Access to genome and biomolecular information has enabled us to understand the causes and development pathophysiologic processes of various diseases in detail at the molecular level. Precision medicine refers to the appropriate medical treatment and personal medical care selected based on precise classification of the patient’s condition. In relation to individualized medicine in patients with allergic diseases, attempts have been made to identify biomarkers, genetic factors, relationships with environmental factors, and phenotypes for the selection of appropriate individualized therapies. Evidence from large-scale biological databases, proteomics, metabolomics, genomics, and diverse cellular assays is needed to precisely characterize patients for selecting tailor-made treatments. Herein, we summarize the indications for treatments such as macrolide, antibiotics, mepolizumab, benralizumab, omalizumab, dupulimab, lebrikizumab, and tezepelumab. Also, we have indicated the phenotypes suitable for treatment with histamine H1 receptor antagonists, leukotriene receptor antagonists, and intranasal corticosteroids among patients with allergic rhinitis, and discussed the phenotypes, endotypes, and the possibility of precision medicine for patients with allergic airway diseases, including bronchial asthma, allergic rhinitis and rhinosinusitis, often encountered in clinical practice, as “One airway, one disease”.
The subjects of this study were patients with refractory patulous Eustachian tubes (PETs), who required surgical intervention, including Kobayashi plug insertion or ventilation tube insertion. We mainly used Eustachian tube function tests (tubotympanoaerodynamic graphy: TTAG and sonotubometry: SON), to investigate the differences in the pathology and optimal treatment strategy in patients with and without habitual sniffing.
We identified 35 patients (49 ears) with refractory PETs, in whom several rounds of conservative therapy were ineffective, and divided the patients into a group with habitual sniffing (sniff-type PET) and the another without habitual sniffing (non-sniff-type PET). The sniff-type PET group included 14 patients (20 ears) and the non-sniff-type PETgroup included 21 patients (29 ears).
The pretreatment TTAG of many sniff-type PET patients showed synchronous changes at high levels of pressure (over 40 daPa) in the external auditory meatus and nasopharynx during performance of a slight Valsalva manoeuvre (below 200 daPa) (p<0.005). The pretreatment SON showed a significant decrease in the test tone sound pressure level applied to the nostril in the non-sniff-type PET group (p<0.005). On the basis of the findings, we concluded that the “pressure change in the middle ear” was large in the sniff-type PET group and “sound invasion into the middle ear” was large in the non-sniff-type PET group. These findings could be related to the chief complaint of “aural fullness” in the patients with sniff-type PET, and of “autophonia” in the patients with non-sniff-type PET.
Posttreatment SON and TTAG showed that the Kobayashi plug suppressed not only “sound invasion into the middle ear,” but also “pressure change in the middle ear.” Ventilation tube insertion for sniff-type PET suppressed the “pressure changes in the middle ear,” alleviating “auditory hyperethesia,” and prevented progression to cholesteatoma by “maintaining the average pressure.”
Solitary fibrous tumors (SFT) often occur as pleural lesions and are extremely rare in the parotid gland. In the present paper, we report a case of SFT occurring in the parotid gland. The patient was a 35-year-old woman admitted by a local doctor for further examination of a swelling in front of the left ear that the patient had first noticed three months earlier. She was referred to our institution for surgery, and we performed extirpation of the left parotid gland tumor (superficial cervical fascia) five months after her first visit to us. The surgery was performed by the usual method. Histopathology showed a hyperplastic spindle cell tumor with an edematous matrix, and positive results of immunohistochemistry for CD34, CD99, bcl-2, and STAT6. Based on the findings, the tumor was diagnosed as a SFT. A whole-body scan was subsequently performed, which revealed no pleural lesions or relapses. Latent SFT should be considered malignant, and followed up closely.
Granular cell tumor (GCT), also known as Abrikossoff tumor, is known as a benign, slow-growing neoplasm. While GCT can arise anywhere in the body, these tumors in the head and neck region, especially involving the tongue, account for 30%–50% of all cases. On the other hand, to the best of our knowledge, hypopharyngeal lesions are extremely rare, with only 11 case reports published in the literature.
Herein, we report a case of benign GCT arising from the hypopharynx in a 30-year-old female patient. The lesion in the hypopharynx was excised by microlaryngoscopic surgery. Histopathology of the resected lesion revealed features consistent with the diagnosis of GCT. Positive results of immunohistochemical staining for 100 protein and neuron-specific enolase (NSE) were helpful for making the correct diagnosis. The postoperative course was uneventful. The patient was asymptomatic without any evidence of recurrence postoperative observation.
GCT is a solitary submucosal tumor, however, in about 4%-16% of cases, multiple lesions are found. To detect multiple lesions, especially esophageal lesion, upper gastrointestinal endoscopy should be performed. Several reports have mentioned the possibility of misdiagnosing pseudoepitheliomatous hyperplasia of the overlying mucosa of a GCA as SCC. To prevent misdiagnosis, it is important to consider clinical findings, not only pathological diagnosis.
Fishbone (FB) foreign bodies in the pharynx are commonly encountered in daily clinical practice; however, a FB embedded in the extra-pharyngeal space is rare. We describe a 76-year-old woman with a yellowtail bone that was embedded in the submucosa of the posterior pharyngeal wall and was successfully removed using direct laryngoscopy via the oral cavity. The ingested fishbone most likely became embedded in the posterior pharyngeal wall as a result of mucosal swelling. The FB was impacted in the submucosa of the posterior pharyngeal wall at the superior margin of the hyoid bone to the pyriform fossa. As the infection was mild without abscess formation, removal through the oral cavity via direct laryngoscopy was possible. When selecting appropriate surgical instruments, the shape, location, and distance from the oral cavity of the FB and an accurate preoperative assessment of the level of the FB impaction are important considerations, as is ensuring a good surgical field. This considerations can enable an oral cavity approach for the removal of a FB foreign body.
Chondrosarcoma of the larynx is extremely rare in young people. Total laryngectomy to treat this tumor in young patients would have a markedly deleterious effect on the long-term quality of life of the patients. Therefore, it would be worthwhile attempting larynx-preserving surgery in such patients. Herein, we report a case of chondrosarcoma arising from the cricoid cartilage in a young patient.
A 32-year-old man presented with the complains of hoarseness of the voice and breathlessness. Biopsy of the lesion performed under computed-tomographic guidance revealed a low-grade chondrosarcoma arising from the right side of the cricoid cartilage. We resected the tumor while preserving the larynx. While we had to resect a part of the laryngeal structure, we reconstructed the lost section with a costal cartilage graft. At present, six months after the surgery, the patient shows no evidence of recurrence or metastases.
If a patient with a laryngeal tumor has a good performance status, the malignancy grade of the tumor is not high, and less than half the larynx needs to be resected, it may be possible to achieve complete tumor resection while preserving the laryngeal function.
Granulocyte-colony stimulating factor (G-CSF)-producing carcinomas have been reported in various organs and are known to be associated with a poor clinical prognosis. Carcinoma of unknown primary site (CUP) is an uncommon malignancy that accounts for about 1%–4% of all head and neck malignant neoplasms, and also has a poor prognosis. We report a very rare case of G-CSF-producing CUP (G-CSF-CUP), which is considered to have an even poorer prognosis.
A 67-year-old woman was admitted to our hospital with a left neck mass.
Laboratory examination revealed a high serum level of G-CSF. FDG PET/CT showed intense FDG uptake in the left cervical mass and the spine. The site of origin of the primary tumor could not be identified despite thorough diagnostic evaluation. Therefore, we made the diagnosis of G-CSF-CUP of the head and neck. The patient was treated by surgical resection of the neck mass and postoperative chemoradiation therapy, following which the serum levels of G-CSF returned to normal range and the FDG accumulation in the spine on PET decreased. At present, more than 21 months since the surgery, the patient remains alive with no evidence of recurrence.
Extracardiac rhabdomyoma is a rare mesenchymal tumor that shows skeletal muscle differentiation. It is classified into the adult, fetal and genital types. Adult-type rhabdomyoma has a predilection for the head and neck region. Only a few cases of the tumor in the submandibular region have been reported in the literature.
We report the case of a 77-year-old man who presented to us with a tumor in the left submandibular region. Cervical ultrasound and CT revealed a well-defined tumor posterior to the left submandibular gland. Fine needle aspiration cytology was performed, however, the diagnosis could not be confirmed because the specimen was inadequate. Surgical resection was performed, and histopathologic evaluation of the resected specimen revealed the diagnosis of adult-type rhabdomyoma. At present, 9 months since the surgery the patient remains well, with no evidence of disease recurrence. This case indicates that surgical treatment is effective for adult-type rhabdomyoma. However, careful follow-up is necessary, as there are reports of recurrence due to incomplete removal of the tumor.
A 34-year-old man consulted a neurosurgeon for severe headache. A CT angiography showed constrictions of the internal jugular vein on either side. The surgeon placed stents in the internal jugular veins of both sides, and the patient reported alleviation of the headaches after the surgery. However, a follow-up CT showed that the stents had become crushed between the styloid processes and the C1 lateral processes on both sides. Therefore, we resected the styloid processes on both sides to avoid recurrent obstruction, and the patient had no more headaches. In recent years, there have been reports of various styloidogenic diseases that cannot be considered as classic cases of Eagle syndrome. We believe that it is necessary to establish a new disease concept, including this case as a case with a new variant of Eagle syndrome.
We report a case of hypopharyngeal carcinoma with essential thrombocythemia (ET). A 66-year-old woman became aware of a difficulty in swallowing and visited a local doctor. She was referred to our hospital based on a suspicion of hypopharyngeal carcinoma. She was diagnosed as having postcricoid carcinoma based on a physical examination, and we selected surgery as the optimal treatment. In addition, She was diagnosed as having ET because of a marked increase in her platelet count. Since ET increases the risk of thrombosis and bleeding, it requires perioperative platelet control. This surgery required revascularization, and minimization of the risk of thrombosis was considered important. During the perioperative period, we administered hydroxycarbamide, a small amount of aspirin, and heparin to control the platelet count. She did not develop any complications, such as thrombosis. Control of the platelet count, antiplatelet therapy, and anticoagulant therapy throughout the perioperative period are very important for surgical patients with ET.