carotid artery involvement is suspected, this relationship often determines whether or not to operate. In the case of adhesive neck metastases along the internal jugular vein, it becomes possible to predict preoperatively if the integrity of this vein may be preserved. Ultrasonography has the ability to differentiate subtle from gross adherence, or simple compression from vascular invasion. This is done by manually palpating the tumor mass and asking the patient to perform various maneuvers while observing on a monitor the relationship of the tumor mass to the nearby artery. This article correlates the preoperative computed tomography/magnetic resonance imaging (CT/MRI) and ultrasound findings in 41 patients with large nodal metastases which were subsequently confirmed during surgery. In case of positive ultrasonographic invasion of the carotid artery, a transcranial Doppler ultrasonography (TCD) exam was performed to confirm adequate crossflow. Our experience with ultrasonography and TCD in patients with suspected involvement of the carotid artery shows reliable results and obviates in our hands the routine need for more complex, invasive, and expensive tests.

Background: Quantitative DNA measurements have demonstrated prognostic relevance in various malignancies, including head and neck cancer. The application of DNA measurements in monitoring and predicting the outcome of chemotherapy in treating patients with head and neck cancer was investigated., Methods: Twenty-five patients with advanced squamous cell carcinomas of the head and neck who underwent primary chemotherapy with three courses of cisplatin and 5-fluorouracil (5-FU) were examined in this study. Cytologic smears from the tumor site, as well as from normal mucosa, were taken before and 1 week after each course of chemotherapy. Quantitative DNA measurements were performed using an automatic microscope and a TV-based image analysis system. The DNA parameters (ie, mean DNA content of the tumor cells, 2c deviation index (2c DI), 5c exceeding rate (5c ER), DNA malignancy grade, and stemline analysis) were determined from the single cell measurements., Results: Tumors which responded to chemotherapy showed a shift of the mean DNA content and stemline towards euploidy and a decrease of aneuploid tumor cells with a DNA content of more than 5c. Tumors which did not respond to chemotherapy showed a persistent high percentage of aneuploid tumor cells and a high malignancy grade. These changes in the DNA content were observed after the first course of chemotherapy. In a clinical follow-up, patients with a shift of the DNA data towards euploidy during chemotherapy showed a significant longer recurrence-free interval than patients with residual aneuploid cell clones., Conclusions: Quantitative DNA measurements appear to be useful in monitoring therapy and to predict the outcome after chemotherapy. Although no typical constellation was found which predicts good or bad response, the DNA data suggest that changes in the data after the first course of chemotherapy may correlate with outcome.

Defects in the head and neck region following extensive tumor removal are sometimes difficult to reconstruct by local or free flaps. An epithesis is a recommended alternative in defects of the ear, the nose or the orbital region. Nevertheless problems may arise in the appropriate fixation of the epithesis. With the intermobile-cylinder-implant-system (IMZ), the epithesis is firmly fixed by means of osseointegration of the implants and an abutment in the area of the defect. The various steps of the operation and clinical applications are presented.