A multidisciplinary approach to head and neck cancer

Head and neck cancer and its treatment can leave patients with impaired swallowing and ability to communicate. A multidisciplinary approach from the speech and language therapist and dietician can help the patient maximise their function and identify when additional methods of support are required.

Lhermitte-Duclos disease associated with Cowden disease

We encountered a patient with Lhermitte-Duclos disease accompanied by Cowden disease, the second reported in Japan. The histological findings are described in detail. It is important to suspect Cowden disease in patients with Lhermitte-Duclos disease. Although Cowden disease is little known, making the diagnosis is very important, because cancer frequently occurs in the patient's family and genetic counseling is necessary.

Lost airway during anesthesia induction: alternatives for management

Pediatric and adult patients with upper airway obstruction pose several challenges to the anesthesiologist and otolaryngologist--head and neck surgeon. The initiation of general anesthesia and endotracheal intubation may progress to complete life-threatening respiratory decompensation with failure to achieve endotracheal intubation or mask ventilation. Hurried invasive maneuvers such as large-bore needle tracheal entry and cricothyrotomy are recognized salvage techniques, but other modes of extratracheal ventilation are now possible before surgical airway procedures are required. The laryngeal mask airway and esophagotracheal Combitube (Kendall Sheridan Health Care Products Co., Argyle, NY) are described, with examples of their clinical application. The combined technique of anterior commissure laryngoscopy and intubation with the gum elastic bougie is the preferred alternative for achieving tracheal entry when extratracheal ventilation cannot be accomplished. An algorithm for joint management of the problem airway by anesthesiologist and otolaryngologist--head and neck surgeon is illustrated.

Development of squamous cell carcinoma in hepatitis C virus-associated lichen planus

The hepatitis C virus may occasionally be associated with oral lichen planus. The present report details the features of a patient with hepatitis C virus infection and oral lichen planus who developed a squamous cell carcinoma of the tongue.

Additional neoplasms and HCV infection in low-grade lymphoma of MALT type

Several chronic inflammatory conditions and genetic alterations are likely to be involved in the pathogenesis of low-grade lymphoma of MALT type. In a well-characterized series of 27 patients with low-grade lymphoma of MALT type, we studied: (1) the incidence of other neoplasms, which might be indicative of genetic instability, apparently a characteristic of this disease; (2) the prevalence of serologic and molecular markers of HCV infection, which has been found in association with other lymphoproliferative disorders. Three patients had one or more additional cancers; a total of eight tumours, five of which occurred in the same patient, suggests the presence of some genetic instability in at least some cases of the disease. Rather unexpectedly, anti-HCV antibodies and HCV RNA sequences were documented in 50% of the patients examined, without elevation of serum transaminases. Of interest, the two patients with parotid and conjunctival MALT lymphomas, respectively, with a previous history of Sjögren's syndrome, were HCV positive. We suggest, for the first time, that HCV may be considered, in addition to Helicobacter pylori, as another potential infectious co-factor in the multistep pathogenesis of low-grade lymphomas of MALT type.

An uncommon indication for tracheal resection

In well selected cases, in which preoperative investigations allow us to plan a tracheal resection-anastomosis, surgery is the best current treatment also for secondary tumours involving the trachea. We report a case of a patient suffering from severe dyspnoea for tracheal stenosis due to recurrence of an epidermoid cancer of the tongue. Surgical treatment allowed us to obtain very good palliation.

Screening for syphilis in patients with carcinoma of the tongue

The oral signs of syphilis have been comprehensively described and can be identified at each stage of the infection. Despite the historical recognition that inadequately treated or untreated syphilitic leukoplakia may undergo malignant transformation, many surgical units no longer routinely screen patients presenting with malignant or premalignant lesions. In this study, five of the 63 patients (8%) who presented with neoplasms of the tongue reacted to syphilis antibodies. These results indicate that syphilis is still prevalent in this group of patients and suggest that serological investigations may be warranted in the initial assessment of all patients with oral cancer.

Changes in nerve fibers adjacent to transplanted VX2 carcinoma in rabbit tongue

This study was undertaken to examine the relationship between malignant tumor tissue and nerve fibers using a transplantation model and nerve fiber strains. Most of the neural tissue, as well as the other host tissues, showed severe degenerative changes as the transplanted tumor grew. Furthermore, the degenerative changes were chiefly confined to the area anterior to the tumor. These changes were probably provoked chiefly by the compressive effects of the rapidly enlarging transplant. The results could possibly explain clinical symptoms such as paralysis or disturbances in the movement of the tongue observed occasionally in some patients with lingual carcinomas.

Updated management strategy for patients with cervical osteophytic dysphagia

Anterior cervical osteophytes impinging upon the pharynx or esophagus constitute a rare cause of dysphagia. In severe cases, surgical removal of these osteophytes can provide symptomatic relief. We describe a patient of this type who failed to improve postoperatively, only to be found subsequently to have a carcinoma of the base of the tongue. To assist other clinicians in evaluating similar patients, and also to emphasize the great utility of modern radiologic techniques in these cases, we propose a diagnostic algorithm that incorporates magnetic resonance or computerized tomographic imaging.

Head and neck carcinoma in Fanconi's anaemia--report of a case and review of the literature

Fanconi's anaemia (FA) is a rare autosomal recessive syndrome characterised by progressive lethal pancytopenia, skeletal abnormalities, hyperpigmentation and increased chromosomal aberrations. A high incidence of leukaemia and hepatocellular and squamous cell carcinomas (SCC) have been reported in FA patients. A rare case of SCC of the dorsum of the tongue in a FA patient is presented. A review of the reported cases of head and neck carcinoma in FA patients shows a different male:female ratio than previously reported, and a high incidence of carcinoma of the tongue.

Leiomyoma of the tongue presenting as congenital airway obstruction

Leiomyoma is a benign tumor of smooth muscle origin that is most commonly found in the uterus, gastrointestinal tract, and skin. Intraoral leiomyomas are rare, usually asymptomatic, and, most often present in the fifth decade of life. A review of the literature since 1884 yielded only 125 cases, including 23 of the tongue. We report the first case of a congenital leiomyoma of the tongue presenting with airway obstruction. A 6-day-old female infant, intubated since birth for respiratory distress, was evaluated for an obstructing oropharyngeal mass. The tumor was pedunculated, mucosa-covered, and localized to the posterior tongue. The mass was completely excised using a CO2 laser. There has been no recurrence in 1 year of follow-up.

Myelodysplastic syndrome associated with immunoblastic lymphadenopathy-like T-cell lymphoma: simultaneous clinical improvement with chemotherapy

A 75-year-old woman presented with anemia, lymphadenopathy, hepatomegaly and lingual tumor, but no constitutional symptoms. The laboratory data showed pancytopenia and polyclonal hypergammaglobulinemia. A bone marrow aspirate represented an apparent myelodysplastic syndrome (MDS) feature, specifically, refractory anemia with excess of blasts. A lymph-node biopsy revealed the disappearance of normal architecture, small arborizing blood vessels, large lymphoid cells with prominent cytoplasm (so-called pale cells) and a clonal proliferation of T-lymphocytes. The patient was diagnosed as having MDS associated with immunoblastic lymphadenopathy (IBL)-like T-cell lymphoma. She was subsequently treated with cyclophosphamide, adriamycin, vincristine and prednisolone for lymphoma which successfully induced a remission of not only the T-cell lymphoma but also the MDS. The case suggested that MDS might be a paraneoplastic complication of IBL-like T-cell lymphoma.

Acute enlargement of the tongue

Acute enlargement of the tongue can present as an emergency. The problems of management in the acute situation and the diagnosis of the underlying condition are discussed and illustrated with reference to four unusual cases. There is a case for a simple classification and such a classification is presented.

[Radiation complications in the combined treatment of cancer of the oropharyngeal area]

A follow-up of 236 patients exposed to combined radiotherapy, carried out at the Chelyabinsk oncologic center, has shown that 27 (11.4%) of these patients developed radiologic complications, 18 (7.6%) developed ulcers and 9 (3.8%) osteomyelitis. Radiation ulcers occurred in 6.7% of the patients with cancer of the oral cavity fundus mucosa, osteomyelitis in 9%. In the patients with lingual carcinoma the complications occurred in 4.6 and 10.8%, respectively, in those with cancer of the lower lip radiation ulcers developed in 3.5% of patients, whereas osteomyelitis did not occur. Radiation injuries developed mostly in the patients with large tumors located near osseous structures. The authors emphasize a careful follow-up of this patient population, particularly in the earliest period after the irradiation.

Tongue gastric choristoma: failure to localize by technetium-99m pertechnetate scan

Congenital rests of gastric epithelium have been reported in a variety of head and neck locations. Presenting symptoms of these lesions range from an asymptomatic cyst to one which is compromising the airway. The true diagnosis is rarely suspected prior to excision. A case of a gastric choristoma of the tongue is presented which was noted at birth as an intermittently bleeding ulcer. Complete excision of the mass was difficult to ascertain due to poor delineation of the tumor margins from the tongue musculature. A postoperative technetium-99m pertechnetate scan failed to demonstrate residual gastric mucosa. Conservative management resulted in only transient healing of the ulcer. Repeat excision demonstrated abundant residual gastric mucosa. Technetium-99m pertechnetate scanning may not be a reliable indicator of ectopic gastric mucosa in the head and neck region.

[Squamous cell carcinoma of the tongue and HIV infection]

It is reported the case of a 39 year old male, non homosexual, seropositive to HIV due to polytransfusion, without AIDS diagnostic criteria and with a severe depression in cellular immunity, expressed as lowering in CD4+ T cells, and in the CD4+/CD8+ ratio, who showed, without having any risk-factors, a squamous cell carcinoma of the tongue. We review the cases reported in the scientific literature on the association between squamous-cell carcinoma and AIDS or HIV infection.