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Abstract Objectives Staging of the cN0 neck with sentinel node biopsy (SNB) in early‐stage oral squamous cell carcinoma (OSCC) is validated in patients with a previously untreated neck. We aimed to investigate the feasibility and diagnostic accuracy of SNB and unexpected drainage patterns in patients with cT1‐T2N0 OSCC and a history of previous head and neck cancer comprising treatment of the neck, that is, surgery, radiotherapy, or both. Methods Fifty patients with a previously treated neck diagnosed with a new primary or recurrent cN0 OSCC between 2014 and 2021 were included and retrospectively analyzed. Feasibility was assessed by the rate of successfully performed SNB neck staging procedures. Based on follow‐up data, the diagnostic performance of SNB was evaluated by calculation of negative predictive value (NPV) and false omission rate (FOR). Results A SNB staging procedure was successfully performed in 76% (38/50) of the patients. Technical failures were due to the lack of drainage preoperatively or failure in intraoperative SN detection. In patients successfully staged with SNB, the rate of a positive SN was 13% (5/38). In the SNB‐negative group, no patients were diagnosed with a regional node recurrence during follow‐up, and the NPV and FOR were 100% and 0%, respectively. Unexpected lymphatic drainage occurred in 32% (12/38) of the patients. Conclusion SNB is technically feasible in cT1‐2N0 OSCC patients with a previously treated neck with a high diagnostic accuracy. Importantly, SNB enables the detection of individual and unexpected lymphatic drainage patterns.

Paragangliomas are neoplasms of neural crest cells. They represent less than 1% of head and neck tumors. Laryngeal paragangliomas constitute a smaller fraction of head and neck paragangliomas. Malignant laryngeal paragangliomas with metastasis are extremely rare tumors. Definitive treatment includes complete surgical excision with maximum preservation of laryngeal function. Here, we report a rare case of a 55 year old woman who was diagnosed with recurrent laryngeal paraganglioma along with neck metastasis. A complete excision of mass with a lateral pharyngotomy approach along with neck dissection followed by chemotherapy was done. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to investigate the effectiveness of selective neck disection with use of intraoeprative gamma probe technique which is performed to maintain cancer-free survival and reduce complication rates. Material and Methods: The patients were divided to two groups, of which the first included recurrent patients and the second group included non-recurrent. The independent samples t-test was used to compare the parameters with a normal distribution, according to the presence of a relapse, and the Mann-Whitney U test was used to compare the results with a non-normal distribution. Results: The study included 41 patients who underwent selective neck disection with the use of gamma probe and total thyroidectomy with papillary thyroid cancer. In total, 12 (29.3%) patients' disease recurred. The presence of recurrence did not depend on gender (p=0.398). While 12.5% of males (n=1) had recurrence, 33.3% of females (n=11) had recurrence. No statistically significant difference was obtained between the median values of the total number of malignant lymph nodes according to groups (p=0.174). There was no statistically significant difference between the median values of number of follow-up months according to patient group (p=0.148). Conclusion: The use of preoperative United States-mapping with intraoperative gamma probe in selective neck disection for patients with metastatic differentiated thyroid cancer is technically safe, and effective for determining the borders of the neck dissection of which is related with unnecessary surgical extension. [ABSTRACT FROM AUTHOR]

Background: Lateral neck swellings in ENT have various causes, commonly found in the anterior triangle of the neck. Accurate diagnosis through imaging, FNAC, and biopsy is crucial for appropriate treatment, ranging from conservative management to surgery. Understanding incidence, etiology, pathology, and clinical behaviour is important for effective management and follow-up. Materials and Methods: Institutional Ethical committee approval was obtained and informed consent was taken from the study subjects. Patients with lateral neck swellings underwent clinical examination and FNAC, followed by further investigations based on FNAC reports. Lymph node biopsies were taken for histopathological examination. Management was based on the final diagnosis, and patients were followed up for six months. Results were analyzed and tabulated. Results: In our study of 96 patients, lateral neck masses were most common in individuals aged 46-59, with an equal male-to-female ratio. The majority of cases (82.29%) were from low socioeconomic status. Metastasis in cervical lymph nodes was the most frequent cause of lateral neck swellings, primarily in males aged over 45, and tubercular lymphadenitis was the second most common cause in females aged 18-30. The clinical diagnosis had high sensitivity (87.18%) and specificity (92.98%) for detecting malignant lesions, and these values increased when the histopathological examination was used as the gold standard. Conclusion: To evaluate and manage lateral neck swellings, a multidisciplinary approach is necessary, including medical history, clinical examination, imaging, and pathological investigations like FNAC and HPE. Prompt and accurate diagnosis is critical to prevent morbidity and mortality, and management depends on the underlying cause. Effective management requires close communication between the clinician and the pathologist. [ABSTRACT FROM AUTHOR]

Simple Summary: This study presents the experience of a single center in sentinel lymph node biopsy (SLNB) as an alternative to elective neck dissection (END) in T1/T2 cN0 oral tongue squamous-cell carcinoma (OTSCC) patients. A 20-year retrospective analysis was conducted at the Ear Nose Throat (ENT) and Maxillofacial Surgery department of the Istituto Nazionale Tumori in Naples. Between January 2002 to January 2022, 122 patients were eligible and were enrolled. Out of 122 patients, 24.6% showed positivity in SLN biopsy, with a 21.9% positivity ratio for resected nodes. Preoperative radioactive tracer injection and lymphoscintigraphy facilitated sentinel lymph node identification. This study suggests SLNB as a reliable staging tool, enabling early micrometastasis detection in clinically negative necks in patients affected by OTSCC. Oral tongue squamous-cell carcinoma (OTSCC) is the most prevalent malignancy in the head and neck region. Lymphatic spread, particularly to cervical lymph nodes, significantly impacts 5-year survival rates, emphasizing the criticality of precise staging. Metastatic cervical lymph nodes can decrease survival rates by 50%. Yet, elective neck dissection (END) in T1–2 cN0 patients proves to be an overtreatment in around 80% of cases. To address this, sentinel lymph node biopsy (SLNB) was introduced, aiming to minimize postoperative morbidity. This study, conducted at the ENT and Maxillofacial Surgery department of the Istituto Nazionale Tumori in Naples, explores SLNB's efficacy in early-stage oral tongue squamous-cell carcinoma (OTSCC). From January 2020 to January 2022, 122 T1/T2 cN0 HNSCC patients were enrolled. Radioactive tracers and lymphoscintigraphy identified sentinel lymph nodes, aided by a gamma probe during surgery. Results revealed 24.6% SLN biopsy positivity, with 169 SLNs resected and a 21.9% positivity ratio. The study suggests SLNB's reliability for T1-2 cN0 OTSCC patient staging and early micrometastasis detection. [ABSTRACT FROM AUTHOR]

Purpose: The purpose was to investigate the diagnostic performance of bimodal optical and radio-guided sentinel node biopsy (SNB) for oral squamous cell carcinoma (OSCC) sub-sites in the anterior oral cavity. Methods: Prospective study of 50 consecutive patients with cN0 OSCC scheduled for SNB was injected with the tracer complex Tc99m:ICG:Nacocoll. A near-infrared camera was applied for optical SN detection. Endpoints were modality for intraoperative SN detection and false omission rate at follow-up. Results: In all patients, a SN could be detected. In 12/50 (24%) of cases, the SPECT/CT showed no focus in level 1, but intraoperatively a SN in level 1 was optically detected. In 22/50 cases (44%), an additional SN was identified only due to the optical imaging. At follow-up, the false omission rate was 0%. Conclusion: Optical imaging appears to be an effective tool to allow real-time SN identification comprising level 1 unaffected by possible interference of radiation site from the injection. [ABSTRACT FROM AUTHOR]

Objective: The presence of clinically detectable papillary thyroid carcinoma (PTC) metastases in the lateral neck is an indication for neck dissection (ND) and thyroidectomy. Although there is a consensus regarding the importance of therapeutic selective ND of involved levels II to IV in patients with clinically evident locoregional metastatic disease, the prognostic benefit of level V prophylactic ND remains debatable. Methods: All patients who underwent thyroidectomy with ND for metastatic PTC between 2006 and 2019 were included in a single-institution retrospective study. Preoperative characteristics at initial presentation, imaging workup, intraoperative findings, and the final histopathological reports were retrieved from the institutional database. Results: A total of 189 patients with locally advanced PTC were identified, of whom 22 (11.6%) patients underwent therapeutic selective ND at levels II to IV together with level V dissection due to clinical involvement. Comparison of the patients who were operated on level V to those who were not revealed no significant difference. The disease recurrence rate was 20.1% throughout an average follow-up of 5.1±3.1 years. No significant differences in recurrence rate were found between patients who underwent and those who did not undergo level V ND (22.7% vs 19.8%, P =.648). No recurrence at resected level V was detected during follow-up, while recurrence at level V was found in 4 (2.1%) patients who did not undergo level V dissection. Evidence of macroscopic and microscopic extrathyroidal extension was significant predictors of disease recurrence risk. Conclusion: There were no significant associations between level V dissection and risk for recurrence. Recurrence at level V was rare (4/189 patients, 2.1%). Our study's findings suggest a low prophylactic benefit of an elective level V ND. Elective level V ND should not be done routinely when lateral ND is indicated but should rather be considered after careful evaluation in high-risk patients. [ABSTRACT FROM AUTHOR]

Abstract Background Hodgkin lymphoma (HL) is diagnosed definitively by biopsy, and treatment is based on stage. Owing to the nature of the disease, post‐treatment efficacy is determined mainly by fluorodeoxyglucose‐positron emission tomography/computed tomography, and the efficacy of treatment is not confirmed by histopathology. We report a case of tongue cancer after treatment for HL, in which a post‐treatment lymph node with complete remission was histopathologically confirmed by neck dissection. Case The patient was a 74‐year‐old man who was referred to our hospital for cancer on the right side of his tongue. He had previously undergone chemotherapy for HL involving the right side of his neck and achieved complete remission. Because he had cT3N2cM0 tongue cancer, glossectomy and bilateral neck dissection were performed. Surprisingly, histopathological examination revealed that there was neither metastatic lymph nodes nor lymphoma cells in his right neck. Moreover, there was no lymphatic structure in his remnant lymph nodes. Conclusion This was a rare case in which complete remission of HL was confirmed by histopathological analysis. The absence of lymph node structure and lymphatic flow led to contralateral neck lymph node metastases of tongue cancer.

Aims: Being an important prognostic predictor in carcinoma oral tongue, neck metastasis poses an adverse impact on prognosis.The management of neck is still controversial. Neck metastasis depends on features like tumor thickness, depth of invasion, lymphovascular invasion and perineural invasion. Thus by correlating these features with the level of nodal metastasis and by correlating clinical and pathological staging, a preoperative assumption for a more conservative neck dissection may be done. Objectives: To correlate clinical staging, pathological staging and depth of invasion (DOI) of tumor with cervical nodal metastasis, for a preoperative assumption of a more conservative neck dissection. To study the correlation of additional prognostic features like lymphovascular invasion, perineural invasion, positive resection margin, worst pattern of invasion, lymphocytic infiltration and presence of necrosis with that of cervical nodal metastasis. Materials and Methods: The study was conducted on 24 patients of carcinoma oral tongue who underwent resection of the primary with an appropriate neck dissection and their clinical, imaging, and postoperative histopathological findings were correlated. Results: We found a significant association of the CC (craniocaudal) dimension and radiologically determined DOI (depth of invasion) with the pN also significant association of clinical and radiological DOI with histological DOI. The probability of occult metastasis was found to be more when the MRI-DOI is > 5 mm. The sensitivity and specificity of cN staging were 66.67% and 73.33% respectively. The accuracy of cN was 70.8%. Conclusion: In the present study a good sensitivity, specificity and accuracy of cN (clinical nodal stage) was found. Craniocaudal (CC) dimension and DOI of the primary tumor measured by MRI is a strong predictor of the disease extension and nodal metastasis. MRI-DOI > 5 mm warrants an elective neck dissection of level I-III. For tumors MRI DOI < 5 mm observation can be recommended with adherence to a strict follow-up. [ABSTRACT FROM AUTHOR]

Abstract Background One third of all head and neck cancers are caused by laryngeal cancer. However, the incidence and prevalence rates have decreased over the past 3 decades. Neck metastasis from cancer larynx is important to be addressed as its presence greatly reduces the probability of survival. However, quality of life should be taken into consideration. Hence, it was important to analyze factors related to neck metastasis from primary laryngeal cancer to detect any change of tumor behavior with time. Results One hundred thirty-eight patients underwent concomitant neck dissection with laryngectomy (total or partial). Supraglottic tumors had the greatest share in the neck metastasis with a count of 11 (of 26 neck metastasis), representing 42% and a total value of 11 (of 30 total supraglottic cancer) representing a tendency of spread in 37% of the total case number. Tumor midline crossing was present in 77% cases (20 of 26) with positive nodes, representing a P value 0.05. Conclusion This study investigated different factors related to lymph node metastasis from primary laryngeal tumor. The most important factors were the site of the tumor and its relation to the midline.

Papillary thyroid carcinoma, the most common subtype of thyroid malignancy, rarely presents with cutaneous metastatic spread.  Despite metastatic cutaneous lesions presenting as slow and indolent growing nodules of the head and neck, such lesions most frequently appear in the setting of diffuse and dramatic metastatic disease and a bleak prognosis.  Given the rarity of these metastatic lesions, the diagnosis may be delayed, and often the initial diagnosis is incorrect.  Several case reports have been published in the literature noting unusual or interesting presentations of thyroid carcinoma with cutaneous metastasis.  Here we present a classic case of a patient with a prior diagnosis of thyroid carcinoma presenting with a slowly growing ulcerated lesion on the neck nine years after partial thyroidectomy and characteristic histopathology on microscopic examination.  Furthermore we review the literature regarding papillary thyroid carcinoma with cutaneous metastasis and the diagnostic challenge these lesions present to practitioners.

Renal cell carcinoma (RCC) is a malignant tumor that can metastasize easily. Hence, many patients have already developed metastasis when they are diagnosed. It is also one of the most common tumors that metastasize to the head and neck through extranodal disease. Herein, we reported a case of a 53-year-old man with cervical metastasis from bilateral RCC. Interestingly, whole exome sequencing (WES) and clonal evolution analysis revealed that bilateral renal tumor lesions and neck metastases (squamous cell carcinoma) share the same subclones and a large number of gene variants, while the pathological morphology is different (left nephrotic foci, a mixed pattern of mucinous tubular and spindle cell carcinoma (MTSCC) with papillary adenoma; right renal foci, papillary renal cell carcinoma (PRCC)). This was first reported in RCCs to the best of our knowledge. This case suggests that genotype analysis can be a powerful supplementary examination for clinical histopathological diagnosis. Gene detection has great significance for the accurate diagnosis and treatment of RCC metastasis or multiple lesions.

Renal cell carcinoma (RCC) is a malignant tumor that can metastasize easily. Hence, many patients have already developed metastasis when they are diagnosed. It is also one of the most common tumors that metastasize to the head and neck through extranodal disease. Herein, we reported a case of a 53-year-old man with cervical metastasis from bilateral RCC. Interestingly, whole exome sequencing (WES) and clonal evolution analysis revealed that bilateral renal tumor lesions and neck metastases (squamous cell carcinoma) share the same subclones and a large number of gene variants, while the pathological morphology is different (left nephrotic foci, a mixed pattern of mucinous tubular and spindle cell carcinoma (MTSCC) with papillary adenoma; right renal foci, papillary renal cell carcinoma (PRCC)). This was first reported in RCCs to the best of our knowledge. This case suggests that genotype analysis can be a powerful supplementary examination for clinical histopathological diagnosis. Gene detection has great significance for the accurate diagnosis and treatment of RCC metastasis or multiple lesions. [ABSTRACT FROM AUTHOR]

Introduction: Nodal metastasis reduces the survival by 50% in head-and-neck squamous cell carcinomas. The presence of nodal extension/extracapsular spread (ECS) further reduces survival. Current literature favors a selective level IIb sparing neck dissection in clinically N0 neck. Studies have evaluated the role of primary tumour size, number of lymph nodes, and depth of invasion (DOI) with the occurrence of extranodal extension (ENE). Patients and Methods: Patients were retrospectively reviewed who presented with oral cavity carcinomas and clinically N0 neck. Relationship was sought between tumour site, size, histological grading, DOI, and the occurrence of level IIb metastasis and ECS. A P < 0.05 was considered statistically significant. Results: The relationship showed insignificant correlation with P values (0.6643, 0.6704, 0.6779, and 0.6779) between site, size, grading, DOI, and level IIb and ENE. Discussion: Previous studies have shown DOI >5 mm and lymph node size 15 mm and multiple lymph nodes predict ECS. DOI and primary site with more than 20% for occult metastasis predicts elective neck treatment. However, in our study, no correlation was found between primary tumour characteristics and ECS or level IIb metastasis. Elective neck dissection is the standard surgical protocol from both diagnostic and therapeutic viewpoints. The only criterion for level IIb dissection is concomitant presence of level IIa involvement intraoperatively. Since ENE can occur early in the disease process, elective neck dissection remains the standard of care. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: The accurate diagnostic assessment of clinically relevant human papillomavirus (HPV) infections in patients with head and neck squamous cell carcinoma represents an urgent unmet medical need. The aim of this study was to determine feasibility, accuracy, and clinical significance of HPV16/18 E6 oncoprotein detection on cytological specimens from oropharyngeal squamous cell carcinoma (OPSCC) and neck lymph node metastasis of SCC from unknown primary tumor (CUP) via a protein immunochromatographic assay. Study Design: Cross‐sectional study. Methods: Cytological specimens from primary tumor and neck metastases were collected from 34 patients with OPSCC or CUP and applied to a lateral flow format test that detects HPV16 and HPV18 E6 oncoproteins. E6 oncoprotein positivity or negativity in these specimens was compared to the specimens' "HPV‐driven" reference status, defined by presence of HPV‐DNA in combination with p16INK4a overexpression and/or HPV E6 seropositivity. Results: Eighteen of 29 OPSCC (62%) and three of five CUP (60%) were HPV‐driven according to our reference method. The E6 oncoprotein lateral flow test had a sensitivity of 94% (95% CI: 70%–100%) and a specificity of 100% (95% CI: 66%–100%) on primary tumor, and a sensitivity of 88% (95% CI: 64%–99%) and a specificity of 100% (95% CI: 74%–100%) on neck metastases. Test agreement between the E6 lateral flow test and the clinical reference method, HPV‐DNA plus p16INK4a was excellent, both for primary lesion and neck metastases. Conclusions: We found the detection of HPV16/18 E6 oncoproteins to be a feasible, highly reliable, and low‐invasive method to assess "HPV‐driven" status in OPSCC and CUP. Level of Evidence: II Laryngoscope, 131:1042–1048, 2021 [ABSTRACT FROM AUTHOR]

Objectives: Parotid lymph node metastases are common in head and neck cutaneous squamous cell carcinoma (cSCCHN). Here we evaluate the diagnostic, prognostic, and therapeutic implications of intraglandular lymph node (IGLN) metastases in cSCCHN. Study Design: Retrospective study in a tertiary referral university cancer institute. Methods: We included patients with cSCCHN who underwent parotidectomy and neck dissection (ND), with or without synchronous resection of the skin primary, between January 1999 and January 2018. The characteristics of cSCCHN with or without IGLN involvement were compared. Results: Altogether, 68 patients were included. Of the 29 (42.6%) patients classified as cN0, eight were upstaged pN+ and had concomitant IGLN involvement. Of 21 patients with pN0 disease, IGLN metastases were absent in only three cases, resulting in a specificity and sensitivity of parotid metastases to diagnose occult nodal neck metastases of 14.29% and 100%, respectively. The positive and negative predictive values were 14.29% and 100%, respectively. Univariate analyses only displayed a significantly higher rate of moderately and poorly differentiated primaries in patients with IGLN metastases (P =.015). Only advanced T‐stages were significantly associated with neck recurrences. Conclusion: IGLN status in advanced cSCCHN is potentially predictive for occul nodal neck metastases. Our results suggest that ND in patients with histopathologically negative IGLNs and clinically negative neck lymph nodes may not be necessary given the high negative predictive value of IGLN status in this group of patients. Therefore, accurate diagnostic evaluation of IGLN involvement is mandatory. Level of Evidence: 4 Laryngoscope, 131:788–793, 2021 [ABSTRACT FROM AUTHOR]

Aim:Multifocal papillary thyroid cancer (MPTC) has aggressive and poor prognosis. The main aim of this study was to evaluate the lymph node metastasis pattern in MPTC patients.Methods:We retrospectively investigated the records of 2530 patients who underwent thyroidectomy for papillary thyroid cancer between January 2010 and December 2017. The age, gender, tumor size, thyroid capsule invasion and neck metastatic disease were evaluated in 515 of these patients having MPTC.Results:We compared multifocal and unifocal papillary thyroid cancer patients considering papillary thyroid capsule invasion (29.9%/10.86%), mean tumor diameter (15.9 mm/16.1 mm), central lymph node metastasis (56.5%/18.3%) and lateral neck lymph node metastasis (23.1%/6.3%). Capsule invasion was associated with an increased risk of multifocal disease. The incidence of capsular invasion and central and lateral neck metastases in MPTC patients was statistically significantly higher than in patients with unifocal thyroid papillary cancer (p

Background: The prognostic value of lymph node yield (LNY) and lymph node ratio (LNR), or the ratio of number of metastatic LNs to total number dissected, has not been well established in p16‐associated oropharyngeal squamous cell carcinoma (OPSCC). Methods: This retrospective cohort study evaluated locoregional disease‐free survival (LRDFS) in 82 patients with p16+ OPSCC who underwent neck dissection at a single institution from 2009 to 2017. LNR and LNY cutoffs were estimated using time‐dependent receiver operator characteristic (ROC) curves. Prognostic significance of these cutoffs was compared with Eighth Edition AJCC Nodal Staging. Results: An increased LNR ≥ 0.129 was associated with worse 2‐year LRDFS (66.9% vs 96.8%, P =.005). LNY was not significantly associated with LRDFS (P =.304). An LNR‐based risk model was a better prognosticator than Eighth Edition AJCC Nodal Staging (Harrell's C, 0.9065 vs 0.7668). Conclusions: LNR has good prognostic utility in predicting LRDFS in p16+ OPSCC, but further evaluation of this measure is warranted. [ABSTRACT FROM AUTHOR]

Objective: To investigate possible metastasis predictors for neck sublevel IIb in papillary thyroid carcinoma (PTC) with lateral neck metastasis and to determine the reliability of preoperative ultrasound‐guided fine‐needle aspiration biopsy (FNAB) as a method of detecting positive lymph nodes in sublevel IIa in comparison with the finding of definitive pathohistological analysis. Design: Prospective study with patients with proven lateral neck metastases from PTC at the time of initial diagnosis. All patients had total thyroidectomy, central neck dissection (level VI) and selective neck dissection (levels II‐V). Potential predictive factors for the occurrence of metastasis in sublevel IIb were analysed. Sensitivity and specificity tests were used to determine the reliability of preoperative ultrasound‐guided FNAB. Patients were monitored for recurrence for at least ten years. Setting: Single‐centre study. Participants: Study included 53 patients with proven lateral neck metastases from PTC at the time of initial diagnosis. Results: Predictive factors for the occurrence of metastasis in sublevel IIb that have reached statistical significance are positive sublevel IIa, number of positive lymph nodes and positive levels IIa + III + IV + V. None of the patients who fulfilled predefined criterion for minimum 10‐year follow‐up had local recurrence in operated lateral levels. Conclusion: Highest clinical significance has positivity of sublevel IIa. Therefore, it is necessary to prove or exclude metastasis in sublevel IIa, preoperatively or intraoperatively, to decide whether to include sublevel IIb in dissection. Preoperative ultrasound‐guided FNAB is a reliable method for the detection of positive lymph nodes in sublevel IIa in comparison with the definitive histopathological analysis. [ABSTRACT FROM AUTHOR]

Background: The submandibular gland (SMG) is sacrificed during neck dissection in patients undergoing curative surgery for oral squamous cell carcinoma (OSCC). This may cause a decrease in the production of saliva and result in xerostomia., Purpose: This study aimed to determine the incidence, invasion patterns, risk factors, and prognosis of SMG involvement in OSCC., Methods: The primary predictor variable in this study was SMG involvement, and the secondary predictor was prognosis., Main Findings: The primary outcome variables were patient characteristics and pathological results for extranodal extension (ENE), perineural invasion (PNI), and pN stage. Four out of 173 patients (2.23 %) showed SMG involvement. Of these cases, one (25 %) was from the primary lesion and three (75 %) were from the metastatic neck lymph nodes (LNs). The primary lesion was located on the lower gingiva, and the other three were from level-Ib LNs with ENE. The pathological PNI was observed in three of the four patients, and ENE was observed in three of the four patients. Preoperative CT and MR revealed SMG invasion and contact in two patients. There were significant differences in the ENE and pN stages between patients with and without SMG involvement (P<0.05). There was a significant difference in the overall survival between patients with (25.0 %) and without (71.5 %) SMG involvement (P = 0.011)., Conclusions: SMG involvement was associated with ENE, pN stage, and poor prognosis., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interest., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Objective: To observe the association between local properties of larynx cancer and neck metastasis. Methods: In total, 119 patients who underwent total or partial laryngectomy and neck dissection for laryngeal carcinoma at the Otolaryngology Head and Neck Surgery Clinic of Health Sciences University Gaziosmanpaşa Taksim Training and Research Hospital between 2003 and 2016 were enrolled in this study. Postoperative pathological examinations included tumor histopathology, tumor differentiation; perineural, cartilage, and lymphovascular invasion; laryngeal primary tumor localization; anterior commissure; piriform sinus apex; tongue root; pre-epiglottic region; thyroid cartilage; band; aryepiglottic plateau; laryngeal ventricle; arytenoid vocal processes; arytenoid involvement; vocal cord movements; and metastatic lymph node status in neck dissection. Tumor histopathology and the association between invasion and neck dissection in the anatomical regions that determine local spread were investigated. Results: Patient age, opening of preoperative tracheotomy, and status of vocal cord movements did not affect neck metastasis. Piriform sinus, tongue base retention, band involvement, aryepiglottic plica involvement, involvement of laryngeal face epiglottis, and involvement of arytenoid significantly affected local spread. Conclusion: Although similar findings have been reported in the literature, multidisciplinary studies involving more patients, especially those with neck metastasis, are warranted to arrive at a definite conclusion. [ABSTRACT FROM AUTHOR]

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Objective: To determine the association of thickness of tumor of oral lesions with and without metastasis in neck based on computerized tomography (CT) scan. Methods: A retrospective study was conducted among patients having age >18 years of either gender diagnosed with oral squamous cell carcinoma (SCC). Moreover, patients with buccal mucosa and tongue malignant tumor were also included. CT scan was performed on all patients and tumor thickness in anteroposterior, transverse, and craniocaudal positions were measured. Results: A total of 119 patients were included. The mean age of the patients was 46.97 ±11.79 years. Male preponderance was found to be higher 102 (85.7%) than that of females 17 (14.3%). The mean anterioposterior thickness level was significantly higher in right side of oral cavity as compared to left side (4.39 ±2.12 vs 3.52 ±1.56, p-value 0.015). Moreover, mean transverse dimension was found significantly higher among patients in whom post tongue was involved as compared to those among which post tongue was not involved (5.05 ±1.56 vs 2.64 ±1.78, p-value 0.009). Metastasis was significantly higher among patients with right side of oral tumor as compared to those with left side of oral tumor (p-value 0.043). Conclusion: Metastasis of anterioposterior thickness level was significantly higher among patients with right side of SCC while transverse dimension was found significantly higher among patients in whom post tongue was involved. [ABSTRACT FROM AUTHOR]

The authors reported a case of a 27-year-old man with a nontender left neck mass that had grown quite rapidly within few weeks. FNAB and CT were not consistent to establish the definite diagnosis. After excisional biopsy, the histopathological examination and the immunohistochemical study of the specimen revealed a cervical metastasis of seminoma. The patient was treated with chemotherapy with a complete clinical remission. This uncommon case-report can represent a great diagnostic and therapeutic challenge and should be considered in the differential diagnosis of every cervical masses occurring in young males patients. Diagnostic delays are unfortunately common and may lead to metastatic spread and worse prognosis. [ABSTRACT FROM AUTHOR]

Objectives: Unlike glottic cancer, supraglottic cancer often presents with neck metastases. This different might be attributable to the location of the primary lesion. This study aimed to clarify the relationships between the sublocation of T1-2 supraglottic cancer, human papillomavirus (HPV) infection, neck metastasis, and prognosis of supraglottic cancer.Methods: This retrospective clinical study investigated 55 Japanese patients with T1-2 supraglottic cancer treated between 1994 and 2015.Results: Of 55 patients with T1-2 supraglottic cancer, neck metastasis was present at initial diagnosis in 14 patients (25.5%). Presence of neck metastasis was the only factor associated with worse prognosis of T1-2 supraglottic cancer (p=0.004). In multivariate analysis, age <70years (p=0.033) and sublocation of the primary lesion in the superior epilaryngeal portion (p=0.017) were significantly associated with presence of neck metastasis in multivariate analysis. Twelve (27.9%) of 43 patients showed positive results for human papillomavirus infection. However, human papillomavirus infection was not associated with prognosis, presence of neck metastasis, or primary lesion sublocation in T1-2 supraglottic cancer.Conclusion: Relatively young patients with supraglottic cancer at the superior epilaryngeal portion are more likely to show neck metastasis. Human papillomavirus infection was not associated with frequency of neck metastasis. [ABSTRACT FROM AUTHOR]

Abstract: Background: The effectiveness of dynamic MRI in evaluating the relationship between metastatic lymph nodes and the carotid artery was investigated. Methods: Thirty‐two patients with metastatic lymph nodes, possibly adherent to the carotid artery, were evaluated with dynamic MRI before surgery. Consecutive axial and oblique images were obtained during swallowing. The displacement rate of the target carotid artery to the contralateral carotid artery and the low‐intensity stripe between the metastatic lymph nodes and the carotid artery wall were compared with the surgical findings. Results: A displacement rate > 50% indicated resectable metastatic lymph nodes. Low‐intensity stripe was present in 65% of patients and indicated no invasion; 82% of patients without low‐intensity stripe had resectable metastatic lymph nodes. The others without low‐intensity stripe required carotid artery resection due to malignant invasion. The accuracy rate, sensitivity, and specificity were 78%, 83%, and 100%, respectively. Conclusion: Dynamic MRI during swallowing is useful for assessing suspected carotid artery involvement in patients with metastatic lymph nodes to achieve maximal safe resection. [ABSTRACT FROM AUTHOR]

Objectives: Management of neck metastases in terms of diagnosis and treatment has always been a controversial issue in patients of head and neck malignancy. The main area of debate in case of diagnosis lies with the fact that whether we should rely on ultrasound, as a diagnostic modality for diagnosing micrometastases in the neck in head and neck malignancy patients? The second controversial issue is the management of N0 neck, whether to be radical or conservative? Materials and Methods: This study was conducted on 70 diagnosed patients of head and neck carcinoma who were planned for resection of the primary. An appropriate neck dissection was performed in all the patients, and their clinical, ultrasonography, and postoperative histopathological neck findings were correlated. Results: In our center, the most common site of the primary tumor was oral cavity with most involving buccal mucosa. As expected, T4 lesions were commonly associated with nodal metastasis (71%). The sensitivity of clinical examination and ultrasound was 80% and 93.3%, respectively, and specificity of clinical examination and ultrasound was 57% and 27.2%, respectively. Histopathologically positive but clinically nonpalpable metastases in the study group were more frequent in levels Ib, II, and III, respectively. Conclusion: We concluded that ultrasonography being a low cost and a highly sensitive investigation can act in tandem with clinical examination for diagnosing the neck for metastases preoperatively in head and neck malignancy patients. However, due to its low specificity, we cannot completely rely on it, hence doing a neck dissection in selective form, will definitely improve the clinical course of the disease in N0 necks. [ABSTRACT FROM AUTHOR]

Neck metastasis of oral squamous cell carcinoma (OSCC) indicates a poor prognosis. Few neck metastasis models are currently available for drug trials and clinical research on OSCC. This study constructed a feasible animal model of neck metastasis by using CD44 + stem cell-like cancer cells. Real-time PCR was used to determine the expression levels of several reported cancer stem cell (CSC) markers, including CD44, CD133, ALDH1 and OCT4, in three OSCC cell lines. Magnetic sorting and DiO/DiD labelling were used to isolate subpopulations of cells and monitor cancer cell migration. Sorted and labelled CSC-like cells were injected into the tongue of nude mice. Tumour and metastatic lymph nodes were histologically examined through immunostaining and tracer staining. High rate of metastasis was observed in neck lymph nodes in CD44 + group. This phenomenon was confirmed in clinical OSCC patients, and CD44 expression levels were higher in tumours with lymph node metastasis than in carcinomas in situ. Therefore, we have successfully constructed a neck m e tastasis model by using CD44 + CSCs. This model can form tumour and show metastases within a short period of time compared with other models; additionally, this model may be used in short-term pharmacological experiments involving animals and in basic clinical studies. [ABSTRACT FROM AUTHOR]

Objective: To determine the relationship of tumor thickness of oral lesions with metastasis in neck based on CT scan. Methods: A total of 58 oral squamous cell carcinoma patients having the median age of 46 (39-55) years. with either gender presented with malignant tumor of buccal mucosa and tongue were prospectively enrolled. A CT Scan with contrast was performed on all patients. Correlation of tumor thickness level with metastasis in neck was calculated using spearman's rank correlation coefficient test. Results: Median age of the patients was 46 (39-55) years with preponderance of male gender, i.e. 48 (82.8%). Strong positive significant correlation was observed in between transverse dimension (TS) tumor size and stages of tumor (rho 0.673, p-value <0.001), Anterioposterior (AP) tumor size and stages of tumor (rho 0.675, p-value <0.001), and Craniocaudal (CC) tumor size and stages of tumor (rho 0.771, p-value <0.001). Conclusion: CT scan of neck with contrast can be used for predicting the positive presence of lymph node in neck with primary tumors having a size of more than 4 mm. [ABSTRACT FROM AUTHOR]

Ovarian cancer is the most common cause of gynecologic cancer death worldwide. Ninety-five percent of ovarian malignancies derive from epithelial cells. Dissemination of ovarian cancer is usually locoregional and occurs by invasion of adjacent viscera. Recurrence in the supradiaphragmatic lymph nodes is rare and only reported in a few cases in the literature. The authors describe the finding of a late metastasis in the cervical lymph nodes in a 56-year-old patient with ovarian serous cell carcinoma. [ABSTRACT FROM AUTHOR]

Introduction: Olfactory neuroblastoma is a rare sinonasal tumor with high potential for local recurrence. It arises from the olfactory neuroepithelium. Case Report: We present a 55-year-old man who was previously diagnosed with an olfactory neuroblastoma and had undergone endoscopic excision of the tumor followed by radiotherapy. He was well until nine months post-treatment, when he presented with a three-month history of left-sided neck swelling. Neck examination revealed left submandibular lymphadenopathy. Nasoendoscopy showed no recurrence. Fine needle aspiration cytology (FNAC) confirmed it to be a metastatic olfactory neuroblastoma. Computed tomography (CT) showed radioimaging evidence of mild enhancement within the ethmoid sinuses and left submandibular lymph node suggestive of metastasis. Positron Emission Tomography (PET) scan demonstrated high uptake at level I and level II neck nodes with no uptake at the previous primary site. He subsequently underwent bilateral modified radical neck dissection. Conclusion: Multimodality imaging and clinical examination are important in identifying recurrence of disease before proceeding with its management, especially for tumors with a high risk of local recurrence which includes olfactory neuroblastoma. [ABSTRACT FROM AUTHOR]

Malignant conversion of sinonasal inverted papilloma (SNIP) occurs in approximately ten percent of cases. These tumors are classically described as locally destructive, but without metastatic potential. Only four cases of malignant conversion with cervical nodal metastases have been described in the English literature. We present the rare case of a 61-year-old Caucasian male with a nasopharyngeal recurrence of malignant SNIP with cervical and retropharyngeal nodal metastases. The patient underwent endoscopic transpterygoid with nasoseptal flap reconstruction, followed by staged bilateral and retropharyngeal node dissection. Histopathology of the specimens demonstrated poorly differentiated invasive nonkeratinizing squamous cell carcinoma with inverted-type features. Three months after surgery, the patient suffered from C1-C2 fractures consistent with osteoradionecrosis and expired. Although the rate of malignant conversion of SNIP is low, this case highlights the need for aggressive, definitive treatment and surveillance. [ABSTRACT FROM AUTHOR]

The appearance of a solitary lateral cervical cystic mass as the only initial presenting symptom of occult thyroid carcinoma is uncommon. Its presence is often related with the more frequently branchial cyst in young adults, but also rarely related with thyroid carcinomas. In most of these cases all such lesions may initially be considered as metastatic foci from a primary thyroid lesion. However, an alternative explanation by means of which ectopic thyroid tissue is associated with a branchial cyst has to be considered, especially if no primary tumour is observed in the histological examination of the thyroid gland. We present two case of solitary cystic lymph node metastasis of occult papillary carcinoma of the thyroid. [Cukurova Med J 2011; 36(1): 29-33]

Even with 1% of the incidence, laryngeal neuroendocrine tumors are the second common tumors in larynx; as a subtype, typical carcinoid tumors are extremely rare. We presented a case of laryngeal typical carcinoid tumor and we discussed diagnostic criteria and treatment of these tumors. A 57-year-old male with a 3 months history of hoarseness was examined endoscopically and a laryngeal mass on left supraglottic area was seen. High levels of serum calcitonin were detected. The histopathological analysis of biopsy material was typical carcinoid tumor. Laryngeal tumor resection and left neck dissection were performed. The histopathologic result was TTF 1 and calcitonin positive primer laryngeal typical carcinoid tumor with cervical lymphoid metastasis. Serum calcitonin level returned to normal levels postoperatively. The distinction between laryngeal carcinoid tumors and metastasis of thyroid medullary carcinoma are difficult histopathologically. So, laryngeal carcinoid tumors should be kept in mind in these circumstances. [ABSTRACT FROM AUTHOR]

Aim To determine the most accurate noninvasive imaging modality for occult metastasis in clinically node-negative necks in oral squamous cell carcinoma from a granulomatous disease endemic region. Method Prospective, observational study comparing ultrasound ( US), contrast enhanced computed tomography ( CECT) and positron emission tomography-computed tomography ( PET-CT). Level wise assessment of neck nodes with each imaging modality was performed and compared with final histopathology. Results Eighty-five necks were evaluated in 70 patients. Sensitivity, specificity and accuracy of the three modalities were 78.9, 68.75 and 73.25% for US, 73.6, 85.4 and 80.2% for CECT, and 81.5, 54.1 and 66.2% for PET- CT, respectively. CECT performed better than US and PET-CT scan particularly in levels IB and II (accuracy of 81.4 and 88.3% for CECT, 73.25 and 79.1% for US, and 68.6 and 68.6% for PET-CT scan, respectively). Concordance with histology was best with CECT (κ = 0.615) followed by US (κ = 0.461) and PET- CT (κ = 0.337). Conclusion The quest for the most accurate imaging modality in clinically node-negative necks continues. US alone is inadequate. While PET-CT may not be a specific imaging modality in detecting occult cervical nodal metastasis in endemic regions of chronic granulomatous diseases, the performance of PET CECT in this setting remains to be evaluated. CECT scan, routinely used in imaging for primary disease, is fairly accurate in detecting nodal metastasis. However, in early oral cancers that are generally treated without any imaging for the primary tumor, management of the neck will largely depend on clinical judgment. [ABSTRACT FROM AUTHOR]

The treatment of lymph node metastases involving the carotid artery is controversial. The aim of the present study was to determine the outcomes of head and neck cancer patients with radiographic carotid artery involvement in neck metastases. A total of 27 patients with head and neck cancer and radiologically diagnosed advanced metastases involving the common carotid artery or internal carotid artery were enrolled. All patients underwent a primary or salvage neck dissection and surgical carotid peeling. The oncological outcome and survival of all patients were analyzed. Loco-regional control was observed in 13 of the 27 patients (48.1%). During follow-up, five patients (18.5%) developed second primaries and 11 (40.7%) developed distant metastases. The survival time was poor independent of regional control. The median overall survival was 1.55 years and disease-free survival was 0.71 year. Radiographic carotid artery involvement in neck metastases in head and neck cancer appears to correlate with a poor long-term prognosis, with a high rate of distant metastases despite loco-regional control. [ABSTRACT FROM AUTHOR]

Stratification of head and neck squamous cell carcinomas (HNSCC) based on HPV16 DNA and RNA status, gene expression patterns, and mutated candidate genes may facilitate patient treatment decision. We characterize head and neck squamous cell carcinomas (HNSCC) with different HPV16 DNA and RNA (E6*I) status from 290 consecutively recruited patients by gene expression profiling and targeted sequencing of 50 genes. We show that tumors with transcriptionally inactive HPV16 (DNA+ RNA-) are similar to HPV-negative (DNA-) tumors regarding gene expression and frequency of TP53 mutations (47%, 8/17 and 43%, 72/167, respectively). We also find that an immune response-related gene expression cluster is associated with lymph node metastasis, independent of HPV16 status and that disruptive TP53 mutations are associated with lymph node metastasis in HPV16 DNA- tumors. We validate each of these associations in another large data set. Four gene expression clusters which we identify differ moderately but significantly in overall survival. Our findings underscore the importance of measuring the HPV16 RNA (E6*I) and TP53-mutation status for patient stratification and identify associations of an immune response-related gene expression cluster and TP53 mutations with lymph node metastasis in HNSCC. [ABSTRACT FROM AUTHOR]

Objective: To identify the effects of clinical and histopathological parameters on neck metastasis in early-stage oral cavity cancers. Methods: The medical records of 92 patients who underwent primary surgical resection and concurrent neck dissection due to early-stage oral cavity squamous cell cancer at İzmir Atatürk Training and Research Hospital between June 2001 and June 2010 were retrospectively reviewed. The associations of clinical and histological parameters with neck metastasis were assessed. Based on the histological data, the histological sections of the operative tissue were obtained via the measurement of tumor width and tumor depth. Using an optical micrometer, the maximum width at the horizontal plane and the maximum depth at the vertical plane were measured and the maximum depth was recorded as tumor thickness. Results: The association between neck metastasis and tumor localization, T stage, degree of differentiation, tumor thickness, perineural invasion, vascular invasion and perilymphatic invasion in early-stage oral cavity cancers was found statistically significant (p<0.05). The value of critical tumor thickness for the neck metastasis was found to be 5.6 mm. Conclusion: On the basis of our results, a tumor thickness of 5.6 mm is the critical value for the development of neck metastasis in oral cavity cancers. The neck metastasis risk showed a significant increase in cases where the tumor thickness exceeded this threshold value. In oral cavity cancers with a high risk of occult metastasis, the tumor thickness may be identified pre-operatively or intra-operatively and, a decision can be taken to perform neck dissection when they exceed critical values. [ABSTRACT FROM AUTHOR]

Neck dissection is an important treatment for metastases from upper aerodigestive carcinoma; an event that markedly reduces survival. Since its inception, the philosophy of the procedure has undergone significant change from one of radicalism to the current conservative approach. Furthermore, nonsurgical modalities have been introduced, and, in many situations, have supplanted neck surgery. The refinements of imaging the neck based on the concept of neck level involvement has encouraged new philosophies to evolve that seem to benefit patient outcomes particularly as this relates to diminished morbidity. The purpose of this review was to highlight the new paradigms for surgical removal of neck metastases using an evidence-based approach. © 2014 Wiley Periodicals, Inc. Head Neck 37: 915-926, 2015 [ABSTRACT FROM AUTHOR]