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Introduction Human papilloma virus (HPV)-associated oropharyngeal squamous cell carcinoma (HPV-OPSCC) has been recognized to have an excellent response to treatment and has a distinct pathologic staging. For this reason, HPV testing is recommended in cytology specimens of metastatic OPSCC, although the guidelines for testing are not clearly defined. The aim of the current study was to establish a threshold for interpretation of p16 in aspirates from metastatic OPSCC. Materials and methods Cases diagnosed as metastatic SCC by cytology in neck lymph nodes with concurrent p16 on cytology and on paired surgical specimen or an in situ hybridization (ISH) for HPV were included in the study. Stain intensity and percentage positive cells for p16 was compared with p16 on paired surgical pathology specimens and/or ISH RNA for HPV on cytology specimens. Results Of the 52 cases diagnosed as metastatic SCC on neck aspirates, paired surgical pathology specimens and/or ISH HPV was available in 17 cases. A p16 expression in ≥10%-15% cells resulted in a sensitivity and negative predictive value of 66% and 37%, respectively. However, when even minimal expression in tumor fragments is considered positive, the negative predictive value increases to 100%. Conclusions We recommend that even minimal nuclear expression for p16 in viable tumor fragments must be considered as positive in cytology specimens. Expression limited to only background single tumor cells or in a necrotic specimen must be interpreted with caution.

Summary Introduction Cutaneous squamous cell carcinoma (cSCC) shows malignant behaviour in 3–4% of patients with locoregional metastases and a poor prognosis, metastases that are difficult to predict clinically. Therefore, sentinel lymph node biopsy (SLNB) has been assessed, with contradictory findings thus far. We aimed to clarify the prognostic value of SLNB in high-risk cSCC patients. Patients and methods We completed a retrospective clinical study amongst 63 patients, preoperatively classified as N0 with a high-risk primary cSCC of the head and neck who underwent SLNB between 2001 and 2014 at Helsinki University Hospital (Finland). Considered high risk, the inclusion criteria comprised at least two of the following characteristics: tumour diameter ≥10 mm and/or thickness ≥4 mm and a specific tumour location, such as the lips, ear, scalp and central face. Patients were followed-up postoperatively for a median of 4.1 years (0.2–13.8 years). Results Only four (6.3%) patients had positive sentinel nodes. One of these patients died of cSCC, while the other three ultimately survived their disease. Five (7.9%) patients showed a negative SLNB, but developed recurrence within one year postoperatively. Recurrence appeared in the neck lymph nodes concurrently with locoregional soft-tissue invasion in all patients. Amongst these patients, three died for cSCC and the remaining two from other causes. Comparing the SLNB-positive and SLNB-negative groups with recurrence, we identified no significant differences in terms of patient or tumour characteristics. Conclusions SLNB appears to carry no prognostic value for identifying recurrent disease amongst high-risk cSCC in the head and neck area.

Papillary thyroid carcinoma commonly metastasizes to regional lymph nodes. However, metastasis to liver alone is extremely rare. Here we present a 36-year-old woman who underwent total thyroidectomy and bilateral neck lymph nodes dissection for papillary thyroid carcinoma and received radioiodine (131I) ablation therapy for 2 times 1 month and 5 months after surgery, respectively. The images after the 131I therapy showed a solitary occult metastasis in the liver.

The physiological uptake of 68Ga-FAPI-04 due to the change of the internal environment is little known. We report the case of a 45-year-old woman who was highly suspected to have advanced nasopharyngeal carcinoma. 18F-FDG and 68Ga-FAPI-04 PET/CT was performed for evaluating the disease. Both PET and CT with different tracers detected the primary nasopharyngeal carcinoma and metastases in right neck lymph nodes, liver, and bones. To our surprise, intense diffuse uptake of 68Ga-FAPI-04 was found in both breasts, which might be due to the hormone stimulation because the patient received 68Ga-FAPi-04 PET/CT just at the period of ovulation.

BACKGROUND: Low incidence of preoperative vocal cord palsy (VCP) promotes a diagnosis model to eliminate patients without the necessity of preoperative laryngoscopy assessments, avoiding medical costs and discomfort. However, previous studies lacked a comprehensive strategy and external validation data to effectively detect VCP in thyroid cancer patients. This study aimed to develop a VCP scoring system that could calculate cumulative VCP risks and determine preoperative laryngeal examinations based on the clinical characteristics of VCP patients from the Union Hospital, Tongji Medical College of Huazhong University of Science and Technology. METHODS: A retrospective study recruited 5,354 thyroid cancer patients was performed. Preoperative VCP incidence was recorded, and a prediction table was constructed using independent, significant risk factors for preoperative VCP. The visualized nomogram, including five parameters, was proportionally assigned 0 to 100 points. Finally, the diagnostic performance was confirmed by verifying the nomogram in the internal and external cohort. RESULTS: The incidence of preoperative VCP by preoperative laryngoscopy assessment was 1.57%. Age at diagnosis (OR: 1.04; P=0.006), history of neck surgery (OR: 11.57; P

OBJECTIVE The space comprised between tumor and neck lymph nodes (T-N tract) is one of the main routes of tumor spread in oral cavity tumors. Aim of the study was to investigate the impact of T-N tract involvement on the postoperative radiotherapy (PORT) outcomes. MATERIALS AND METHODS Patients (pts) treated between 2000 and 2016 with indication to PORT were retrospectively retrieved. Inclusion criteria were: (a) locally advanced tumors of the oral cavity, (b) who received with indication to PORT (c) with a minimum follow-up of six months. RESULTS One hundred and fifty-seven pts met the inclusion criteria (136 pts treated with PORT and 21 pts not treated with PORT). In the PORT cohort, the T-N tract involvement had no impact on both OS (p = .09) and LRFS (p = .2). Among the non-PORT cohort, both OS (p = .007) and LRFS (p = .017) were worse for pts with positive T-N tract compared to those with negative T-N tract. PORT improved both OS (p = .008) and LRFS (p = .003) in pts with positive T-N tract but not in those with negative T-N tract (p = .36 and p = .37, respectively). CONCLUSIONS Our results suggest that involvement of T-N tract should be considered as prognostic factors informing the indication to PORT.

Objectives This study aims to propose a cytological classification, to evaluate predictive factors of the final malignancy, and to suggest a proper management strategy for neck lymph nodes (LNs) with indeterminate cytology. Methods Patients who had neck lymphadenopathy with indeterminate cytology between 2007 and 2017 were analyzed retrospectively in a tertiary medical center. Cytological classification was conducted according to the cytological descriptions. We examined the clinical characteristics according to the final diagnosis of the neck lymphadenopathy. Results According to the final diagnoses, there were 142 malignant and 95 benign neck LNs among 237 patients. Multivariate analyses using a stepwise logistic regression model showed that cytological classification [p < 0.001, OR = 5.67 (3.48–9.23)], prior history of malignancy [p = 0.01, OR = 2.97 (1.26–6.99)], long axis [p = 0.01, OR = 3.06 (1.33–7.06)], short-to-long axis (S/L) ratio [p = 0.047, OR = 2.15 (1.01–4.57)] and internal echogenicity [p = 0.01, OR = 2.72 (1.26–5.86)] were independent predictors of malignancy. Conclusions In patients who have neck LNs with indeterminate cytology, a cytological classification and four other predictors (prior history of malignancy, long axis ≥ 1.93 cm, S/L ratio ≥ 0.64 and heterogeneity of internal echogenicity) are statistically associated with the risk of malignancy and helpful in guiding further management.

Kawasaki disease is a common childhood vasculitis. Fever and lymphadenopathy, at times, are the only clinical presentation of Kawasaki disease, which mimics infectious lymphadenitis, especially, when other features are yet to evolve. In such a scenario, ultrasonography of cervical lymph nodes can help to differentiate Kawasaki disease lymphadenitis from infectious lymphadenitis. We present one such patient who was initially diagnosed as having bacterial lymphadenitis; however, ultrasonography of the neck lymph nodes showed typical imaging features described with Kawasaki disease lymphadenitis.

Data on the prevalence of extrapulmonary tuberculosis (EPTB) patients are limited in many African countries including Malawi. We conducted a retrospective review of all histology reports for cancer suspected patients at Mzuzu Central Hospital (MZCH) between 2013 and 2018 to determine the proportion of EPTB cases among cancer suspected patients and characterised them epidemiologically. All reports with inconclusive findings were excluded. In total, 2214 reports were included in the review, 47 of which reported EPTB, representing 2.1% (95% CI 1.6−2.8). The incidence of EPTB was significantly associated with sex, age and HIV status. Men were more than twice (OR 2.1; 95% CI 1.2–3.9) as likely to have EPTB as women while those with HIV were more than six times (OR 6.4; 95% CI 1.7–24.8) as likely to have EPTB compared to those who were HIV-negative. EPTB demonstrated an inverse relationship with age. The highest proportion of EPTB was found from neck lymph nodes (10.3% (5.4–17.2)). A reasonable number of EPTB cases are diagnosed late or missed in Malawi's hospitals. There is a need for concerted efforts to increase EPTB awareness and likely come up with a policy to consider EPTB as a differential diagnosis in cancer suspected patients.

Purpose: To assess whether the three-dimensional reconstructions of preoperative computed tomography (CT) scans are helpful for establishing extranodal extension (ENE) in head and neck carcinoma. Approach: Patients with a histological diagnosis of ENE ([Formula: see text]) were considered “cases” and patients with negative histological examination for ENE ([Formula: see text]) were considered “controls.” Cases and controls were divided into two groups: a major nodes (MaN) group (lymph nodes on [Formula: see text]) and a minor nodes (MiN) group (lymph nodes on [Formula: see text]). The preoperative CT scans were uploaded to the Anatomage Table and were randomly and blindly provided to the radiologist for assessment. The findings at the Anatomage Table were compared with those of CT and magnetic resonance imaging (MRI) scans. Results: Analysis of data from the MaN group showed that the Anatomage Table had a higher percentage of concordance with histopathological examination (90%) than the CT and MRI scans. The Anatomage Table had 100% sensitivity in identifying all [Formula: see text] patients, associated with a lower specificity. The negative predictive value of 100% allowed identification of [Formula: see text] patients. In the MiN group, on the other hand, sensitivity was lower, related to a high number of false-negative results. Conclusions: The Anatomage Table could represent a useful tool for preoperatively establishing the extranodal extension of cervical lymph node metastasis.

Ameloblastoma is a benign epithelial tumour and the most common odontogenic tumour, accounting for about 18% of cases. We present a patient to illustrate the first use of tomoelastography for quantitatively mapping tissue stiffness (shear wave speed) and fluidity (loss angle of the complex shear modulus) in a metastasised ameloblastoma of the left mandible. Tomoelastography maps clearly depicted the extent of the tumour by abnormally high values of stiffness and fluidity (1.73±0.23 m/s, 1.18±0.08 rad) compared with normal values in the contralateral mandible (1.04±0.09 m/s, 0.93±0.12 rad). Abnormal stiffness also revealed metastatic involvement of the neck lymph nodes (1.30±0.03 m/s vs 0.86±0.01 m/s). Taken together, stiffness and fluidity measured by tomoelastography can sensitively detect the presence and extent of bone tumours and metastatic spread to cervical lymph nodes.

Background: Pre-operative differentiation of benign from malignant cervical adenopathies remains a challenge. Several studies indicate parameters to discriminate between benign and malignant lymph nodes, which has not yet been enough. Objectives: The aim of the current study was to assess the diagnostic efficacy of diffusion-weighted MR imaging (DWI) to differentiate benign from malignant cervical lymph nodes. Patients and Methods: In all patients, we assessed axial and coronal fast spin echo T2 and T1-weighted images and T1-weighted after contrast injection. DWI sequences were implemented before contrast injection, in axial and coronal planes (b factor of 50, 500 and 1000 s/mm2) and the apparent diffusion coefficient (ADC) maps were reconstructed. Data were assessed in mixed model analysis and results were compared with postoperative histopathologic findings. Results: Thirty seven subjects were enrolled, 10 with benign lymphadenopathy and 27 patients with malignant lymphadenopathies before treatment. The mean ADC of the benign neck lymph nodes was (1.00 ± 0.34) × 10-3 mm2/s, while it was (0.76 ± 0.16) × 10-3 mm2/s in malignant ones (P = 0.058). The mean ADC of the metastatic nodes was (0.81 ± 0.14) × 10-3 mm2/s, while it was (0.56 ± 0.04) × 10-3 mm2/s in lymphoma (P < 0.001). The mean ADC of poorly differentiated metastatic nodes was significantly lower than that of good and moderately differentiated ones [(0.86 ± 0.13) × 10-3 mm2/s vs. (0.66 ± 0.02) × 10-3 mm2/s respectively; P = 0.001]. The area under the ROC curve of ADC was 0.69 [95%CI = 0.52 - 0.83]. Considering cut off points of 0.6 × 10-3, 0.95 × 10-3, and 1.2 × 10-3 yielded sensitivities were 15%, 92.5%, and 100%, respectively; while, in these cutoff points, specificities were 80%, 50%, and 40%, respectively. Conclusion: DWI could be considered as an important diagnostic tool to differentiate enlarged cervical lymphadenopathies.

Objective: To evaluate the diagnostic value of DWI in assessment of metastatic neck lymph node in a sample of Iranian patients with Head and Neck cancer. Methods: 25 patients with 80 neck lymph nodes were analyzed using 1.5 T MRI. DWI was performed with b values of 0 and 1,000 s/mm2. Short axis diameter and ADC values (min, max and mean) were calculated for metastatic and non-metastatic neck LNs and results were compared with histopathological findings. The optimal ADC thresholds were analyzed using receiver coefficient characteristic (ROC) curves for discriminating between metastatic and benign neck lymph nodes. Result: Histopathological findings revealed that there are 45% (n=36) metastatic and 55% (n=44) non-metastatic neck LNs respectively. There was no statistically significant difference in short axis diameter between the two groups (p = 0.346). However, The ADC values of metastatic neck LNs were significantly lower than those of non-metastatic neck LNs (p < 0.001); 0.90 ± 0.10 × 10-3 mm2/s vs 1.06 ± 0.12 × 10-3 mm2/s ( ADC mean ), 0.78 ± 0.08 × 10-3 mm2/s vs 0.92 ± 0.20× 10-3 mm2/s ( ADC min ) and 1.02 ± 0.12 × 10-3 mm2/s vs 1.24 ± 0.15 × 10-3 mm2/s (ADC max ). The optimal mean ADC threshold value was equal to 0.996 × 10-3 mm2/s for differentiating malignant from benign lymph nodes with sensitivity, specificity and accuracy of 80.56 %, 77.27 % and 71.59 % respectively. Conclusion: MR diffusion imaging and ADC values as a non-invasive technique can assess metastatic neck LNs in head and neck cancer with higher sensitivity, specificity and accuracy.

Aim: The aim of the study was to evaluate the performance of real-time strain sonoelastography for comparison of perithyroidal lymph nodes of Hashimoto thyroiditis patients, jugular lymph nodes of healthy individuals and parathyroid lesions. Material and methods: Fifty parathyroid lesions (Group 1), 52 lymph nodes in Hashimoto thyroiditis patients (Group 2) and 51 reactive jugular lymph nodes (Group 3) were examined by ultrasound, and elastography was performed for a total of 95 patients. Real-time strain sonoelastography using elasticity score (E-index) was performed. The differences in E-index between the three groups were evaluated. Results: The mean E-index and size of parathyroid lesions were 2.30 ± 0.91 and 13.46 ± 5.69 mm, respectively. Parathyroid hyperplasia was detected by parathyroidectomy in two patients (2/37; 5%) with a total of four lesions (4/50; 8%). The remaining lesions were considered as adenomas. The mean E-index and size in Group 2 were 2.70 ± 0.93 and 7.83 ± 3.35 mm, respectively. The mean E-index and size in Group 3 were 1.88 ± 0.59 and 11.60 ± 4.96 mm, respectively. There were statistically significant differences between the groups in terms of E-index (p

Peripheral lymph node tuberculosis is one of the most frequent extrapulmonary localizations. The objective of the study : to define the place of peripheral lymph node tuberculosis in the structure of extrapulmonary tuberculosis incidence in the neighboring regions with the unfavorable epidemic situation (Siberian and Far Eastern Federal Districts (SFD and FEFD) and the Republic of Tajikistan); to study the structure of this form of tuberculosis. Subjects and methods . The statistic reports from TB units of SFD, FEFD and the Republic of Tajikistan for 2016-2017 were reviewed. The structure of peripheral lymph node tuberculosis was assessed through a retrospective analysis of medical records of peripheral lymph node tuberculosis patients, notified in the Republic of Tajikistan and Regional Novosibirsk TB Dispensary in 2016 and 2017 in total. Results of the study . In 2016-2017 in SFD and FEFD, isolated forms of extrapulmonary tuberculosis were diagnosed in 1,227 patients, of them, 166 (13.5%) patients suffered from peripheral lymph node tuberculosis. In SFD and FEFD of the Russian Federation, our study detected no statistically significant changes in the proportion of peripheral lymph node tuberculosis in the structure of extrapulmonary tuberculosis incidence in the patients with positive and negative HIV status. In the Republic of Tajikistan, the frequency of peripheral lymph nodes tuberculosis among extrapulmonary tuberculosis cases was statistically significantly higher versus SFD and FEFD in the Russian Federation (504/1 386 and 166/1 227 respectively, p < 0.01). In the Republic of Tajikistan, SFD and FEFD of the Russian Federation, tuberculosis of neck lymph nodes was the most frequent in the structure of peripheral lymph node tuberculosis followed by axillary and inguinal localizations. The difference in the frequency of each localization between the compared regions was not statistically significant.

Objectives 18 F-FDG PET/CT is widely used in clinical oncology. Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) represents an emerging disease that differs from HPV-negative OPSCC in clinical behavior and tumour biology. In these tumours, HPV-oncogenes might lead to distinct alterations in metabolic pathways. Therefore, we compared metabolic parameters using 18 F-FDG PET/CT in HPV-positive and HPV-negative OPSCC in relation to histopathological findings. Materials Eighty-six patients with OPSCC received pre-therapeutic 18 F-FDG PET/CT. Standardised uptake volume (SUV), total lesion glycolysis (TLG) and metabolic tumour volume (MTV) were analysed for the primary tumour. SUVmax was determined for neck lymph nodes. HPV-status was determined; overall survival rates (OS) were estimated. Results 32/86 patients (37.2%) had HPV-related OPSCC. Overall, PET-parameters in primary tumours of both groups did not differ significantly. Comparing early with locally advanced primary tumours, there was a significant increase in 18 F-FDG uptake in HPV-negative patients (p 18 F-FDG uptake between primary and respective positive nodes in HPV-related primary OPSCC (p = 0.001). SUV-max and –mean values did not correlate with OS in HPV-related OPSCC. Conclusion The intraindividual homogeneity of 18 F-FDG uptake in HPV-related OPSCC could reflect the more homogenously, HPV-triggered carcinogenesis compared to the mutation-driven carcinogenesis in the HPV-negative OPSCC with heterogenic 18 F-FDG uptake.

The purpose of this study is to determine the ability of ultrasound guided needle biopsy of a neck lymph node to provide adequate tissue for complete pathologic evaluation of suspected metastatic lung cancer, including molecular testing for epidermal growth factor receptor gene mutations by pyrosequencing and anaplastic lymphoma kinase gene rearrangement by fluorescence in situ hybridization.Institutional review board approval was obtained and the requirement for informed consent was waived. All ultrasound guided neck biopsies performed July 1, 2011, to June 30, 2015, were retrospectively reviewed, and all biopsies performed for suspected lung cancer metastatic to supraclavicular and cervical lymph nodes were included.Forty patients with suspected lung cancer underwent ultrasound-guided needle biopsy of an abnormal appearing neck lymph node identified on preprocedure computed tomography or positron emission tomography/computed tomography. Thirty-seven patients were subsequently diagnosed with lung cancer and 3 were diagnosed with lymphoma. A definitive pathologic diagnosis was rendered in 95% of neck node biopsies (38/40; 95% confidence interval, 84%-99%). Of the 36 specimens diagnostic for lung cancer, 16 were considered for further molecular testing and the specimen was adequate for molecular testing in 15 (94%; 73%-100%) cases. Therefore, the neck node biopsy specimens were adequate for complete pathologic workup in 93% (37/40; 81%-98%). No complications related to the biopsies were observed.In patients presenting with suspected lung cancer and suspicious neck lymph nodes, ultrasound-guided needle biopsy frequently provides adequate tissue for complete pathologic evaluation and eliminates the need for more invasive procedures.

Olfactory neuroblastoma is a rare and often locally aggressive malignancy that invades the orbit via local destruction. It is known to recur in a delayed fashion, particularly to the neck lymph nodes. This is a case of a 65-year-old gentleman who presents with recurrence in the orbit and a neck lymph node 19 years after treatment for his initial disease. This report describes the longest known interval in orbital recurrence and should alert the monitoring physician that extreme delays in recurrence can occur.

A retrospective analysis was made in 63 patients who undergone the examination and treatment in Dmitry Rogachev National Research Center between January 2012 and August 2017. In the retrospective series 36 (57.1%) patients who underwent neck dissection for thyroid cancer and 27 (42.9%) head and neck cancer patients of other primary site. All patients underwent organpreserving block neck dissection. We detected statistically significantly more frequent metastatic lesion of the lymph nodes (p < 0.01), with fewer complications (p < 0.05), long-term disease-free survival and better outcomes (p < 0.01). Thus, thyroid cancer can be isolated into a separate class in which precision lymphodissection is of particular importance as an independent method of therapy and preventive treatment of metastatic involvement of the neck lymph nodes in head and neck cancer. It is especially important in children. As for other head and neck tumors, neck dissection is a secondary method of combined therapy.

Objective: To evaluate the four commonly used incisions for Radical Neck Dissection on the basis of certain defined parameters. Patients and Methods: The investigators designed and implemented a prospective comparative study composed of patients with oral squamous cell carcinoma. The predictor variable was time taken to raise and close the flaps, accessibility to the neck lymph nodes, injury to vital structures and scar cosmesis followed up to a period of three months. Descriptive statistics were computed. Results: The sample was composed of 40 patients grouped as follows: Macfee Incision (=10 patients), Modified Macfee Incision (=10 patients), Modified Schobinger Incision (=10 patients) and Reverse Hockey Stick Incision (=10 patients). Group A, consisiting of the patients with Macfee Incision, took the least time to close among all the groups ( Mean= 32.60 minutes) while Group C (patients with Modified Schobinger Incision) required the most time for closure ( Mean= 51.90 minutes). The Modified Schobinger Incision provided best exposure to neck node levels. The Macfee Incision was found to have the best scar cosmesis among the four incisions. Conclusion: The results of this study suggest that Modified Schobinger Incision is the preferred incision for adequate access to neck lymphatics while Macfee Incision was found to provide the best scar cosmesis.

It is not difficult to justify the role of ultrasound in head and neck diagnostic procedures. In most cases, ultrasound examination is required to analyze neck lymph nodes, as discussed in detail in other chapters. Ultrasound is also a very helpful tool in the differential diagnosis of other neck diseases, because different diseases are characterized by typical sonographic findings. Ultrasound is helpful to diagnose neck infections and to evaluate various solid tumors, whether located superficially or in the depth of the neck. Nevertheless, exact anatomic knowledge of different neck structures, including their sonographic appearance, is necessary to differentiate normal neck structures from pathologies. Thus it is possible to diagnose many neck diseases by their clinical and sonographic features alone, and the use of other imaging methods such as CT or MRI scan is often not needed to find the correct diagnosis.

Currently considered a variant of Ewing sarcoma, adamantinoma-like Ewing sarcoma is a rare malignancy that shows classic Ewing sarcoma-associated gene fusions but also epithelial differentiation. Here we present the 6th reported case of adamantinoma-like Ewing sarcoma involving the thyroid gland. Sections of the thyroid tumor from a 20-year old woman showed sheets, lobules and trabeculae of primitive, uniform, small round blue cells that diffusely expressed pankeratin, p40 and CD99. Fluorescent in situ hybridization revealed an EWSR1 gene rearrangement and an EWSR1-FLI1 fusion was detected by RT-PCR. Neck lymph nodes were not involved, and the patient was treated with a Ewing sarcoma chemotherapy protocol and radiation and is disease free 7 months after surgery. The unusual histology and immunohistochemical profile of adamantinoma-like Ewing sarcoma makes diagnosis and classification very challenging. We also present a literature review of adamantinoma-like Ewing sarcoma involving the thyroid.

Background The measurement of calcitonin in washout fluids of thyroid nodule aspirate (FNA-calcitonin) has been reported as accurate to detect medullary thyroid carcinoma (MTC). The results from these studies have been promising and the most updated version of ATA guidelines quoted for the first time that “FNA findings that are inconclusive or suggestive of MTC should have calcitonin measured in the FNA washout fluid.” Here we aimed to systematically review published data on this topic to provide more robust estimates. Research Design and Methods A comprehensive computer literature search of the medical databases was conducted by searching for the terms “calcitonin” AND “washout.” The search was updated until April 2015. Results Twelve relevant studies, published between 2007 and 2014, were found. Overall, 413 thyroid nodules or neck lymph nodes underwent FNA-calcitonin, 95 were MTC lesions and 93 (97.9%) of these were correctly detected by this measurement regardless of their cytologic report. Conclusions The present study shows that the above ATA recommendation is well supported. Almost all MTC lesions are correctly detected by FNA-calcitonin and this technique should be used to avoid false negative or inconclusive results from cytology. The routine determination of serum calcitonin in patients undergoing FNA should improve the selection of patients at risk for MTC, guiding the use of FNA-calcitonin in the same FNA sample and providing useful information to the cytopathologist for the morphological assessment and the application of tailored ancillary tests. Diagn. Cytopathol. 2015. © 2015 Wiley Periodicals, Inc.

Although relatively rare, polymorphous adenocarcinoma (PAC) is likely the second most common malignancy of the minor salivary glands (MiSG). The diagnosis is mainly based on an incisional biopsy. The optimal treatment comprises wide surgical excision, often with adjuvant radiotherapy. In general, PAC has a good prognosis. Previously, PAC was referred to as polymorphous low-grade adenocarcinoma (PLGA), but the new WHO classification of salivary gland tumours has also included under the PAC subheading, the so-called cribriform adenocarcinoma of minor salivary glands (CAMSG). This approach raised controversy, predominantly because of possible differences in clinical behaviour. For example, PLGA (PAC, classical variant) only rarely metastasizes, whereas CAMSG often shows metastases to the neck lymph nodes. Given the controversy, this review reappraises the definition, epidemiology, clinical presentation, diagnostic work-up, genetics, treatment modalities, and prognosis of PAC of the salivary glands with a particular focus on contrasting differences with CAMSG. ispartof: EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY vol:275 issue:7 pages:1681-1695 ispartof: location:Germany status: published

Background: Inadvertent parathyroidectomy (IP) during thyroid operations is a recognised phenomenon. We evaluated the incidence of IP during thyroid operations in a large case-series and identified the risk factors involved. Methods: Retrospective review of all thyroidectomy operations [total thyroidectomies (TT) and near-total thyroidectomies (NTT)] performed in a single institution from January 2004 to January 2009. We excluded re-operative cases, combined thyroid and parathyroid pathology, hemithyroidectomies and neck lymph nodes (LN) dissections. Pathology reports were correlated with operative records to identify the details of the IP glands. Relevant data (patient demographic data, preoperative diagnosis and operative details) were collected and a logistic regression was performed. Results: One thousand three hundred and seventy-three patients were included in our study, 1,149 of them females (84%). IP rate was 11.3%. Univariate analysis showed that gender, thyroid gland weight, thyroid activity pre-operatively and type of operation are associated with IP. Logistic regression analysis has shown that female gender and the absence of LN in pathology were associated with less likelihood in developing IP than males and patients with presence of LN (P=0.051 and P=0.014 respectively). IP occurs 2.14 and 2.28 times more often in TT and NTT when compared to the combination of TT and NTT (P=0.047 and P=0.048 respectively). Conclusions: We present the largest single-centre case series on this topic, to our knowledge. The presence of LN, female gender and the type of operation are positively correlated to the IP rate. These factors could alert the surgeon to consider early calcium supplementation if the parathyroid glands (PG) have not been identified intraoperatively.

Generally, thyroglobulin (Tg), calcitonin (CT), and PTH are determined in blood. However, in the last decades, these molecules have been measured in fluids from FNA of neck lymph nodes (FNA-Tg and FNA-CT), thyroid nodules (FNA-CT), or suspicious parathyroids (FNA-PTH). These measurements rapidly emerged as powerful and relatively cheap tools to refine challenging clinical diagnosis in patients with thyroid/parathyroid lesions and have been included in international guidelines. Nevertheless, a definitive standardization of these procedures has not yet been reached, and further efforts should be made in order to better define pre-analytical, analytical, and post-analytical aspects. Also, a close cooperation between laboratory specialists, pathologists, and clinicians involved in thyroid/parathyroid diseases’ care is mandatory to define the most appropriate procedures.

Image-guided percutaneous biopsy of cervical lymph nodes is a minimally invasive method performed for the characterization of abnormal lymph nodes, staging, and for the detection of regional tumor recurrence. When performed with proper technique and by a skilled proceduralist, this technique offers a very high diagnostic yield and can potentially save the patient from more invasive procedures. Its diagnostic role in different disease processes and the variations in technique as well as its potential risks and pitfalls will be discussed in this article.

Objectives The presence of thyroglobulin (Tg) in needle washouts of fine needle aspiration biopsy (Tg-FNAB) in neck lymph nodes (LNs) suspected of metastasis has become a cornerstone in the follow-up of patients with papillary thyroid carcinoma (PTC). However, there are limited data regarding the measurement of anti-Tg antibodies in these washouts (TgAb-FNAB), and it is not clear whether these antibodies interfere with the assessment of Tg-FNAB or whether there are other factors that would more consistently justify the finding of low Tg-FNAB in metastatic LNs. Materials and methods We investigated 232 FNAB samples obtained from suspicious neck LNs of 144 PTC patients. These samples were divided according to the patient’s serum TgAb status: sTgAb- (n = 203 samples) and sTgAb+ (n = 29). The TgAb-FNAB levels were measured using two different assays. Tg-FNAB was also measured using two assays when low levels (< 10 ng/mL) were identified in the first assay of the metastatic LNs from the sTgAb+ samples. Results The TgAb-FNAB results were negative in both assays in all samples. Low levels of Tg-FNAB were identified in 11/16 of the metastatic LNs of the sTgAb+ patients and 16/63 of the sTgAb- patients (p < 0.05) using assay 1. The measurement of the Tg-FNAB levels using assay 2 indicated additional metastases in 5 LNs of the sTgAb+ patients. Conclusions Factors other than the presence of TgAb-FNAB may contribute to the higher number of metastatic LNs with undetectable Tg-FNAB in the sTgAb+ group. In addition, the measurement of Tg-FNAB using different assays was useful to enhance the diagnosis of metastatic LNs, particularly when cytological and Tg-FNAB results are discordant.

Objectives: This study is aimed to review the ultrasound imaging (USG) of benign, malignant and metastases lesions in cervical lymph nodes. Literature Review: This article was written based on some scientific literatures in which will explain the interpretation technique and imaging characteristic to distinguish between benign, malignancies and metastases lesions in cervical lymph nodes through ultrasound imaging. There are many pathological conditions may occur in cervical lymph nodes that can be analyzed in ultrasound. The signs of benign, malignant and metastases lesions in cervical lymph nodes, all may have different characteristics. Those characteristics could help the practitioners and radiologists to distinguish the lesions based on several assessment categories. Hopefully, the reader of this article could understand the technique to distinguish benign, malignant and metastases lesions in neck lymph nodes in ultrasound. Conclusion: Ultrasonography is the most commonly used modality for lymph nodes examination, although the accuracy cannot be trusted or guaranteed 100% but this modality always be used and becoming one of all choices. Through the ultrasound, it could be concluded that some of the characteristics of the assessment can be a guide to distinguish benign, malignant and metastases lesions in cervical lymph nodes.

A major advantage of head and neck sonography over other imaging methods is that the attending physician performs the examination himself/herself and can directly compare the imaging findings with other clinical and endoscopic findings. Given the "big picture," the physician is thus able to interpret the sonographic findings correctly. The first part of this article gives an exemplary overview of lesions of the skin, neck, and lymph nodes as well as the ensuing oncologic follow-up with ultrasound. In the second part the focus lies on salivary glands, paragangliomas, the esophagus, and vascular pathologies.

Objective This study aimed to investigate the feasibility and safety of endoscopic neck dissection in the treatment of early-stage oral cancer and to evaluate the long-term clinical outcomes. Study Design Six patients with early-stage oral cancer were enrolled in this pilot study from December 2006 to May 2007. All the patients underwent endoscopic selective neck dissection (levels I-IV) of the ipsilateral neck and partial glossectomy or hemiglossectomy as the primary treatment. Results All endoscopic procedures were successfully performed, with important neck structures identified and preserved. All the patients survived with no persistent or recurrent disease during the 76- to 83-month follow-up. Conclusions Our preliminary results indicated that endoscopic neck dissection is a technically feasible and safe technique for treating early-stage oral cancer. The oncologic indications and validation should be further confirmed in patients with clinically positive neck lymph nodes in a future study.

This report presents the case of a 54-year-old woman with a collision tumour of malignant melanoma and medullary thyroid carcinoma in the thyroid. Twenty four of 25 neck lymph nodes contained metastatic melanoma, with the rest having both metastatic melanoma and medullary carcinoma. Systemic chemotherapy was administered for the malignant melanoma, and a complete response was thus obtained. However, just after having the chemotherapy, multiple lung and brain metastases emerged. The simultaneous occurrence of malignant melanoma and medullary carcinoma in the same thyroid has not been previously reported in the literature. Collision tumour of malignant melanoma and medullary carcinoma of the thyroid might imply bad prognosis.

Purpose: To evaluate the role of real-time sonoelastography (UE) and apparent diffu- sion coefficient (ADC) value measurement in differentiating benign versus malignant enlarged neck lymph nodes. Materials and methods: This study included 26 patients presented with 32 enlarged neck lymph nodes (LNs), underwent real-time UE and diffusion weighted MRI (DWI). ADC maps are gener- ated from DWI and ADC values were calculated. Both UE and ADC findings were compared with histopathological results. Results: The LNs were 12 benign lymphadenopathy (37.5%, seen in 10 patients), 10 metastatic (31.25% seen in 8 patients) and 10 lymphoma (31.25%, seen in 8 patients) including 4 LNs with Hodgkin's lymphoma (HL, seen in 3 patients) and 6 LNs with non Hodgkin's lymphoma (NHL, seen in 5 patients). On UE 10 of the 12 benign LNs had pattern of 1-2 (83.3%) and 18 of 20 neo- plastic LNs (90%) had pattern of 4-5. The mean ADC values of the benign, metastases and lym- phoma groups were 1.52 ± 0.37, 0.90 ± 0.15 and 0.72 ± 0.12 · 10 3 (mm 2 /s), respectively. Conclusion: Combined real-time UE and ADC value measurement are non invasive techniques useful for differentiation of enlarged neck lymph. The combination potentially could reduce unnec- essary biopsy especially for elasticity pattern 1-2. � 2014 Production and hosting by Elsevier B.V. on behalf of Egyptian Society of Radiology and Nuclear Medicine.