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Seborrheic Keratosis are common, benign skin tumours usually found in the head neck region of elderly patients in their fifties. Etiopathogenesis and its association with malignant skin tumours such as Malignant Melanoma, Basal cell Carcinoma, remains obscure which highlights the importance of treatment modality offered to such patients. We present a case of 54-year-old male with a lesion mimicking Malignant Melanoma which was diagnosed as Seborrheic Keratosis on histopathologic examination. [ABSTRACT FROM AUTHOR]

Head and neck desmoid fibromatosis is a rare type of benign but locally aggressive tumour that has varied presentations and is difficult to manage with a high chance of causing morbidity to the patient. This report highlights the importance of proper diagnosis and surgical planning before embarking on a strenuous surgical resection. [ABSTRACT FROM AUTHOR]

Oral cancer ranks as the sixth most common malignancy worldwide, with Squamous Cell Carcinoma (SCC) being the predominant type observed in the head and neck region. Incidence and mortality rates of SCC have significantly increased over the past few decades. Smoking and tobacco chewing are the most common aetiological factors, predominantly affecting elderly males. Distant metastasis at the time of diagnosis is a rare occurrence, typically disseminating through blood vessels or lymphatics. The lungs are the most frequent site for distant metastasis, followed by bone, mediastinal nodes, and occasionally the liver. However, in our cases, we observed metastasis to uncommon sites, excluding the liver. Accurate diagnosis necessitates the correlation with clinical history, radiological, histopathological, and immunohistochemical findings. Despite employing various surgical and radiotherapeutic modalities, distant metastasis diminishes the chances of survival, successful treatment, and worsens the prognosis. This article presents four cases of oral SCC that exhibited metastasis to unusual sites. Two cases had a primary tumour in the left lateral border of the tongue, with distant metastasis to the breast and skin (chest wall), while the other two cases had a primary tumour in the left buccal mucosa and left mandibular region, with distant metastasis to the kidney and liver.

Oral cancer ranks as the sixth most common malignancy worldwide, with Squamous Cell Carcinoma (SCC) being the predominant type observed in the head and neck region. Incidence and mortality rates of SCC have significantly increased over the past few decades. Smoking and tobacco chewing are the most common aetiological factors, predominantly affecting elderly males. Distant metastasis at the time of diagnosis is a rare occurrence, typically disseminating through blood vessels or lymphatics. The lungs are the most frequent site for distant metastasis, followed by bone, mediastinal nodes, and occasionally the liver. However, in our cases, we observed metastasis to uncommon sites, excluding the liver. Accurate diagnosis necessitates the correlation with clinical history, radiological, histopathological, and immunohistochemical findings. Despite employing various surgical and radiotherapeutic modalities, distant metastasis diminishes the chances of survival, successful treatment, and worsens the prognosis. This article presents four cases of oral SCC that exhibited metastasis to unusual sites. Two cases had a primary tumour in the left lateral border of the tongue, with distant metastasis to the breast and skin (chest wall), while the other two cases had a primary tumour in the left buccal mucosa and left mandibular region, with distant metastasis to the kidney and liver. [ABSTRACT FROM AUTHOR]

Copyright of China Journal of Oral & Maxillofacial Surgery is the property of Shanghai Jiao Tong University, College of Stomatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Head and neck tumours are common malignancies that are associated with high mortality. The low rate of early diagnosis and the high rates of local recurrence and distant metastasis are the main reasons for treatment failure. Recent studies have established that the tumour microenvironment (TME) can affect the proliferation and metastasis of head and neck tumours via several mechanisms, including altered expressions of certain genes and cytokines. Increasing evidence has shown that epigenetic modifications, such as DNA methylation, histone modification, RNA modification, and non-coding RNAs, can regulate the head and neck TME and thereby influence tumour development. Epigenetic modifications can regulate the expression of different genes and subsequently alter the TME to affect the progression of head and neck tumours. In addition, the cell components in the TME are regulated by epigenetic modifications, which, in turn, affect the behaviour of head and neck tumour cells. In this review, we have discussed the functions of epigenetic modifications in the head and neck TME. We have further examined the roles of such modifications in the malignancy and metastasis of head and neck tumours. [ABSTRACT FROM AUTHOR]

SMARCB1 (INI-1) is a vital tumour suppressor gene on chromosome 22q11.2, preventing tumour development in the SWI/SNF complex. Mutations cause SMARCB1-deficient tumours with distinct features. Loss of INI-1 expression is seen in malignancies, including sinonasal carcinoma and atypical teratoid/rhabdoid tumours. Recently recognized as a separate entity, SMARCB1-deficient sinonasal carcinomas (SDSC) are rare, clinically aggressive, and mimic other malignancies, emphasizing their significant diagnosis due to poorer prognosis, particularly in the elderly. A 66-year-old male presented with a 4-month-old right cheek swelling, diagnosed initially as a sinonasal neoplastic mass. The biopsy revealed sinonasal mucosal fragments infiltrated by a tumour with plasmacytoid morphology. Immunohistochemistry (IHC) of the tumour cells was positive for p63 and pan-cytokeratin and showed INI-1 loss. Subsequent subtotal maxillectomy was performed, and the patient received adjuvant chemotherapy and radiotherapy. At a thirteen-month follow-up, the patient achieved his daily activities with no signs of recurrence. The loss of protein expression in sinonasal cancer is predominantly attributed to the homozygous deletion of SMARCB1. SDSC, a profoundly invasive malignant carcinoma, tends to infiltrate sinuses and extend into the intracranial regions. The IHC findings of our case were in coherence with previous studies in SMARCB1. The prognosis is particularly unfavourable in males and advanced tumours. The tumour's microscopic and immunohistochemical characteristics indicated the SDSC. Due to its aggressive nature and high mortality rates, dealing with a paranasal mass, one should be suspicious of this tumour. • Recently recognized as a separate entity, SMARCB1-deficient sinonasal tumors are rare, clinically aggressive, and mimic other malignancies, emphasizing their significant diagnosis due to poorer prognosis, particularly in the elderly. • SMARCB1 (INI-1) is a vital tumor suppressor gene on chromosome 22q11.2, preventing tumor development in the SWI/SNF complex. • Biopsy was taken and the tumor's microscopic and immunohistochemical (IHC) characteristics indicated the SMARCB1 (INI-1) deficient subtype. [ABSTRACT FROM AUTHOR]

Introduction: High-grade glioma patients and their caregivers often suffer from distress and a lower quality of life. Results from studies with patients with mixed cancer entities suggest that yoga can be an effective support. However, it is unclear whether this also applies to high-grade glioma patients and their caregivers. This study aims to investigate the effects of mindfulness-based online yoga for patients and their caregivers on emotional distress, quality of life and stress-associated physiological parameters compared with a waiting control group (WCG)., Methods & Analysis: The study is designed as a multicentre randomised controlled trial. Adult glioma patients (central nervous system WHO grades 3 and 4) and their caregivers will be recruited. Examined yoga instructors deliver the intervention (1 hour per week) in a synchronous format over 8 weeks via video conferencing. The WCG will receive standard care during the 8-week waiting period. Data will be collected before and after the end of the intervention and another 3 months later using questionnaires as well as blood serum and hair samples to evaluate biochemical stress parameters. Primary outcome is self-reported generalised anxiety and secondary outcomes are self-reported fear of progression, depression and quality of life as well as brain-derived neurotrophic factor (BDNF), dehydroepiandrosterone (DHEA)/dehydroepiandrosterone sulfate (DHEAS), ferritin and hair cortisol. We hypothesise better outcomes in the intervention group compared with the WCG at all measurement points. 70 patients and 70 caregivers will be recruited consecutively. Primary endpoints are significant effect detections in the Generalised Anxiety Disorder scale-7 of patients and caregivers at the end of the intervention. Analyses of covariance will be performed to analyse the treatment effects., Ethics and Dissemination: The Ethics Committee of the University of Würzburg approved the YINOTA-O ( Y oga- I ntervention bei N euroonkologischen T umorpatienten und deren A ngehörigen - O nline) study on 26 October 2021 (No.185/18-me). Results will be presented at conferences and published in peer-reviewed journals., Trial Registration Number: German Clinical Trials Register No. DRKS00029554., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Radiotherapy alone or in association with systemic treatment plays a major role in the treatment of head and neck tumours, either as a primary treatment or as a postoperative modality. The management of these tumours is multidisciplinary, requiring particular care at every treatment step. We present the update of the recommendations of the French Society of Radiation Oncology on the radiotherapy of head and neck tumours from the imaging work-up needed for optimal selection of treatment volume, to optimization of the dose distribution and delivery. [ABSTRACT FROM AUTHOR]

Parapharyngeal Space (PPS) tumours are responsible for 0.5% of head and neck cancers. Presenting features can mimic Peritonsillar Abscess (PTA). A differential diagnosis of PPS tumour should therefore be considered in young, systemically well patients with peritonsillar masses that are refractory to antibiotic therapy. This report focuses on a rare case of parapharyngeal schwannoma in an otherwise fit 29-year-old female, who presented with a three month history of a right sided oropharyngeal swelling and a sensation of ‘something’ in her throat. Blood tests, specifically full blood count and C-Reactive Protein (CRP) were normal and attempts at aspiration under local anaesthetic yielded no pus. As the patient showed no signs of improvement despite Intravenous (i.v.) antibiotics and steroid therapy; further investigations were initiated including Flexible Nasoendoscopy (FNE) and contrast enhanced Magnetic Resonance Imaging (MRI) of the neck. The FNE revealed a right sided parapharyngeal mass which was later confirmed on MRI scanning, measuring 7 cm in craniocaudal dimension arising from the deep lobe of the parotid gland. After a fine needle aspiration yielded inconclusive histological evidence, Multidisciplinary Team (MDT) discussion advised surgical excision. The patient underwent excision of the right parapharyngeal tumour and right partial parotidectomy via a transparotid and transcervical approach utilising a modified blair incision and a facial nerve monitor. Histology confirmed a parapharyngeal schwannoma. Postoperative outcomes have been reassuring as the patient has been disease-free four years postexcision.

Head and neck cancer patients present unique airway challenges, and oropharyngeal, laryngeal, and hypopharyngeal tumours considerably distort and narrow the anatomy of the airway. We describe the use of 3D augmented reality software combined with 3D printed models to assess the anatomy of difficult airways and to assist in the formulation of the most optimal airway management strategy in such patients. The reported patients had computed tomograms (CT) of the neck prior to their anaesthetic and surgical management. DICOM files of the respective scans were imported to 3D rendering software (OsiriX, Pixmeo). We constructed volume rendered models for initial assessment of the airway then generated serial surface rendered models to create a virtual endoscopic path of the airway to simulate the fibreoptic approach. To further facilitate the study of difficult airways we have subsequently printed 3D models of those that were most difficult using rapid prototyping. Head and neck tumours significantly distort the airway. Thorough study of the relevant anatomy prior to airway management for operating reasons enhances communication between the surgeon and anaesthetist, and aids selection of the most appropriate intubation approach. In conclusion, this paper highlights a useful and novel pre-assessment strategy that allows a virtual, visual, 3-dimensional assessment of the airway anatomy combined with 3D modelling and 3D printing. This enables the airway specialist, anaesthetist, and head and neck surgeon to anticipate any critical steps and adjust the plan accordingly. [ABSTRACT FROM AUTHOR]

The discovery of a small subset of cancer cells with self-renewal properties that can give rise to phenotypically diverse tumour populations has shifted our understanding of cancer biology. Targeting cancer stem cells (CSCs) is becoming a promising therapeutic strategy in various malignancies, including head and neck squamous cell carcinoma (HNSCC). Diverse sub-populations of head and neck cancer stem cells (HNCSCs) have been identified previously using CSC specific markers, the most common being CD44, Aldehyde Dehydrogenase 1 (ALDH1), and CD133, or by side population assays. Interestingly, distinct HNCSC subsets play different roles in the generation and progression of tumours. This article aims to review the evidence for a role of specific CSCs in HNSCC tumorigenesis, invasion, and metastasis, together with resistance to treatment.

Objective: To evaluate the advantages and disadvantages of the transmandibular approach to the posterior area of the maxilla, oropharyngeal region and the hypopharynx in head and neck surgery. Methods: A series of 42 patients who underwent a lip-split mandibulotomy procedure to access malignant tumours affecting deep areas of the head and neck region between 2008 and 2018 in the Department of Oral and Maxillofacial Surgery at the Ramón y Cajal University Hospital (Madrid, Spain) were retrospectively reviewed. The diagnosis and operations data of the patients were collected and analysed. Results: Using the transmandibular approach, 42 patients were operated on to access malignant tumours located in the oropharynx (n = 23, 54.76%) including the posterior third of the tongue, tonsil and soft palate, retromolar trygone (n = 9, 21.43%), floor of the mouth (n = 3, 7.14%), skull base (n = 2, 4.76%), superior maxilla (n = 3, 7.14%) and deep lobe of the parotid gland (n = 2, 4.76%). Primary reconstruction was carried out in all cases. The most used flap reconstruction method was the forearm fasciocutaneous flap in 48.71% of cases, followed by the anterolateral thigh flap in 20.51% of cases. The remaining cases were treated with other methods. The most frequent complication was surgical wound infection. Conclusion: The transmandibular approach is a good alternative to provide access for the removal of complex tumours affecting the oropharyngeal region. This approach facilitates direct visualisation of the lesion and bleeding control, allowing tumour resection with wide margins and making primary reconstruction easier. Although further progress in the transoral robotic approach could be a good option in selected cases, given the current state of knowledge, the transmandibular approach is a good option to access tumours affecting deep areas of the oral cavity and oropharynx. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to evaluate the yields of 2-deoxy-2-[18F]-fluoro-D-glucose positronemission tomography/magnetic resonance imaging (18FFDG-PET/MRI) and 18F-FDG-PET/computed tomography (CT) for the detection of metastatic involvement of locoregional neck nodes in patients with head and neck malignancy. Patients and Methods: A total of 90 patients (66 men and 24 women) met the inclusion criteria. Preoperative staging was performed: 53 examinations using PET/CT and 37 using PET/MRI. Results: For PET/MRI, the study demonstrated a sensitivity of 89%, specificity of 64%, positive predictive value of 85%, and negative predictive value of 70%; PET/CT had a sensitivity of 95%, specificity 47%, positive predictive value of 82%, and negative predictive value of 78%. Conclusion: Both methods have a high yield in N-clinical staging with statistically insignificant differences. We assume PET/MRI to be the first-choice method in organ-targeted examinations, for pediatric patients and repeat examinations. In cases of MRI contraindication, PET/CT can be used with no impact on the quality of care. [ABSTRACT FROM AUTHOR]

The aim of this study was to integrate the available data published on desmoplastic ameloblastoma (DA) into a comprehensive analysis of its clinical/radiographic features. As it is not clear whether the hybrid ameloblastoma has a unique biological behaviour, the clinical/radiographic features of conventional DA were compared with those of the hybrid variant. An electronic search was undertaken in May 2019. Eligibility criteria included publications with sufficient clinical/radiographic/histological information to confirm the diagnosis. A total of 128 publications reporting 285 DAs were included (246 central non-hybrid, 33 central hybrid, 6 peripheral). There was a statistically significant difference between non-hybrid and hybrid cases concerning lesion location, radiographic limits, and size. In contrast to non-hybrid tumours, which showed a similar distribution in the mandible and maxilla, hybrid tumours showed a high predominance of mandible location. Non-hybrid lesions more often showed ill-defined radiographic margins, and were smaller tumours than hybrid DAs. Enucleation with an additional therapy (either curettage or peripheral osteotomy) or resection led to a lower recurrence risk in comparison to curettage or enucleation without additional therapy. The location of the lesion and type of treatment are related to tumour recurrence. There are important differences in location and radiographic limits between hybrid and non-hybrid DAs, which support their classification as distinct lesions. [ABSTRACT FROM AUTHOR]

Introduction: Paragangliomas are neuroendocrine tumours commonly located in the abdomen, thorax, head and neck. The definitive treatment for these tumours is surgical resection, which in some cases can be very challenging due to the involvement of critical neurovascular structures and their high vascularity. Therefore, pre-operative embolisation may be performed to reduce the risk of complications. This study aimed to present our experience with endovascular embolisation of head and neck paragangliomas (HNP)., Material and Methods: In this single-centre study, we reviewed data from consecutive patients with HNP who underwent pre-operative embolisation from 2017 to 2023. The efficacy of embolisation, the method of embolisation, as well as the rate of complications, were noted., Results: A total of 27 patients (15 females) with an average age of 47 years underwent selective embolisation of HNP. Satisfactory embolisation, defined as occlusion of > 75% of the blood supply, was achieved in 22/27 cases (81.5%). The most commonly used embolic agents included coils and microspheres. With the exception of minor vessel dissections in two patients and embolic agent migration in two patients causing reversible occlusion of the intracranial vessels, there were no other complications associated with embolisation. No neurological deficits occurred in relation to the endovascular procedure., Conclusions: The results of our study indicate that endovascular embolisation of HNP prior to surgical resection is a safe and efficacious procedure, with a relatively low complication rate and associated morbidity.

Objectives: Ultrasound-guided wire (USGW) localisation for small non-palpable tumours before a revision head and neck surgery is an attractive pre-operative option to facilitate tumour identification and decrease potential complications. We describe five cases of pre-operative USGW localisation of non-palpable head and neck lesions to facilitate surgical localisation and resection., Methods: All patients undergoing pre-operative USGW localisation for non-palpable tumours of the head and neck region at London Health and Sciences Center, London, Ontario, Canada, were included. All the USGW localisations were performed by the same interventional radiologist, and the surgeries were performed by fellowship trained head and neck surgeons., Results: Five patients were included. All patients were undergoing revision surgery for recurrent or persistent disease. All successfully underwent a pre-operative USGW localisation of the non-palpable lesion before revision surgery. All lesions were localised intra-operatively with no peri-operative complications., Conclusions: USGW localisation is a safe and effective pre-operative technique for the identification of small non-palpable head and neck tumours., (Copyright © 2023 Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale, Rome, Italy.)

The management of oral cancer is a multidisciplinary endeavour, as each patient presents the treating clinicians with a unique set of challenges the management of which impacts on both survival and quality of life. This article focuses on the management of oral cancer. We highlight the epidemiology and risk factors for oral cancer in Australia, the various clinical presentations that occur and the staging of oral cancer. In the vast majority of cases surgery remains the mainstay of treatment. Radiation and medical oncology is usually used in an adjuvant context. Dental professionals play a critical role in many stages of management from the initial detection, to optimising pre treatment dental health and managing the short and long term sequelae of treatment. Monitouring for recurrence and the development of second primary tumours is a key role. [ABSTRACT FROM AUTHOR]

The development of advanced technologies including computerized tomography devices of new generation (MSCT) and MRI devices has enabled the application of high quality techniques that are used for functional analysis of head and neck tumors. Therefore, the role of conventional CT and MR imaging techniques relating to anatomical domain has been transferred to functional level thus enabling better understanding of biological characteristics of the tumor tissue and better differentiation of benign and malignant neck lymph nodes. Positron emissin tomography (PET) is a functional technique that can detect metastatic neck lesions on the basis of increased glucose metabolism in tumor cells. However, due to poor anatomical resolution some hybrid methods (PET / CT and PET / MR) have been designed that provide morphological and functional information about the tumor tissue and thus are considered to be superior in comparison to conventional PET. Perfusion techniques have proved to be beneficial in the diagnosis of head and neck tumors, especially in the diagnosis of recurrent disease after radiotherapy and for the characterization of the lymph nodes. Diffusion weighted imaging (DWI) is very useful in the diagnosis of malignant lymph nodes smaller than 10 mm that are otherwise difficult to diagnose by means of conventional methods. The paper describes the role of high quality techniques including positron emission tomography PET in combination with CT or MRI (PET / CT and PET / MR) in the diagnostics of metastatic neck lymph nodes, possibilities of perfusion imaging techniques (MSCT / MRI) in the analysis of tumor tissues, as well as possibilities of diffusion MR imaging (DWI-MRI) and MRI with nanoparticles of iron oxide in the differentiation of benign and malignant neck lymph nodes.

Ethical dilemmas arise in managing head and neck cancers during pregnancy. The timing of treatment is an important determinant on foetal wellbeing. Diagnostic and treatment modalities may harm the foetus, while delaying or choosing suboptimal treatment in order to preserve foetal health may worsen maternal outcome. A multidisciplinary approach should be adopted to enable parents and clinicians to make the best clinical decision. We report on two cases. Case 1 is a 34-year-old female who presented with squamous cell carcinoma of the tongue at 29 weeks' gestation. Partial glossectomy, selective neck dissection and posterior tibial flap reconstruction was performed at 31 weeks. She underwent induction and early delivery at 38 weeks prior to receiving radiotherapy. Case 2 is a 36-year-old female who presented with carcinoma of the cervical oesophagus complicated by tracheal invasion, thyroid and cervical lymph node metastasis at 13 weeks' gestation. Pregnancy was terminated at 16 weeks. She received a course of neoadjuvant chemoirradiation.

Integration, which leads to the disruption of the circular HPV genome, is considered as a critical, albeit not obligatory, step in carcinogenic progression. Although cervical carcinomas with extrachromosomal HPV plasmid genomes have been described, the virus is integrated in 70% of HPV16-positive cervical tumours. Limited information is available about HPV integration in head and neck tumours (HNC). In this study, we have characterised the physical status of HPV in a set of tonsillar tumour samples using different methods--the mapping of E2 integration breakpoint at the mRNA level, the 3' RACE based Amplification of Papillomavirus Oncogene Transcripts (APOT) assay and Southern blot. Furthermore, the impact of HPV integration on patients' prognosis has been evaluated in a larger set of 186 patients with head and neck cancer. Based on the analysis of E2 mRNA, HPV was integrated in the host genome in 43% of the HPV-positive samples. Extrachromosomal or mixed form was present in 57%. In fresh frozen samples, the APOT and E2 mapping results were in agreement. The results were confirmed using Southern blotting. Furthermore, the type and exact site of integration were determined. The survival analysis of 186 patients revealed HPV positivity, tumour size and lymph node positivity as factors that influence disease specific survival. However, no statistically significant difference was found in disease specific survival between patients with HPV-positive integrated vs. extrachromosomal/mixed forms of the virus. [ABSTRACT FROM AUTHOR]

Objective We aimed to assess the potential role of interpretation by cytopathologists on the level of diagnostic adequacy of head and neck fine needle aspirations ( FNAs). Methods An audit ('first audit') was performed between 1 May 2007 and 30 April 2008 using data from three different hospitals (A, B and C). The specimens were interpreted by two cytopathologists with specific experience in head and neck pathology in hospitals A and B, and by any of the eight cytopathologists (only two of whom were experienced in head and neck cytopathology) in hospital C. Following the analysis of the initial findings, there was a change in practice in hospital C, after which specimens were also read only by two experienced cytopathologists. A new audit ('second audit') was then performed between 20 January 2011 and 20 December 2012 in the same three hospitals. Results During the first audit, the diagnostic adequacy of FNAs from hospital C was 84.2% compared with 96.6% in hospital A and 97.7% in hospital B ( P = 0.000). No significant difference in the diagnostic adequacy rate of the FNAs performed in hospitals A and B was found when comparing the first and second audits. The FNA diagnostic adequacy for hospital C increased significantly in the second relative to the first audit (95.5% versus 84.2%, P = 0.000). Conclusions Our study confirms that expert cytology interpretation is important in achieving optimal diagnostic adequacy of head and neck FNAs. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the differences between three methods of classification of recurrences in patients with head and neck tumours treated with Radiation Therapy (RT). Materials and methods: 367 patients with head and neck tumours were included in the study. Tumour recurrences were delineated in the CT images taken during patient follow-up and deformable registration was used to transfer this volume into the planning CT. The methods used to classify recurrences were: method CTV quantified the intersection volume between the recurrence and the Clinical Target Volume (CTV); method TV quantified the intersection between the Treated Volume and the recurrence (for method CTV and TV, recurrences were classified in-field if more than 95% of their volume were inside the volume of interest, marginal if the intersection was between 20-95% and outfield otherwise); and method COM was based on the position of the Centre Of Mass of the recurrence. A dose assessment in the recurrence volume was also made. Results: The 2-year Kaplan-Meier locoregional recurrence incidence was 10%. Tumour recurrences occurred in 22 patients in a mean time of 16.5 ± 9.4 months resulting in 28 recurrence volumes. The percentage of in-field recurrences for methods CTV, TV and COM was 7%, 43% and 50%, respectively. Agreement between the three methods in characterizing individually in-field and marginal recurrences was found only in six cases. Methods CTV and COM agreed in 14. The percentage of outfield recurrences was 29% using all methods. For local recurrences (in-field or marginal to gross disease) the average difference between the prescribed dose and D98% in the recurrence volume was -5.2 ± 3.5% (range: -10.1%-0.9%). Conclusions: The classification of in-field and marginal recurrences is very dependent on the method used to characterize recurrences. Using methods TV and COM the largest percentage of tumour recurrences occurred in-field in tissues irradiated with high doses. [ABSTRACT FROM AUTHOR]

Copyright of Bulletin: Newsletter of the Society of Radiographers of Slovenia & the Chamber of Radiographers of Slovenia is the property of Slovenian Society of Radiographers and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim was to study the prevalence and sociodemographic features of odontogenic, non-odontogenic and salivary glands lesions among patients seen in Hospital Universiti Sains Malaysia. This information is essential to assist clinician in formulating reliable differential diagnosis of such lesion. Data on patient demographics, lesion location, tissue of origin and microscopic diagnosis were extracted from the Laboratory and Diagnosis record registries for biopsy specimen accessioned from year 2000 to 2012. This data was subsequently analyzed based on World Health Organization Classification of Head and Neck Tumours (2005). A total of 748 cases were included in the study. Out of the total number of cases, 367 cases were males and 377 cases were females. Ninety seven cases (13%) were of odontogenic origin, while 90 cases (12%) and 197 cases (26%) were of non-odontogenic and salivary gland origin respectively. Forty five percent of cases involved oral mucosal lesions. The most prevalent odontogenic lesion reported within the twelve years period was radicular cyst and ameloblastoma. Non-odontogenic bone lesion was rarely encountered with it making up less than two percent of total cases reported. Pleomorphic adenoma was the most prevalent benign salivary glands neoplasm reported within similar time period. [ABSTRACT FROM AUTHOR]

Cancers of the head and neck are a malignancy causing a considerable health burden. In head and neck cancer patients, tumour hypoxia has been shown to be an important predictor of response to therapy and outcome. Several imaging modalities can be used to determine the amount and localization of tumour hypoxia. Especially PET has been used in a number of studies analyzing this phenomenon. However, only few studies have reported the characteristics and development during (chemoradio-) therapy. Yet, the characterization of tumour hypoxia in the course of treatment is of great clinical importance. Successful delineation of hypoxic subvolumes could make an inclusion radiation treatment planning feasible, where dose painting is hypothesized to improve the tumour control probability. So far, hypoxic subvolumes have been shown to undergo changes during therapy; in most cases, a reduction in tumour hypoxia can be observed, but there are also differing observations. In addition, the hypoxic subvolumes have mostly been described as geographically rather stable. However, studies specifically addressing these issues are needed to provide more data regarding these initial findings and the hypotheses connected with them.

Background: The diagnostic and therapeutic procedures performed in a series of patients with primary parapharyngeal space (PPS) tumours treated at the ENT Departments of San Giovanni Bosco Hospital, Turin, and of the Pugliese-Ciaccio Hospital, Catanzaro, Italy, in the period 2001-2010 are evaluated. Materials and methods: The retrospective review included 20 patients, 11 male and 9 female, average age of 41 years operated on for 21 primary PPS tumours. The most common tumours found were neurogenic neoplasms, while those of salivary origin were the next most common. Results: There were 14 paragangliomas (7 originating from carotid glomus, 5 from vagal and 2 from tympanicum), 1 sympathetic chain schwannoma and 6 pleomorphic adenomas. All the tumours were benign in nature and gave rise to few signs or symptoms. Patients underwent preoperative computed tomography (CT) scan or magnetic resonance imaging (MRI) or both. Most contrast-enhanced masses were submitted to some type of angiography. Most of the surgeries were planned through imaging alone, as preoperative fine needle aspiration (FNA) biopsy was performed only in six cases. Four different approaches were adopted for tumour removal: transcervical, transcervical/transparotid, cervical-transparotid-transmandibular and infratemporal fossa approach. There was no operative mortality, though neurologic morbidity was significant. Follow-up, extended to a maximum of 11 years, did not reveal any recurrences. In conclusion, neurogenic tumours may be the most common of PPS masses. Surgery is the mainstay treatment and external approaches offer the potential for satisfactory tumour resection. Of such external approaches, transcervical and cervical/transparotid are the most often used in benign forms. Conclusion: The number of perioperative complications encountered in this series confirms the difficulty of performing surgery in this complex area, even in benign cases. The chances of avoiding vascular damage and saving the trunks or most of the nerve fibres involved depend not only on the skill and experience of the surgeon but also on the anatomy of the lesion, the type of connection between the tumour and the nerve from which it originates and the distribution of neural fibres in or around the tumour mass. [ABSTRACT FROM AUTHOR]

Aim of the study is to evaluate the results of postoperative radiotherapy of paragangliomas, prognostic factors and causes of treatment failure. Material and methods: Forty-four patients (39 females and 5 males) aged 20 to 74 years were treated for paraganglioma between 1970 and 2010 at the Centre of Oncology in Kraków. Patient survival probability was estimated with the Kaplan-Meier method. Log-rank tests and Cox proportional hazard model were used in univariate and multivariate analysis, respectively. Results: The most common locations of paragangliomas were the following: the ear, carotid body and internal jugular vein bulb. Forty (91%) out of them were benign and 4 - malignant. All patients underwent surgery followed by adjuvant radiotherapy. The delivered dose ranged from 50 to 72 Gy, the mean dose was 60 Gy. Five-year overall survival was 84%. Five-year relapse-free survival was 84%, either. The multivariate analysis has shown that the dose in an independent prognostic factor for the overall survival. The univariate analysis has shown significantly higher 5-year overall survival in patients who received a dose of 60 Gy or higher - 92% vs. 70% in patients who received a dose lower than 60 Gy. Conclusions: Postoperative radiotherapy with doses higher than 60 Gy in patients with paragangliomas is associated with longer overall survival. [ABSTRACT FROM AUTHOR]

Purpose: Our objectives were to assess the quality of PET images and coregistered anatomic images obtained with PET/MR, to evaluate the detection of focal uptake and SUV, and to compare these findings with those of PET/CT in patients with head and neck tumours. Methods: The study group comprised 32 consecutive patients with malignant head and neck tumours who underwent whole-body F-FDG PET/MR and PET/CT. PET images were reconstructed using the attenuation correction sequence for PET/MR and CT for PET/CT. Two experienced observers evaluated the anonymized data. They evaluated image and fusion quality, lesion conspicuity, anatomic location, number and size of categorized (benign versus assumed malignant) lesions with focal uptake. Region of interest (ROI) analysis was performed to determine SUVs of lesions and organs for both modalities. Statistical analysis considered data clustering due to multiple lesions per patient. Results: PET/MR coregistration and image fusion was feasible in all patients. The analysis included 66 malignant lesions (tumours, metastatic lymph nodes and distant metastases), 136 benign lesions and 470 organ ROIs. There was no statistically significant difference between PET/MR and PET/CT regarding rating scores for image quality, fusion quality, lesion conspicuity or anatomic location, number of detected lesions and number of patients with and without malignant lesions. A high correlation was observed for SUV and SUV measured on PET/MR and PET/CT for malignant lesions, benign lesions and organs ( ρ = 0.787 to 0.877, p < 0.001). SUV and SUV measured on PET/MR were significantly lower than on PET/CT for malignant tumours, metastatic neck nodes, benign lesions, bone marrow, and liver ( p < 0.05). The main factor affecting the difference between SUVs in malignant lesions was tumour size ( p < 0.01). Conclusion: In patients with head and neck tumours, PET/MR showed equivalent performance to PET/CT in terms of qualitative results. Comparison of SUVs revealed an excellent correlation for measurements on both modalities, but underestimation of SUVs measured on PET/MR as compared to PET/CT. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated the combined use of intravoxel incoherent motion (IVIM) and time-signal intensity curve (TIC) analyses to diagnose head and neck tumours. Methods: We compared perfusion-related parameters ( PP) and molecular diffusion values ( D) determined from IVIM theory and TIC profiles among 92 tumours with different histologies. Results: IVIM parameters ( f and D values) and TIC profiles in combination were distinct among the different types of head and neck tumours, including squamous cell carcinomas (SCCs), lymphomas, malignant salivary gland tumours, Warthin's tumours, pleomorphic adenomas and schwannomas. A multiparametric approach using both IVIM parameters and TIC profiles differentiated between benign and malignant tumours with 97 % accuracy and diagnosed different tumour types with 89 % accuracy. Conclusions: Combined use of IVIM parameters and TIC profiles has high efficacy in diagnosing head and neck tumours. Key points: • Head and neck tumours have wide MR perfusion/diffusion properties. • Dynamic contrast-enhanced (DCE) MR imaging can characterise tumour perfusion (TIC analysis). • Intravoxel incoherent motion (IVIM) imaging can provide diffusion and perfusion properties. • However, IVIM or DCE imaging alone is insufficient for diagnosing head/neck tumours. • Multiparametric approach using both IVIM and TIC profiles can facilitate the diagnosis. [ABSTRACT FROM AUTHOR]

The development of advanced technologies including computerized tomography devices of new generation (MSCT) and MRI devices has enabled the application of high quality techniques that are used for functional analysis of head and neck tumors. Therefore, the role of conventional CT and MR imaging techniques relating to anatomical domain has been transferred to functional level thus enabling better understanding of biological characteristics of the tumor tissue and better differentiation of benign and malignant neck lymph nodes. Positron emissin tomography (PET) is a functional technique that can detect metastatic neck lesions on the basis of increased glucose metabolism in tumor cells. However, due to poor anatomical resolution some hybrid methods (PET / CT and PET / MR) have been designed that provide morphological and functional information about the tumor tissue and thus are considered to be superior in comparison to conventional PET. Perfusion techniques have proved to be beneficial in the diagnosis of head and neck tumors, especially in the diagnosis of recurrent disease after radiotherapy and for the characterization of the lymph nodes. Diffusion weighted imaging (DWI) is very useful in the diagnosis of malignant lymph nodes smaller than 10 mm that are otherwise difficult to diagnose by means of conventional methods. The paper describes the role of high quality techniques including positron emission tomography PET in combination with CT or MRI (PET / CT and PET / MR) in the diagnostics of metastatic neck lymph nodes, possibilities of perfusion imaging techniques (MSCT / MRI) in the analysis of tumor tissues, as well as possibilities of diffusion MR imaging (DWI-MRI) and MRI with nanoparticles of iron oxide in the differentiation of benign and malignant neck lymph nodes. Acta Medica Medianae 2013;52(4):53-57. [ABSTRACT FROM AUTHOR]

Head and neck tumours are common malignancies that are associated with high mortality. The low rate of early diagnosis and the high rates of local recurrence and distant metastasis are the main reasons for treatment failure. Recent studies have established that the tumour microenvironment (TME) can affect the proliferation and metastasis of head and neck tumours via several mechanisms, including altered expressions of certain genes and cytokines. Increasing evidence has shown that epigenetic modifications, such as DNA methylation, histone modification, RNA modification, and non-coding RNAs, can regulate the head and neck TME and thereby influence tumour development. Epigenetic modifications can regulate the expression of different genes and subsequently alter the TME to affect the progression of head and neck tumours. In addition, the cell components in the TME are regulated by epigenetic modifications, which, in turn, affect the behaviour of head and neck tumour cells. In this review, we have discussed the functions of epigenetic modifications in the head and neck TME. We have further examined the roles of such modifications in the malignancy and metastasis of head and neck tumours., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Liu, Wang, Yang, Li, Wu, Xiang, Kan, Hao and Liu.)

Head and neck neoplasia can affect certain fundamental functions, including eating, drinking, speaking and respiration. One overriding factor in deciding on treatment policy is the tendency for head and neck malignancy to be limited to the primary site and regional lymph nodes with surgery and chemotherapy and radiotherapy. The aim of the study was to analyze the occurrence of Head and Neck tumours operated at ENT clinic Tuzla, University Clinical Center Tuzla, Bosnia and Herzegovina. Medical records of patients with histopathologically confirmed head and neck malignancies over a 5 year period (2003-2007) were analyzed. Eight hundred and eight one (881) cases, made up of 519 (58,8%) males and 362 (41,1%) females were found. The most common sites for head and neck malignancies were found to be in the larynx (26,1%), oral cavity (21,7%), the thyroid gland (14,64 %) and the neck (8,51%). A total of 230 patients were diagnosed with laryngeal carcinoma (M:173; E57), showing the increasing number of female patients. The histopathological tumour types found in this work were mostly squamous cell carcinoma (72,09%), papillary carcinoma (12,2%), while many other minor histopathological variants accounted for 13%. The most patients were presented with stage I and stage III of disease (27% and 28,3%), and 19,9% with stage IV. About 40% of patients did not have data about smoking habit and alcohol drinking. The incidence of head and neck tumours seems to be relatively high, but without significant increase during investigated period. More investigation concerning risk factors, diagnostic procedures, and management strategies should be done in future.

The article reviews the use of robotic technology for head and neck tumours. The authors discuss the development of transoral robotic surgery (TORS), the current status of the technology, and the set-up in the operating room. The article provides a review of the literature, highlighting the applications, advantages, functional outcomes, and disadvantages of TORS for each anatomic subsite (oropharynx, hypopharynx, larynx, parapharyngeal space, and skull base). New challenges related to reconstruction are also presented. Overall early functional and oncologic outcome data are promising; further long-term prospective trials are still needed to confirm the oncological safety of TORS [ABSTRACT FROM AUTHOR]

Abstract: Background and purpose: Hypoxia in head and neck tumours is associated with poor prognosis and outcome, and can be visualized using 18F-MISO-PET imaging; however, it is not clear whether the size and location of hypoxic subvolumes remain stable during therapy. In a pilot project, we conducted an exploratory analysis of persistent tumour hypoxia during treatment. Materials and methods: Sixteen patients with locally advanced head and neck tumours underwent consecutive 18F-MISO-PET scans before and during primary chemoradiotherapy. The size, location and overlap of the hypoxic subvolumes were analysed using a semi-automatic algorithm based on a tumour to normal tissue ratio of 1.5. Results: Quantitative evaluation showed tumour hypoxia in week 0 in 16 out of 16 and in week 2 in 5 out of 14 patients. For the five patients with persistent hypoxia, both increased and decreased hypoxic subvolumes could be observed. Mean hypoxic subvolume overlap was 55% of the hypoxic volume of the first scan and 72% of the hypoxic volume of the second scan. A stationary (in four out of five patients) and dynamic component (in three out of five patients) could be differentiated. Conclusion: In patients with persistent hypoxia after 2weeks of treatment, the hypoxic subvolumes showed mostly a geographically relatively stable conformation. [Copyright &y& Elsevier]

Introduction. Rhabdomyoma in adults is a rare benign tumor originating from striated muscle cells. It was first described by Zenker in 1864. The term rhabdomyoma is now used for two types of tumours: cardiac rhabdomyoma and the far rarer extracardiac form. Ninety per cent of the tumours occur in the head and neck region. Material and methods. We present a case of rhabdomyoma localized in the submandibular and mental area in a 46-year-old man. The patient had been originally treated twice by surgery at the Department of Maxillofacial Surgery. The procedure had proved to be non-radical, the tumour recurred, and the patient was sent to the ENT Department of the Silesian Medical University. The patient was operated from external approach under general anaesthesia. Central tracheotomy was performed and the tumour was removed from the floor of oral cavity and submandibular region, including the submandibular gland. Results. Eighteen-month follow-up did not reveal symptoms of tumour recurrence. Conclusions. Rhabdomyoma should always be considered in case of neck tumours, particularly those that are slow-growing, non-painful and oligosymptomatic. The patients should be followed- up even several tens of years after the surgery. [ABSTRACT FROM AUTHOR]

Introduction. Nonchromaffin paragangliomas (chemodectomas) are rare tumors of the nervous system. They are formed from receptive cells of the parasympathetic autonomic system that create groups of nonchromaffin paragangliomatic bodies. The term 'chemodectoma' is related to the chemoreceptive abilities of the neoplastic cells. In the head and neck region they are usually situated in glomus caroticum, glomus tympanicum, glomus vagale and glomus jugulare. Aim. The aim of study was a long-term clinical analysis of three paragangliomatic patients treated by surgery. Materials and methods. The authors present a retrospective study of three glomus tumours: two situated in glomus caroticum and one in glomus tympanicum. Results. Imaging techniques, such as computed tomography, magnetic resonance and arteriography were found to be vital for successful preoperative diagnostics. In both patients with glomus caroticum tumour, a paralysis of the vocal folds was observed on the operated side after 13 and 6 years since the surgical treatment. There were no differences in hearing ability in the patient with glomus tympanicum tumor after 10 years since the surgery. Conclusions. The prognosis for benign glomus tumours is good, while considerable experience is required in their surgical treatment due to the risk of profuse intraoperative heamorrhage. The paralysis of the vocal fold after glomus caroticum surgery is irreversible. [ABSTRACT FROM AUTHOR]

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