Factors influencing the prognosis of patients with p16-positive oropharyngeal carcinoma in whom surgery is selected as the initial treatment have not yet been determined. We retrospectively reviewed the data of 55 cases of p16-positive oropharyngeal carcinoma who underwent surgery as the initial treatment at the Department of Otolaryngology, Head and Neck Surgery, University of Tokyo, between 2004 and 2019. The variables examined were the old and new staging, resection margin status, number of metastatic lymph nodes, presence/absence of extranodal extension, and use of postoperative irradiation (yes/no), and the results were compared by univariate analysis. The patients ranged in age from 46 to 82 years (median 67 years), and the male/female ratio was 47/8. Stage I/II/III/IV cases were 3/10/13/29 cases according to the old classification, and Stage I/II/III cases were 47/6/2 cases according to the new classification. The transoral approach/open approach was used in 40/15 cases, of which 15cases (11 transoral/4 open) had positive surgical margins, 6 cases of p16-positive oropharyngeal carcinoma who underwent surgery as the initial treatment had 5 or more lymph node metastases, and 7 cases of p16-positive oropharyngeal carcinoma who underwent surgery as the initial treatment had extranodal extension. Univariate analysis identified pN0 as a favorable prognostic factor, and a trend towards a better prognosis in patients who received postoperative adjuvant radiotherapy, although the difference did not reach statistical significance. The overall 5-year overall survival rate and 5-year recurrence-free survival rate were 86.2% and 75.2%, respectively. The 5-year overall survival rate and 5-year recurrence-free survival rate were influenced by the 8th edition stage classification and the number of pathologically positive lymph nodes (pN classification). In conclusion, in this single-center retrospective study, the number of pathologically positive lymph nodes correctly predicted the prognosis in patients with p16-positive oropharyngeal carcinoma who underwent surgery as the initial treatment, suggesting the possibility of prognostic stratification by PN classification.
Morphometrics of the larynx provides useful information to otolaryngologists undertaking clinical interventions such as intubation, endoscopy, microlaryngeal surgery, and phonosurgery. The aim of this study was to measure the length of the vocal folds (LVF) and the length of the membranous vocal folds (MVF) in Japanese subjects.
This study was conducted in 73 patients with laryngeal diseases, such as vocal fold nodules, vocal fold polyps, and vocal fold leukoplakia. MVF was measured in all the 73 patients (age range, 17-94 years; male/female ratio, 41/32), while the LVF was measured in 64 of the 73 patients (age range, 17-94 years; male/female ratio, 36/28). The measurements were performed during the course of microlaryngeal surgery, using a millimeter-graded ruler. Gender differences in the MVF and LVF were also evaluated. In additional, the age, height and weight were examined to identify the existence of any correlations of the LVF and/or MVF with these variables in each gender.
The mean LVF values in the men and women were 14.8±3.0 mm and 12.7±2.3 mm, respectively. Furthermore, the mean MVF values in the men and women were 11.8±2.2 mm and 10.0±2.1 mm, respectively. Both the LVF and MVF values were significantly higher in the men as compared with the women (LVF, p<0.01; MVF, p<0.05). No positive correlations of the MVF or LVF was observed with any of the other parameters examined in this study.
Our study suggests that the gender exerts an important influence on the laryngeal morphometrics in Japanese adults.
We examined the data of 23 cases of carotid body tumors that were surgically resected at Keio University Hospital. There were no serious complications, such as death or cerebral infarction, and the incidence of postoperative neuropathy was lower than that reported in the past. After considering the surgical indications, we were able to undertake safe surgery through interdisciplinary collaboration between the divisions of neurosurgery and vascular surgery. By measuring the angle at which the tumor surrounds the internal carotid artery before surgery, it is possible to infer, to some degree at least, the necessity for carotid artery reconstruction.
The cribriform variant of papillary thyroid carcinoma is a rare form accounting for less than 0.5% of all thyroid carcinomas. It is classified into the sporadic type and familial adenomatous polyposis (FAP)-associated type. Since the FAP-associated type manifests as synchronous or metachronous multiple tumors, total thyroidectomy is recommended even for a single lesion. A 22-year-old woman visited our hospital complaining of a neck mass. Since she had family history of FAP and imaging studies revealed multiple tumors in both lobes of the thyroid gland, we suspected the FAP-associated cribriform variant of papillary carcinoma. Total thyroidectomy was performed, and histology revealed the cribriform variant of papillary carcinoma. Lower gastrointestinal endoscopy showed FAP. Preoperative pathological diagnosis is ideal for the FAP-associated cribriform variant of papillary carcinoma, as total thyroidectomy is recommended even for a single lesion. Although the findings of ultrasonography, CT, and fine needle aspiration cytology are not different from those of conventional papillary carcinoma, a history of FAP, young female patient, and presence of multiple tumors is a characteristic triad in patients with the cribriform variant of papillary carcinoma.
Rarely, fungal rhinosinusitis is of the invasive type, with a poor prognosis. The invasive type can cause cranial nerve symptoms depending on the site of fungal infiltration. In this study, we investigated clinical features, diagnosis, treatment, and prognostic markers for infection control in four cases of invasive fungal rhinosinusitis.
The patients were two men and two women in the age range of 70-84 years. Three of the four patients were suspected as having invasive fungal rhinosinusitis based on the typical findings on CT/MRI, i.e., bone destruction on CT and low to no signal intensity on T2-weighted MRI; however, in the remaining one patient without a fungal mass, the diagnosis could not be suspected either by preoperative imaging examinations or during surgery. Postoperative histology revealed Aspergillus infection in all cases. All the four patients are alive, although only poor infection control was achieved in one patient with clival bone involvement.