An inflammatory myofibroblastic tumor, previously known as an inflammatory pseudotumor, is an uncommon neoplasm. This tumor, which has characteristic morphologic and immunohistochemical features, is mostly seen in the lung. We present a rare case of an inflammatory myofibroblastic pseudotumor of the parotid gland. A 45-year-old woman presented with a 4-month history of a swelling in her right parotid region. A partial parotidectomy with preservation of the facial nerve branches was performed. The incidence of inflammatory myofibroblastic tumor in the parotid gland is low, and local resection is currently the best treatment. A prolonged postoperative follow-up period is necessary for patients with inflammatory myofibroblastic tumor. Inflammatory myofibroblastic tumor of the parotid gland is discussed with a brief literature review.
Purpose: To evaluate the effect of strabismus surgery on dynamic balance by using computerized dynamic posturography in children with strabismus. Methods: This study was designed as a prospective observational study. Hearing tests and complete ophthalmological examinations were performed for all subjects. Patients with moderate and severe amblyopia, hearing loss at any level, and/or any suspicion of balance impairment were excluded from the study. Postural stability evaluation was performed by computerized dynamic posturography including sensory organization test, adaptation test, and rhythmic weight shift test. All tests were applied preoperatively and in the postoperative 1st and 3rd months, respectively. Results: Fifteen female and twelve male pre-adolescents aged between 7 and 12 (9.67 ± 1.62 years) were included in the current study. In the sensory organization test, the preoperative visual ratio percentages (73.19 ± 14.95%) improved statistically significantly at the postoperative 1st and 3rd months (78.59 ± 16.21% and 81.44 ± 14.18; p = .026, p = .021, respectively). The preoperative toes up (110.66 ± 33,48) and toes down (81.46 ± 28.36) adaptation tests improved statistically significantly in the postoperative 3rd month (88.74 ± 20.94 and 63.36 ± 16.03; p < .001, p = .001, respectively). In the Rhythmic Weight Shift test, the postoperative 3rd-month directional control (forward-backward) value (74.25 ± 11.51%) was statistically significantly higher compared to the preoperative directional control (forward-backward) value (67.76 ± 11.38%) (p = .011). The postoperative 3rd-month directional control (forward-backward) value (74.25 ± 11.51%) was statistically significantly higher compared to the postoperative 1st-month directional control (forward-backward) value (68.43 ± 14.00%) (p = .028). Conclusion: Surgical treatment resulted in an improvement in the maintenance of dynamic balance in children with strabismus.
Abstract Objective: To present clinical experience and surgical outcomes of end-to-end anastomosis in the management of laryngotracheal stenosis and tracheal defects following invasive thyroid malignancy resection. Methods: A retrospective analysis was performed of 14 patients with laryngotracheal stenosis and tracheal invasive thyroid malignancy. All patients underwent tracheal or cricotracheal resection and primary end-to-end anastomosis. Results: Length of stenosis was 1.7–4 cm. Stenosis was classified as Myer and Cotton grade II in 4 patients, grade III in 6 and grade IV in 2. Surgical procedures included tracheotracheal end-to-end anastomosis ( n = 4), cricotracheal anastomosis ( n = 2) and thyrotracheal anastomosis ( n = 6). Patients with invasive thyroid malignancy underwent segmental resection of the involved segment with tumour-free margins, and tracheal or cricotracheal end-to-end anastomosis. Successful decannulation was achieved in 13 patients (93 per cent). Post-operative complications were: wound infection ( n = 1), subcutaneous emphysema ( n = 1), temporary unilateral vocal fold palsy ( n = 1), granulation tissue development ( n = 1), and restenosis ( n = 2). Conclusion: End-to-end anastomosis can be used safely and successfully in the management of advanced laryngotracheal stenosis and wide laryngotracheal defects. Greater success can be achieved using previously described surgical rules and laryngotracheal release manoeuvres.
Beckwith-Wiedemann syndrome is a congenital syndrome with some anomaly in overgrowth. Most common manifestations are exomphalos, macroglossia, gigantism, and visceromegaly. Overgrowth in tongue's size caused clinical symptoms such as dysphagia, speech disorder, strong in chewing, upper-airway obstruction, and psychological problems with appearance. Cold surgical techniques are commonly used in treating macroglossia. We presented tongue reduction with laser and its early result on a child with Beckwith-Wiedemann syndrome for macroglossia.
Different types of genetic and epigenetic changes are associated with HNSCC. The molecular mechanisms of HNSCC carcinogenesis are still undergoing intensive investigation. WWOX gene expression is altered in many cancers and in a recent work reduced WWOX expression has been associated with miR-134 expression in HNSCC. In this study we investigated the WWOX messenger RNA expression levels in association with the promoter methylation of the WWOX gene and miR-134 expression levels in 80 HNSCC tumor and non-cancerous tissue samples. Our results show that WWOX expression is down-regulated especially in advanced-stage tumor samples or in tumors with SCC. This down-regulation was associated with methylation of the WWOX promoter region but not with miR-134 expression. There was an inverse correlation between the expression level and promoter methylation. We also analyzed whole exons and exon/intron boundries of the WWOX gene by direct sequencing. In our study group we observed 10 different alterations in the coding sequences and 18 different alterations in the non-coding sequences of the WWOX gene in HNSCC tumor samples. These results indicate that the WWOX gene can be functionally inactivated by promoter methylation, epigenetically or by mutations affecting the sequences coding for the enzymatic domain of the gene, functionally. We conclude that inactivation of WWOX gene contributes to the progression of HNSCC.
Abstract Cancers of the head and neck comprise a diverse group of tumors with squamous cell carcinoma (HNSCC) as the predominant form. Epidemiological data suggest that the etiology and pathogenesis of HNSCC are influenced by environmental and life-style-related factors, such as tobacco use, dietery factors and exposure to toxic substances. However, only a small fraction of tobacco users develop HNSCC suggesting that genetic factors may play a key role in the development of HNSCC. Therefore, genetic abnormalities in HNSCC have been studied extensively. The genetic changes associated with HNSCC affect a variety of different pathways and vary from point mutations to chromosomal aberrations which impair the function or expression of both oncogenes and tumor suppressor genes. Liver Kinase B1 (LKB1) is one of the recently identified tumor suppressor genes which is mutated in Peutz-Jeghers syndrome. It codes for a well-conserved serine-threonine kinase and regulates multiple biological processes and signaling pathways including the control of cell-cycle arrest, p53-mediated apoptosis, Wnt signaling, TGF-ß-signaling, ras-induced cell transformation and energy metabolism. Somatic LKB1 alterations have been reported in a variety of carcinomas. Different studies have shown that the LKB1 protein can be inactivated by a wide spectrum of mutations that are scattered all over the protein or by promoter methylation in different types of cancer. Recently, it has been reported that LKB1 is transcriptionally regulated by binding of the FOXO3 protein to the cis-regulatory elements in the promoter region of the LKB1 gene. The FOXO proteins can affect a wide range of biological processes such as cell cycle, stress resistance, development, reproduction, and ageing. In this study we investigated the effect of FOXO3 in the silencing of LKB1 expression in head and neck cancer. For this purpose LKB1 and FOXO3 expression levels and methylation status of the LKB1 promoter were analyzed by real-time PCR and methylation-specific PCR in LKB1-mutant and wild-type HNC tumor samples and matched normal tissue from 49 patients with HNSCC. The average decrease in FOXO3 mRNA expression in the tumor samples was 40%. Downregulation of LKB1 mRNA expression was also observed in a similar fraction of the patients (44%). However, the association was not statistically significant. We observed partial promoter methylation only in 3 of the tumor samples. LKB1 mRNA was downregulated particularly in grade IV tumors indicating that alterations of LKB1 take place during the later stages of HNC carcinogenesis. Our results suggest that LKB1 downregulation is not the result of promoter methylation or modulation by FOXO3. Therefore, the exact understanding of the regulation of LKB1 and FOXO3 in HNSCC requires further studies. Citation Format: Nejat Dalay, Seda Ekizoglu, Emin Karaman, Demet Akdeniz, Ahmet Ozaydin, Nur Buyru. LKB1 downregulation in head and neck cancer is independent of promoter methylation or FOXO3 expression. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 5382. doi:10.1158/1538-7445.AM2013-5382
Paragangliomas of the head and neck are highly vascular lesions originating from paraganglionic tissue located at the carotid bifurcation (carotid body tumors), along the vagus nerve (vagal paragangliomas), and in the jugular fossa and tympanic cavity (jugulotympanic paragangliomas) and should be considered in the evaluation of all lateral neck masses. The aim of this study is to review an institutional experience in the management of these tumors.Twenty-six patients with 27 paragangliomas were treated in our institution during a period of 7 years (2000-2007). There were 15 women (57.6%) and 11 men (42.4%) with a mean age of 33.5 years. A painless lateral neck mass was the main finding in 16 patients (61.5%). There was no evidence of a functional tumor. Carotid angiography was performed on all of our patients (100%) to define the vascular anatomy of the lesion. Twenty-two paragangliomas (of the 25 operated paragangliomas; 88%) underwent selective embolization of the major feeding arteries. We performed surgery on 24 (92.3%) patients. Two patients were treated with radiotherapy.Most lesions were paragangliomas of the carotid bifurcation (n = 14 [51.8%]), whereas 6 patients were diagnosed with jugular (22.2%), 1 with a vagal (3.7%), 1 with a tympanic paraganglioma (3.7%), 2 with jugulotympanic paraganglioma (7.4%), and 1 with laryngeal paraganglioma (3.7%). In 1 patient (3.8%), bilateral paragangliomas in the carotid bifurcation were detected. There was an evidence of malignancy in all cases (3.8%). Preoperative embolization has proven successful in reducing tumor vascularity in approximately 22 (of 25 who accepted surgery; 88%) paraganglioma patients. The common preoperative complication was vascular injury, which occurred in 6 (23%) of 26 patients; the main postoperative complication was transient cranial nerve deficit in 4 (15.3%) of 26 patients; and a permanent Horner syndrome was documented in 2 patients (7.6%). Cerebrospinal fluid leak occurred in 1 patient (3.7%). Postoperatively, stroke was occurred in 1 patient (3.7%). Two patients with jugular paraganglioma were treated with irradiation because of skull base extension with significant symptomatic relief.The primary therapeutic option for paragangliomas is complete excision of tumor with preservation of vital neurovascular structures. Combined therapeutic approach with preoperative selective embolization followed by surgical resection is the safe and the effective method for complete excision of the tumors with a reduced morbidity rate.
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