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Pediatric neck masses are a common occurrence and often represent a diagnostic challenge. The primary aim of this retrospective study was to evaluate the clinical and radiological features of neck masses in children and how they can drive diagnosis. The secondary aim was to create a diagnostic algorithm based on clinical features. We evaluated 190 children with neck masses who needed hospitalization. Clinical data and imaging findings were collected. The patients were divided into six groups: congenital/developmental lesions, tumors, acute and subacute lymphadenopathies, chronic nonspecific lymphadenopathies, cat-scratch disease, and mycobacteriosis. Reactive lymphadenopathies were observed in the majority of cases (65.8%). Congenital/developmental cysts were present in 28.9%, while 5.3% had a tumor. A lower mean age was observed for acute/subacute lymphadenopathies and mycobacteriosis. Fever and a painful mass were typical of acute/subacute lymphadenopaties and cat-scratch disease. A hard and fixed mass was not only typical of tumors. Concerning imaging findings, multiple lymph nodes at the same level was mainly observed in mycobacteriosis, while bilateral lymph node enlargement and colliquation were present in lymphadenopathies.Conclusion:A complete and adequate clinical assessment should be the basis for every diagnostic and therapeutic choice in children with neck masses. What is Known: ⢠Pediatric neck masses are a common occurrence and often represent a diagnostic challenge. ⢠Clinical features, serological exams and imaging findings should drive the physician to an appropriate diagnostic hypothesis. What is New: ⢠A lower mean age was observed for acute/subacute lymphadenopathies and mycobacteriosis. ⢠A hard and fixed mass was not only typical of tumors. ⢠Multiple lymph nodes at the same level were mainly observed in mycobacteriosis, while bilateral lymph node enlargement and colliquation were present in nonspecific lymphadenopathies.
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Enfermedad por Rasguño de Gato/diagnóstico , Quistes/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico , Linfadenopatía/diagnóstico , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Cuello/patología , Adolescente , Distribución por Edad , Análisis de Varianza , Enfermedad por Rasguño de Gato/epidemiología , Enfermedad por Rasguño de Gato/patología , Niño , Preescolar , Quistes/epidemiología , Quistes/patología , Femenino , Neoplasias de Cabeza y Cuello/epidemiología , Neoplasias de Cabeza y Cuello/patología , Humanos , Lactante , Recién Nacido , Ganglios Linfáticos/patología , Linfadenopatía/epidemiología , Linfadenopatía/patología , Imagen por Resonancia Magnética , Masculino , Infecciones por Mycobacterium no Tuberculosas/epidemiología , Infecciones por Mycobacterium no Tuberculosas/patología , Cuello/diagnóstico por imagen , Estudios RetrospectivosRESUMEN
OBJECTIVE: Aim of this observational study is the evaluation of olfactory and gustatory impairments in laryngectomized long-term survivors compared to control subjects. Correlation between smell and taste alterations, age, and previous adjuvant treatments in laryngectomees was investigated. METHODS: Fifty control subjects and 50 patients who underwent total laryngectomy for advanced laryngeal carcinoma were evaluated. All subjects underwent symptoms evaluation, oropharyngeal exam, endoscopic fiberoptic nasal examination, and Taste Strips and Sniffin' Sticks tests. RESULTS: Hyposmia was reported by all laryngectomees and hypogeusia by 54% of patients. Sniffin' Sticks and Taste Strips tests demonstrated a statistically significant difference between controls and laryngectomees regarding olfactory threshold, odor discrimination and identification, Threshold Discrimination Identification (TDI) score, and sour, salty, and gustatory Total Taste score ( P < .05). Multivariate analysis for Total Taste score in laryngectomees showed a statistically significant correlation with aging, having an odds ratio of 0.127 for age ≥65 years, but not with TDI score, radiotherapy, and follow-up time, whereas multivariate analysis for TDI score demonstrated no correlation with radiotherapy, age, and follow-up time. CONCLUSIONS: Total laryngectomy determines olfactory and gustatory impairments that should be taken into account in clinical practice. Relationships between sensorial alterations, aging, follow-up period, and adjuvant treatments should be further evaluated in prospective studies.
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Laringectomía/efectos adversos , Trastornos del Olfato/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Trastornos del Gusto/diagnóstico , Factores de Edad , Anciano , Femenino , Humanos , Neoplasias Laríngeas/cirugía , Masculino , Persona de Mediana Edad , Trastornos del Olfato/etiología , Trastornos del Olfato/fisiopatología , Complicaciones Posoperatorias/fisiopatología , Ventilación Pulmonar , Estudios Retrospectivos , Sobrevivientes , Trastornos del Gusto/etiología , Trastornos del Gusto/fisiopatologíaRESUMEN
OBJECTIVES: Recurrent or metastatic salivary gland malignancies (RMSGM) are not suitable for conventional treatment. We report the clinical outcomes of 60 patients affected by RMSGM who were treated with DDP+VNB as a first-line or second-line scheme. MATERIALS AND METHODS: Sixty patients between 2001 and 2008, affected by RMSGM were enrolled in this cohort prospective study; they received the following first-line or second-line chemotherapy (CT), for a maximum of 6 cycles: DDP at 80 mg/m on day 1+VNB at 25 mg/m on day 1 and 8, at 3-week intervals. RESULTS: Seventy percent of the patients received DDP+VNB as the first-line CT and 30% of them received it as the second-line CT. After 5 cycles (median) of first-line DDP+VNB, 7% of the patients achieved a complete response, 24% achieved a partial response, 33% achieved an no change, and 36% achieved a PD. After 4 cycles (median) of second-line CT, 0 patients achieved a CR, 5% achieved a PR, 33% achieved an NC, and 62% achieved a PD. The median overall survival period was 10 months for those who received the first-line CT and 4 months for those who received the second-line CT. The best ORR (54%) and median survival were observed, during first-line treatment, in adenocarcinomas, whereas undifferentiated tumours were unresponsive with a poor median survival (4.6 mo). CONCLUSIONS: Adenocarcinomas show the best response and prognosis with DDP+VNB scheme that seems to be an effective and well-tolerated first-line CT for RMSGM, whereas it has only low palliative activity as a second-line CT.
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Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Cisplatino/administración & dosificación , Recurrencia Local de Neoplasia/tratamiento farmacológico , Neoplasias de las Glándulas Salivales/tratamiento farmacológico , Neoplasias de las Glándulas Salivales/secundario , Vinblastina/análogos & derivados , Adulto , Anciano , Carcinoma de Células Escamosas , Femenino , Neoplasias de Cabeza y Cuello , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Carcinoma de Células Escamosas de Cabeza y Cuello , Resultado del Tratamiento , Vinblastina/administración & dosificación , Vinorelbina , Adulto JovenRESUMEN
OBJECTIVE: Complete separation of upper and lower respiratory tract after total laryngectomy results in permanent effects on nasal cavities and tracheo-bronchial airways. Aim of this study is evaluating nasal and tracheal cytological alterations of mucosa in laryngectomy long-term survivors, analyzing the feasibility of scraping for cytological examination of tracheal mucosa. METHODS: Twenty-five laryngectomy patients underwent symptoms' evaluation, endoscopic fiber optic examination, prick tests, and nasal and tracheal scraping for cytological exam. Twenty-five healthy subjects underwent the same assessment, except for tracheal scraping. Eleven laryngectomy patients accepted inferior turbinate biopsy for histological examination. RESULTS: Nasal cytological analysis demonstrated mucous cell metaplasia in 20% of laryngectomized patients, but it was absent in all healthy subjects; no squamous cell metaplasia was found in both groups. In 15 patients (60%), bacteria were present, without inflammatory infiltrate. Tracheal cytological analysis demonstrated a quite high rate of squamous cell metaplasia (24%), neutrophilic infiltrate (32%), and presence of bacteria (40%). Histological examination of inferior turbinate showed submucosal stromal fibrosis in all patients and submucosal inflammatory infiltrate in 1 case (9%). CONCLUSION: Nasal cavities and trachea of laryngectomy patients undergo long-term cytological and histological changes of mucosa and submucosa, probably due to airflow modifications.
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Carcinoma de Células Escamosas/cirugía , Células Epiteliales/patología , Células Caliciformes/patología , Neoplasias de Cabeza y Cuello/cirugía , Neoplasias Laríngeas/cirugía , Laringectomía , Mucosa Nasal/patología , Tráquea/patología , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Metaplasia , Persona de Mediana Edad , Mucosa Respiratoria/patología , Carcinoma de Células Escamosas de Cabeza y Cuello , SobrevivientesRESUMEN
PURPOSE: Liposarcoma is the most common soft tissue sarcoma in adults. It represents approximately 20 % of all mesenchymal malignancies. It most frequently involves retroperitoneum, trunk, and extremities. Hypopharyngeal and esophageal localization of liposarcoma is extremely rare. METHODS: We performed a systematic review of literature and reported 26 and 33 cases of hypopharyngeal and esophageal liposarcoma. We analyzed natural history, imaging features, histology, treatment, and prognosis, with a specific focus to similarities and differences between tumors of hypopharynx and esophagus. RESULTS: Hypopharyngeal and esophageal liposarcomas have more similarities than differences. Incidence has a peak at 6th and 7th decades. The diagnostic procedures are barium swallow, endoscopic examination, and CT/MR imaging. Well-differentiated liposarcoma represents the most frequent histological subtype. Surgical excision is the main treatment. Endoscopic resection can be useful for pedunculated tumors of hypopharynx and cervical esophagus. Differences between hypopharyngeal and esophageal liposarcoma are represented by local recurrence rate (greater for hypopharyngeal tumors), number of giant tumors, and time to recurrence (greater for esophageal tumors). Finally, liposarcomas of distal esophagus need more extended approaches. CONCLUSIONS: Liposarcomas of hypopharynx and cervical esophagus could be considered a unique pathological entity, with similar features and treatment options. Survival rate is dependent on histological type and location. Local recurrence is common, especially for hypopharyngeal liposarcoma, while the risk of lymph node or distant metastasis is very low. Patients should undergo regular examinations to rule out local recurrence, also for a long time, especially for esophageal tumors.
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Esófago/patología , Neoplasias Hipofaríngeas/terapia , Hipofaringe/patología , Liposarcoma/terapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Neoplasias Hipofaríngeas/patología , Liposarcoma/patología , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
INTRODUCTION: Liposarcoma is considered the most common soft tissue sarcoma in adults. It represents approximately 20 % of all mesenchymal malignancies, and most frequently it involves the retroperitoneum, trunk, and extremities. Hypopharyngeal localization of liposarcoma is extremely rare. METHODS: We report a new rare case of giant pedunculated liposarcoma arising from the left antero-lateral wall of the hypopharyngeal-esophageal junction, and we present a complete review of the literature. RESULTS: An 81-year-old man presented with a 5-month history of dysphagia and 30-kg weight loss, due to a giant pedunculated liposarcoma of the hypopharynx, which is resected with cervical approach. CT scan imaging revealed a 25-cm-long pedunculated heterogeneous mass with fat-like density originating from the anterior wall of hypopharyngeal-esophageal junction protruding into the lumen. The polypoid mass was identified as well as the stalk, and it was completely delivered through the cervical incision. Histopatological examination showed a dedifferentiated liposarcoma, without positive or close margins. No further chemoradiation therapy was performed due to the patient's age, comorbidities, negative margins, and absence of distant metastases. Dysphagia solved 1 month after surgery. No evidence of tumor recurrence was seen in the 12 months following surgery. CONCLUSIONS: When base of the tumor is located in hypopharynx or cervical portion of the esophagus, and tumor is not aggressive, cervical approach is better, irrespective of the tumor size, except for cases in which an endoscopic approach is feasible.
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Hipofaringe , Liposarcoma , Anciano de 80 o más Años , Humanos , Hipofaringe/patología , Liposarcoma/patología , MasculinoRESUMEN
BACKGROUND: Oxidative stress has been recently identified as the pivotal pathway of cochlear damage. The aims of this study were to evaluate whether distortion product otoacoustic emissions (DPOAEs) can discriminate normal subjects with a risk of damage induced by sound exposure, the effectiveness of OAEs in monitoring the protective effects of Coenzyme Q10 terclatrate (QTer), and the role of blood parameters in monitoring preventive therapies. MATERIAL/METHODS: Twenty volunteers were randomized to two groups: the first (n=10) was treated with Q-Ter (200 mg orally once daily) for 7 days before noise exposure and the second group was treated with placebo using the same schedule. All participants were exposed to white noise of 90 dB HL for 15 minutes. DPOAEs and pure-tone audiometry (PTA) were measured before and 1 h, 16 h, and 7 and 21 days after exposure. Inflammatory and oxidative stress parameters were measured before and 2 and 24 h after exposure. RESULTS: In the placebo group, DPOAE amplitudes were reduced 1 and 16 h after exposure compared with the baseline values (p<0.05). In the Q-Ter group, DPOAEs did not show any significant difference between baseline and post-exposure (p>0.1). PTA threshold values in the Q-Ter and placebo groups did not differ before and after exposure. No significantly different levels of the inflammatory markers were observed in the Q-Ter and placebo groups at the different time points. CONCLUSIONS: This pilot study confirms that DPOAEs represent a sensitive test for monitoring the effects of noise in preclinical conditions and pharmacological treatment.