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The unique case of a 55-year-old man with multifocal adenolymphoma (Warthin's tumour) of both parotid glands, the neck and post-nasal space is presented. Warthin tumour is almost exclusively a parotid tumour but is known to be bilateral in 7-10% of cases and multifocal in 2% of cases. Most extraglandular Warthin tumours have been located in neck lymph nodes and only a few cases have been reported from other sites. The presented case is unique in having synchronous and metachronous Warthin tumours, as well as one of the tumours being neither truly parotid, nor within a lymph node.

Rationale and Objectives The quantitative assessment of neck lymph nodes in the context of malignant tumors requires an efficient segmentation technique for lymph nodes in tomographic three-dimensional (3D) datasets. We present a stable 3D mass-spring model for lymph node segmentation in computed tomography (CT) datasets. Materials and Methods For the first time our model concurrently represents the characteristic gray value range, directed contour information, and shape knowledge, which leads to a robust and efficient segmentation process. Results Our model design and the segmentation accuracy were both evaluated with 40 lymph nodes from five clinical CT datasets containing malignant tumors of the neck. Conclusion The segmentation accuracy proved to be comparable to that of manual segmentations by experienced users and significantly reduced the time and interaction needed for the lymph node segmentation.

The quantitative assessment of neck lymph nodes in the context of malign tumors requires an efficient segmentation technique for lymph nodes in tomographic 3D datasets. We present a Stable 3D Mass-Spring Model for lymph node segmentation in CT datasets. Our model for the first time represents concurrently the characteristic gray value range, directed contour information as well as shape knowledge, which leads to a much more robust and efficient segmentation process. Our model design and segmentation accuracy are both evaluated with lymph nodes from clinical CT neck datasets.

OBJETIVO: determinar el valor del tratamiento electivo del cuello y el riesgo de enfermedad microscópica en pacientes sin adenopatías al diagnóstico (N0). MATERIAL Y MÉTODOS: de 318 pacientes con diagnóstico histológico de carcinoma epidermoide de lengua móvil, tratados entre 1967 y 1997, 247 presentaron un estadio N0. Características: 187 varones y 56 mujeres; edad mediana: 57 años (24-89); estadios I: 69 pacientes, II: 101 pacientes, III: 39 pacientes, IV: 11 pacientes y 23 pacientes recidivas postquirúrgicas. El tumor primario fue tratado con braquiterapia (121 pacientes), irradiación externa (17 pacientes) o combinación de ambas (105 pacientes). Las áreas ganglionares se trataron con cirugía electiva en 13 pacientes, irradiación electiva en 127 pacientes (dosis mediana: 50 Gy), y 103 pacientes fueron sometidos a observación. Análisis estadístico: test Kaplan-Meier y Log-rank para comparación de curvas de supervivencia. RESULTADOS: la supervivencia causa específica y el control local actuarial a 5 años fue 65,3% y 66,9%, respectivamente. El intervalo libre de enfermedad locorregional a 5 años fue del 52,1%. La tasa de recidiva ganglionar según la modalidad de tratamiento cervical fue 0%, 21,3% y 25,7% para cirugía electiva, irradiación electiva y observación, respectivamente. El control ganglionar actuarial a 5 años fue para los mismos grupos del 100%, 78,7% y 74,3% (p=NS). Para evaluar el riesgo de enfermedad microscópica, analizamos la influencia de las variables pronósticas en el subgrupo de 93 pacientes con estadios precoces sometidos a observación. La única variable identificada como factor pronóstico independiente en el análisis multivariante fue el espesor tumoral, con un control ganglionar actuarial a 5 años del 16,7% vs. 86,7%, para espesores mayores y menores de 1 cm, respectivamente (p=0,0003). CONCLUSIONES: dada la alta incidencia de recidiva ganglionar y la baja supervivencia en los pacientes con esta recidiva, consideramos aconsejable el tratamiento electivo del cuello en pacientes con tumores de lengua móvil. PURPOSE: To determine the role of the neck elective treatment and the risk of occult lymph node metastases in clinically negative (N0) early stage mobile tongue carcinomas. METHODS AND MATERIALS: The study of 243 out of 318 patients with histologically confirmed mobile tongue carcinomas with clinically negative neck seen between 1967 and 1999 is presented. The sample consisted of 187 males and 56 females with a median age of 57 years (range, 24-89 years). According to the 2002 TNM stage classification, 69 patients belonged to stage I, 101 patients to stage II, 39 patients to stage III, and 11 patients to stage IV. The primary tumors were treated by brachytherapy alone (121 patients), external beam radiation therapy alone (17 patients) or a combination of both (105 patients). The management of the neck lymph nodes was individualized according to the characteristics of the patients: 13 were treated with elective neck dissection, 17 with elective neck irradiation (median dose 50 Gy), and 103 patients were carefully followed up without any elective treatment. The statistical analysis was made by means of the Kaplan-Meyer and Log-rank tests for survival curves comparison. RESULTS: The five-year actuarial cause-specific survival and the local control were 65.3 and 66.9%, respectively. The general five-year loco-regional disease-free survival was 52%. The nodal relapse rate according to the treatment modality employed was 0% for elective neck dissection, 21.3% for elective radiation therapy, and 25.7% for the cases followed up without any elective treatment. The corresponding regional disease-free survivals were 100%, 78.7% and 74.3% (p = NS). The prognostic variables offered by the subset of patients without any elective therapy were analyzed to evaluate the risk of occult node metastases. Tumor thickness was identified as a prognostic factor of regional relapse by multivariate analysis; the 5-year regional disease-free survival was 86.7% for a thickness 1 cm (p = 0.0003). CONCLUSIONS: Considering the high incidence of lymph node relapse and the poor survival rate of relapsing patients, we recommend the elective neck dissection to treat all patients with early stage mobile tongue carcinoma.

The head and neck contain many critical, noninvolved structures in close vicinity to the targets. The tightly conformal doses produced by intensity-modulated radiation therapy (IMRT), and the lack of internal organ motion in the head and neck, provide the potential for organ sparing and improved tumor irradiation. Many studies of treatment planning for head and neck cancer have demonstrated the dosimetric superiority of IMRT over conventional techniques in these respects. The initial results of clinical studies demonstrate reduced xerostomia. They suggest an improvement in tumor control, which needs to be verified in larger studies and longer follow-up. Critical issues for successful outcome of head and neck IMRT are accurate selection of the neck lymph nodes that require adjuvant treatment, and accurate delineation on the planning computed tomography (CT) of the lymph-node bearing areas and subclinical disease adjoining the gross tumor. This review emphasizes these topics and provides some guidelines.

We report the case history of a patient with complete spontaneous regression of metastatic cutaneous melanoma with parotid and neck lymph node metastases. Complete spontaneous regression of metastatic melanoma is very rare, with an estimated incidence of 0.22%-0.27%. We review the literature on this subject. Elucidation of the process of spontaneous regression may offer the possibility of improved methods of treating and preventing cancer.

Twenty-seven patients (24 men, 3 women; ages: 39-74 years) were diagnosed as having squamous cell carcinoma of the nasopharynx (NPC) as confirmed by pathologic findings of biopsies. In addition, three of the 27 patients had metastases to neck lymph nodes. The results of 2-4-hour SPECT images of the head and neck after intravenous injection of 15-20 mCi of Tc-99m (V) DMSA were compared with normal Tc-99m (V) DMSA images and CT of heads and necks. The results showed that of the 27 NPC cases, none of the patients had a significant uptake of Tc-99m (V) DMSA. However, in the three cases complicated with metastases of neck lymph nodes, the metastatic lesions could be detected by Tc-99m (V) DMSA. Our results challenge previous reports in which carcinomas of the head and neck were detected by Tc-99m (V) DMSA. The tumor-seeking agent Tc-99m (V) DMSA is not a good choice for the detection of NPC among malignancies of the head and neck.

In the past 15 years high-frequency B-mode sonography and colour–power Doppler have become the most important and most widely employed imaging modalities for the study of the neck, in particular for thyroid gland, parathyroids and lymph nodes. Sonography allows not only the detection but often also the characterization of the diseases of these organs, distinguishing benign from malignant lesions with high sensitivity and specificity, which could be further improved by the employ of ultrasound contrast agents and harmonic imaging. Although no single sonographic criterion is specific for benign or malignant nature of the lesions, the combination of different signs can be markedly helpful to speed up the diagnostic process. Fine-needle aspiration biopsy (FNAB) remains the most accurate modality for the definitive assessment of thyroid gland nodules and of any doubtful case of nodal disease. In association with clinical findings and serum levels of parathormone, FNAB has specificity close to 100% for the characterization of parathyroid adenomas. A combined approach with sonography and FNAB is generally highly effective.

Background: Fine needle aspiration of neck nodes is quick, safe and convenient method for the diagnosis of various lesions. The procedure is well tolerated by the patients, has minimal complications and repeatable. Because of its minimally invasive characteristic, this technique is now being used routinely for quick and accurate diagnosis. Enlarged lymph nodes are one of the most frequently sampled tissues. The diagnostic accuracy of FNAC in neck node malignancy is high. Aims & Objective: To study efficacy of aspiration cytology in suspected metastatic neck lymph nodes. Material and Methods: A prospective hospital based study was conducted among patients attending cytology lab in Department of Pathology, of a tertiary care centre in this region over a period of three years. All new patients having clinically suspected neck lymph nodes were included in the study. All previously treated patients and those with recurrence were excluded from the study. Cervical lymph nodes were aspirated, and smears were prepared & processed following standard techniques. Findings were correlated with previous studies. A total number of 225 cases were examined. Results: A total of 225 cases of lymph node aspirates were examined. Out of these, 190 cytologically diagnosed cases, as metastatic cervical lymph nodes were further evaluated. Most number of cases was seen in males, in the age group of 45-76 years. Higher number of patients had known primary sites, seen in oral cavity. Confirmatory cytological diagnosis could be made in maximum number of cases. Conclusion: Fine needle aspiration cytology is a safe, rapid and highly accurate method for diagnosis of superficially palpable lymph nodes. It is now considered as a routine OPD procedure, and most convenient method for confirmation of suspected metastatic nodes.

Received June 13, 2014 Revised July 18, 2014 Accepted August 11, 2014 Address for correspondence Han-Sin Jeong, MD, PhD Department of OtorhinolaryngologyHead and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea Tel +82-2-3410-3579 Fax +82-2-3410-3879 E-mail hansin.jeong@gmail.com Background and ObjectivesZZThe open surgical biopsy (OSB) of neck lymph nodes is considered a definite diagnostic procedure; however, the diagnostic accuracy of this procedure has not been fully studied. Thus, we aimed to identify the false negative rates of OSB for malignancy and the possible causes of misdiagnosis that might severely affect patient prognosis. Subjects and MethodZZWe extracted the data from 495 OSB of neck lymph nodes between 2005 and 2012. The diagnostic accuracy of OSB of neck lymph nodes was estimated based on rebiopsy. In addition, we reviewed possible clinical factors related to false negativity, cause of misdiagnosis and its clinical impacts. ResultsZZThe false negative rate of OSB of neck nodes was 2.2% with a risk of 3.8% false diagnosis among subjects with initial ‘benign’ results. The cases of the initial misdiagnosis (n=7) had the dismal outcomes (4 deaths, 1 disease progression). The main cause of misdiagnosis was the failure to target the disease-affected lymph nodes (85.7%). Malignancy-related symptoms persisted in all cases of misdiagnosis, which required re-biopsy. ConclusionZZAccurate targeting of lymph nodes, close monitoring of clinical symptoms and comparison of biopsy results with symptoms are very important to reduce false negativity for malignancy in OSB of neck lymph nodes. Korean J Otorhinolaryngol-Head Neck Surg 2014;57(12):841-6

The prognostic significance of lymph node metastases was evaluated in an unselected material of 427 oropharyngeal cancer patients treated primarily with radiotherapy. At first referral, palpable lymph node metastases were present in 60% of the patients. After irradiation, 60% of all palpable nodes had disappeared. As many as 50% of the nodes initially palpable in N3 patients vanished after irradiation. Recurrences were significantly increased in patients primarily with lymph node metastases (N1–3) compared with No. patients; recurrences in the primary tumour site were (56% vs. 43%) in neck lymph nodes (40% vs. 9%) and in distant metastases (14% vs. 5%). Surgery was performed in 98 of 256 patients (38%) with recurrent or metastatic disease. The 5-year disease-free survival rate after radiotherapy for NO patients was an improvement (44%) on that of Nl-3 patients (23%). The N-stage is an important prognostic factor for oropharyngeal canter patients.

The effect of elective lymph node dissection in patients with cutaneous malignant melanoma of the head and neck was investigated in a retrospective study. Of 517 patients in clinical stage I, 84 underwent elective dissection of the ipsilateral neck lymph nodes. In six of these patients, lymph node metastases were demonstrated at histopathological examination. There was a slight reduction in the incidence of recurrent disease in the regional lymph nodes in the group of patients who had undergone elective lymph node dissection, but this difference was not statistically significant. No significant differences were seen between the two groups regarding overall survival of disease-related survival.

Results: Between December 2005 and April 2009, 112 eligible patients were enrolled. The median age was 55 (range, 25-88) years with the majority being males (81%). The predominant primary site and T and N staging were oropharynx 74%, T2 36% and N2 75% (N2b 38%). The median pre-treatment nodal size of the dominant node was 30mm (range, 11-90mm). Residual CT/MRI nodal abnormalities were present in 41 of the 103 (40%) patients with a neck negative PET (median size 15mm, range 10-40mm). All PET negative patients were observed and, with a median follow-up of 24 months (range, 9-60), the 2-year isolated regional failure rate for this group was 0% (95% CI 0-3.5%). of the 9 PET neck positive patients, 8 underwent a post-RT neck dissection with 3 subsequently experiencing an isolated regional failure. The 2-year isolated regional failure rate for the entire cohort was 2.5% (95% CI 0.6 -10.0%) with a neck dissection rate of 7%.

Background: Primary sinonasal malignant melanoma represents a rare entity with poor prognosis. In order to increase the diseasefree survival complex treatment approach is recommended (incl. surgery, postoperative radiotherapy (RT) and combined chemotherapy (CCT). Methods: A clinical case of a 64-year old male patient with locally advanced sinonasal malignant amelanotic melanoma with a 2-year follow-up is presented. The optimal treatment strategy is discussed, based on the literature review. Results: In a case of locally advanced sinonasal malignant amelanotic melanoma local tumoral control was achieved by using combined treatment modalities (surgery with mediofacial resection, postoperative RT, several courses of CCT and surgery again). After two years regional disease recurred with involvement of the contralateral neck lymph nodes. There was no evidence of distant spread. Conclusions: The late lymphatic spread of the mucosal melanoma points out the necessity of thorough staging of the neck lymph nodes already at first presentation. In locally advanced mucosal melanoma postoperative RT should be carried out. There is still no uniform opinion on the optimal radiation schedule, the fractionation, the overall dosis and the target volume. -------------------------------------------------------------- Увод: Синоназалните малигнени меланоми са редки заболявания с лоша прогноза. За подобряване на свободната от заболяване преживяемост се препоръчва комплексно лечение (хирургия, следоперативна лъчетерапия (ЛТ) и полихимиотерапия (ПХТ)). Материал и метод: Представяме нашите 2-годишни наблюдения при 64‑годишен пациент с локално авансирал синоназален ахроматичен меланом. На фона на литературни данни се обсъжда оптималното комплексно лечение при това рядко срещано заболяване. Резултати: След комбинирано лечение (медиофациална резекция, следоперативна ЛТ; 5 курса ПХТ и реоперация) бе постигнат локален туморен конрол (ЛТК) при локално авансирал меланом на околоносните кухини. Две години след лечението бе диагностициран контралатерален регионален рецидив, без далечно метастазиране. Заключение: Късното лимфно метастазиране при мукозните меланоми, обосновава необходимостта от прецизиране на шийния нодален статус още при диагностициране на заболяването. При локално авансиралите мукозни меланоми се налага провеждане на следоперативна ЛТ, чийто оптимално фракциониране, доза и обем все още не са определени.

Objectives: Radiation dose to the larynx has been a major concern in the treatment of head and neck cancer. The use of splitting field (SF) IMRT can improve the dose to the larynx but it may result in inadequate tumor coverage and dosimetric uncertainties at the matchline. In this study, we propose a selective extended field (SEF) method to avoid the use of splitting field while reducing the larynxdose and achieving the adequate tumor coverage. Materials and Methods: Five nasopharyngeal patients with the gross tumor volume extended to the lower neck were treated with extended field (EF)‐IMRT. SEF IMRT plans were created by extending only three anterior and anterior oblique beams to the supraclavicular region while the other fields were restricted to the superior of the vocal cord. For comparison, SF‐IMRT plans were also created and matched with the conventional AP field. All plans were compared based on the tumor volume coverage, mean dose to the larynx while meeting other planning requirement in RTOG protocol of 0225. Results: The average doses to 95% (D95) of the pGTVs and pCTV were 67.10 ± 6.56 Gy, 70.65 ± 1.62 Gy, 72.74 ± 1.76 Gy and 55.21 ± 3.41 Gy, 57.17 ± 1.51 Gy, 59.92 ± 1.01 Gy for SF, SEF, and EF‐IMRT plans, respectively. The tumordose coverage in SF IMRT plans was the worst among three methods. Accordingly, the average mean doses to the larynx were 29.25 ± 5.61 Gy, 29.41 ± 2.99 Gy, 41.87 ± 10.61 Gy, respectively. The mean dose to the larynx in EF‐IMRT plans were the highest among the three methods. Conclusions: The selective extended field IMRT provides adequate tumordose coverage and protects the larynx with the similar mean dose as the SF method. Research is supported by Siemens Corporation.

Background : The exact preoperative diagnosis of diffuse sclerosing papillary carcinoma (DSPC) is required for aggressive surgical treatment due to its extended involvement with thyroid and neck lymph nodes. The present study investigated the cytomorphologic characteristics of DSPC and identified cytologic features for preoperative diagnosis of DSPC. Methods : A retrospective review of cytologic and histologic features of 16 patients diagnosed with DSPC after thyroidectomy and underwent preoperative fine needle aspiration cytology (FNAC) was performed. Results : Prominent psammoma bodies were observed in 16 (100%) and 10 (62.5%) cases of histology and FNAC, respectively. Lymphocytes were observed in nine (56.2%) and four (25.0%) cases, and squamous cells were noted in seven cases (43.7%) and one case (6.2%) on histology and FNAC, respectively. Nuclear grooves and inclusions, which are characteristics of papillary carcinoma, were observed in FNAC and histology slides in all 16 cases. Conclusions : DSPC displays prominent psammoma bodies and characteristic nuclear features of papillary carcinoma such as nuclear groove and inclusion in FNAC. However, the preoperative diagnosis of DSPC using only FNAC could be difficult due to the absence of other characteristic features such as lymphocytes and metaplastic squamous cells.

Purpose: To report two cases of multicentric Castleman's disease involving the orbital area. Case summary: A 52-year-old man presented with discomfort of the right eye on eyeball movement that began 45 months ago. He had been diagnosed as Castleman's disease upon the biopsy of his neck lymph nodes 2 years ago. Proptosis was found in his right eye, and orbital computed tomography revealed an enlarged mass in the inferior orbit compared to the former image. An incisional biopsy confirmed Castleman's disease. A 57-year-old man presented with left eyelid swelling that began 3 months ago. Orbital and chest computed tomography revealed a mass in the left superotemporal orbit and the enlarged lymph nodes of the mediastinal area. Castleman's disease was confirmed by biopsy of the lymph nodes in the mediastinal area. Conclusions: Steroid therapy was prescribed for the 52-year-old man. The 57-year-old man was placed under close observation.

Fifty-two patients with laryngeal cancer who underwent radical neck dissections were studied to provide further information on the prognosis of various clinical and histopathological parameters. Extracapsular spread (ECS) was found in 31% of patients with Nl nodes, and in 60% of patients with histopathologically positive nodes. The 5-year survival rate of histopathological findings was as follows: patients with no pathological evidence of neck metastasis (81%), patients with neck metastasis confined to the lymph node (no ECS) (76%), and patients with ECS (17%). The difference in survival rate between patients with no ECS and patients with ECS was statistically significant (P = .001). Staging classification, T-stage classification, the number of malignant nodes, the diameter of malignant nodes, and combined therapy had no prognostic importance. The most significant factor was the presence of extracapsular spread.

We recently experienced a case of malignant melanoma of the soft tissue, which is a rare disease. The patient was a 29-year-old woman who complained of a mass on the right supraclavicular fossa. Wide resection was performed with dissection of neck lymph nodes as the tumor was suspected to be a clear cell sarcoma of tendons and aponeuroses by incisional biopsy. A tumor embolism was noted in the right subclavian vein. In the surgical specimen, melanin pigment was light-microscopically noted and melanosomes were detected electron-microscopically in the tumor cells. The tumor was diagnosed as soft-tissue malignant melanoma, termed clear cell sarcoma of tendons and aponeuroses by Enzinger et al. The patient underwent DVA adjuvant chemotherapy and is currently alive without any recurrent sign after the operation.

Summary This study was carried out to assess whether the regression rate of neck node metastases after radiotherapy could be a prognostic factor for local control. Measurements of 283 neck nodes were made before and at completion of treatment and at intervals during 3 years follow-up. The results indicate that complete regression at the end of treatment correlates strongly with local control. A false negative rate of 0.1 was calculated. Partial regression seems to be a prognostic factor for failure in lymph nodes because of a true positive rate of 0.8. The results suggest that accurate measurements of the response of neck lymph nodes could give early prognostic information, useful for the choice of optimal treatment.

• The relationship of a cancer patient's immunoreactivity and prognosis appears to be more complex than originally reported. Many earlier studies seemed to show that these assessments of immune competence had prognostic significance. Later reports showed no correlation. Newer technology has given the capability of measuring T-lymphocyte subpopulations and offers the possibility of a more sophisticated assessment of immunoreactivity that might correlate with prognosis. A study of 59 head and neck cancer patients was undertaken to assess the value of measuring the T-cell subpopulations in the peripheral blood and from regional neck lymph nodes. This study shows no difference between those patients free of disease and those either living or dying of disease. The conclusion of this study is that the measurement of T-cell subpopulations offers no prognostic value for patients with head and neck carcinoma. ( Arch Otolaryngol Head Neck Surg 1986;112:938-941)

Carcinoid tumor of the larynx was diagnosed in a 66-year-old man. The patient had complained of sore throat for ten months. A supraglottic tumor covered with smooth mucosal surface was found. Total laryngectomy was perfbrmed (pT3N0); the pathological diagnosis was carcinoid tumor. The ultrastructural findings showed many secretory vesicles.The patient had metastases to the neck lymph nodes several times, and repeated neck dissection were performed. Four years after the first operation, the patient died of pulmonary and hepatic metastases.On the basis of this and previously reported cases, recommendations are made for the management of carcinoid tumor of the larynx.

The clinical study on 24 cases of gum carcinoma treated in our department from April 1982 to March 1986 was presented. Of the 24 cases, 3 cases were palliative, and 21 cases were surgically treated. Among the 21 surgical cases, radical neck dissection was performed in 18 cases and in 9 cases the lymph-nodes were proven positive.The ratio of metastasis to neck lymph nodes was 3/8 (40%) from the maxilla, 5/6 (30%) from the mandible. The percentages of cases were neck dissection was performed, was 60% in the former, 80% in the latter. In the mandible, segmental and marginal resection was performed in 10 cases and 4 cases respectively.It was concluded that an extra-oral approach to mandibular gum carcinoma requires neck dissection, especially modified neck dissection or supra-omohyoid neck dissection.

Primary thyroid lymphoma (PTL) is defined as a lymphoma involving only the thyroid gland or both thyroid gland and neck lymph nodes, without contiguous spread or distant metastases from other areas of involvement at diagnosis. Despite its rarity, PTL should be promptly recognized because its management is quite different from the treatment of other neoplasms of the thyroid gland. In the present study, we report a case of PTL treated by surgery and adjuvant chemotherapy. Otherwise, literature review allowed us to define main characteristics of this located lymphoma.

The results of 25 years of quasi-routine total parotidectomy performance are shown. At the Department of Otolaryngology of the University of Florence, 582 patients were treated as follows: on 527 occasions by total parotidectomy with facial never preservation; 24 occasions by lateral lobectomy; 27 occasions by total parotidectomy with removal of the whole facial nerve; four times by enucleo-resection of the disease. Benign tumours were 378; primary and metastatic malignant tumours—100; non tumoral lesions—104.The benign tumours follow-up showed three recurrences only (two pleomorphic adenomas—one of them proved to be an adenoid-cystic carcinoma, and one monomorphic adenoma, which also proved to be an adenoid-cystic carcinoma), respectively 6, 6 and 8 years later. The malignant tumours were also treated by total parotidectomy with adequate management both of the facial nerve and the neck lymph nodes. The results thoroughly justify the nerve preservation, when preserved.

A series of 56 cases of carcinoma of the anterior two-thirds of the tongue treated surgically was reviewed. Lymph node metastasis occurred in 50% of cases. There was 22% false-negative clinical assessments of lymph node status for the ipsilateral side of the neck. Because of these and the difficulty in ensuring early treatment of subsequent node metastasis, concurrent ipsilateral radical neck dissection is recommended. When the ipsilateral side of the neck was involved the contralateral side had 22% false-negative assessments. Elective radical neck dissection for the contralateral side is recommended in this situation. The overall five-year survival was 50·6%, and was greatly affected by the status of the neck lymph nodes.

Cystadenolymphomas (Warthin's tumors) are the second most frequent lesions of the parotid gland. Due to their benign clinical behavior, the low rates of recurrence and malignant transformation they were classified as tumor-like lesions. In addition, a polyclonal growth of the epithelial components of the tumor could be detected. Warthin's tumors occur bilateral in 7-10%, whereas a multifocal appearance is extremely rare. Even if the pathogenesis is still unclear a heterotopia of salivary tissue during embryogenesis is the most likely explanation for the origin of these tumors in the upper neck and periparotideal region. Here we present a rare case of bilateral, multifocal, extraglandular Warthin's tumors in lymph nodes of the upper neck and give a brief review of the literature. If a primary malignancy can be excluded by a careful staging procedure prior to the operation an isolated excision of the lesions of the neck is the adequate treatment.

In 100 normal subjects who had a sonographic examination of the neck, 1211 lymph nodes were detected. In all the subjects, at least five lymph nodes were seen. The distribution, number, echogenicity, shape, presence or absence of echogenic hilus, and the sharpness of nodal borders of normal cervical lymph nodes were determined. The usefulness of these sonographic features in understanding the normal distribution and characteristics of the nodes in the Chinese population is discussed. The relationship between the shape and size of lymph node also was assessed.