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BACKGROUND: Herein, we evaluated the attributable fraction (AF) of human papillomavirus (HPV)-mediated (HPV+) oropharyngeal carcinomas (OPCs) in Greece over a recent calendar period. PATIENTS AND METHODS: ORPHEAS, a retrospective, observational, multicenter, cross-sectional study with prospective recruitment, included adult patients with OPC in 2017-2022, each of them with a high-quality, treatment-naïve tumor specimen. The primary endpoint was the HPV-AF, defined as combined positivity for p16INK4a (p16) overexpression and HPV DNA presence by central laboratory testing, among included patients. Other endpoints evaluated the HPV+/HPV- patient/disease characteristics at OPC diagnosis and the HPV subtypes for HPV+ patients. RESULTS: 144/147 patients with available HPV status by central laboratory testing were analyzed [median age: 60.0 years; males: 111 (77.1%)]. The most common tumor anatomical sites were the tonsils (70/147, 48.6%) and the base of the tongue (51, 35.4%), and most patients were at the American Joint Committee on Cancer eighth edition TNM (tumor-node-metastasis) stages III (25, 22.7%) and IV (43, 39.1%). The HPV-AF was 52.1% (75/144; 95% confidence interval 43.6% to 60.5%). Most HPV+ patients were infected by an HPV type targeted by the 9-valent HPV vaccine (72/75, 96.0%), especially HPV16 (70/75, 93.3%). HPV+ compared with HPV- patients were younger (median age 58.0 versus 64.0 years; P = 0.003); more likely to have tumors in the tonsils (65.0% versus 30.4%; P < 0.001); less likely to have tumors in the base of the tongue (25.3% versus 46.4%; P = 0.008); and less frequently at TNM stage IV (20.4% versus 57.1%; overall P < 0.001). CONCLUSIONS: In Greece, we observed a high HPV-AF (52.1%) in OPC, approximating the AFs reported for some Northern European countries. HPV+ versus HPV- patients were younger, more frequently with tonsillar tumors, and less frequently at TNM stage IV. Since most patients were infected by ≥1 HPV type targeted by the 9-valent vaccine, the HPV+ OPC burden could be mitigated through a routine HPV gender-neutral vaccination program.
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Introduction: Paragangliomas are rare tumors representing a therapeutic challenge. In particular, the surgical removal may lead to life-threatening bleeding. The preoperative percutaneous embolization is an alternative that allows a high closure rate of tumor-feeding vessels in a short intervention time and thus significantly reduces intraoperative bleeding probability. Complete tumor resection is facilitated thereby. The use of a new non-adhesive liquid embolic agent is presented here. Methods: A 50-year old patient presented with 4 cm large paraganglioma of the carotid body (Shamblin II). A percutaneous embolization with 7 ml PHIL™ (injectable precipitating hydrophobic liquid) was performed preoperatively. 24 h later the complete surgical resection of the tumor was performed. Results: A good distribution of the liquid embolic agent could be achieved over the entire tumor. Intraoperative resection of the tumor was much easier and faster due to low bleeding tendency over the entire surface of the tumor. Total blood loss was less than 50 ml. All adjacent nerve and arterial structures could be spared. Postoperative nerve function was normal and the patient was discharged on the 4th postoperative day. Conclusion: The combination of percutaneous embolization and surgical resection provides a safe combination in the treatment of advanced carotid body paragangliomas. The use of a novel liquid embolic agent may possibly further optimize the therapy.
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Tumor del Cuerpo Carotídeo/terapia , Embolización Terapéutica/métodos , Terapia Neoadyuvante , Polivinilos/uso terapéutico , Tumor del Cuerpo Carotídeo/irrigación sanguínea , Terapia Combinada , Hemorragia/prevención & control , Humanos , Complicaciones Intraoperatorias/prevención & control , Masculino , Persona de Mediana EdadAsunto(s)
Articulación Atlantoaxoidea/patología , Dolor de Cuello/diagnóstico , Enfermedades de la Columna Vertebral/diagnóstico , Enfermedades de la Columna Vertebral/cirugía , Quiste Sinovial/diagnóstico , Quiste Sinovial/cirugía , Adolescente , Diagnóstico Diferencial , Femenino , Humanos , Dolor de Cuello/etiología , Dolor de Cuello/prevención & control , Enfermedades de la Columna Vertebral/complicaciones , Quiste Sinovial/complicaciones , Resultado del TratamientoRESUMEN
The increase in the incidence of thyroid cancer is accompanied by a mortality rate that is stable or perhaps even slightly decreasing. This phenomenon is due to the increased frequency of papillary microcarcinomas (thyroid tumors with a diameter of less than 1 cm), which is presumably attributable to the improved diagnosis enabled by high resolution ultrasound and fine needle aspiration cytology. The American and European Thyroid Associations have recently published new guidelines for the diagnosis and therapy of differentiated thyroid tumors. These guidelines are aimed at minimizing the diagnostic and therapeutic procedures without reducing their effectiveness. This goal is particularly important for papillary thyroid microcarcinoma patients, who have an excellent prognosis and almost normal life expectancy. This article summarizes the history of thyroid surgery and introduces papillary thyroid microcarcinoma--an important topic in modern thyroid oncology. Current methods for diagnosis, treatment and follow-up care of this disease are discussed.
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Carcinoma/diagnóstico , Carcinoma/terapia , Otolaringología/normas , Guías de Práctica Clínica como Asunto , Radioterapia/normas , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/terapia , Tiroidectomía/normas , Carcinoma Papilar , Europa (Continente) , Humanos , Otolaringología/tendencias , Radioterapia/tendencias , Cáncer Papilar Tiroideo , Tiroidectomía/tendencias , Estados UnidosRESUMEN
BACKGROUND: Transoral laser microsurgery (TLM) has led to an expansion of the therapeutic modalities for malignomas of head and neck. This study aims to assess the oncologic results and functional outcomes of TLM in early carcinomas. PATIENTS AND METHODS: This is a retrospective study of 947 cases with T1-2 carcinomas primarily managed with laser surgery between 1979 and 2007. All cases were assessed for survival, with respect to location, T and N classification and status of surgical margins. Cases were additionally evaluated for incidence of major complications and retention of laryngeal and pharyngeal function. RESULTS: Disease specific survival was 78.6% for oropharyngeal, 68.9% for hypopharyngeal, 82.3% for supraglottic und 95.2% for glottis carcinomas. Survival estimates were found to be significantly better for cases without cervical metastasis and with negative surgical margins. A low rate of major complications (4.7%) were noted. 1% of the patients had a permanent dysfunction of swallowing and 1.1 % needed a permanent tracheostomy. CONCLUSION: Laser surgery appears to be a very effective management modality for small carcinomas of the head and neck as long as clear surgical margins can be achieved. This technique offers acceptable oncologic results with a low incidence of complications and satisfactory retention of function.
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Carcinoma de Células Escamosas/cirugía , Endoscopía/métodos , Neoplasias Hipofaríngeas/cirugía , Neoplasias Laríngeas/cirugía , Terapia por Láser/métodos , Microcirugia/métodos , Neoplasias Orofaríngeas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Quimioradioterapia , Terapia Combinada , Trastornos de Deglución/etiología , Femenino , Humanos , Neoplasias Hipofaríngeas/mortalidad , Neoplasias Hipofaríngeas/patología , Estimación de Kaplan-Meier , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/patología , Masculino , Persona de Mediana Edad , Disección del Cuello/métodos , Invasividad Neoplásica , Estadificación de Neoplasias , Neoplasias Orofaríngeas/mortalidad , Neoplasias Orofaríngeas/patología , Complicaciones Posoperatorias/etiología , Estudios RetrospectivosRESUMEN
Laryngeal cancer can affect the patients' voice. For assessment of the patients' self-perception of their voice, several tools were introduced into clinical routine. The voice handicap index questionnaire (VHI) is regarded as the "gold standard". However, in benign laryngeal pathologies and in functional dysphonia, the shorter voice-related quality of life questionnaire (V-RQOL) proved to be equivalent. This study examines the correlation of both questionnaires in patients who had been treated for small (T1 and T2) laryngeal cancer. It was performed during regular outclinic examinations. In total, 65 patients aged 62.1 ± 10.0 years completed the German versions of the VHI and V-RQOL. Their average VHI total score was 38.9 ± 26.0 points and the average V-RQOL score was 70.1 ± 24.4%. The total scores correlated with |ρ| = 0.92 and p < 0.01. Both questionnaires give quasi identical results, the shorter V-RQOL may be favoured for clinical application.
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Evaluación de la Discapacidad , Neoplasias Laríngeas/cirugía , Calidad de Vida , Trastornos de la Voz/rehabilitación , Calidad de la Voz , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Neoplasias Laríngeas/complicaciones , Neoplasias Laríngeas/fisiopatología , Laringectomía , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Trastornos de la Voz/etiología , Trastornos de la Voz/psicologíaRESUMEN
A 20-year-old male patient presented with a left cervical solid indolent swelling. On mirror examination a prominence in the lateral wall of the oro- and hypopharynx and, in the throat, a solid indolent and easily movable swelling in regions II-III were seen. B-mode and Doppler ultrasound demonstrated a sharply defined, hypoechoic, inhomogeneous mass without perfusion, while on MRI a contrast-enhancing left pharyngeal homogenous mass causing carotid artery and jugular vein displacement was seen. No invasive growth was observed.
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Edema/diagnóstico , Edema/etiología , Ganglioneuroma/complicaciones , Ganglioneuroma/diagnóstico , Neoplasias Faríngeas/complicaciones , Neoplasias Faríngeas/diagnóstico , Humanos , Masculino , Cuello , Adulto JovenRESUMEN
The latest revision of the UICCs TNM classification in 2002 subdivided advanced laryngeal carcinoma into the subcategories T4a and T4b, in order to emphasise the poor prognosis and inoperability of the latter group. Our study aims at evaluating the prognostic relevance of this subclassification. This retrospective analysis includes 163 patients treated for advanced laryngeal carcinoma between 1980 and 2002. The disease-free 5-year-survival rates for patients suffering from T4a and T4b laryngeal carcinoma were 32.4 and 6.7%, respectively (P = 0.003). The T-category and free margins proved to be significant prognostic factors. The survival of patients suffering from T4a carcinoma proved to be independent of specific location and number of invaded structures. This study confirms the much poorer prognosis for patients suffering from T4b carcinoma and thus supports the modified TNM classification.
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Carcinoma/clasificación , Neoplasias Laríngeas/clasificación , Estadificación de Neoplasias/métodos , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/diagnóstico , Carcinoma/mortalidad , Femenino , Estudios de Seguimiento , Alemania/epidemiología , Humanos , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/mortalidad , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tasa de Supervivencia/tendencias , Tomografía Computarizada por Rayos XAsunto(s)
Neoplasias de los Nervios Craneales/diagnóstico , Neurilemoma/diagnóstico , Enfermedades del Nervio Vago/diagnóstico , Biomarcadores de Tumor/análisis , Neoplasias de los Nervios Craneales/patología , Neoplasias de los Nervios Craneales/cirugía , Trastornos de Deglución/etiología , Diagnóstico Diferencial , Endoscopía , Femenino , Humanos , Persona de Mediana Edad , Mucina-1/análisis , Neurilemoma/patología , Neurilemoma/cirugía , Proteínas S100/análisis , Ultrasonografía , Enfermedades del Nervio Vago/patología , Enfermedades del Nervio Vago/cirugíaRESUMEN
BACKGROUND: Pleomorphic adenomas of the small salivary glands are very rare and usually arise from the hard palate. CASE REPORT: We present a female patient who was referred to our Department because of a bleeding enoral tumor, which persisted for 35 years. Histopathological examination after complete tumor excision showed a pleomorphic adenoma. CONCLUSION: Pleomorphic adenomas are an important differential diagnosis for tumors of the hard palatine. The therapy of choice is surgical excision.