Tumors constantly release many substances into the bloodstream, including tumor cells, cell-free DNA, and exosomes. These are sources of tumor-derived information, and are therefore potentially useful biomarkers for early detection, diagnosis, and monitoring of disease. Liquid biopsy is a newly developed blood test that detects such circulating biomarkers, that could gradually become applicable to clinical practice. Liquid biopsy has several advantages over tissue biopsy, and is recognized not only as an easily accessible, non-invasive, and repeatable examination, but also as one that allows comprehensive analysis of the tumor tissue profile. Herein, we describe the current situation of detection of circulating tumor cells (CTCs) for head and neck squamous cell carcinoma (HNSCC). In the future, further development of liquid biopsy, including CTC analysis, could provide useful information that could enable precision medicine for HNSCC.

The glomus tympanicum tumor is a vascular-rich tumor arising from the paraganglion. We report herein on the case of a 70-year-old female case of with a glomus tympanicum tumor. A red pulsating mass in the tympanic cavity was observed on otoscopic examination. CT findings showed an 8 mm tumor in the meso-tympanic area. Without preoperative embolization, the tumor was completely resected. The blood loss was minor. No recurrence was seen during a 3-year postoperative follow-up. Based on our experience, preoperative embolization may not be necessary for Glasscock type I tumors.

The concept of a disease called ANCA-related vasculitic otitis media (OMAAV: Otitis Media with ANCA Associated Vasculitis) has been proposed as one of the causes of refractory otitis media, and awareness about this disease has been reported to be useful for early diagnosis and treatment of acute otitis media. We diagnosed OMAAV based on histopathological detection of granulomatous lesions and vasculitis lesions in biopsy specimens of the middle ear and inferior turbinate in a patient who had been diagnosed as having acute mastoiditis and been treated by mastoidectomy at another hospital and presented to us with facial nerve paralysis and hypertrophic pachymeningitis. We believe that early intervention will be possible through further improvement of the diagnostic algorithms for intractable otitis media, diagnostic criteria for OMAAV, and promotion of awareness about these disease entities.

We report a case of a wooden foreign body located in the orbit. A 65-year-old man had been followed up after he sustaining injury to his right eye with a piece of bamboo; however, a remnant bamboo chip in his right orbit had failed to be detected. Two months after the accident, he began to have double vision and ocular movement disorder. A tumor shadow was recognized in his right orbit and the shadow became larger in the following CT and MRI, we planned surgery for accurate diagnosis. The endoscopic endonasal approach was chosen, because the tumor was located inferiorly on the internal aspect of the orbit. The examination revealed inflammatory granulation tissue covering a bamboo chip, and was diagnosed as a foreign body granuloma caused by the bamboo foreign body. Postoperative treatment with an oral steroid and tranilast resulted in a reduction of the tumor size and improvement of the patient’s symptoms.

Ocular trauma itself is not a very rare accident, but it is rare for a small foreign body to lodge itself completely within the orbit. Especially, in cases where the foreign body is wooden, it would be difficult to detect until any symptoms like ocular movement disorder or double vision or a change in the imaging findings develop. The approach to an intraorbital tumor would vary depending on the location of the foreign body, and if the object is located inferiorly on the inner aspect of the orbit, endoscopic approach via the paranasal sinuses may serve as a good minimally invasive approach.

Pyogenic spondylitis of the cervical spine is a rare disease and is difficult to diagnose. We report the case of a 77-year-old man who presented with the complaints of occipital neck pain and difficulty in rotating his head. Examination of the throat revealed redness and swelling of the pharyngeal mucosa which led to the suspicion of a retropharyngeal abscess. We performed a trans-oral incision, however, there was no pus, and further examinations, including imaging examinations, revealed the diagnosis of pyogenic spondylitis. In general, swelling of the pharyngeal mucosa is not observed in case of pyogenic spondylitis. Our findings in this patient suggests that pyogenic spondylitis of the cervical spine can cause inflammation of the retropharyngeal space, and consequently, retropharyngeal abscess. For this reason, there is a possibility that posterior pharyngeal abscess without risk factors should be considered as a possibility of spread of inflammation of pyogenic spondylitis.

A clinical study was conducted of 19 patients who had undergone surgical treatment for mediastinal goiter at our department between 2010 and 2016. Thirteen out of the 19 retrosternal goiters were anterior mediastinal, and 6 were posterior mediastinal. In 17 patients with the substernal goiter, the cervical approach was used, while in the remaining two patients, a thoracic approach was required for goiter removal. In regard to the results of histological examination, all the patients were diagnosed as having adenomatous goiter, and only two patients showed evidence of micropapillary adenocarcinoma. The post-operative course was uneventful, with no major morbidities. Permanent recurrent laryngeal nerve injury occurred in two patients, and hypoparathyroidism in 4 patients. The surgery via the cervical approach for substernal goiter removal was safety performed in almost all the patients, without necessity for any extracervical procedure. The thoracic approach may be needed for the goiter removal in some cases of primary goiter.

Laryngeal or pharyngeal necrosis is a severe complication of radiotherapy for laryngeal or hypopharyngeal cancer. We treated a patient who developed hypopharyngeal necrosis developed after concurrent chemoradiotherapy (CCRT) by total pharyngolaryngectomy. A 75-year-old man with hypopharyngeal cancer (cT2N0M0) accompanied by early thoracic esophageal cancer received CCRT for hypopharyngeal cancer, which resulted in complete remission. Three months after the CCRT, endoscopic submucosal dissection (ESD) was performed for early esophageal cancer. Five months after the CCRT (3 months post-ESD), the patient developed severe pharyngeal pain and was diagnosed as having radionecrosis of the hypopharynx with a prevertebral abscess. A tracheotomy and drainage operation was performed and antibiotic therapy was started, which failed to control the hypopharyngeal necrosis. Finally, a total pharyngolaryngectomy and reconstruction with a myocutaneous flap were performed. Hypopharyngeal necrosis may be caused by a minor injury, such as that from ESD, after acceptable dose of radiotherapy in combination with acceptable dose of chemotherapy. Once hypopharyngeal radionecrosis occurs, it progresses irreversibly and becomes uncontrollable, necessitating total pharyngolaryngectomy. Hypopharyngeal radionecrosis may have a serious or fatal outcome, and thus early diagnosis and treatment are recommended.

Recently, the noninvasive encapsulated follicular variant of papillary thyroid carcinoma has been reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) by the WHO in the new World Health Organization classification system for endocrine tumors. We encountered three cases of NIFTP at our hospital. The patients were an 83-year-old woman, 43-year-old woman, and 53-year-old man, and each was treated by lobectomy for suspected malignant thyroid tumor. The tumor was diagnosed by histopathology as a NIFTP in each patient.

NIFTP is characterized by the presence of a complete capsule, clear demarcation from the surrounding thyroid tissue, absence of invasion, a follicular growth pattern, and the nuclear features of papillary carcinoma. The tumor has an extremely low malignant potential, therefore, lobectomy represents adequate treatment and complete thyroidectomy and radioactive iodine therapy should be avoided. One of aims of this reclassification by the WHO is to decrease the rate of overtreatment of these tumors and to reduce the psychological burden to the patients that would arise from a diagnosis of cancer. It is important for physicians to be aware of the new classification of low-malignant thyroid tumors and of the appropriate clinical management of these tumors.

We clinically investigated 299 cases of fresh nasal bone fractures diagnosed using CT scans in our hospital from January 2008 to December 2017. The ages of the patients ranged from 2 to 93 years with an average of 29.4 years. Males and females accounted for 207 and 92, respectively. The causes of the nasal bone fractures were attributed to sports (93 cases), falls (80 cases), blows or injuries (53 cases), violence or fights (40 cases) and traffic accidents (33 cases). Males in their teenage years accounted for the majority of all cases, especially in the sports-related injuries. In these cases, the most common cause was baseball (32 cases), followed by soccer (19 cases), softball (15 cases), basketball (8 cases) and so on. In the cases of traffic accidents, nasal bone fractures were caused by bicycles (18 cases), cars (10 cases), motorcycles (2 cases) and so on. Elderly males and females accounted for high numbers of falls. The external appearance of the nasal bone fractures were divided into 3 types; 171 cases of the displacement type, 96 cases of the depressed type and 32 cases of the mixed type. CT scans revealed nasal septum fractures in 132 cases (44.2%). Complicated facial bone fractures, apart from nasal septum fractures, were found in 35 cases (11.7%, mainly blow-out and maxillary bone fractures). Two hundred and twenty-one cases (73.9%) underwent closed reductions of the nasal bone fracture. Of these 221 cases, 206 cases (93.2%) were treated under general anesthesia and in 131 cases (59.3%), open reduction of the nasal septum fractures was mainly performed.

In the cases of nasal bone fractures combined with nasal septum fractures, open reduction of the nasal septum fractures was helpful for the recovery of the nasal obstruction and nasal deformity.