98 research outputs found
Role of narrow-band imaging in detection of head and neck unknown primary squamous cell carcinoma
No full textObjectives/Hypothesis: There is no general consensus on what kind of examination to include in an optimal detection strategy for head and neck squamous cell carcinomas of unknown primary (SCCUPs). This study investigates the role of narrow-band imaging (NBI) in their identification.Study Design: Case series.Methods: Twenty-nine consecutive patients affected by SCCUPs were referred at two academic institutions. Selection criteria were: 1) lymph node cytology positive for squamous cell carcinoma (SCC); 2) no evidence of any primary at white light (WL); 3) negative contrast-enhanced computed tomography (CT) and/or magnetic resonance imaging, and positron emission tomography-CT; and 4) no contraindication to general anesthesia. Each patient underwent office-based NBI panendoscopy. If a suspicious area was identified, a biopsy was performed for histological confirmation. When no suspicious area was detected in the office, patients underwent WL and NBI under general anesthesia. If this examination was still negative, bilateral tonsillectomy and base of the tongue (BOT) mucosectomy were performed.Results: Office-based NBI identified 10 SCCs (34.5%), one in the nasopharynx, three in the tonsil, four in the BOT, and two in the supraglottis. In only one (3.5%) NBI-negative patient was a primary found in the BOT. In one (3.5%) we found an NBI suspicious area during panendoscopy under general anesthesia, but histology did not confirm this finding after BOT mucosectomy. Seventeen (58.6%) patients remained as having true SCCUPs. NBI sensitivity, specificity, positive, negative predictive values, and accuracy were 91%, 95%, 91%, 95%, and 90%, respectively.Conclusions: In the present study, office-based NBI increased the detection rate of head and neck SCCUPs by 34.5% and should be strongly recommended as an adjunctive tool in their diagnostic workup
Microsurgical procedures during COVID‐19 pandemic: the VITOM® 3D‐HD exoscopic system as alternative to the operating microscope to properly use personal protective equipment (PPE)
No full textRole of p53 mutations on survival after pancreatoduodenectomy for ductal adenocarcinoma of the pancreatic head.
No full textBACKGROUND/AIMS - To determine the role of p53 mutations on survival after pancreatoduodenectomy for adenocarcinoma of the pancreatic head.
METHODOLOGY - Resected specimens were assessed for expression of wild-type or mutated p53. Survival of p53-negative and- positive patients was investigated, and differences noted at 0.05 level.
RESULTS - Expression of wild-type p53 is associated with a significant improvement in overall survival, especially for patients without nodal metastases.
CONCLUSIONS - Preoperative p53 determination could enable further patient selection for aggressive surgery
Collision tumor composed of an inflammatory myofibroblastic tumor and adenocarcinoma of the colon: A rare entity
No full textThis report presents the case of an 83-year old man with a collision tumor consisting of an inflammatory myofibroblastic tumor (IMT) and adenocarcinoma of the left colon. As the clinical and radiologic features of IMT are non-specific, only the accurate histopathological examination from the left hemicolectomy specimen was diagnostic. Although the prognosis of a colorectal IMT seemed more favorable than in other sites, four months after surgery the patient developed a tumor relapse. Therefore, malignant behavior of IMT could not be totally excluded. Recent studies have demonstrated that a chromosomal rearrangement involving 2p23, the site of the anaplastic lymphoma kinase (ALK) gene, is present in a subset of these tumors. In our patient, tumor cells did not present ALK-1 perinuclear positivity and it could have indicated a less favorable prognosis. The collision of these different entities is extremely rare and this is the first case reported in literature. Further cases of collision tumors with clinical information including their treatment and prognosis are needed
T3 LARYNGEAL SCC: A RETROSPECTIVE ANALYSIS OF DIFFERENT THERAPEUTIC APPROACHES IN POLICLINICO SAN MARTINO, GENOVA
No full textEndoscopic Preoperative Assessment, Classification of Stenosis, Decision-Making
No full textPediatric Laryngo-Tracheal Stenosis (LTS) comprises different conditions that require precise preoperative assessment and classification. According to the guidelines, the optimal diagnostic work-up of LTS patients relies both on a comprehensive anamnesis and on endoscopic and radiological assessments. All the causes of LTS result in an impairment in airflow, mucociliary clearance, phonation, and sometimes in swallowing disorders. The main goals of treatment are to maintain an adequate respiratory space and restore the Upper Aero-Digestive Tract (UADT) physiology. The first step when dealing with LTS patients is to properly assess their medical history. The main causes of pediatric LTS can be divided into two groups, i.e., congenital and acquired. The most common causes of congenital LTS are: laryngomalacia (60%), vocal fold paralysis (15–20%), subglottic stenosis (SGS) (10–15%), laryngeal webs and atresia (5%), subglottic hemangioma (1.5–3%), and others. On the other hand, 90% of acquired pediatric LTS cases are subsequent to post-intubation injuries. Other less frequent causes are: iatrogenic complications from endoscopic laryngeal interventions, benign tumors, caustic or thermal injuries, external blunt force injury or trauma, chronic inflammatory disorders, or idiopathic causes. Diagnostic work-up consists in a step-by-step investigation: awake and asleep transnasal fiberoptic laryngoscopy (TNFL), direct laryngoscopy with 0° and angled telescopes to investigate the type of stenosis (arytenoid mobility, craniocaudal extension, involved anatomical sites, and active or mature scar tissue), and broncho-esophagoscopy to rule out associated mediastinal malformations. To date there are several available classifications for each of the involved sites: Cohen's classification for anterior glottic stenosis, Bogdasarian's for posterior glottic stenosis (PGS) and Myer-Cotton's for subglottic stenosis, even though others are used in daily practice (Lano-Netterville, FLECS, etc.). The European Laryngological Society recently proposed a new classification which is applicable in all LTS cases. In this chapter we deal with preoperative assessment and staging, reviewing the most relevant classifications applicable in patients affected by LTS, conditio sine qua non in order to tailor the best treatment modality to each subject. We'll also detail the comprehensive radiological, endoscopic and functional assessment for the correct use of each staging classification
D1 versus D2 pancreatoduodenectomy in surgical therapy of pancreatic head cancer.
No full textBACKGROUND/AIMS - The aim of this study was to evaluate the influence of standard pancreatoduodenectomy versus pancreatoduodenectomy with extended lymphadenectomy and the role of adjuvant therapy on survival in patients with ductal adenocarcinoma of the pancreatic head. In addition the problems related to resection are discussed.
METHODOLOGY - A total number of 124 pts operated on between 1985 and 1999 were divided into three groups according to our different strategies. Standard resection (D1) was performed on 48 patients (group A), extended resection (D2) on 45 patients (group B) and combined treatment (extended resection plus adjuvant therapy) on 31 patients. The outcome of these three groups was compared with regard to postoperative morbidity and survival.
RESULTS - There was no significant difference in terms of survival between group A and B, while adjuvant therapy (group C), achieved statistical significance as factor influencing survival, together with tumor stage.
CONCLUSIONS - Our data suggest that no further improvement can be obtained on long-term survival by extended retroperitoneal dissection while chemoradiotherapy showed a doubling of median survival
Microsurgical procedures during COVID-19 pandemic: the VITOM® 3D-HD exoscopic system as alternative to the operating microscope to properly use personal protective equipment (PPE)
No full textPurpose: In the field of microsurgery, the use of conventional operating microscope, adopted in several disciplines, is not suitable with the full adoption of appropriate personal protective equipment (PPE), as goggles and face shields, needing the eyes to be at close contact with oculars. Methods: Herein we present an exoscopic surgical setup, implemented for transoral laser microsurgery, by the VITOM® 3D-HD system. Results: Our proposed exoscopic setting overcomes safety limits of the conventional operating microscope, being suitable with the adoption of full PPE necessary facing with suspected or confirmed positive SARS-CoV-2 patients needing urgent microsurgical procedures. Conclusion: The use of protocols to reduce the virus spreading is mandatory to safely treat also patients potentially SARS-CoV-2 infected. The described surgical setup is advisable to manage urgent microsurgical procedures along the duration of the COVID-19 pandemic, being applicable PPE necessary to treat potentially or confirmed SARS-CoV-2-infected patients
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