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Chio CF, Sam WP, Wong SI, Sio CU, Kok LF, Pai KM, Hlaing T. Nasopharyngeal mucoepidermoid carcinoma with mastermind-like transcriptional coactivator 2 translocation: A case report and comprehensive literature review of a rare entity. SAGE Open Med Case Rep 2024; 12:2050313X241281323. [PMID: 39376552 PMCID: PMC11457284 DOI: 10.1177/2050313x241281323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 08/20/2024] [Indexed: 10/09/2024] Open
Abstract
Mucoepidermoid carcinoma is one of the most common malignant tumors in salivary glands and is usually associated with mastermind-like transcriptional coactivator 2 (MAML2) rearrangement. Primary nasopharyngeal mucoepidermoid carcinoma is extremely rare, and MAML2 status was reported in only two studies. Herein, we present a 70-year-old male patient with incidentally found nasopharyngeal mucoepidermoid carcinoma. MAML2 translocation was detected by fluorescence in situ hybridization test. Additionally, we conducted a comprehensive literature review and summarized the clinicopathological features of this rare condition. Nasopharyngeal mucoepidermoid carcinoma shows a similar mean age at diagnosis and gender ratio to those of mucoepidermoid carcinoma in salivary glands. More than half of the patients exhibit high histologic grade at the time of diagnosis. As MAML2 status is unreported in almost all published cases, further studies are needed to explore the incidence and prognostic value of MAML2 rearrangement in nasopharyngeal mucoepidermoid carcinoma.
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Affiliation(s)
- Chan-Fong Chio
- Department of Anatomical Pathology, Conde de São Januário Hospital, Macao SAR, China
| | - Wan-Pang Sam
- Department of Otorhinolaryngology, Conde de São Januário Hospital, Macao SAR, China
| | - Sio-In Wong
- Department of Anatomical Pathology, Conde de São Januário Hospital, Macao SAR, China
| | - Cheong-Un Sio
- Department of Otorhinolaryngology, Conde de São Januário Hospital, Macao SAR, China
| | - Lai-Fong Kok
- Department of Anatomical Pathology, Conde de São Januário Hospital, Macao SAR, China
| | - Ki-Man Pai
- Department of Otorhinolaryngology, Conde de São Januário Hospital, Macao SAR, China
| | - Thazin Hlaing
- Department of Anatomical Pathology, Conde de São Januário Hospital, Macao SAR, China
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2
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Wu WB, Cai WL, Zou YH, You R, Liu YP, Yuan ZD, Li Q, Li WC, Pi ZX, Xie YL, Wen K, Chen MY, Sun R. Outcomes of patients in nasopharyngeal adenoid cystic carcinoma in the IMRT era: a single-center experience. BMC Cancer 2024; 24:576. [PMID: 38730348 PMCID: PMC11084105 DOI: 10.1186/s12885-024-12159-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 03/21/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE Nasopharyngeal adenoid cystic carcinoma (NACC) is a rare malignancy with special biological features. Controversies exist regarding the treatment approach and prognostic factors in the IMRT era. This study aimed to evaluate the long-term outcomes and management approaches in NACC. METHODS Fifty patients with NACC at our institution between 2010 and 2020 were reviewed. Sixteen patients received primary radiotherapy (RT), and 34 patients underwent primary surgery. RESULTS Between January 2010 and October 2020, a total of 50 patients with pathologically proven NACC were included in our analysis. The median follow-up time was 58.5 months (range: 6.0-151.0 months). The 5-year overall survival rate (OS) and progression-free survival rate (PFS) were 83.9% and 67.5%, respectively. The 5-year OS rates of patients whose primary treatment was surgery and RT were 90.0% and 67.3%, respectively (log-rank P = 0.028). The 5-year PFS rates of patients whose primary treatment was surgery or RT were 80.8% and 40.7%, respectively (log-rank P = 0.024). Multivariate analyses showed that nerve invasion and the pattern of primary treatment were independent factors associated with PFS. CONCLUSIONS Due to the relative insensitivity to radiation, primary surgery seemed to provide a better chance of disease control and improved survival in NACC. Meanwhile, postoperative radiotherapy should be performed for advanced stage or residual tumours. Cranial nerve invasion and treatment pattern might be important factors affecting the prognosis of patients with NACC.
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Affiliation(s)
- Wen-Bin Wu
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P.R. China
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, China
| | - Wu-Lin Cai
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P.R. China
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, China
| | - Ye-Hao Zou
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P.R. China
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, China
| | - Rui You
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P.R. China
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, China
| | - You-Ping Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P.R. China
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, China
| | - Zhao-Di Yuan
- Department of Clinical Medicine, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Qiong Li
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P.R. China
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, China
| | - Wen-Chao Li
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P.R. China
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, China
| | - Zhi-Xuan Pi
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P.R. China
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, China
| | - Yu-Long Xie
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P.R. China
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, China
| | - Kai Wen
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P.R. China
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, China
| | - Ming-Yuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P.R. China.
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, China.
| | - Rui Sun
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P.R. China.
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, China.
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3
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Tan Q, Yang Q, Li H, Li M, Chen W, Liang Z, Yang Z, Li Y, Ning L, Zhao C, Guo X, Yang A, Shan H, Ouyang D. Short-Term Efficacy of the Transnasal-Transoral Approach to Endoscopic Nasopharyngectomy for Nasopharyngeal Adenocarcinoma. Ann Otol Rhinol Laryngol 2022:34894221120722. [PMID: 36039471 DOI: 10.1177/00034894221120722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Nasopharyngeal adenocarcinomas (NPACs) are rare malignant tumors. The treatment of NPACs is usually surgery with resection of normal nasal passage tissues.We introduced an innovative double endoscopic surgery for NPACs patients and evaluated the clinical efficacy of this approach. METHODS The clinical data of 4 NPACs patients who underwent radical endoscopic nasopharyngectomy using a combined transnasal and transoral approach were analyzed to determine the efficacy of this surgery. The endpoints were en bloc resection and relief of clinical symptoms. RESULTS All surgeries were successfully performed without any severe postoperative complications or death. Postoperative MRI revealed that en bloc resection was achieved for all patients with NPACs, and they had high quality of life without postoperative complications. CONCLUSIONS The transnasal-transoral approach to endoscopic nasopharyngectomy for nasopharyngeal adenocarcinoma is safe and effective.
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Affiliation(s)
- Qingjian Tan
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Qing Yang
- Department of Endoscopy, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Hao Li
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Mingtian Li
- Department of Anesthesiology & Operating Theatre, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Wenkuan Chen
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Zicong Liang
- Department of Anesthesiology & Operating Theatre, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Zhongyuan Yang
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Yin Li
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Li Ning
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Chong Zhao
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Xiang Guo
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Ankui Yang
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Hongbo Shan
- Department of Endoscopy, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Dian Ouyang
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
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4
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Brandt HH, Baumhoer D, Tetter N. Hyalinizing Clear Cell Salivary Gland Carcinoma of the Epipharynx: A Minor Salivary/Tubarial Gland Malignancy. Biomed Hub 2022; 7:31-35. [DOI: 10.1159/000521830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/29/2021] [Indexed: 11/19/2022] Open
Abstract
Minor salivary gland malignancies are a rare entity among head and neck tumors. As in major gland neoplasms, adenoid cystic carcinoma and mucoepidermoid carcinoma are the most common histological subtypes. Malignant tumors affecting minor salivary glands include a wide range of histopathologic types. Localization in the epipharynx and hyalinizing clear cell carcinoma subtype are exceedingly rare. A 47 year-old male presented to our clinic with a complaint of slowly progressing left-sided nasal obstruction. Endoscopy revealed a well-defined nodular epipharyngeal mass. Radiographic evaluation discovered a nonvascularized tumor of the tubal protuberance. The tumor was treated with wide local excision. Staging at the time found no evidence of regional lymph node metastases. Histologic examination revealed a hyalinizing clear cell salivary gland carcinoma demonstrating an EWSR1-ATF1 gene fusion. Restaging endoscopy and radiographic imaging 3 months after initial therapy did not reveal any signs of tumor persistence. The patient is currently in follow-up.
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5
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Yan F, Lao WP, Nguyen SA, Sharma AK, Day TA. Elective neck dissection in salivary gland malignancies: Systematic review and meta-analysis. Head Neck 2021; 44:505-517. [PMID: 34862810 DOI: 10.1002/hed.26923] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/25/2021] [Accepted: 10/26/2021] [Indexed: 12/27/2022] Open
Abstract
We defined the occult nodal metastasis (ONM) rate of clinical node-negative salivary gland malignancies and examined the role of elective neck dissection (END). Meta-analysis querying four databases, from inception of databases to March 25th, 2020. Fifty-one studies with 11 698 patients were included. ONM rates were 64% for salivary ductal carcinoma (SDC), 51% for undifferentiated carcinoma, 34% for carcinoma ex-pleomorphic adenoma (CXPA), 32% for adenocarcinoma not otherwise specified (ANOS), 31% for lymphoepithelial carcinoma (LE), 20% for mucoepidermoid carcinoma, 17% for acinic cell carcinoma, and 17% for adenoid cystic carcinoma. T3/T4 tumors had a 2.3 times increased risk of ONM than T1/T2 tumors. High-grade tumors had a 3.8 times increased risk of ONM than low/intermediate-grade tumors. ONM rates were exceedingly high for T3/T4, high-grade, and undifferentiated, SDC, ANOS, CXPA, and LE tumors, indicating the potential role of END.
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Affiliation(s)
- Flora Yan
- Department of Otolaryngology-Head and Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Wilson P Lao
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, USA
| | - Shaun A Nguyen
- Head and Neck Tumor Center, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Anand K Sharma
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Terry A Day
- Head and Neck Tumor Center, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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6
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Bubola J, Antonescu CR, Weinreb I, Swanson D, De Almeida JR, MacMillan CM, Dickson BC. A novel low-grade nasopharyngeal adenocarcinoma characterized by a GOLGB1-BRAF fusion gene. Genes Chromosomes Cancer 2020; 60:49-53. [PMID: 32951290 DOI: 10.1002/gcc.22897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 11/10/2022] Open
Abstract
Nasopharyngeal adenocarcinoma is a rare malignancy that is classified into conventional/surface- and salivary-types. Herein we report the case of a 52-year-old male who presented with a right nasopharyngeal mass and right-sided hearing loss. Diagnostic imaging revealed a circumscribed 1.7 cm mass centred in the right antero-lateral aspect of the nasopharynx. A biopsy showed a gland-forming neoplasm that was in continuity with the surface epithelium. The tumor exhibited a nested to micro-papillary architecture, with mild cytologic atypia. Immunohistochemistry demonstrated diffuse staining for CK7, SOX10, and p16; the abluminal layer was highlighted by CK5 and p63, while the luminal cells expressed CD117. The tumor was not amenable to subclassification and was diagnosed as a low-grade nasopharyngeal adenocarcinoma, not otherwise specified (NOS). Subsequent RNA sequencing was performed which identified a novel GOLGB1-BRAF fusion product. Based on its unique morphology and molecular findings, this is presumed to represent a novel subtype of nasopharyngeal adenocarcinoma. In addition to being of diagnostic relevance, this fusion may ultimately represent a potential therapeutic target.
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Affiliation(s)
- Justin Bubola
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.,Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ilan Weinreb
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - David Swanson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - John R De Almeida
- Department of Otolaryngology Head and Neck Surgery, Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Christina M MacMillan
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Brendan C Dickson
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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7
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Sun M, Qu Y, Wang K, Wu R, Zhang Y, Zhang S, Xiao J, Yi J, Gao L, Xu G, Huang X, Luo J. Long-term outcomes of patients in different histological subtypes of primary nasopharyngeal adenocarcinoma: A single-center experience with 71 cases. Oral Oncol 2020; 111:104923. [PMID: 32795912 DOI: 10.1016/j.oraloncology.2020.104923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/17/2020] [Accepted: 07/19/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study is aimed to evaluate the long-term outcomes and management approaches in different histological subtypes of primary nasopharyngeal adenocarcinoma (NPAC). MATERIALS AND METHODS 71 patients with NPAC at our institution between 1984 and 2016 were reviewed, including adenoid cystic carcinoma (ACC) in 43 patients, mucoepidermoid carcinoma (MEC) in 17 patients, and primary traditional adenocarcinoma (AC) in 11 patients. 37 patients received primary radiotherapy and 34 patients underwent primary surgery. RESULTS The median time of follow-up was 77 months. The 5-year overall survival rate (OS), locoregional failure-free survival rate (LRFFS) and distant metastasis failure-free survival rate (DFFS) were 69.9%, 67.1% and 77.9%, respectively. Patients who received combined modality therapy had better 5-year OS (73.7% vs 66.2%, p = 0.065) and LRFFS (73.1% vs 64.5%, p = 0.047) than patients receiving single modality therapy. Regarding the different histological subtypes, the survival rates of patients with ACC undergoing primary radiotherapy and primary surgery were similar (5-year OS 82.3% vs 68.8%, LRFFS 70.0% vs 70.8%, p>0.05). As to patients with MEC and AC, those who underwent primary surgery achieved better 5-year OS (75.6% vs 45.5%, p = 0.001) and LRFFS (70.6%% vs 57.1%, p = 0.014) than those who received primary radiotherapy. Multivariate analyses indicated that histological subtypes and radiotherapy technique were independent factors for OS. CONCLUSIONS The optimal treatment policy for NPAC remained the combination of radiotherapy and surgery. For patients with ACC, radiotherapy could be considered as the primary treatment. Surgery was suggested to be the primary treatment in patients with MEC and AC.
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Affiliation(s)
- Meng Sun
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yuan Qu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Kai Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Runye Wu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ye Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shiping Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jianping Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Junlin Yi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Li Gao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Guozhen Xu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiaodong Huang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Jingwei Luo
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
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8
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Zemni I, Tounsi N, Bouraoui I, Slimene M, Sahraoui G, Ayadi MA, Chargui R, Rahal K. A Single Liver Metastasis From Adenoid Cystic Carcinoma of the Parotid Gland: Case Report. J Investig Med High Impact Case Rep 2020; 7:2324709619879631. [PMID: 31556756 PMCID: PMC6764036 DOI: 10.1177/2324709619879631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Adenoid cystic carcinoma is an uncommon malignant neoplasm of the salivary gland.
Liver metastasis from salivary gland cancer is a rare situation. In this
article, we report the case of a 29-year-old woman treated 5 years previously
for adenoid cystic carcinoma of the parotid gland by surgery and radiotherapy,
who presented for a large hypervascularized hepatic metastasis of 20 cm. After
3-cycle chemotherapy stability, hepatic surgery was successfully performed. The
patient maintained disease-free period of 12 months after the surgical
treatment. This rare case represents a therapeutic challenge for oncologists and
surgeons. Through this case and a review of the literature, we try to better
detail the management of this uncommon entity.
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Affiliation(s)
- Ines Zemni
- Department of surgical oncology, Salah Azaiz Institute, University Tunis El Manar, Tunis, Tunisia
| | - Nesrine Tounsi
- Department of surgical oncology, Salah Azaiz Institute, University Tunis El Manar, Tunis, Tunisia
| | - Imene Bouraoui
- Department of surgical oncology, Salah Azaiz Institute, University Tunis El Manar, Tunis, Tunisia
| | - Maher Slimene
- Department of surgical oncology, Salah Azaiz Institute, University Tunis El Manar, Tunis, Tunisia
| | - Ghada Sahraoui
- Department of pathology, Salah Azaiz Institute, University Tunis EL Manar, Tunis, Tunisia
| | - Mohamed Ali Ayadi
- Department of surgical oncology, Salah Azaiz Institute, University Tunis El Manar, Tunis, Tunisia
| | - Riadh Chargui
- Department of surgical oncology, Salah Azaiz Institute, University Tunis El Manar, Tunis, Tunisia
| | - Khaled Rahal
- Department of surgical oncology, Salah Azaiz Institute, University Tunis El Manar, Tunis, Tunisia
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9
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Xie D, Chen A, Lv S, Zhang H, Liu X, Su Y. Late-course accelerated hyperfractionated intensity-modulated radiotherapy for nasopharyngeal adenoid cystic carcinoma: A case report. Med Dosim 2019; 45:46-51. [PMID: 31213401 DOI: 10.1016/j.meddos.2019.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/28/2019] [Accepted: 05/21/2019] [Indexed: 12/01/2022]
Abstract
Nasopharyngeal adenoid cystic carcinoma is a rare neoplasm characterized by strong local invasiveness and a higher tendency to relapse. Because of the rare cases, there is a little consensus on treatment. We report a case of T3N0 NACC with a positive resection margin treated with postoperative adjuvant radiotherapy. MRI reexamination indicated suspected tumor progression during the course of radiotherapy. In order to improve local control, late-course accelerated hyperfractionated intensity-modulated radiotherapy (LCAF-IMRT) was performed to escalate total dose, which achieved good local control with no significant late toxicity.
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Affiliation(s)
- Dehuan Xie
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
| | - Aoqiang Chen
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
| | - Shaowen Lv
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
| | - Huizhong Zhang
- Department of Pathology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
| | - Xuekui Liu
- Department of Head and Neck Surgery, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
| | - Yong Su
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
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10
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Booth JR, Unsal AA, Tadros S, Byrd JK, Kountakis SE. Salivary Gland Cancers of the Nasopharynx: A Population-Based Analysis of 383 Cases. Otolaryngol Head Neck Surg 2019; 161:442-449. [DOI: 10.1177/0194599819849923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives/Hypothesis Salivary gland nasopharynx cancers (SGNPCs) are rare malignancies with few cases discussed in the literature. This study represents the largest cohort of SGNPC to date. Study Design Retrospective population-based analysis. Methods The Surveillance, Epidemiology, and End Results registry from 1973 to 2015 was utilized to extract 383 cases of SGNPC. Data were analyzed for demographic characteristics, incidence, clinicopathologic traits, and outcome prognosticators. Results White female patients aged >40 years were most commonly affected. The incidence was measured as 0.019 per 100,000 people. The majority of tumors presented at advanced stages (stage III/IV, 60.8%). Adenoid cystic carcinoma, adenocarcinoma, and mucoepidermoid carcinoma were the most commonly encountered histologies (43.1%, 31.6%, 13.3%, respectively). Cervical node involvement and distant metastasis were measured at 23% and 11.9%, respectively. Mucoepidermoid carcinomas presented with the best disease-specific survival at 5 and 10 years. Asian ethnicity, age <80 years, and earlier American Joint Committee on Cancer stages were positive prognostic factors. The inclusion of surgical therapy improved 5-year outcomes among the most common histologies, except for mucoepidermoid carcinoma. Conclusions Salivary gland nasopharyngeal cancer represents a group of rare histologies with similar outcomes as squamous cell carcinomas. However, prognosis is primarily dependent on histologic subtype, race, age, and American Joint Committee on Cancer stage.
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Affiliation(s)
- J. Renee Booth
- Department of Otolaryngology–Head and Neck Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Center for Skull Base Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Aykut A. Unsal
- Department of Otolaryngology–Head and Neck Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Center for Skull Base Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Sandra Tadros
- Department of Otolaryngology–Head and Neck Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - J. Kenneth Byrd
- Department of Otolaryngology–Head and Neck Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Center for Skull Base Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Stilianos E. Kountakis
- Department of Otolaryngology–Head and Neck Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
- Center for Skull Base Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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11
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Guarnizo A, Glikstein R, Torres C. Imaging Features of isolated hypoglossal nerve palsy. J Neuroradiol 2019; 47:136-150. [PMID: 31034896 DOI: 10.1016/j.neurad.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 10/26/2022]
Abstract
The hypoglossal nerve gives motor innervation to the intrinsic and extrinsic muscles of the tongue. Pathology of this nerve affects the balanced action of the genioglossus muscle causing tongue deviation toward the weak side. Clinically, hypoglossal nerve palsy manifests with difficulty chewing, swallowing and with dysarthric speech herein, we review the anatomy of the hypoglossal nerve as well as common and infrequent lesions that can affect this nerve along its course.
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Affiliation(s)
- Angela Guarnizo
- Neuroradiology Fellow, University of Ottawa - The Ottawa Hospital, Ottawa, Canada
| | - Rafael Glikstein
- Neuroradiologist, University of Ottawa - The Ottawa Hospital, Ottawa, Canada.
| | - Carlos Torres
- Neuroradiologist, University of Ottawa - The Ottawa Hospital, Ottawa, Canada
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12
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A Review of Salivary Gland Malignancies: Common Histologic Types, Anatomic Considerations, and Imaging Strategies. Neuroimaging Clin N Am 2018; 28:171-182. [PMID: 29622112 DOI: 10.1016/j.nic.2018.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Major and minor salivary gland malignancies come in various shapes and sizes. They can present as palpable masses or can be detected incidentally when imaging patients for other indications. A complete evaluation of salivary gland malignancies requires knowledge of the anatomy and various routes of spread of neoplasias. Computed tomography (CT) and MR imaging are complementary tools in this respect and offer useful information to the proceduralist. Advanced imaging (diffusion-weighted imaging and PET-CT) and other modalities (eg, ultrasound) help with characterization, although biopsy or excision is often needed for definitive tissue diagnosis.
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13
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Ryckman JM, Kusi Appiah A, Simone CB, Verma V. Treatment approaches for nasopharyngeal adenoid cystic carcinoma. Acta Oncol 2018; 57:995-1001. [PMID: 29338490 DOI: 10.1080/0284186x.2018.1426878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jeffrey M. Ryckman
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Adams Kusi Appiah
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Charles B. Simone
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
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14
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Chang CF, Hsieh MY, Chen MK, Chou MC. Adenoid cystic carcinoma of head and neck: A retrospective clinical analysis of a single institution. Auris Nasus Larynx 2018; 45:831-837. [PMID: 29653784 DOI: 10.1016/j.anl.2017.10.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 10/03/2017] [Accepted: 10/16/2017] [Indexed: 12/31/2022]
Abstract
Objective In this study, patients with head and neck adenoid
cystic carcinoma were investigated with respect to disease
characteristics, treatments, and potentially prognostic variables. Materials and Methods Between January 1995 and
December 2010, 29 patients with ACC of the head and neck
treated at our institution were retrospectively reviewed. Results The 29 patients had a mean age of 54.7 years. Of the
29 patients, 4 (13.8%) underwent surgical resection only, 21
(72.4%) underwent surgery with radiotherapy, and 4 (13.8%)
received postoperative chemoradiotherapy. Of 9 patients
(31.0%) who experienced a recurrence within the follow-up
period, 3 (10.3%) had local recurrence and 5 (17.2%) had
distant metastasis; 1 (3.4%) patient had both local recurrence
and distant metastatic spread. Conclusion ACC is a relatively rare tumor associated
with long survival, even in metastatic settings. Despite
aggressive therapy with surgery, radiotherapy, and chemo-
therapy, a marked potential for local and distant recurrence
still remains.
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Affiliation(s)
- Chin-Fang Chang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; Department of Otorhinolaryngology, Head and Neck Surgery, Jen-Ai Hospital, Taichung 400, Taiwan; Central Taiwan University of Science and Technology, Taichung, Taiwan.
| | - Ming-Yu Hsieh
- Department of Otorhinolaryngology, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan.
| | - Mu-Kuan Chen
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; Department of Otorhinolaryngology, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan.
| | - Ming-Chih Chou
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan.
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15
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Wang X, Luo Y, Li M, Yan H, Sun M, Fan T. Management of salivary gland carcinomas - a review. Oncotarget 2018; 8:3946-3956. [PMID: 27992367 PMCID: PMC5354805 DOI: 10.18632/oncotarget.13952] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 12/08/2016] [Indexed: 11/29/2022] Open
Abstract
Salivary gland carcinomas are a heterogeneous group of tumors with many histological subtypes which occur in both major and minor salivary glands. However, they have a relatively low of incidence. Their rarity limits study size and the ability to perform phase III trials. Therefore, to date, the entire management is usually varied. Certain published studies have paid more attention to the systemic therapy in the management of metastatic or locally recurrent salivary gland cancer, while little effort has been made to study the entire management for this lesions. Although results of treatment for patients with salivary gland carcinoma have improved in recent years, the treatment of salivary gland cancers is still not standardized. And some patients who haven’t received optimal treatment strategies had a reduced survival. In this review, the topics covered include surgery and radiotherapy, selective neck dissection, chemotherapy, and targeted therapy, which aimed to summarize the optimal management approaches and to develop recommendations for managing this lesions. For these rare cancers, there is also a need for a determined, coordinated effort to conduct high-quality clinical trials.
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Affiliation(s)
- Xiaoli Wang
- School of Medical and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Yijun Luo
- School of Medical and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Minghuan Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Hongjiang Yan
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Mingping Sun
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Tingyong Fan
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
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16
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Ünsaler S, Başaran B, Aslan I, Yilmazbayhan D. Endonasal endoscopic nasopharyngectomy for the treatment of nasopharyngeal papillary adenocarcinoma: Report of a rare case. Int J Pediatr Otorhinolaryngol 2018; 104:51-53. [PMID: 29287881 DOI: 10.1016/j.ijporl.2017.10.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 11/19/2022]
Abstract
We report a case of low-grade nasopharyngeal papillary adenocarcinoma in a 9 year-old male that was diagnosed incidentally after an adenoidectomy procedure and treated with endonasal endoscopic nasopharyngectomy without any adjuvant therapy. The patient has been followed up for 3 years with no evidence of recurrence. We point out the importance of preoperative fiberoptic nasopharyngoscopy in the absence of longstanding symptoms in school-aged children and histopathologic examination of adenoidectomy specimens in the presence of atypical findings. We also suggest endonasal endoscopic resection in case of papillary adenocarcinoma.
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Affiliation(s)
- Selin Ünsaler
- Department of Otolaryngology, Acıbadem Altunizade Hospital, Üsküdar, Istanbul, 34662, Turkey.
| | - Bora Başaran
- Department of Otolaryngology Head and Neck Surgery, Istanbul University, Istanbul Faculty of Medicine, Fatih, Istanbul, 34093, Turkey
| | - Ismet Aslan
- Department of Otolaryngology Head and Neck Surgery, Istanbul University, Istanbul Faculty of Medicine, Fatih, Istanbul, 34093, Turkey
| | - Dilek Yilmazbayhan
- Department of Pathology, Istanbul University, Istanbul Faculty of Medicine, Fatih, Istanbul, 34093, Turkey
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17
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Ali SM, Yao M, Yao J, Wang J, Cheng Y, Schrock AB, Chirn GW, Chen H, Mu S, Gay L, Elvin JA, Suh J, Miller VA, Stephens PJ, Ross JS, Wang K. Comprehensive genomic profiling of different subtypes of nasopharyngeal carcinoma reveals similarities and differences to guide targeted therapy. Cancer 2017; 123:3628-3637. [PMID: 28581676 DOI: 10.1002/cncr.30781] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/31/2017] [Accepted: 04/19/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND To date, no targeted therapy has been approved for nasopharyngeal carcinoma (NPC), and this underscores the need for an in-depth understanding of clinically relevant genomic alterations (CRGAs). METHODS Comprehensive genomic profiling was performed for 190 NPC patients, including 20 patients with nasopharyngeal adenocarcinoma (NPAC), 62 patients with nasopharyngeal squamous cell carcinoma (NPSCC), and 108 patients with nasopharyngeal undifferentiated carcinoma (NPUC). The associations of genes and pathways with subtypes, Epstein-Barr virus (EBV) infections, and the tumor mutation burden (TMB) were statistically evaluated. RESULTS Although the overall rates of genomic alterations were similar, the 3 NPC subtypes exhibited different mutational landscapes. Notably, mutations in a proven-treatable target gene, isocitrate dehydrogenase 2 (IDH2), were significantly associated with NPUC but not with NPAC or NPSCC. The top 5 ranked CRGAs included CDKN2A (29%), IDH2 (16%), SMARCB1 (7%), PIK3CA (6%), and NF1 (5%) in NPUC; CDKN2A (27%), PIK3CA (23%), FBXW7 (11%), PTEN (11%), and EGFR (8%) in NPSCC; and CDKN2A (20%), KRAS (15%), CCND1 (10%), MAP3K1 (10%), and NOTCH1 (10%) in NPAC. The incidence of EBV infections significantly correlated with the subtypes and with TP53, CDKN2A, and CDKN2B. The TMB status correlated with the subtypes and with LRP1B, FBXW7, and PIK3CA mutations as well as DNA repair, phosphoinositide 3-kinase/mammalian target of rapamycin, and mitogen-activated protein kinase pathways. CONCLUSIONS These results indicate that different NPC subtypes harbor different CRGAs. Both EBV infections and the TMB are associated with the NPC subtypes as well as the alterations of individual genes and pathways. The high frequency of IDH2 mutations in NPUC may facilitate potential targeted therapy and will ultimately point to new therapeutic strategies. Cancer 2017;123:3628-37. © 2017 American Cancer Society.
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Affiliation(s)
- Siraj M Ali
- Foundation Medicine, Inc, Cambridge, Massachusetts
| | | | | | | | | | | | | | | | | | - Laurie Gay
- Foundation Medicine, Inc, Cambridge, Massachusetts
| | | | - James Suh
- Foundation Medicine, Inc, Cambridge, Massachusetts
| | | | | | - Jeffrey S Ross
- Foundation Medicine, Inc, Cambridge, Massachusetts.,Albany Medical College, Albany, New York
| | - Kai Wang
- OrigiMed, Shanghai, China.,Zhejiang University International Hospital, Hangzhou, China
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18
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Nasopharyngeal adenocarcinoma: A population-based analysis. Am J Otolaryngol 2017; 38:297-300. [PMID: 28173955 DOI: 10.1016/j.amjoto.2017.01.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 01/25/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe the incidence and determinants of survival of patients with nasopharyngeal adenocarcinoma between the years of 1973 to 2012 using the Surveillance, Epidemiology, and End Result (SEER) database. STUDY DESIGN Retrospective cohort study using a national database. METHODS The SEER registry was utilized to calculate survival trends for patients with nasopharyngeal adenocarcinoma between 1973 and 2012. Patient data was then analyzed with respect to histopathology, age, sex, race, stage, grade, and treatment modalities (surgery and radiation therapy). Overall (OS) and disease-specific survival (DSS) were calculated. RESULTS A total of 148 cases of nasopharyngeal adenocarcinoma were identified. The cohort was composed of 54.7% males. The mean age at diagnosis was 59.0years. The median OS was 60.6months. 59.4% of cases were treated with surgery, while 64.1% received radiation therapy. OS at 2, 5, and 10years was 63%, 49%, and 36%, respectively. There was no significant difference in OS and DSS between adenocarcinoma of the nasopharynx versus the sinonasal tract (p>0.05). On univariate analysis, younger age, surgery, surgery and radiation, and lower tumor grade were associated with improved OS and DSS, while papillary subtype, lower stage, and no distant metastasis were associated with improved OS alone (all p<0.05). CONCLUSIONS Nasopharyngeal adenocarcinoma is an extremely rare malignancy with poor prognosis, with the exception of the papillary subtype. Age, grade, and surgical therapy are predictors of survival.
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19
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Endoscopic Endonasal Resection of Recurrent Nasopharyngeal Mucoepidermoid Carcinoma. J Craniofac Surg 2017; 27:1053-5. [PMID: 27171943 DOI: 10.1097/scs.0000000000002618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Nasopharyngeal mucoepidermoid carcinoma is a rare entity, for which surgical resection is the treatment of choice. The open technique is considered the standard approach, but this often results in significant morbidities such as trismus, dysphagia, and neurologic deficits. The advent of endoscopic endonasal techniques has made endoscopic resection a viable alternative to the open approach in terms of access, adequacy of resection, and lesser surgical morbidity. The authors describe a patient of recurrent nasopharyngeal mucoepidermoid carcinoma that was resected entirely endoscopically. The authors also present a literature review of this little-known disease and a comparison between the endoscopic and open approach.
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20
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Gentile MS, Yip D, Liebsch NJ, Adams JA, Busse PM, Chan AW. Definitive proton beam therapy for adenoid cystic carcinoma of the nasopharynx involving the base of skull. Oral Oncol 2016; 65:38-44. [PMID: 28109466 DOI: 10.1016/j.oraloncology.2016.11.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/19/2016] [Accepted: 11/26/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Management of unresectable adenocystic carcinoma (ACC) of the nasopharynx is challenging given the high dose required for tumor control while respecting dose constraints. We evaluated long-term outcomes and toxicity in patients with unresectable ACC of the nasopharynx treated with definitive proton beam therapy. METHODS Between 2000 and 2013, 14 patients with ACC of the nasopharynx were treated. Ninety-three percent had T4 disease. All had involvement of the skull base. Seventy-nine percent and 21% of patients underwent biopsy and endoscopic debulking surgery, respectively. Median dose was 73.8Gy (RBE). Fifty percent of patients received concurrent chemotherapy. Locoregional control and overall survival probabilities were estimated by the Kaplan-Meier method. Treatment toxicity was scored by the Common Terminology Criteria for Adverse Events version 4.0. RESULTS Median follow-up of surviving patients was 69months. There were 3 local, 1 regional, and 4 distant failures. Median time of local failures was 69months (range: 63-161). All local recurrences were within previous high-dose regions. Four patients developed metastatic disease at a median of 30months (range: 4-64). Five-year overall survival was 59%. The most common cause of death was due to metastatic disease. There was one acute grade 3 toxicity. No patient required gastrostomy tube or hospitalization. Three patients developed grade 3 or higher late toxicity. Two of these patients received combined modality treatment. With 176months follow-up, no second cancer was observed. CONCLUSION Proton beam therapy results in promising local control with acceptable toxicity in patients with unresectable ACC of the nasopharynx. As late recurrence is common, longer follow-up is necessary to confirm our findings.
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Affiliation(s)
- Michelle S Gentile
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Darwin Yip
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Norbert J Liebsch
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Judith A Adams
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Paul M Busse
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Annie W Chan
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
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21
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Lombardi D, McGurk M, Vander Poorten V, Guzzo M, Accorona R, Rampinelli V, Nicolai P. Surgical treatment of salivary malignant tumors. Oral Oncol 2016; 65:102-113. [PMID: 28017651 DOI: 10.1016/j.oraloncology.2016.12.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/16/2016] [Accepted: 12/09/2016] [Indexed: 12/14/2022]
Abstract
Salivary gland malignant tumors (SGMT) are of key interest for head and neck surgeons since surgery with adjuvant radiotherapy is considered the treatment of choice in most of the cases. Some factors, namely rarity, high histologic heterogeneity, and possible occurrence in all the head and neck subsites, contribute to make this topic very controversial; some unclear aspects pertain surgical treatment. When dealing with major salivary gland malignant tumors (MaSGMT), the most debated issues remain the extent of surgery and management of facial nerve. In minor salivary gland malignant tumors (MiSGMT), conversely, surgical planning is influenced by the specific pattern of growth of the different neoplasms as well as the site of origin of the lesion. Finally, two additional issues, the treatment of the neck (therapeutic or elective) and reconstructive strategy after ablative surgery, are of pivotal importance in management of both MaSGMT and MiSGMT. In this review, we discuss the most relevant and controversial issues concerning surgery of SGMT.
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Affiliation(s)
- Davide Lombardi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Italy.
| | - Marc McGurk
- Guys and St. Thomas NHS Trust, London, United Kingdom
| | - Vincent Vander Poorten
- Otorhinolaryngology - Head and Neck Surgery and Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium; European Salivary Gland Society, Geneva, Switzerland
| | - Marco Guzzo
- Department of Head and Neck Surgery, Istituto Nazionale dei Tumori, Milan, Italy
| | - Remo Accorona
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Italy
| | - Vittorio Rampinelli
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Italy
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22
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Carrillo JF, Celis MA, Ramirez-Ortega M, Rivas B, Ochoa FJ. Osteoplastic Maxillotomy for Treatment of Neoplasms of the Nasopharynx and Infratemporal Fossa. Ann Otol Rhinol Laryngol 2016; 114:58-64. [PMID: 15697164 DOI: 10.1177/000348940511400111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Approaches to the infratemporal fossa and nasopharynx are difficult because of the anatomic complexity of these regions. We describe our experience with osteoplastic maxillotomy, with our own modifications, and evaluate oncological outcomes and postoperative quality of life. Ten patients underwent osteoplastic maxillotomy, 3 of whom had a diagnosis of malignancy, and 7 of whom had nasopharyngeal angiofibromas (NPAs). A Weber-Fergusson incision was made to develop facial flaps and preserve the vascularity of the maxilla. Osteotomies were performed through the facial aspects of the maxilla, on the orbital rims, and on the malar eminence for the medial variant of the procedure. The anterolateral variant involved descent of the temporalis muscle with preservation of the facial nerve, and a zygomatic osteotomy. Four craniotomies were done. Two patients had the medial variant of the procedure, and 8 had the anterolateral variant. The complications were transient and mild. The patients who had malignancies are alive with no disease, and there was 1 recurrence among the 7 patients with NPAs. We found excellent aesthetic results in 8 of the 10 patients, and no change in basic functions in 8 patients. Osteoplastic maxillotomy allows resection of massive NPAs with no significant bleeding. Resection of malignant lesions with good results is feasible.
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Affiliation(s)
- Jose F Carrillo
- Head and Neck Department, Instituto Nacional de Cancerología, Mexico City, Mexico
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23
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Green B, Rahimi S, Brennan PA. Current management of the neck in salivary gland carcinomas. J Oral Pathol Med 2016; 46:161-166. [DOI: 10.1111/jop.12458] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2016] [Indexed: 01/12/2023]
Affiliation(s)
- Ben Green
- Department of Gastroenterology; Torbay Hospital; Torquay UK
| | - Siavash Rahimi
- Department of Histopathology; Queen Alexandra Hospital; Portsmouth UK
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24
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Wang X, Yan H, Luo Y, Fan T. Low-grade nasopharyngeal papillary adenocarcinoma: a case report and review of the literature. Onco Targets Ther 2016; 9:2955-9. [PMID: 27274289 PMCID: PMC4876094 DOI: 10.2147/ott.s100447] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Low-grade nasopharyngeal papillary adenocarcinoma is an extremely rare tumor, with only a limited number of cases reported in the literature. Some published studies have paid more attention to the clinicopathological features of nasopharyngeal adenocarcinoma, while little effort has been made to study the optimal therapeutic strategies. We report about a woman diagnosed with low-grade nasopharyngeal papillary adenocarcinoma. She received the treatment approach that combined transnasal endoscopic surgery to remove the lesion with postoperative radiotherapy for nasal cavity. There was no evidence of recurrence after 4 months of surgery, and further follow-up is being continued. Through this example, we wanted to explore the optimal therapeutic strategies for primary nasopharyngeal adenocarcinomas.
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Affiliation(s)
- Xiaoli Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, People's Republic of China; School of Medicine and Life Sciences, Shandong Academy of Medical Sciences, University of Jinan, Jinan, People's Republic of China
| | - Hongjiang Yan
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, People's Republic of China
| | - Yijun Luo
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, People's Republic of China; School of Medicine and Life Sciences, Shandong Academy of Medical Sciences, University of Jinan, Jinan, People's Republic of China
| | - Tingyong Fan
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, People's Republic of China
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25
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Afani L, Errihani H, Benchafai I, Lalami Y. [Nasopharyngeal adenoid cystic carcinoma, a rare but highly challenging disease with unmet therapeutic needs: A case-report and review of the literature]. Cancer Radiother 2016; 20:400-4. [PMID: 27131394 DOI: 10.1016/j.canrad.2015.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 12/15/2015] [Accepted: 12/24/2015] [Indexed: 01/25/2023]
Abstract
Nasopharyngeal adenoid cystic carcinoma is a rare tumour. Compared with others nasopharyngeal tumours, it is characterised by slow evolution but it is locally aggressive and has a high tendency to recurrences. Due to the rarity of cases, no consensus exists about treatment approaches. We report the case of 45-year-old-man with a locally advanced adenoid cystic carcinoma. The patient received concurrent chemoradiation and had a good objective response. After one year, he developed a paucisymptomatic lung metastasis. The follow-up showed local recurrence after 3 years. One cycle of chemotherapy was given but poorly supported. Carbon ion radiotherapy was proposed. The aim of this work is to review the literature concerning this rare malignancy and discusses treatment approaches in initial situations and during recurrences.
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Affiliation(s)
- L Afani
- Service d'oncologie médicale, institut Jules-Bordet, boulevard de Waterloo, 121, 1000 Bruxelles, Belgique.
| | - H Errihani
- Service d'oncologie médicale, institut national d'oncologie, BP 6213 RI, Rabat, Maroc
| | - I Benchafai
- Service d'ORL, hôpital militaire d'instruction Mohammed-V, Rabat, Maroc
| | - Y Lalami
- Service d'oncologie médicale, institut Jules-Bordet, boulevard de Waterloo, 121, 1000 Bruxelles, Belgique
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26
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Cervical Lymph Node Metastasis in Adenoid Cystic Carcinoma of the Larynx: A Collective International Review. Adv Ther 2016; 33:553-79. [PMID: 27084720 PMCID: PMC4846710 DOI: 10.1007/s12325-016-0311-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Indexed: 01/15/2023]
Abstract
Adenoid cystic carcinoma (AdCC) of the head and neck is a well-recognized pathologic entity that rarely occurs in the larynx. Although the 5-year locoregional control rates are high, distant metastasis has a tendency to appear more than 5 years post treatment. Because AdCC of the larynx is uncommon, it is difficult to standardize a treatment protocol. One of the controversial points is the decision whether or not to perform an elective neck dissection on these patients. Because there is contradictory information about this issue, we have critically reviewed the literature from 1912 to 2015 on all reported cases of AdCC of the larynx in order to clarify this issue. During the most recent period of our review (1991-2015) with a more exact diagnosis of the tumor histology, 142 cases were observed of AdCC of the larynx, of which 91 patients had data pertaining to lymph node status. Eleven of the 91 patients (12.1%) had nodal metastasis and, based on this low proportion of patients, routine elective neck dissection is therefore not recommended.
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27
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Liu LZ, Zhang YM, Chen Y, Li L. Spreading patterns, prognostic factors and treatment outcomes of nasopharyngeal papillary adenocarcinoma and salivary gland-type carcinomas. Clin Otolaryngol 2016; 41:160-8. [PMID: 26118586 DOI: 10.1111/coa.12492] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES In this study, we aim to analyse the different spreading patterns, prognostic factors and treatment outcomes of nasopharyngeal papillary adenocarcinoma (NPAC) and salivary gland-type carcinomas (NPCs). DESIGN, SETTING AND PARTICIPANT The current study report on a retrospective analysis of oncologic outcome of 76 pathologically confirmed consecutive cases of nasopharyngeal adenocarcinomas (NAC), including 31 NPAC, 33 adenoid cystic carcinomas (ACC) and 12 mucoepidermoid carcinomas (MEC). MAIN OUTCOME MEASURE Overall survival rates (OS) and disease-free survival rates (DFS). RESULTS In 12 patients with cranial nerve (CN) palsy, there were ACC (n = 9), NPAC (n = 2) and MEC (n = 1) (P = 0.016). CT-/MRI-detected CN involvements were found in 22 patients. Lymph node metastasis was observed in 25.8% of NPAC (n = 8), 12.1% of ACC (n = 4) and 8.3% of MEC (n = 1). Significant differences were observed in 5-year overall survival (OS) and disease-free survival (DFS) rates between patients with and without CT-/MRI-detected CN involvement (P = 0.002 and P = 0.002, respectively), and similar results were found between patients with and without lymph node metastasis (P = 0.002 and P = 0.018, respectively). In 37 patients with early-stage disease (stages I-II), significant differences were observed in 5-year OS and DFS rates between the surgical and non-surgical treated groups (P = 0.031 and P = 0.012, respectively). In 39 patients with advanced-stage disease (stages III-IV), significant or marginally differences were observed in DFS and OS between the chemoradiotherapy and non-chemoradiotherapy groups (P = 0.007 and P = 0.062, respectively). CONCLUSIONS ACC has a higher CN invasion than NPAC and MEC, and NPAC has the highest rate of lymphatic metastases. CT-/MRI-detected CN involvements and lymph node metastasis indicate a negative impact on the prognosis. The outcome of surgical patients in our series is encouraging in early-stage NPAC and NPCs, and chemoradiotherapy may be the optimal treatment for the advanced-stage patients.
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Affiliation(s)
- L Z Liu
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China.,Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Y M Zhang
- Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Y Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - L Li
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China.,Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou, China
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28
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Shum JW, Chatzistefanou I, Qaisi M, Lubek JE, Ord RA. Adenoid cystic carcinoma of the minor salivary glands: a retrospective series of 29 cases and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 121:210-4. [PMID: 26686954 DOI: 10.1016/j.oooo.2015.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 10/06/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Approximately 78% of minor salivary gland tumors are malignant, of which adenoid cystic carcinoma (ACC) represents 15% in our series. ACC is an uncommon tumor characterized by slow growth and a high potential for recurrence. This series of 29 consecutive patients examines clincopathologic features, management, and survival outcomes. MATERIALS AND METHODS This study is a retrospective chart review of 29 patients with ACC of the minor salivary glands in a period of 23 years (1989 and 2012). RESULTS The mean age was 61.2 years (16-89 years), with no gender predilection. The majority occurred in the palate/maxilla (66%) and initial presentation was stage IV. Mean follow-up was 42.6 months. Recurrence rate was 10% local, 14% distant over the observation period. CONCLUSIONS The palate/maxilla is the preferred location for occurrence, and initial presentation at stage IV is common. Postoperative radiation remains a common strategy to prevent local recurrence in lesions with adverse features.
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Affiliation(s)
- Jonathan W Shum
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center, Houston, TX, USA.
| | - Ioannis Chatzistefanou
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Greece
| | - Mohammed Qaisi
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Mississippi, Jackson, MS, USA
| | - Joshua E Lubek
- Assistant Professor and Fellowship Director Oral, Head and Neck Surgery/Microvascular Surgery, Department of Oral and Maxillofacial Surgery, University of Maryland School of Dentistry and Greenebaum Cancer Center, Baltimore, MD, USA
| | - Robert A Ord
- Professor and Chair, Department of Oral and Maxillofacial Surgery, University of Maryland School of Dentistry and Greenebaum Cancer Center, Baltimore, MD, USA
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29
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Myoepithelial Carcinoma of the Nasopharynx: Report of a Rare Case and a Review of the Literature. Head Neck Pathol 2015; 9:474-80. [PMID: 26115759 PMCID: PMC4651929 DOI: 10.1007/s12105-015-0638-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 06/20/2015] [Indexed: 12/26/2022]
Abstract
Salivary gland carcinomas are very rare in the nasopharynx, with the most frequent histologic types being adenoid cystic carcinoma, mucoepidermoid carcinoma and adenocarcinoma, not otherwise specified. Myoepithelial carcinoma (MECA) is a rare tumor of the salivary glands, and there are only three previously reported cases of nasopharyngeal MECA. The case presented is the fourth reported case of MECA in the nasopharynx. Due to the morphologic heterogeneity of MECA, immunohistochemistry is indispensable in ascertaining the diagnosis. MECA is a locally aggressive tumor, but the long-term prognosis of this tumor in the nasopharynx remains uncertain. In our case the tumor was unresectable and the patient was given chemo-radiotherapy. Despite this, residual tumor was seen on nasoscopy 5 months after initial diagnosis and was documented on a re-biopsy which displayed the same histomorphologic features as the original tumor.
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30
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Dong J, Zhang L, Mo Y, Tian L, Liu L, Wu P. Discovery of invasion routes for nasopharyngeal adenoid cystic carcinoma. J Cancer 2015; 6:90-7. [PMID: 25553093 PMCID: PMC4278919 DOI: 10.7150/jca.10739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/20/2014] [Indexed: 12/28/2022] Open
Abstract
The aim of this study is to discover regional invasion routes for nasopharyngeal adenoid cystic carcinoma (NACC) through analyses of the magnetic resonance (MR) images and comparison with keratinizing squamous cell carcinoma (KSCC). Both MR results and clinical records were retrospectively reviewed for 18 patients with NACC and 182 patients with KSCC. The metastasis routes of NACC were identified by analysis of MR images of patients who underwent magnetic resonance imaging (MRI). There were significant differences in skull base invasion and cavernous sinus invasion (p = 0.020 and 0.028, respectively) while parapharyngeal space invasion rate was not. The laryngopharynx invasion rate and external pterygoid muscle invasion rate were higher in NACC patients than that in KSCC patients (16.7% vs. 0.5 %, p = 0.002; 27.8% vs. 11.0%, p = 0.040, respectively). Paralysis of the cranial nerves had a significant higher incidence in the NACC group compared to the KSCC group (66.7% vs. 8.2%, p < 0.001). There was significant difference in invasion to the neural foramen between the NACC and KSCC groups (66.7% vs. 36.3%, p = 0.020). Foramen ovale was a common invasion site, significantly higher in NACC patients than in KSCC patients (50.0% vs. 24.1%, p = 0.018). Based on the MRI findings, a regional invasion model of NACC with two possible routes has been built, including aggressive local infiltration along submucosa to laryngopharynx or external pterygoid muscle, and extension from pharyngonasal cavity, through cranial nerve canal to cavernous sinus. The significant difference in overall survival (OS) time between the two different invasion routs and the recurrent rates in different regions also supported the validity of the invasion model.
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Affiliation(s)
- Jun Dong
- Department of Medical Imaging & Image Guided Therapy, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; East Dong Feng Road 651, Guangzhou, Guangdong, 510060.P.R.China
| | - Liang Zhang
- Department of Medical Imaging & Image Guided Therapy, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; East Dong Feng Road 651, Guangzhou, Guangdong, 510060.P.R.China
| | - Yunxian Mo
- Department of Medical Imaging & Image Guided Therapy, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; East Dong Feng Road 651, Guangzhou, Guangdong, 510060.P.R.China
| | - Li Tian
- Department of Medical Imaging & Image Guided Therapy, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; East Dong Feng Road 651, Guangzhou, Guangdong, 510060.P.R.China
| | - Lizhi Liu
- Department of Medical Imaging & Image Guided Therapy, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; East Dong Feng Road 651, Guangzhou, Guangdong, 510060.P.R.China
| | - Peihong Wu
- Department of Medical Imaging & Image Guided Therapy, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; East Dong Feng Road 651, Guangzhou, Guangdong, 510060.P.R.China
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31
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Amit M, Binenbaum Y, Sharma K, Ramer N, Ramer I, Agbetoba A, Glick J, Yang X, Lei D, Bjørndal K, Godballe C, Mücke T, Wolff KD, Fliss D, Eckardt AM, Copelli C, Sesenna E, Palmer F, Ganly I, Patel S, Gil Z. Incidence of cervical lymph node metastasis and its association with outcomes in patients with adenoid cystic carcinoma. An international collaborative study. Head Neck 2014; 37:1032-7. [PMID: 25060927 DOI: 10.1002/hed.23711] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 01/19/2014] [Accepted: 04/04/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The patterns of regional metastasis in adenoid cystic carcinoma (ACC) of the head and neck and its association with outcome is not established. METHODS We conducted a retrospective multicentered multivariate analysis of 270 patients who underwent neck dissection. RESULTS The incidence rate of neck metastases was 29%. The rate observed in the oral cavity is 37%, and in the major salivary glands is 19% (p = .001). The rate of occult nodal metastases was 17%. Overall 5-year survival rates were 44% in patients undergoing therapeutic neck dissections, and 65% and 73% among those undergoing elective neck dissections, with and without nodal metastases, respectively (p = .017). Multivariate analysis revealed that the primary site, nodal classification, and margin status were independent predictors of survival. CONCLUSION Our findings support the consideration of elective neck treatment in patients with ACC of the oral cavity.
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Affiliation(s)
- Moran Amit
- Department of Otolaryngology Head and Neck Surgery, Rambam Medical Center, Haifa, Israel.,The Laboratory for Applied Cancer Research, the Clinical Research Center at Rambam Rambam Medical Center, the Technion, Israel Institute of Technology, Israel
| | - Yoav Binenbaum
- The Laboratory for Applied Cancer Research, the Clinical Research Center at Rambam Rambam Medical Center, the Technion, Israel Institute of Technology, Israel
| | - Kanika Sharma
- The Laboratory for Applied Cancer Research, the Clinical Research Center at Rambam Rambam Medical Center, the Technion, Israel Institute of Technology, Israel
| | - Naomi Ramer
- Department of Radiotherapy and Oncology, Max Cancer Center, New Delhi, India
| | - Ilana Ramer
- Department of Radiotherapy and Oncology, Max Cancer Center, New Delhi, India
| | - Abib Agbetoba
- Mount Sinai Medical Center, Department of Pathology, The Mount Sinai School of Medicine, New York, New York
| | - Joelle Glick
- Mount Sinai Medical Center, Department of Pathology, The Mount Sinai School of Medicine, New York, New York
| | - Xinjie Yang
- Department of Otolaryngology, The Mount Sinai School of Medicine, New York, New York
| | - Delin Lei
- Department of Otolaryngology, The Mount Sinai School of Medicine, New York, New York
| | - Kristine Bjørndal
- Department of Oral and Maxillofacial Surgery, School of Stomatology, the Fourth Military Medical University, People's Republic of China
| | - Christian Godballe
- Department of Oral and Maxillofacial Surgery, School of Stomatology, the Fourth Military Medical University, People's Republic of China
| | - Thomas Mücke
- Department of Otolaryngology Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Klaus-Dietrich Wolff
- Department of Otolaryngology Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Dan Fliss
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - André M Eckardt
- Department of Otolaryngology Head and Neck Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Chiara Copelli
- Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Enrico Sesenna
- Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Frank Palmer
- Maxillo-Facial Surgery, University-Hospital of Parma, Italy
| | - Ian Ganly
- Maxillo-Facial Surgery, University-Hospital of Parma, Italy
| | - Snehal Patel
- Maxillo-Facial Surgery, University-Hospital of Parma, Italy
| | - Ziv Gil
- Department of Otolaryngology Head and Neck Surgery, Rambam Medical Center, Haifa, Israel.,The Laboratory for Applied Cancer Research, the Clinical Research Center at Rambam Rambam Medical Center, the Technion, Israel Institute of Technology, Israel.,Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
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32
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Thompson LDR, Penner C, Ho NJ, Foss RD, Miettinen M, Wieneke JA, Moskaluk CA, Stelow EB. Sinonasal tract and nasopharyngeal adenoid cystic carcinoma: a clinicopathologic and immunophenotypic study of 86 cases. Head Neck Pathol 2013; 8:88-109. [PMID: 24037641 PMCID: PMC3950387 DOI: 10.1007/s12105-013-0487-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Abstract
Primary sinonasal tract and nasopharyngeal adenoid cystic carcinomas (STACC) are uncommon tumors that are frequently misclassified, resulting in inappropriate clinical management. Eighty-six cases of STACC included 45 females and 41 males, aged 12-91 years (mean 54.4 years). Patients presented most frequently with obstructive symptoms (n = 54), followed by epistaxis (n = 23), auditory symptoms (n = 12), nerve symptoms (n = 11), nasal discharge (n = 11), and/or visual symptoms (n = 10), present for a mean of 18.2 months. The tumors involved the nasal cavity alone (n = 25), nasopharynx alone (n = 13), maxillary sinus alone (n = 4), or a combination of the nasal cavity and paranasal sinuses (n = 44), with a mean size of 3.7 cm. Patients presented equally between low and high stage disease: stage I and II (n = 42) or stage III and IV (n = 44) disease. Histologically, the tumors were invasive (bone: n = 66; neural: n = 47; lymphovascular: n = 33), composed of a variety of growth patterns, including cribriform (n = 33), tubular (n = 16), and solid (n = 9), although frequently a combination of these patterns was seen within a single tumor. Pleomorphism was mild with an intermediate N:C ratio in cells containing hyperchromatic nuclei. Reduplicated basement membrane and glycosaminoglycan material was commonly seen. Necrosis (n = 16) and atypical mitotic figures (n = 11) were infrequently present. Pleomorphic adenoma was present in 9 cases; de-differentiation was seen in two patients. Immunohistochemical studies showed positive reactions for pan-cytokeratin, CK7, CK5/6, CAM5.2, and EMA, with myoepithelial reactivity with SMA, p63, calponin, S100 protein and SMMHC. CD117, CEA, GFAP and p16 were variably present. CK20 and HR HPV were negative. STACC needs to be considered in the differential diagnosis of most sinonasal malignancies, particularly poorly differentiated carcinoma, olfactory neuroblastoma and pleomorphic adenoma. Surgery (n = 82), often accompanied by radiation therapy (n = 36), was generally employed. A majority of patients developed a recurrence (n = 52) 2-144 months after initial presentation. Overall mean follow-up was 19.4 years (range 0.4-37.5 years): 46 patients died with disease (mean 6.4 years); 5 were alive with disease (mean 5.4 years), and 35 patients were either alive or had died of unrelated causes (mean 16.3 years). ACC of the SNT is uncommon. Recurrences are common. The following parameters, when present, suggest an increased incidence of either recurrence or dying with disease: mixed site of involvement, high stage disease (stage IV), skull base involvement, tumor recurrence, a solid histology, perineural invasion, bone invasion, and lymphovascular invasion.
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Affiliation(s)
- Lester D. R. Thompson
- grid.417224.6Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, 5601 De Soto Avenue, Woodland Hills, CA 91365 USA
| | - Carla Penner
- grid.21613.370000000419369609Department of Pathology, Health Sciences Centre and Faculty of Dentistry, University of Manitoba, Winnipeg, MB Canada
| | - Ngoc J. Ho
- grid.280062.e0000000099577758Southern California Permanente Medical Group, Pasadena, CA USA
| | - Robert D. Foss
- grid.414467.40000000105606544Naval Postgraduate Dental School, Bethesda, MD USA
| | - Markku Miettinen
- grid.94365.3d0000000122975165National Institutes of Health, Bethesda, MD USA
| | | | | | - Edward B. Stelow
- grid.27755.32000000009136933XUniversity of Virginia, Charlottesville, VA USA
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Ettl T, Gosau M, Brockhoff G, Schwarz-Furlan S, Agaimy A, Reichert TE, Rohrmeier C, Zenk J, Iro H. Predictors of cervical lymph node metastasis in salivary gland cancer. Head Neck 2013; 36:517-23. [PMID: 23780687 DOI: 10.1002/hed.23332] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This study compares clinicopathological parameters with novel molecular markers for predicting cervical lymph node metastasis in salivary gland cancer. METHODS Three hundred sixteen salivary gland carcinomas were included in this study. Genomic epidermal growth factor receptor (EGFR), human epidermal growth factor receptor 2 (HER2), phosphatase and tensin homolog (PTEN), and hepatocyte growth factor receptor (MET) was determined by fluorescence in situ hybridization (FISH). Chi-square tests, multivariate regression, and Kaplan-Meier survival analysis were used for statistics. RESULTS Nodal staging determines long-term survival. Clinicopathological parameters associated with positive neck nodes are advanced age (p = .006), T3/T4 classification, histological high-grade malignancy, and diagnosis of salivary duct carcinoma (p < .001 each). Neck node metastases also correlate with copy number gain of EGFR (p = .004) and HER2, aberration of MET, and deletion of PTEN (p < .001 each). Multivariate analysis showed SDC (p = .002) to be the strongest predictor of lymph node metastasis, followed by MET aberration (p = .009), T3/T4 classification (p = .017), PTEN deletion (p = .042), and adenocarcinoma not otherwise specified (NOS; p = .047). CONCLUSION The histological subtype is crucial for decisions regarding neck dissection. New molecular parameters may also indicate elective treatment of the neck.
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Affiliation(s)
- Tobias Ettl
- Department of Oral and Maxillofacial Surgery, Regensburg University Medical Center, Regensburg, Germany
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34
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Amit M, Binenbaum Y, Sharma K, Naomi R, Ilana R, Abib A, Miles B, Yang X, Lei D, Kristine B, Christian G, Thomas M, Klaus-Dietrich W, Fliss D, Eckardt AM, Chiara C, Sesenna E, Frank P, Patel S, Gil Z. Adenoid cystic carcinoma of the nasal cavity and paranasal sinuses: a meta-analysis. J Neurol Surg B Skull Base 2013; 74:118-25. [PMID: 24436900 PMCID: PMC3709956 DOI: 10.1055/s-0033-1347358] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 03/10/2013] [Indexed: 10/26/2022] Open
Abstract
Objectives To identify independent predictors of outcome in patients with adenoid cystic carcinoma (ACC) of the paranasal sinuses and skull base. Design Meta-analysis of the literature and data from the International ACC Study Group. Setting University-affiliated medical center. Participants The study group consisted of 520 patients, 99 of them from the international cohort. The median follow-up period was 60 months (range, 32 to 100 months). Main Outcome Measures Overall survival (OS) and disease-specific survival (DSS). Results The 5-year OS and DSS of the entire cohort were 62% and 67%, respectively. The local recurrence rate was 36.6%, and the regional recurrence rate was 7%. Distant metastasis, most commonly present in the lung, was recorded in 106 patients (29.1%). In the international cohort, positive margins and ACC of the sphenoid or ethmoidal sinuses were significant predictors of outcome (p < 0.001). Perineural invasion and adjuvant treatment (radiotherapy or chemoradiation) were not associated with prognosis. Conclusion Tumor margin status and tumor site are associated with prognosis in ACC of the paranasal sinuses, whereas perineural invasion is not. Adjuvant treatment apparently has no impact on outcome.
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Affiliation(s)
- Moran Amit
- Department of Otolaryngology, Head and Neck Surgery, Rambam Medical Center, Haifa and Israel Institute of Technology, Technion, Haifa, Israel
| | - Yoav Binenbaum
- Department of Otolaryngology, Head and Neck Surgery, Rambam Medical Center, Haifa and Israel Institute of Technology, Technion, Haifa, Israel
| | - Kanika Sharma
- Department of Radiotherapy & Oncology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Ramer Naomi
- Department of Pathology, Mount Sinai Medical Center, New York, New York, USA
| | - Ramer Ilana
- Department of Pathology, Mount Sinai Medical Center, New York, New York, USA
| | - Agbetoba Abib
- Department of Otolaryngology, The Mount Sinai School of Medicine, New York, New York, USA
| | - Brett Miles
- Department of Otolaryngology, The Mount Sinai School of Medicine, New York, New York, USA
| | - Xinjie Yang
- Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, P. R. China
| | - Delin Lei
- Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, P. R. China
| | - Bjoerndal Kristine
- Department of Otolaryngology Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Godballe Christian
- Department of Otolaryngology Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Mücke Thomas
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts der Isar, Technische Universität München, München, Germany
| | - Wolff Klaus-Dietrich
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts der Isar, Technische Universität München, München, Germany
| | - Dan Fliss
- Department of Otolaryngology Head and Neck Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - André M. Eckardt
- Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Copelli Chiara
- Maxillo-Facial Surgery, University-Hospital of Parma, Parma, Italy
| | - Enrico Sesenna
- Maxillo-Facial Surgery, University-Hospital of Parma, Parma, Italy
| | - Palmer Frank
- Head and Neck Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Snehal Patel
- Head and Neck Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Ziv Gil
- Department of Otolaryngology, Head and Neck Surgery, Rambam Medical Center, Haifa and Israel Institute of Technology, Technion, Haifa, Israel
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35
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Poorten VV, Hunt J, Bradley PJ, Haigentz M, Rinaldo A, Mendenhall WM, Suarez C, Silver C, Takes RP, Ferlito A. Recent trends in the management of minor salivary gland carcinoma. Head Neck 2013; 36:444-55. [DOI: 10.1002/hed.23249] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2013] [Indexed: 11/07/2022] Open
Affiliation(s)
- Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery and Leuven Cancer Institute; Department of Oncology-Head and Neck Oncology; University Hospitals Leuven; KULeuven Belgium
- European Salivary Gland Society; Geneva Switzerland
| | - Jennifer Hunt
- Department of Pathology and Laboratory Services, College of Medicine; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Patrick J. Bradley
- European Salivary Gland Society; Geneva Switzerland
- Department of Otolaryngology-Head and Neck Surgery; Nottingham University Hospital; Queens Medical Centre Nottingham United Kingdom
| | - Missak Haigentz
- Division of Oncology; Department of Medicine; Montefiore Medical Center, Albert Einstein College of Medicine; Bronx New York
| | - Alessandra Rinaldo
- Department of Surgical Sciences; ENT Clinic, University of Udine; Udine Italy
| | | | - Carlos Suarez
- Department of Otolaryngology; Hospital Universitario Central de Asturias; Oviedo Spain
| | - Carl Silver
- Departments of Surgery and Otolaryngology-Head and Neck Surgery; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx New York
| | - Robert P. Takes
- Department of Otolaryngology-Head and Neck Surgery; Radboud University Nijmegen Medical Center; Nijmegen The Netherlands
| | - Alfio Ferlito
- Department of Surgical Sciences; ENT Clinic, University of Udine; Udine Italy
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Re M, Pasquini E. Nasopharyngeal mucoepidermoid carcinoma in children. Int J Pediatr Otorhinolaryngol 2013; 77:565-9. [PMID: 23294931 DOI: 10.1016/j.ijporl.2012.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 12/06/2012] [Indexed: 11/27/2022]
Abstract
Salivary gland tumours represent 1-4% of all human neoplasms and less than 5% occur in children and adolescents. Malignant salivary gland tumours only represent 0.08% of all childhood tumours and mucoepidermoid carcinoma (MEC) is the most common histological type. The majority of MECs in the paediatric group are histologically classified as low or intermediate grade of malignancy, favouring a good prognosis. Complete excision of the lesion with free surgical margins is the treatment of choice and the one that offers the best local control of the disease. Experience with minor salivary gland carcinoma arising specifically within the nasopharynx is limited because nasopharyngeal MEC is an extremely rare malignancy and there is controversy regarding its optimal treatment. We hereby report a case of mucoepidermoid carcinoma arising from the nasopharynx in a 7-year-old girl, which was managed via an endonasal endoscopic procedure. To our knowledge the case we describe is the second case of nasopharyngeal MEC in paediatric age reported in literature and is the only one occurred in the first decade of life.
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Affiliation(s)
- M Re
- Department of Otorhinolaryngology, Polytechnic University of Marche, Ancona, Italy.
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Cao CN, Luo JW, Xu GZ, Gao L, Xu ZG, Tang PZ. Management of Nasopharyngeal Adenoid Cystic Carcinoma. J Oral Maxillofac Surg 2013; 71:e203-9. [DOI: 10.1016/j.joms.2012.12.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 12/06/2012] [Accepted: 12/30/2012] [Indexed: 11/16/2022]
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Glicksman JT, Franklin JH, Shepherd J, Rotenberg BW. An endonasal approach to the resection of a papillary seromucinous adenocarcinoma of the eustacian tube. J Otolaryngol Head Neck Surg 2013; 42:12. [PMID: 23663512 PMCID: PMC3650951 DOI: 10.1186/1916-0216-42-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 01/06/2013] [Indexed: 12/04/2022] Open
Abstract
Objectives Papillary seromucinous adenocarcinoma of the sinonasal tract is exceedingly rare. The objectives of this case report are to describe a case of papillary seromucinous adenocarcinoma presenting in the nasopharynx and to review the literature pertaining to other similar cases. Methods A review of the patient's chart and a review of the English literature were conducted. Results We describe the case of a 64 year-old woman who presented with a 3-year history of epistaxis and right-sided otitis media with effusion. The patient had been followed for a known nasopharyngeal mass that had twice been biopsied and in both cases was considered a benign mass pathologically. A third biopsy was diagnosed as a low-grade papillary seromucinous adenocarcinoma. The patient was otherwise asymptomatic. The patient was referred to a multidisciplinary cancer clinic at which endoscopic resection was determined to be the preferred treatment modality. A literature review and approach to patients with nasopharyngeal masses will be presented. Conclusions Papillary seromucinous adenocarcinoma is a rare tumor that can present in the nasopharynx. We describe the endoscopic surgical management of one such patient that presented to our care.
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Affiliation(s)
- Jordan T Glicksman
- Department of Otolaryngology, Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada.
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Nasopharyngeal mucoepidermoid carcinoma: A case report and review of literature. Rep Pract Oncol Radiother 2012; 18:117-20. [PMID: 24416538 DOI: 10.1016/j.rpor.2012.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 08/16/2012] [Accepted: 10/19/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Salivary gland-type tumors originating in the nasopharynx are rare, and only a few articles about mucoepidermoid carcinomas (MEC) in this location have been reported. We describe one case of nasopharyngeal MEC and, based on a review of the literature, discuss different therapeutic approaches that can be taken regarding the result of histological findings, radiological tests and extent of disease. CASE PRESENTATION A 47-year-old woman diagnosed with mucoepidermoid carcinoma of nasopharynx, T1 N3 M0 (stage IV-B) was treated in 2007 with a combination of radiotherapy and chemotherapy to a maximum dose of 70 Gy and concomitant Cisplatin during the radiation. One year later, with the head and neck disease under control, mediastinal nodes relapse appeared which were treated with exclusive radiotherapy to a maximum dose of 65 Gy. One year after the first relapse, a second relapse was detected in the right lung, next to the previously treated mediastinal regions, and the patient initiated a treatment with exclusive chemotherapy based on TPF scheme. CONCLUSION For limited or resectable MEC, combined surgery with radiotherapy, or radiochemotherapy, should be considered the main treatment policy. On the other hand, in poorly differentiated, unresectable tumors or nasopharyngeal MEC, radiochemotherapy could be currently the main treatment approach.
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Ettl T, Schwarz-Furlan S, Gosau M, Reichert TE. Salivary gland carcinomas. Oral Maxillofac Surg 2012; 16:267-283. [PMID: 22842859 DOI: 10.1007/s10006-012-0350-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 07/18/2012] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Salivary gland carcinomas are rare tumours of heterogeneous morphology that require distinctive surgical and adjuvant therapy. METHODS Relevant studies were electronically searched in PubMed and reviewed for innovative and important information. RESULTS Recent insights in genetic alterations like chromosomal aberrations, expression of receptor tyrosine kinases, malfunction of tumour suppressor genes or DNA promoter methylations increased the knowledge about aetiology and pathogenesis. New histological subtypes are recognised, and a three-tiered grading system seems reasonable. Ultrasound remains the basic diagnostic imaging procedure. New developments comprise the diffusion-weighed magnetic resonance imaging, while fluorodeoxyglucose positron emission tomography/computed tomography shows good diagnostic accuracy in detecting distant metastases and local recurrence. Fine-needle aspiration cytology helps in differentiating a neoplasia from a non-neoplastic lesion while being unreliable in recognising malignancy. In contrast, additional core needle biopsy and/or intraoperative frozen section diagnosis increase the accuracy in diagnosing a malignant lesion. Conservative parotid surgery with nerve monitoring remains state-of-the-art. Free flaps or musculoaponeurotic flaps are proposed for prevention of Frey's syndrome. As parotid cancer often shows skip metastases, complete ipsilateral neck dissection (level I-V) is indicated particularly in high-grade lesions. Adjuvant radio(chemo)therapy increases local tumour control, whereas overall survival is not necessarily improved. Current results of systemic chemotherapy or targeted therapy in advanced tumour stages are disappointing. CONCLUSION Despite several developments, salivary gland carcinomas remain a heterogeneous group of tumours challenging both pathologists and clinicians.
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Affiliation(s)
- Tobias Ettl
- Department of Oral and Maxillofacial Surgery, Regensburg University, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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Sinonasal tract adenoid cystic carcinoma ex-pleomorphic adenoma: a clinicopathologic and immunophenotypic study of 9 cases combined with a comprehensive review of the literature. Head Neck Pathol 2012; 6:409-21. [PMID: 22941242 PMCID: PMC3500902 DOI: 10.1007/s12105-012-0381-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 07/23/2012] [Indexed: 01/11/2023]
Abstract
Primary sinonasal tract carcinoma ex-pleomorphic adenoma (CEPA) is very uncommon, with adenoid cystic carcinoma (ACC) CEPA exceptional. These tumors are often misclassified. This is a retrospective study. Nine cases of ACC CEPA included 7 females and 2 males, aged 39-64 years (mean, 51.1 years). Patients presented most frequently with obstructive symptoms (n = 5), epistaxis (n = 3), nerve changes or pain (n = 3), present for a mean of 25 months (men: 9.5 versus women: 29.4 months; p = 0.264). The tumors involved the nasal cavity alone (n = 5), nasopharynx (n = 2), or a combination of locations (n = 2) with a mean size of 2.9 cm (females: 3.3; males: 1.7; p = 0.064). Most patients presented at a low clinical stage (n = 7, stage I), with one patient each in stage II and IV, respectively. Histologically, the tumors showed foci of PA associated with areas of ACC. Tumors showed invasion (lymph-vascular: n = 4; perineural: n = 6; bone: n = 6). The neoplastic cells were arranged in tubules, cribriform and solid patterns, with peg-shaped cells arranged around reduplicated basement membrane and glycosaminoglycan material. Mitoses ranged from 0 to 33, with a mean of 8.7 mitoses/10 HPFs. Necrosis (n = 2) and atypical mitotic figures (n = 1) were seen infrequently. Immunohistochemical studies showed positive reactions for cytokeratin, CK5/6, p63, CK7, EMA, SMA, calponin, S100 protein and CD117, several highlighting luminal versus basal cells components. GFAP, CK20 and MSA were non-reactive. p53 and Ki-67 were reactive to a variable degree. Surgery (n = 8), accompanied by radiation therapy (n = 5) was generally employed. Five patients developed a recurrence, all of whom died with disease (mean, 8.4 years), while 4 patients are either alive (n = 2) or had died (n = 2) without evidence of disease (mean, 15.9 years). In summary, ACC CEPA probably arises from the minor mucoserous glands of the upper aerodigestive tract, usually presenting in patients in middle age with obstructive symptoms in a nasal cavity based tumor. Most patients present with low stage disease (stage I and II), although invasive growth is common. Recurrences develop in about a 55 % of patients, who experience a shorter survival (mean, 8.4 years) than patients without recurrences (mean, 15.9 years). The following parameters, when present, suggest an increased incidence of recurrence or dying with disease: bone invasion, lymph-vascular invasion, and perineural invasion.
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Primary salivary gland-type carcinomas of the nasopharynx: Prognostic factors and outcome. Int J Oral Maxillofac Surg 2012; 41:958-64. [DOI: 10.1016/j.ijom.2012.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 12/29/2011] [Accepted: 04/13/2012] [Indexed: 11/19/2022]
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XU T, LI ZM, GU MF, WEI WH, ZHANG GY, WU QL, SU Y, HU WH. Primary nasopharyngeal adenocarcinoma: A review. Asia Pac J Clin Oncol 2012; 8:123-31. [DOI: 10.1111/j.1743-7563.2011.01499.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Liu XW, Xie CM, Li H, Zhang R, Geng ZJ, Mo YX, Zhao J, Cai MY, Lv YC, Wu PH. Nasopharyngeal adenoid cystic carcinoma: magnetic resonance imaging features in ten cases. CHINESE JOURNAL OF CANCER 2011; 31:19-28. [PMID: 22200180 PMCID: PMC3777462 DOI: 10.5732/cjc.011.10242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Nasopharyngeal adenoid cystic carcinoma (NACC) is a rare malignancy with high local invasiveness. To date, there is no consensus on the imaging characteristics of NACC. To address this, we retrospectively reviewed 10 cases of NACC and summarized the magnetic resonance imaging (MRI) features. MR images of 10 patients with histologically validated NACC were reviewed by two experienced radiologists. The location, shape, margin, signal intensity, lesion texture, contrast enhancement patterns, local invasion, and cervical lymphadenopathy of all tumors were evaluated. Clinical and pathologic records were also reviewed. No patients were positive for antibodies against Epstein-Barr virus (EBV). The imaging patterns of primary tumors were classified into two types as determined by location, shape, and margin. Of all patients, 7 had tumors with a type 1 imaging pattern and 3 had tumors with a type 2 imaging pattern. The 4 tubular NACCs were all homogeneous tumors, whereas 3 (60%) of 5 cribriform NACCs and the sole solid NACC were heterogeneous tumors with separations or central necrosis on MR images. Five patients had perineural infiltration and intracranial involvement, and only 2 had cervical lymphadenopathy. Based on these results, we conclude that NACC is a local, aggressive neoplasm that is often negative for EBV infection and associated with a low incidence of cervical lymphadenopathy. Furthermore, MRI features of NACC vary in locations and histological subtypes.
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Affiliation(s)
- Xue-Wen Liu
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
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Megwalu UC, Shin EJ. Second primaries after major salivary gland cancer. Otolaryngol Head Neck Surg 2011; 145:254-8. [PMID: 21493280 DOI: 10.1177/0194599811402899] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To evaluate the risk of second primary cancers in patients with major salivary gland cancer using a large population database and to examine the effects of sex, salivary gland cancer histology, and radiation therapy on the risk of second primaries. STUDY DESIGN Population-based study using the Surveillance, Epidemiology, and End Result (SEER) cancer database. SUBJECT AND METHODS The subjects were 15,572 men and women ages 15 and above, diagnosed with cancer of the major salivary glands from 1973 to 2006. RESULTS There was an increased risk of oral cavity (standardized incidence ratio [SIR] = 3.48, P < .05), salivary (SIR = 9.97, P < .05), lung and bronchus (SIR = 1.60, P < .05), kidney (SIR = 1.68, P < .05), and thyroid (SIR = 2.66, P < .05) cancers. Men had an increased risk of developing kidney cancer (SIR = 1.70, P < .05) compared with women (SIR = 1.64, P > .05). Patients with mucoepidermoid carcinoma had an increased risk of a second salivary gland cancer (SIR = 8.97, P < .05) and thyroid cancer (SIR = 3.97, P < .05). Patients with adenoid cystic carcinoma had an increased risk of oral cavity (SIR = 3.76, P < .05) and nasopharyngeal (SIR = 16.88, P < .05) cancers. Patients with acinar cell carcinoma had an increased risk of salivary (SIR = 31.36, P < .05), kidney (SIR = 2.98, P < .05), and thyroid (SIR = 3.85, P < .05) cancers. Patients who received radiation therapy had a higher incidence of lung and bronchus (SIR = 2.11, P < .05), laryngeal (SIR = 3.08, P < .05), and thyroid (SIR = 2.95, P < .05) cancers compared with patients who did not receive radiation therapy (SIR = 1.18, 0.48, and 2.39, respectively; P > .05). Patients had an increased risk of developing second primaries, even 10 years after diagnosis of primary salivary gland cancer. CONCLUSIONS Patients with major salivary gland cancers are at a risk for certain second primary cancers. This highlights the need for long-term surveillance in these patients, not only for recurrence but also for second primary cancers.
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Affiliation(s)
- Uchechukwu C Megwalu
- Department of Otolaryngology–Head and Neck Surgery, The New York Eye and Ear Infirmary, New York, New York 10003, USA.
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Different therapeutic strategies in primary salivary gland-type nasopharyngeal carcinomas. Curr Opin Otolaryngol Head Neck Surg 2011; 19:87-91. [PMID: 21297475 DOI: 10.1097/moo.0b013e3283448402] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Primary salivary gland-type nasopharyngeal carcinoma (PSGT-NPC) is an uncommon malignancy with aggressive behavior and poor prognosis. Its optimal treatment policy remains debated, even though recent evidence provides support for a multimodality approach. The aim of this study was to summarize the optimal management approaches and treatment outcomes of PSGT-NPCs. RECENT FINDINGS As most of the PSGT-NPCs, such as adenoid cystic carcinoma, mucoepidermoid carcinoma and low-grade (well-differentiated) adenocarcinoma, have low sensitivity to radiation, combined surgical treatment and radiotherapy are still the main treatment approach for limited or resectable lesions. As a result of the fact that in well-differentiated PSGT-NPCs the occult neck metastasis rate is low (less than 20%), elective neck dissection is not recommended in patients with a node-negative neck. Since high-grade (poorly-differentiated) PSGT-NPCs are relatively sensitive to radiation, radiotherapy or chemoradiotherapy is currently considered as the main treatment policy for such patients. There is no evidence to indicate that chemotherapy would improve overall survival. Cranial nerve infiltration, residual tumor, and distant metastases are independent predictive factors of overall survival. SUMMARY In most patients with PSGT-NPCs, especially for well-differentiated tumors, combined surgical treatment and radiotherapy should be recommended. For poorly-differentiated or unresectable tumors, radiotherapy or chemoradiotherapy is still considered the main treatment approach. Because of the rare incidence of PSGT-NPCs, the number of cases available for analysis is relatively small, and large multicentric studies should be conducted to further evaluate their optimal treatment policy.
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Zhang XM, Cao JZ, Luo JW, Xu GZ, Gao L, Liu SY, Xu ZG, Tang PZ. Nasopharyngeal mucoepidermoid carcinoma: A review of 13 cases. Oral Oncol 2010; 46:618-21. [DOI: 10.1016/j.oraloncology.2010.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 06/05/2010] [Accepted: 06/07/2010] [Indexed: 10/19/2022]
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Liu TR, Chen FJ, Qian CN, Guo X, Zeng MS, Guo ZM, He JH, Cao JY, Yang AK, Zhang GP. Primary salivary gland type carcinoma of the nasopharynx: therapeutic outcomes and prognostic factors. Head Neck 2010; 32:435-44. [PMID: 19760795 DOI: 10.1002/hed.21203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Primary salivary gland type nasopharyngeal carcinoma (SNPC) is a rare malignancy with diverse clinical behavior and different prognoses. Previous studies have reported on limited patient populations, and few long-term studies have outlined outcomes and prognostic factors. Furthermore, controversy exists as to the treatment policy of SNPC. The aim of this study was to define management approaches, therapeutic outcomes, and prognostic factors of SNPC. METHODS The medical records of 67 patients with SNPC at 1 institution between 1977 and 2005 were reviewed. Patient records were analyzed for management approaches, outcomes, and prognostic factors. RESULTS SNPC is a rare malignancy accounting for only 0.29% of nasopharyngeal malignancies, and the lymphatic metastases and distant metastases rates were 28.4% and 23.9%, respectively. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 41.1% and 57.1%, respectively; no significant differences were found in DFS or OS between different histological subtypes. A significant difference was found in OS between surgical treatment and nonsurgical treatment in T1-T2 patients with well-differentiated tumors. Multivariate analyses indicated that lymph node metastases, stage, and distant metastases were independent factors for DFS, whereas cranial nerve invasion, tumor residue, and distant metastases were independent factors affecting OS. CONCLUSIONS SNPC is a malignancy with generally favorable prognosis. In T1-T2 patients with well-differentiated tumors, SNPC should be treated by combined surgical operation and radiotherapy. Cranial nerve invasion, tumor residue, and distant metastases were independent factors affecting OS.
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Affiliation(s)
- Tian-Run Liu
- Key Laboratory of Oncology in Southern China, Guangzhou, Guangdong, China
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Ladziński P, Majchrzak H, Szymczyk C, Kaspera W, Maliszewski M, Maciejewski A, Wierzgoń J, Majchrzak K, Tymowski M, Adamczyk P. Direct and remote outcome after treatment of tumours involving the subtemporal fossa and related structures with the extended subtemporal approach. Neurol Neurochir Pol 2010; 44:148-58. [PMID: 20496285 DOI: 10.1016/s0028-3843(14)60006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE The aim of the study was to present our results of the surgical treatment of subtemporal fossa tumours and surrounding regions using the extended subtemporal approach. MATERIAL AND METHODS Twenty-five patients (10 women, 15 men) with subtemporal fossa tumours were included in the study. The neurological and performance status of the patients were assessed before and after surgery as well as at the conclu-sion of treatment. The approximate volume of the operated tumour, its relation to large blood vessels and cranial nerves, as well as consistency and vascularisation were assessed. RESULTS The symptom duration ranged from 2 to 80 months (mean: 14 months). In 44% of patients, headache was the predominant symptom. Less frequent symptoms were: paralysis of the abducent nerve and disturbances of the trigeminal nerve. Approximate volume of the tumours ranged from 13 to 169 cm3 (mean: 66 cm3). The most frequent histological diagnosis was meningioma (16%), followed by angiofibroma, neurinoma and adenocystic carcinoma (12%). Total or subtotal resection was achieved in 80% of patients. CONCLUSIONS The extended subtemporal approach allows for the removal of tumours of the subtemporal fossa and surrounding regions. This approach also allows one to remove tumours expanding in the regions surrounding the subtemporal fossa only. In such cases the subtemporal fossa constitutes the way of the surgical approach.
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Affiliation(s)
- Piotr Ladziński
- Katedra i Oddział Kliniczny Neurochirurgii w Sosnowcu, Slaski Uniwersytet Medyczny w Katowicach.
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Guo ZM, Liu WW, He JH. A retrospective cohort study of nasopharyngeal adenocarcinoma: a rare histological type of nasopharyngeal cancer. Clin Otolaryngol 2009; 34:322-7. [PMID: 19673979 DOI: 10.1111/j.1749-4486.2009.01952.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the clinical manifestations, Epstein-Barr virus (EBV) serology, and treatment outcome of patients with nasopharyngeal adenocarcinoma (NPAC). DESIGN A retrospective study of clinical data from consecutive patients with NPAC identified between 1964 and 2000. SETTING A tertiary cancer center in China. PARTICIPANTS Forty-eight patients diagnosed with NPAC. MAIN OUTCOME MEASURES Crosstabs and chi-square test were conducted to study the association of positive VCA-IgA levels among different pathological types of NPAC, and also to compare the proportions of local control rates in patients treated with different modalities. The survival rate was calculated using the Kaplan-Meier method, and the Log Rank test was used to compare the survival rates considering different factors. To balance the distribution bias, a multivariate COX model survival analysis was also performed. RESULTS Of the 48 NPAC patients identified, 45% presented with cervical metastasis. Pathologically, 58% of NPAC cases were common type and 42% were salivary gland type. The positive rate for the EBV antibody VCA-IgA in all patients was 53% and only 24% in the salivary gland type of NPAC. The overall local control rate and the 5-year disease-free survival rates were 87% and 65% respectively. Patients treated with surgery plus radiotherapy (RT) had a significantly higher 5-year disease-free survival rate than patients receiving RT alone (89%versus 75% respectively) (P = 0.039). Multivariate analysis confirmed that treatment modality was the significant factor influencing patient survival (P = 0.027) and the pathological type was not a factor predicting survival. CONCLUSIONS Nasopharyngeal adenocarcinoma is a distinct entity in all types of nasopharyngeal carcinoma and EBV serology has limited value in its diagnosis. The combination of surgery and RT should be considered for treatment of early lesions of NPAC.
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Affiliation(s)
- Z M Guo
- Department of Head and Neck Surgery, Cancer Center of Sun Yat-Sen University, Guangzhou, China
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