Practica Oto-Rhino-Laryngologica

Angiogenesis in Head and Neck Cancer

Hiroyuki Mineta

2006 Volume 99 Issue 4 Pages 257-265
Published: April 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.257

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Angiogenesis is a rare event that is tightly controlled under normal physiological conditions, because normal cells secrete only low levels of positive regulators and high levels of negative regulators of angiogenesis.
Angiogenesis plays an important role not only in wound healing but also in cancer development. Recently, the mechanism of cancer progression or metastasis has been shown to be associated with angiogenesis. Vascular endothelial growth factor (VEGF) has been identified as one of the factors that increases permeability and endothelial cell proliferation. We previously reported VEGF expresstion was high in 43% of head and neck squamous cell carcinomas (HNSCCs), and high VEGF expression was significantly correlated with lymph node spread. Furthermore, prognosis was significantly worse in patients with high expression compared to that in those with low expression. Endostatin which is isolated as an endogenous angiogenic inhibitor was overexpressed in 37%. Endostatin expression correlated with tumor size, p53 expression and Ki-67 expression. Such angiogenic inhibitors may be available for cancer treatment.

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A Case of Non-functioning Parathyroid Carcinoma

H. Kitano, [in Japanese]

2006 Volume 99 Issue 4 Pages 266-267
Published: April 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.266

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The Effect of Vestibular Stimulation on Orientation of Sound Lateralization

Rika Otake, Akinori Kashio, Mitsuya Suzuki

2006 Volume 99 Issue 4 Pages 269-274
Published: April 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.269

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Using dichotic sound, the effect of vestibular stimulation on the orientation of sound lateralization was investigated in 13 subjects. The interaural time difference (ITD) discrimination test was performed in a dark room while caloric nystagmus was induced by iced water irrigated into the external auditory canal. The amplitudes for the ITD discrimination tests after caloric stimulation (experimental group) were significantly greater than those before caloric stimulation (control group). During caloric stimulation, all subjects reported that their perceptual body axes shifted toward the slow phase side of nystagmus, and the median line of amplitude for the ITD discrimination test shifted to the slow phase side of the nystagmus. In contrast, when subjects were gazing a visual target fixed straight ahead of subjects, there was no significant difference in the amplitudes or the median line shift of amplitude was observed between the control and experimental groups. The current study suggests that sound lateralization sensitivity during ITD discrimination may be altered by vestibular stimulation.

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Cochlear Implantation in a Patient with Takayasu's Arteritis

Mitsuhiro Aoki, Yoichi Yokota, Kenichi Ando, Masayuki Asai, Keisuke Mi ...

2006 Volume 99 Issue 4 Pages 275-278
Published: April 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.275

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Patients with Takayasu's arteritis (TA) rarely suffer sensorineural hearing loss (SNHL), which can be comparatively restored by corticosteroid therapy. We report a 65-year-old woman with aortitis with arch vessel involvement and bilateral severe SNHL. Although her profound deafness failed to improve with corticosteroids, cochlear implantation improved her hearing loss without postoperative problems. Her postoperative open-set syllable recognition without lip reading after cochlear implantation was 90%. When medical treatment fails to improve bilateral severe hearing loss without benefit from hearing aids in TA patients, cochlear implantation is indicated.

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Efficacy of Auto-transfusion for Nasopharyngeal Angiofibroma: Two Case Reports

Shinpei Kada, Masahiko Hayashi, Morimasa Kitamura, Kazuhisa Yuki

2006 Volume 99 Issue 4 Pages 279-284
Published: April 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.279

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Nasopharyngeal angiofibroma is a benign and highly vascular tumor common in adolescent males. We report two cases of nasopharyngeal angiofibroma. One case was a 17-year-old male, and the other case was a 27-year-old male. One case complained of left nasal obstruction and recurrent epistaxis of the left nostril, and the other case complained only one epistaxis of right nostril.
We found large masses filling the choanal cavity and CT scans and MRI images revealed that in both cases, tumors filled the nasopharyngeal cavity, the in one case the tumor extended into the left sphenopalatine fossa, and in the other case it extended into the right sphenoid sinus. Both cases underwent preoperative embolization with gelform one day before surgery and auto-transfusion was performed. In both cases, complete tumor removal was accomplished with a blood loss of 1300 and 1500ml. Nasopharyngeal angiofibroma is such a highly vascular tumor that we shoud perform auto-transfusion in spite of preoperative embolization.

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Skull Base Surgery of a Rhabdomyosarcoma in the Ethmoid Sinus

Hidetaka Shirouzu, Akiteru Maeda, Hirohito Umeno, Tadashi Nakashima

2006 Volume 99 Issue 4 Pages 285-290
Published: April 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.285

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Rhabdomyosarcoma occurs predominantly in infants and children, but less frequently in adolescents and young adults. We experienced a 33-year-old female with a rhabdomyosarcoma which originated in the ethmoid sinus and extended into the brain. After systemic neoadjuvant chemotherapy (ACT-D, VCR, CPA), an extended anterior skull base surgery with reconstruction was successfully performed. Additional radiotherapy of 41.2 Gy and chemotherapy (VP-16, IFM, CDDP, VCR, CPA, THP) were also carried out. The postoperative course of the patient was uneventful for one year. However, there has been recurrence in the oropharynx, cervical lymph node, anterior mediastinum and the brain. For each recurrence, operation, chemotherapy, radiotherapy, and cyberknife were performed, and the patient is presently doing well without any obvious recurrent tumor. Additional immunochemotherapy is now underway.

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A Case of External Dental Fistula

The Protection of the Mandibular Branch of the Facial Nerve

Masaaki Higashino, Ryo Kawata, Ayumi Hayashi, Tetsuya Terada, Hiroshi ...

2006 Volume 99 Issue 4 Pages 291-294
Published: April 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.291

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We experienced a case of external dental fistula that opened from a mandibular lesion. The patient was a 21-years-old woman. She noticed the tumor in a mandibular lesion she had had on her right side since childhood, and left it. It continued to increase in size and became more painful so she sought treatment. She was given treatment of antibiotics, but this was ineffective, so an operation of partial excision was done. However, pus continued to flow from the fistula of the mandibular lesion. So she was referred to our department. The pus disappeared by antibiotic treatment but the fistula remained. We decided to operate. Generally, to protect the facial nerve and avoid paralysis of it while operating on a tumor of the mandibular lesion, method not it confirming the nerve is more safe than the method to confirm it. But, with this case, we had to confirm the nerve to protect it, because the fistula existed near the running of the nerve. It is better to confirm the facial nerve at the top of the inner side of the lower jaw corner, because there is a part before the shared branch. The running and the branch of the nerve vary, so it is difficult to confirm the facial nerve before the operation. So, we need to thoroughly explain to the patient about the possibility of facial nerve damage before the operation of mandibular lesion, especially if inflammation is involved, as in this case.

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Usefulness of Salve for Pressure Ulcers in a Case of Pharyngocutaneous Fistula Following Total Laryngectomy

Kazuhiro Ogi, Norihiko Narita, Yoshimasa Imoto, Yumi Ito, Hideaki Tsuz ...

2006 Volume 99 Issue 4 Pages 295-298
Published: April 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.295

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Pharyngocutaneous fistula is one of the most critical complications of total laryngectomy. When we see this complication, we have to drain saliva out of the fistula. One month later, the fistula is closed by surgery using a hinge flap and deltopectoral flap. In this paper we reported a patient, whose pharyngocutaneous fistula could be closed by conservative therapy only. Bucladesine sodium, that is used for pressure ulcers, was administrated for the treatment. We think this conservative therapy is useful for the treatment of cases of pharyngocutaneous fistula whereby it is difficult to re-operate because of a poor general state.

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Clinical Review of Laryngeal Cancer

a Series of 626 Cases over the Past 33 Years

Meijin Nakayama, Makito Okamoto, Masahiko Takeda, Syunsuke Miyamoto, Y ...

2006 Volume 99 Issue 4 Pages 299-304
Published: April 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.299

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Treatment modalities of laryngeal cancer have enormously evolved since 1971, the year our university hospital opened. In the 1970's, there were only two treatment options: radiation therapy and surgery. Chemotherapy and laser surgery were employed in the 1980's and organ preservation surgery, supracricoid laryngectomy with cricohyoidoepiglottopexy and cricohyoidopexy (SCL-CHEP and CHP), were introduced in 1997 at Kitasato University Hospital. This paper reviewed the clinical data of 626 patients over the past 33 years. Special interest was focused on the survival rates and ratio of laryngeal preservation over different treatment eras (early stage 1971-1982, mid stage 1983-1993, recent stage 1994-2004).
Five-year crude and cause-specific survival rates for all laryngeal cancer patients were 76% and 85% respectively.
Five-year cause-specific survival rates for 456 patients with glottic cancers were 91% (early stage), 91% (mid stage), and 89% (recent stage). Survival rate was already at the upper level and there was no marked difference among the different eras. Introduction of chemotherapy did not significantly contribute to improvement of the survival rate.
The ratios of laryngeal preservation were 68%, 81%, 83% for early, mid, and recent stages, respectively. Chemoradiotherapy, introduced after the mid stage, has played a major role in laryngeal preservation.
Organ preservation surgery, SCL-CHEP and SCL-CHP, played a major role in the recent stage for treating cases of radiation failure or selected cases of advanced diseases.
UICC staging for laryngeal cancer was revised in 2002. Special attention must be paid to classifying the T3 stage based on the clinical features and CT images in order to choose the proper treatment modalities.

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Two Cases of Metastases to the Larynx

Ibuki Hayashi, Michiro Kawakami, Syuji Nishikawa, Katsuhiro Yoshimura, ...

2006 Volume 99 Issue 4 Pages 305-311
Published: April 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.305

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Two cases of metastases to the larynx from distant primaries are reported: metastasis to the thyroid cartilage due to prostatic cancer, and metastasis to the ary-epiglottic fold due to cutaneous melanoma. Laryngeal metastases are uncommon, so it is difficult to diagnose a laryngeal tumor as metastasis to the larynx. Patients with laryngeal metastasis are in the terminal stage, because multiple metastases are present extensively. Therefore, palliative therapies are selected in the patients of laryngeal metastases, as experienced with our own cases.

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A Case of Atypical Carcinoid Tumor of the Larynx

Nobuhiro Uwa, Kunitoshi Yoshino, Takashi Fujii, Hirokazu Uemura, Homar ...

2006 Volume 99 Issue 4 Pages 313-318
Published: April 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.313

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An atypical carcinoid tumor of the larynx was diagnosed in a 59-year-old man. The tumor was located on the right arytenoids and no neck metastases were found. The tumor was diagnosed as a laryngeal poorly differentiated carcinoma in the first medical examination, and it was resolved with radiotherapy of 60Gy. However, the tumor recurred approximately eight years later, and was diagnosed as an atypical carcinoid tumor through total laryngectomy. At 2 years and 9 months, and 5 years and 3 months after the total laryngectomy, local recurrence of the tumor developed, and laryngectomy was conducted. On the basis of this case and of other similar cases, this report will explain laryngeal atypical carcinoid, giving bibliographic consideration.

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Treatment Modality for Stages I/II Malignant Lymphomas of the Head and Neck

Shigenobu Nomiya, Susumu Tominaga, Toru Watanabe, Souichiro Fujii, Aki ...

2006 Volume 99 Issue 4 Pages 319-325
Published: April 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.319

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Between 1988 and 2003, 59 patients with clinical stage I and II malignant lymphoma of the head and neck were treated. Thirty-three patients had stage I and 26 had stage II disease. There were 55 cases of non-Hodgkin's lymphoma. Of these, there were 36 diffuse large B-cell lymphomas, 7 MALT lymphomas, 5 follicular lymphomas and 7 others.
Four patients received chemotherapy, 9 underwent radiation therapy only and 45 had combined modality treatment (CMT). Fifty-seven patients showed CR after the first therapy. Six patients developed recurrence. The 5-year over-all survival rate of the patients with non-Hodgkin's lymphoma was 93.1% and the 5-year disease-free survival was 79%. Prognositc factors were analyzed retrospectively. On univariate analysis, unfavorable prognosis was associated with age, stage and IPI.

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Evaluation of FDG-PET in the Diagnosis of Head and Neck Tumor

Yoko Takane, Kikuo Sakamoto, Yoshimi Miyajima, Hirohito Umeno, Tadashi ...

2006 Volume 99 Issue 4 Pages 327-332
Published: April 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.327

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We investigated the diagnostic value of FDG-PET for malignant head and neck tumor in 179 patients who received FDG-PET at our hospital in 2004. In the analyses, we compared diagnoses of the primary lesion, nodal and distant metastases obtained from FDG-PET with those from echogram, CT, MRI and scintigram.. The sensitivity, specificity, and and accuracy were 94% (92/98), 86% (70/81), and 91% (162/179), respectively. The present analyses indicate that FDG-PET diagnoses of the primary tumor, nodal and distant metastases can be accurately achieved in head and neck tumors. Furthermore, as FDG-PET conducts systemic tomographing, it is useful not only for the diagnosis of distant metastasis but also for the reccurence cancer. However, careful attention should be paid to false positive findings on FDG-PET by such as reactive lymph nodes or inflammation after radiotherapy. In order to acquire better diagnostic results, combined examination by FDG-PET, CT and MRI are highly recommended.

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Clinical Analysis of Multiple Primary Cancers in Patients with Head and Neck Cancer

Satoshi Sonoda, Mikio Suzuki, Satoshi Seno, Hironori Sakurai, Masakazu ...

2006 Volume 99 Issue 4 Pages 333-338
Published: April 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.333

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Recent reports have indicated that the incidence of multiple primary cancers in patients with head and neck cancer has increased. We investigated 25 clinical characteristics of multiple primary cancers in 210 patients who received their initial treatment against their head and neck cancer at our clinic between 1995 and 2002. Clinical stages of these 210 patients were; stage I, 34 cases; stage II, 21; stage III, 29; stage IV, 108; and unknown, 18. Of these 210 patients, 25 patients with hypopharyngeal, laryngeal or mesopharyngeal carcinoma, had multiple primary cancers were diagnosed simultaneously (68%) or metachronously (32%). The multiple primary cancers were frequently observed in the thyroid gland, mesopharynx, larynx, hypopharynx, esophagus and stomach. There were no significant relationships between multiple primary cancers and smoking or drinking habits. It is important to diagnose multiple primary cancers in patients with head and neck cancers as soon as possible.

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Diagnosis and Treatment of Carotid Body Tumors

M. Suzuki, [in Japanese]

2006 Volume 99 Issue 4 Pages 340-341
Published: April 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.340

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