Functional assessment of the elderly (Geriatric Assessment: GA) is important in determining treatment policies for elderly patients with cancer and is being introduced into cancer treatment. Simple screening tools such as the G8 are available and these tools have been reported to be useful in predicting prognosis and adverse events. Currently, the Jikei University Kashiwa Hospital performs its own screening for all elderly inpatients. Using this approach, we examined postoperative outcomes in 42 elderly patients (age 65 years or older) with head and neck cancer who had undergone reconstructive surgery or total laryngectomy. The 42 patients included 38 males and 4 females, and had a median age of 78 years. The screening tools used were a forgetfulness checklist, a nutritional disorder screening sheet, a dysphagia assessment sheet, and a discharge support screening sheet. Associations of screening data with postoperative delirium, complications, final dietary status, and non-home/discharge home were analyzed retrospectively. The results showed that a higher score on the forgetfulness checklist indicated that the patient was more likely to develop postoperative delirium (p = 0.018). This finding will support future development of screening tools with further enhancement of utility.

A 48-year-old man presented with diplopia, conjunctival hyperemia, and ocular protrusion over the previous 4 months. MRI showed a 27 mm mass outside the infraorbital muscular cone. T1-weighted images showed a high signal intensity, T2-weighted images showed a low signal intensity, and fat-suppressed T2-weighted images showed a partially low signal intensity, thus suggesting a dermoid cyst. Dermoid cysts are masses in which skin-like tissue strays outside the body surface and forms a cyst due to an abnormality in the developmental process. Dermoid cysts can occur anywhere in the body; however, malignant transformation is rare. Complete resection is necessary to prevent acute inflammation and a recurrence. Preoperatively, the mass became infected and a high degree of adhesion was anticipated with an external incision. Considering the visual field and operability, we chose a nasal endoscopic excision and resected the mass as a single lump using an endoscopic tri-port approach. In addition, the inner wall of the orbit was rigidly reconstructed using autologous nasal septal cartilage and the nasal mucosa was sutured and reconstructed. In this case, the dermoid cyst in the orbit was completely removed using the endoscopic tri-port approach and the nasal cavity and orbital morphology were successfully preserved. We herein report our approach for the treatment of intraorbital tumors, including a review of the pertinent literature.

Langerhans Cell Sarcoma (LCS) is a rare malignant disease originating from Langerhans cells, and owing to the limited number of reports, there is still no established treatment method. We encountered a case in which pembrolizumab was administered to a patient with LCS with a CPS score >20, which was effective; thus, we report this case. The patient was an 82-year-old male who visited our department with a chief complaint of a 7-cm mass in the left neck area. Contrast-enhanced computed tomography (CT) showed bilateral cervical lymph node and thoracic vertebral metastases. A cervical lymph node biopsy was performed to diagnose LCS. Considering the patient’s medical history and preferences, treatment with pembrolizumab was initiated, which resulted in lesion reduction. However, eight months after the start of treatment, the patient developed thrombocytopenia, leading to the suspension of pembrolizumab. The platelet count recovered at one month after stopping the medication, and pembrolizumab administration was resumed. At the nine-month follow-up, exacerbation of chronic obstructive pulmonary disease (COPD) was observed. The administration of pembrolizumab was stopped, and the patient was hospitalized for treatment. However, the patient died due to acute exacerbation of COPD, acute respiratory distress syndrome, and diffuse alveolar hemorrhaging. Although the direct cause of death was an acute exacerbation of COPD, this was a case in which the reduction effect of pembrolizumab on LCS was confirmed.

We retrospectively investigated 148 patients with thyroid cancer who were surgically treated for curative purposes at our hospital between January 2015 and December 2022. The median age of the patients was 61 years old, 98 were female, and papillary carcinoma was the most common histological type (139 cases). The clinical stage was stage I/II/III/IVA/IVB in 75/23/13/2/6 patients. 29 cases had no malignancy before surgery. The median observation period was 37 months. The 5-year overall survival (OS) rate was 92.3%. In 28 cases, more than 1 year had lapsed from the initial diagnosis to the start of treatment. There were no significant differences in the sex, histological type, clinical stage, pathological stage, five-year overall survival rate, or presence of recurrent nerve palsy before or after surgery between patients in whom more than one year had passed from the initial diagnosis to the start of treatment. The reasons for a delay in treatment included the absence of subjective symptoms, a patient’s unwillingness to undergo fine-needle aspiration cytology or early treatment, the coexistence of other malignant diseases, and psychiatric disorders. In this study, there was no notable worsening of the treatment outcome even when over one year had elapsed before starting treatment. However, because a long-term prognostic evaluation is necessary for patients with slowly progressing thyroid cancer, it is essential to explain the limitations of a preoperative diagnosis and the risk of metastasis to patients with the clinical characteristics described above and to obtain their full understanding. Each patient should be fully informed of the limitations associated with the preoperative diagnosis and the risk of metastasis.

Anti-transcription intermediary factor 1 gamma (anti-TIF1-γ) antibody-positive dermatomyositis is a subtype of dermatomyositis frequently associated with malignancies. Although cases involving lung and gastric cancers have been widely reported, concurrence with oropharyngeal cancer is exceedingly rare. We herein report two cases of anti-TIF1-γ antibody-positive dermatomyositis associated with oropharyngeal cancer.

Case 1 involved a 58-year-old man who presented with facial erythema and swelling in the right neck. The patient was diagnosed with p16-positive oropharyngeal cancer and anti-TIF1-γ antibody-positive dermatomyositis. Prednisolone (PSL) was administered to manage the dermatomyositis, while radiation therapy was initiated for the oropharyngeal cancer. Despite treatment, cervical and pulmonary metastases occurred, and the patient succumbed to the disease 16 months after the initiation of treatment.

Case 2 involved a 61-year-old man who presented with pruritus of the trunk, and who was subsequently diagnosed with anti-TIF1-γ antibody-positive dermatomyositis. Screening for malignancy identified a p16-negative oropharyngeal cancer. PSL was administered for the dermatomyositis, followed by induction chemotherapy and radiotherapy for the oropharyngeal cancer. Unfortunately, cervical and pulmonary metastases developed, leading to disease-specific mortality 8 months after the initiation of treatment.

In these cases, no significant correlation was observed between fluctuations in anti-TIF1-γ antibody levels and the recurrence or metastasis of oropharyngeal cancer. Additionally, in managing head and neck cancers associated with anti-TIF1-γ antibody-positive dermatomyositis, careful consideration of treatment prioritization is essential along with an assessment of the potential risk of treatment-related dysphagia on a case-by-case basis.