Search

Despite improvements in functional outcomes attributable to advances in radiotherapy, chemotherapy, surgical techniques, and imaging techniques, survival in head and neck squamous cell carcinoma (HNSCC) patients has improved only marginally during the last couple of decades, and optimal therapy has yet to be devised. Genomic complexity and intratumoral genetic heterogeneity may contribute to treatment resistance and the propensity for locoregional recurrence. Countering this, it demands a significant effort from both basic and clinical scientists in the search for more effective targeted therapies. Recent genomewide studies have provided valuable insights into the genetic basis of HNSCC, uncovering potential new therapeutic opportunities. In addition, several studies have elucidated how inflammatory, immune, and stromal cells contribute to the particular properties of these neoplasms. In the present review, we introduce recent findings on genomic aberrations resulting from whole-genome sequencing of HNSCC, we discuss how the particular microenvironment affects the pathogenesis of this disease, and we describe clinical trials exploring new perspectives on the use of combined genetic and cellular targeted therapies.

Objective. Human Papillomavirus (HPV)-induced oropharyngeal squamous cell carcinoma (OPSCC) represents an increasing tumor entity with typical clinical and histopathological features, associated with a rising incidence and improved prognosis (1). Detection of HPV-DNA is the most widely used method to diagnose HPV infection in clinical samples. Commercially available diagnostic assays show variable sensitivity and specificity and no international standards have been proposed yet (2). The main purpose of this preliminary study was to evaluate the reliability of EasyPap Direct HPV DNA Test (Ulisse BioMed) on formalin-fixed paraffin-embedded samples (FFPE), despite this test has been designed to work in vaginal mucus, where preliminary data showed a sensitivity of 97%. The test is real-time PCR based, it does not require DNA extraction and it can perform high-risk HPV genotyping. Kit performances have been compared with a commercial kit which requires DNA extraction. Materials and Methods. This pilot study included 38 cases of OPSCC that were surgically treated in our institute. Tumor samples were fixed in buffered formalin, embedded in paraffin and stored at room temperature for 1-13 years (mean storage period 4 ± 4 years). In order to confirm histology and lesion grade, all samples were reviewed by hematoxylin-eosin staining. DNA extraction has been performed starting from FFPE samples through QIAamp® DNA FFPE Tissue Kit (Qiagen, Hilden, Germany) and HPV has been typed through Real Time PCR HPV sign® Pyro Mark System Q96 IDTM (CE-IVD Diatech Pharmacogentetics Iesi Italy). We found 16 cases positive for HPV16, 1 case positive for HPV35 and 21 HPV negative samples. In order to perform HPV detection through EasyPap Direct HPV DNA test, samples underwent deparaffinization with xylene and rehydration with ethanol. Genotyping data were compared to those obtained with Qiagen kit. Results. EasyPap Direct HPV DNA test identified 16 HPVpositive cases and 22 HPV negative cases. Genotyping data showed that 15 samples were HPV16 and 1 sample was HPV35 positive. Concordance analysis showed an agreement- coefficient Kappa Cohen K=0.95 IC95% [0.84-1.00] (excellent agreement, Fleiss classification). The sensibility and specificity of the EasyPap HPV DNA test was 94.1% (95%, confidence interval 80.1%-98.8%) and 100% (95%, confidence interval 88.6%-100%), respectively. The positive predictive value was 100% (95%, confidence interval 88.6%-100%) and the negative predictive value was 95.5% (95% confidence interval, 81.9%-99.3%). Conclusions. Hitherto it was well known that DNA extraction contributes to increase the sensitivity of PCR-based HPV test starting from FFPE tissue samples (3). Despite small sample size has been analyzed, preliminary data obtained through EasyPap Direct HPV DNA test successfully showed that high sensitivity and specificity can be achieved without DNA extraction, with a remarkable decrease of assay cost and time. These results lead us to perform large scale EasyPap testing.

In response to "In Reference to: Neck abscess: An unusual Clinical Presentation of Immunoglobulin G4-Related disease

OBJECTIVE. Human Papillomavirus (HPV)-related squamous cell carcinoma of the oropharynx (HPV-OPSCC) usually originates from the reticulated epithelium lining the crypts of Waldeyer’s ring. The increasing epidemiologic evidence of this type of tumors and the peculiar positive prognosis, suggested to introduce a dedicated staging system (1). The 8th edition of the American Joint Committe on Cancer (AJCC) staging manual presented a new classification to discriminate HPV-related cancers based on p16 over-expression, since it demonstrated to be an important biomarker (2). The detection of HPV-DNA could not be used as a defining factor due to its cost and lack of universal applicability. The main purpose of this preliminary study was to evaluate the concordance between the results of immunohistochemistry for p16 overexpression and the HPV-DNA detection performed with a commercial kit as control. MATERIALS AND METHODS. We retrospectively collected 32 cases of OPSCC diagnosed in 2016 at the Academic Hospital of Cattinara in Trieste, whose samples had been tested with Real Time PCR (Pyro Mark System Q96 IDTM - CE-IVD Diatech Pharmacogentetics Iesi Italy). The study was performed using tumor samples fixed in buffered formalin, embedded in paraffin and stored at room temperature for 6 to 18 months. All samples were selected by a pathologist based on sections stained with hematoxylin and eosin to confirm the adequacy of the tissue. The samples were tested for p16 by immunohistochemistry (CINtech® p16 Histology E6H4 ROCHE) and the positivity was assessed when nuclear expression was ≥+2/+3 intensity and ≥75% distribution according to the 8th edition of the AJCC staging manual. In the context of oropharyngeal cancer, the optimal cut-off for p16 overexpression is ≥+2/+3 intensity (+/- cytoplasmic staining) with ≥75% distribution. RESULTS. Seven cases were excluded because of lack of histological stored material for p16 immunohistochemical analysis (only cytological specimen). Among the remaining 25 cases, there were 5 HPV-positive and 20 HPV-negative tumors. The sensibility and specificity of the p16 immunostaining was equal to 100% (95%, confidence interval 83.4%-100%) and 100% (95%, confidence interval 83.4%-97.8%), respectively; the positive predictive value was 100% (95%, confidence interval 83.4%-100%) and the negative predictive value 100% (95% confidence interval, 83.4%-100%). CONCLUSIONS. In agreement with the literature, p16 overexpression demonstrated to be a reliable parameter to identify the cases of OPSCC in which performing an in-depth analysis by means the detection of HPV-DNA would be indicated. Indeed, it is widely known that the association of p16 immunostaining and HPV-DNA detection by quantitative PCR increases the prognostic discriminator (3). We intend to carry on this study adopting a prospective design increasing the sample size and the test accuracy.

Project was completed in previous post, I joined DMU on 01/01/2016 Infection with high-risk types of human papilloma virus (HPV) is currently the best-established prognostic marker for head and neck squamous cell carcinoma (HNSCC), one of the most common and lethal human malignancies worldwide. Clinical trials have been launched to address the concept of treatment de-escalation for HPV-positive HNSCC with the final aim to reduce treatment related toxicity and debilitating long-term impacts on the quality of life. However, HPV-related tumors are mainly restricted to oropharyngeal SCC (OPSCC) and there is an urgent need to establish reliable biomarkers for all patients at high risk for treatment failure. A patient cohort (n = 295) with mainly non-OPSCC (72.9%) and a low prevalence of HPV16-related tumors (8.8%) was analyzed by MassARRAY to determine a previously established prognostic methylation score (MS). Kaplan-Meier revealed a highly significant correlation between a high MS and a favorable survival for OPSCC (P = 0.0004) and for non-OPSCC (P

Immunoglobulin G4 related disease (IgG4-RD) is a systemic fibroinflammatory disease that can affect almost any organ. Only a few cases of IgG4-RD have been reported to present with cervical lymphadenopathy and none with neck abscesses. We report a case in a patient with bilateral neck mass and bilateral neck abscesses. The patient underwent bilateral neck incision for drainage of the abscesses on two occasions, followed by a neck dissection after a third recurrence. Immunohistochemistry of the specimen revealed IgG4-RD. Although surgery is not the recommended firstline approach for IgG4-RD, only a neck dissection enabled clinical resolution of the lesions in our patient.

Strongly associated with tobacco use, heavy alcohol consumption, and with high-risk human papillomavirus (HPV) infection, head and neck squamous cell carcinoma (HNSCC) is a frequently lethal, heterogeneous disease whose pathogenesis is a multistep and multifactorial process involving genetic and epigenetic events. The majority of HNSCC patients present with locoregional advanced stage disease and are treated with combined modality strategies that can markedly impair quality of life and elicit unpredictable results. A large fraction of those who undergo locoregional treatment and achieve a complete response later develop locoregional recurrences or second field tumors. Biomarkers that are thus able to stratify risk and enable clinicians to tailor treatment plans and to personalize post-therapeutic surveillance strategies are highly desirable. To date, only HPV status is considered a reliable independent predictor of treatment response and survival in patients with HNSCC arising from the oropharyngeal site. Recent studies suggest that telomere attrition, which may be an early event in human carcinogenesis, and telomerase activation, which is detected in up to 90Â % of malignancies, could be potential markers of cancer risk and disease outcome. This review examines the current state of knowledge on and discusses the implications linked to telomere dysfunction and telomerase activation in the development and clinical outcome of HNSCC.

Objective: The current surgical trend in the treatment of pleomorphic adenomas of the parotid gland is to limit the extent of resection. This raises the need to correctly identify the mass within the normal parenchyma so as to avoid dissecting the entire superficial lobe of the gland. We describe ultrasound-guided tattooing as a technique to facilitate identification and excision of parotid pleomorphic adenomas. Methods: We reviewed 23 consecutive patients with pleomorphic adenoma of the parotid gland. All patients underwent ultrasound-guided tattooing of the lesions with a charcoal suspension. Baseline tumor and patients’ characteristics, major and minor complications, and subjective tolerance to the procedure were recorded. We assessed the number of intralesionally marked masses and the percentage of intraoperatively detected marked lesions. Results: The injection was well tolerated. No major complications were recorded. In 2 cases (9%), a transient increase in lesion size was observed. No other minor complications were encountered. Charcoal was found inside the tumor in 19 cases (83%). In 4 cases (17%), it was found in the tissues above the lesion. Twenty-three lesions were intraoperatively detected (100%) and dissected. Conclusion: Charcoal suspension tattooing is safe and well tolerated for the detection of small pleomorphic adenomas during parotid surgery.

Interdigitating dendritic cell sarcoma (IDCS) is an exceedingly rare neoplasm originating from professional antigen presenting cells normally located in the T zone of the lymph node. The purpose of this report was to describe the first case of the IDCS of the submandibular gland and perform a review of the literature of head and neck IDCS. We present a case of an 81-year-old man with a 5 months history of slowly enlarging painless mass in right submandibular region. Fine needle aspiration cytology was suggestive of squamous cell carcinoma. The patient underwent surgical resection of the right submandibular gland and neck dissection. A malignant spindle cell proliferation involving the submandibular gland and colonizing one laterocervical lymph node was found. Morphology and immunophenotype prompted a differential diagnosis of a metastatic spindle cell melanoma versus an IDCS. Transmission electron microscopy was performed and supported a diagnosis of IDCS. The diagnosis of IDCS is a challenging task and may require a large array of techniques.

oral breath in children

a 3 dimensional surgical resection requires a optimal definition of the margins of the tumour; this is available by narrow band imaging technique.

Il carcinoma squamoso del cavo orale rappresenta complessivamente l'ottava neoplasia più frequente a livello mondiale. Il 30% origina a livello linguale, 20% a livello mandibolare, 5% a livello del pavimento orale, 4% a livello del palato molle, 2% a livello della mucosa della guancia.

Oropharynx spinocarcinoma is a tumour of the upper aerodigestive tract; the last research has showed the relevance of the HPV type 16, 18,31 in the etiopathogenesis. Different clinical implications depend from these data.

carotid aneurysm

Research was carried out in collaboration with the Head and Neck Department and the Clinical Neurophysiological Unit at the University of Trieste (Italy) to assess the effects of resonance phenomena on the human body. We worked with volunteers who underwent examination by EEG while listening to tones between 90Hz and 120Hz, similar to the resonant sounds found at some Neolithic structures in Europe (England, Ireland, Italy, Malta). As in the study by Ian Cook at the University of California (UCLA, 2008), all of our volunteers were subjected to a "comfortable" volume of sound whilst in the absorbing sound room. This is used for audiometric tests at the Otorhinolaryngology Clinic and has been modified with suitable software and hardware. This type of room is also protected by a Faraday cage to shield from any possible external electromagnetic interference that could affect the results. After two minutes of silence to evaluate the resting brain rhythm, the volunteers were subjected to the tones of 90, 95, 100, 105, 110, 115, 120Hz arranged in a random way for one minute each. At the end of every cycle they listened to a mantra of the same frequency for a period of two minutes. Technicians examined the EEGs to verify the data collected. They found there was a prevalence of frontal areas or occipital (posterior) areas with no predominance of one cerebral hemisphere (left of right) over the other during playing. Each volunteer had a different sensitivity to all the tones without one tone prevailing (i.e. 110Hz), with each exhibiting a strong response to a subjective and personal tone (90Hz, 105Hz, 120Hz...).

Stenosis of the cartilaginous auditory canal is still difficult to resolve and many techniques of plastic surgery have been proposed. Our experience was first built up in treatment of stenosis of the tracheostomy in patients who had undergone laryngectomy. Since it is simple and effective, we have transferred and modified the technique to the treatment of stenosis of the external auditory canal and of the concha. Fourteen patients with stenosis of the cartilaginous auditory canal (diameters of the stenosis prior to surgery varied from 19 to 78.5 mm(2)) underwent day-surgery conchomeatoplasty under local anaesthesia. Eight months after the operation, the results are good. Following surgery, the surface of the auditory canal, measured at the narrowest point of the external auditory meatus, varied from a minimum of 113 mm(2) to a maximum of 254 mm(2). The technique we propose to correct the stenosis of the external auditory canal is easy to carry out, short, and may be performed under local anaesthesia. Lastly, the auditory canal and the ear auricle have a good blood supply, thus ensuring the flaps will survive.

conference on head and neck cancer

conference on head and neck cancer

conference on head and neck cancer

tempi chirurgici in sala operatoria

otorhinolaryngology and temporo-mandibular joint

harmonic scalpel in head and neck cancer: thiroyd surgery

Radial and anterolateral thigh flaps in head and neck surgery

Lymphoproliferative disorders are heterogeneous malignancy characterized by the expansion of a lymphoid clone more or less differentiated. At the level of the oral cavity, the lymphoproliferative disorder can occur in various ways, most commonly as lymphoid lesions with extranodal externalization, but sometimes, oral lesions may represent a localization of a disease spread. With regard to the primary localizations of lymphoproliferative disorders, a careful examination of the head and neck, oral, and oropharyngeal area is necessary in order to identify suspicious lesions, and their early detection results in a better prognosis for the patient. Numerous complications have been described and frequently found at oral level, due to pathology or different therapeutic strategies. These complications require precise diagnosis and measures to oral health care. In all this, oral pathologists, as well as dental practitioners, have a central role in the treatment and long-term monitoring of these patients.

surgical mandibular reconstruction with free flaps

Purpose The numb chin syndrome is a mental nerve neuropathy that origins in the absence of a mandibular lesion or a dental cause. In most occasions it can be the first symptom of a malignancy. Methods We present a series of four oncologic patients that were complaining of oral and facial numbness associated with neuralgia. All subjects underwent neurological and dental examinations. Computed tomography, magnetic resonance imaging and bone scan were also carried out. Neoplastic neurological involvement was suspected and the analysis of the cerebrospinal fluid was performed. Results The neurological examination, combined with the radiological features and the cerebrospinal fluid analysis confirmed the diagnoses of numb chin syndrome associated with carcinomatous meningitis.

Objective: To optimize the selection of patients eligible for surgical neck treatment optimizing a diagnostic routine to identify neck metastases. Methods: Comparison between sensibility, specificity and diag- nostic accuracy of clinical examination, echography (US), com- puted tomography (CT) in detection of cervical metastases in 53 patients with carcinoma of the upper aerodigestive tract. Results: Clinical examination: sensibility 82.1%, specificity 80%, diagnostic accuracy 81.1%—US with a cut off point for minimal adenopathy diameter of 0.5 cm sensibility 92.8%, specificity 77.3%, diagnostic accuracy 77.3%—US with a cut off point of 1 cm sensibility 82.1%, specificity 80%, diagnostic accuracy 81.1%—US with a cut off point of 1 cm, also considering round shape of multiplicity of the adenopathy: sensibility 82.1%, speci- ficity 80%, diagnostic accuracy 81.1%—CT with cut off point 0.5 cm: sensibility 92.8%, specificity 32%, diagnostic accuracy 64.1%—CT with cut off point 1 cm: sensibility 85.7%, specificity 64%, diagnostic accuracy 75.4%—CT with cut off point 1 cm, also considering central necrosis, extracapsular spread, multi- plicity of adenopathy: sensibility 89.2%, specificity 60%, diag- nostic accuracy 75.5%. Conclusions: (a) A neck positive to palpation must be submitted to neck dissection (81.1% possibility of having a metastases); (b) a neck negative to palpation must be further investigated using the US and CT cut off point of 1 cm; (c) the combined use of US and TC does not offer remarkable advantages in detection of metastases.