BACKGROUND Malignant proliferating trichilemmal tumor(MPTT)is an infrequent malignant neoplasm originating from cutaneous appendages,with only a handful of documented cases.This report delineates a unique instance of ...BACKGROUND Malignant proliferating trichilemmal tumor(MPTT)is an infrequent malignant neoplasm originating from cutaneous appendages,with only a handful of documented cases.This report delineates a unique instance of MPTT situated in the neck,accompanied by lymph node metastasis.A comprehensive exposition of its clinical trajectory and imaging manifestation is presented,aiming to enhance comprehension and management of this atypical ailment.CASE SUMMARY Patient concerns:A 79-year-old male presented with a longstanding right neck mass persisting for over six decades,exhibiting recent enlargement over the past year.Diagnoses:Enhanced magnetic resonance imaging of the neck unveiled an elliptical mass on the right neck side,characterized by an ill-defined border and a heterogeneous signal pattern.The mass exhibited subdued signal intensity on T1-weighted imaging(T1WI)and a heterogeneous high signal on T2-weighted imaging(T2WI),interspersed with a lengthy T1 and T2 cystic signal motif.Close anatomical association with the submandibular gland joint was noted,and intravenous gadolinium diethylene triamine pentaacetic acid administration facilitated conspicuous enhancement.Substantial enhancement of the solid segment prompted an initial preoperative diagnosis of malignant nerve sheath tumor.However,post-surgery histopathological and immunohistochemical analysis conclusively confirmed the diagnosis as malignant hyperplastic external hair root sheath tumor.Intervention:Complete excision of the tumor was successfully executed.Outcomes:The patient experienced a favorable postoperative recovery.CONCLUSION Malignant proliferative trichilemmal tumor external hair root sheath tumor is a cystic-solid lesion,appearing as low signal on T1WI images or high signal on T2WI with enhancement of the solid component.Suspicions of malignancy are heightened when the tumor border is indistinct,tissue planes are breached,or when linear or patchy high signals are observed in the subcutaneous tissue on T1 liver acquisition with volume acceleration enhanced images along with intermediate signal on T2WI and restricted diffusion on diffusion-weighted imaging images.Strong consideration for malignancy should arise if there are signs of compromised adjacent tissue relationships or direct invasion evident on imaging.We have incorporated the above-mentioned content into the entire manuscript.展开更多
Oral squamous cell carcinoma （OSCC） has a high incidence of cervical micrometastases and sometimes metastasizes contralaterally because of the rich lymphatic intercommunications relative to submucosal plexus of oral...Oral squamous cell carcinoma （OSCC） has a high incidence of cervical micrometastases and sometimes metastasizes contralaterally because of the rich lymphatic intercommunications relative to submucosal plexus of oral cavity that freely communicate across the midline, and it can facilitate the spread of neoplastic cells to any area of the neck consequently. Clinical and histopathologic factors continue to provide predictive information to contralateral neck metastases （CLNM） in OSCC, which determine prophylactic and adjuvant treatments for an individual patient. This review describes the predictive value of clinical-histopathologic factors, which relate to primary tumor and cervical lymph nodes, and surgical dissection and adjuvant treatments. In addition, the indications for elective contralateral neck dissection and adjuvant radiotherapy （aRT） and strategies for follow-up are offered, which is strongly focused by clinicians to prevent later CLNM and poor prognosis subsequently.展开更多
Objective： To explore the treatment of clinically negative neck （CN0） patients with squamous cell carcinoma of the tongue. Methods： 165 CN0 patients with squamous cell carcinoma of the tongue from 1985 to 2002 wer...Objective： To explore the treatment of clinically negative neck （CN0） patients with squamous cell carcinoma of the tongue. Methods： 165 CN0 patients with squamous cell carcinoma of the tongue from 1985 to 2002 were investigated retrospectively. Parts of the patients staged at T1, T2 and T3 underwent resection of primary lesion followed by neck observation, and other patients staged above T2 or at T1 but without follow-up were treated with elective neck dissection （END）. All patients were followed up for more than 3 y or until their death. Results： Lymphatic metastasis was identified histologically after operation in 33 of 120 patients treated with END, and 9 of 45 patients treated with resection of primary lesion alone. The overall rate of occult lymphatic metastasis was 25.45%, which increased with the elevating of clinical T stage. The overall rate of neck uncontrolled death was 20.00% for observation group and 5.00% for END group, and significant difference was found between them （P〈0.05）. For T~ patients in the two groups, the rate of neck uncontrolled death was 7.71% and 4.00% respectively, and no significance was found between them （P〉0.05）. When stage T2 and T3 were considered as middle stage together, significant difference （P〈0.05） could be obtained between observation （70.00%） and END group （0%）. Conclusion： The occult metastasis rate of squamous cell carcinoma of tongue increases with the elevating of clinical stage, and elective neck dissection could be considered for NO patients staged over T2 to improve neck control and survival rate; and regional resection alone of primary lesion could be considered for T1N0 patients to improve quality of life if closely followed up is conducted.展开更多
Lingual lymph nodes are an inconstant group of in-transit nodes,which are located on the route of lymph drainage from the tongue mucosa to the regional nodes in neck levels I and II.There is growing academic data on t...Lingual lymph nodes are an inconstant group of in-transit nodes,which are located on the route of lymph drainage from the tongue mucosa to the regional nodes in neck levels I and II.There is growing academic data on the metastatic spread of oral cancer,particularly regarding the spreading of oral tongue squamous cell carcinoma to lingual nodes.These nodes are not currently included in diagnostic and treatment protocols for oral tongue cancer.Combined information on surgical anatomy,clinical observations,means of detection,and prognostic value is presented.Anatomically obtained incidence of lingual nodes ranges from 8.6%to 30.2%.Incidence of lingual lymph node metastasis ranges from 1.3%to 17.1%.It is clear that lymph nodes that bear intervening tissues from the floor of the mouth should be removed to improve loco-regional control.Extended resection volume,which is required for the surgical treatment of lingual node metastasis,cannot be implied to every tongue cancer patient.As these lesions significantly influence prognosis,special efforts of their detection must be made.Reasonably,every tongue cancer patient must be investigated for the existence of lingual lymph node metastasis.Lymphographic tracing methods,which are currently implied for sentinel lymph node biopsies,may improve the detection of lingual lymph nodes.展开更多
Objective:To use the Surveillance,Epidemiology,and End Results(SEER)database to verify the findings of a recent National Cancer Database(NCDB)study that identified factors predicting occult nodal involvement in cutane...Objective:To use the Surveillance,Epidemiology,and End Results(SEER)database to verify the findings of a recent National Cancer Database(NCDB)study that identified factors predicting occult nodal involvement in cutaneous head and neck melanoma(CHNM)while identifying additional predictors of occult nodal metastasis and comparing two distinct cancer databases.Methods:Cases of CHNM in the SEER database diagnosed between 2004 and 2014 were identified.Demographic information and oncologic data were obtained.Univariate and multivariate analysis were performed to identify factors associated with pathologic nodal positivity.Results:There were 34002 patients with CHNM identified.Within this population,16232 were clinically node-negative,1090 of which were found to be pathologically node-positive.On multivariate analysis,factors associated with an increased risk of occult nodal metastasis included increasing depth of invasion(stepwise increase in adjusted odds ratio[OR]),nodular histology(aOR:1.47[95%CI:1.21-1.80]),ulceration(aOR:1.74[95%CI:1.48-2.05]),and mitoses(aOR:1.86[95%CI:1.36-2.54]).Factors associated with a decreased risk of occult nodal metastasis included female sex(aOR:0.80[0.67-0.94])and desmoplastic histology(aOR:0.37[95%CI:0.24-0.59]).Between the SEER database and the NCDB,factors associated with occult nodal involvement were similar except for nodular histology and female sex,which did not demonstrate significance in the NCDB.Conclusion:Regarding clinically node-negative CHNM,the SEER database and the NCDB have similarities in demographic information but differences in baseline population sizes and tumor characteristics that should be considered when comparing findings between the two databases.展开更多
目的 分析甲状腺乳头状癌(PTC)超声图像表现在预测颈部Ⅵ区淋巴结转移(lymph node metastasis in the cervicalregion Ⅵ,CLNM-Ⅵ)危险度的临床价值。方法 选取2022年4月~2023年6月在河北省沧州中西医结合医院接受手术治疗并经病理证实...目的 分析甲状腺乳头状癌(PTC)超声图像表现在预测颈部Ⅵ区淋巴结转移(lymph node metastasis in the cervicalregion Ⅵ,CLNM-Ⅵ)危险度的临床价值。方法 选取2022年4月~2023年6月在河北省沧州中西医结合医院接受手术治疗并经病理证实的350例PTC患者,根据术后病理结果,将患者分为CLNM-Ⅵ组和非CLNM-Ⅵ组。收集并对比两组术前超声图像表现及临床病理特征,应用Logistic回归分析PTC患者CLNM-Ⅵ危险因素,受试者工作特征(ROC)曲线分析PTC超声图像表现对CLNM-Ⅵ的预测价值。结果 单因素分析显示,CLNM-Ⅵ组男性、实性或囊实性、年龄≤45岁、低回声、甲状腺背景正常、点状强回声的构成比均大于非CLNM-Ⅵ组(P均<0.05)。Logistic回归分析显示,男性、实性或囊实性、年龄≤45岁、低回声、甲状腺背景正常、病灶内可见点状强回声是CLNM-Ⅵ的独立危险因素(P均<0.05);进一步经ROC曲线分析显示,以上预测CLNM-Ⅵ的AUC分别为0.565、0.580、0.529、0.585、0.582、0.582,联合预测AUC为0.708。结论PTC超声图像表现在CLNM-Ⅵ风险评估中具有重要意义,可为PTC的预后判断提供一定的参考依据。展开更多
Background Lymph node ratio （LNR） has recently been reported as a potential prognostic marker in many malignant diseases. We aimed to analyze the potential prognostic effect of LNR on hypopharyngeal squamous cell ca...Background Lymph node ratio （LNR） has recently been reported as a potential prognostic marker in many malignant diseases. We aimed to analyze the potential prognostic effect of LNR on hypopharyngeal squamous cell carcinoma （HPSCC） after neoadjuvant therapy in our institution.展开更多
The management of non-melanoma skin cancers metastatic to the neck is challenging due to variability in biological behavior and patterns of regional lymphatic spread.Metastatic non-melanoma skin cancers to the parotid...The management of non-melanoma skin cancers metastatic to the neck is challenging due to variability in biological behavior and patterns of regional lymphatic spread.Metastatic non-melanoma skin cancers to the parotid and neck often behave aggressively,with a high incidence of local recurrence after treatment and reduced five-year survival outcomes.Patterns of lymphatic spread are different from those seen in mucosal squamous cell carcinoma,with higher prevalence of disease in the parotid and superficial lymphatics.These factors require that treatment is individualized to achieve optimal outcomes.Traditionally,the management of non-melanoma skin cancers metastatic to lymph nodes has involved surgical excision followed by adjuvant radiation therapy.However,novel systemic therapies are showing promising results and their role in the management of these cancers is evolving.展开更多
文摘BACKGROUND Malignant proliferating trichilemmal tumor(MPTT)is an infrequent malignant neoplasm originating from cutaneous appendages,with only a handful of documented cases.This report delineates a unique instance of MPTT situated in the neck,accompanied by lymph node metastasis.A comprehensive exposition of its clinical trajectory and imaging manifestation is presented,aiming to enhance comprehension and management of this atypical ailment.CASE SUMMARY Patient concerns:A 79-year-old male presented with a longstanding right neck mass persisting for over six decades,exhibiting recent enlargement over the past year.Diagnoses:Enhanced magnetic resonance imaging of the neck unveiled an elliptical mass on the right neck side,characterized by an ill-defined border and a heterogeneous signal pattern.The mass exhibited subdued signal intensity on T1-weighted imaging(T1WI)and a heterogeneous high signal on T2-weighted imaging(T2WI),interspersed with a lengthy T1 and T2 cystic signal motif.Close anatomical association with the submandibular gland joint was noted,and intravenous gadolinium diethylene triamine pentaacetic acid administration facilitated conspicuous enhancement.Substantial enhancement of the solid segment prompted an initial preoperative diagnosis of malignant nerve sheath tumor.However,post-surgery histopathological and immunohistochemical analysis conclusively confirmed the diagnosis as malignant hyperplastic external hair root sheath tumor.Intervention:Complete excision of the tumor was successfully executed.Outcomes:The patient experienced a favorable postoperative recovery.CONCLUSION Malignant proliferative trichilemmal tumor external hair root sheath tumor is a cystic-solid lesion,appearing as low signal on T1WI images or high signal on T2WI with enhancement of the solid component.Suspicions of malignancy are heightened when the tumor border is indistinct,tissue planes are breached,or when linear or patchy high signals are observed in the subcutaneous tissue on T1 liver acquisition with volume acceleration enhanced images along with intermediate signal on T2WI and restricted diffusion on diffusion-weighted imaging images.Strong consideration for malignancy should arise if there are signs of compromised adjacent tissue relationships or direct invasion evident on imaging.We have incorporated the above-mentioned content into the entire manuscript.
文摘Oral squamous cell carcinoma （OSCC） has a high incidence of cervical micrometastases and sometimes metastasizes contralaterally because of the rich lymphatic intercommunications relative to submucosal plexus of oral cavity that freely communicate across the midline, and it can facilitate the spread of neoplastic cells to any area of the neck consequently. Clinical and histopathologic factors continue to provide predictive information to contralateral neck metastases （CLNM） in OSCC, which determine prophylactic and adjuvant treatments for an individual patient. This review describes the predictive value of clinical-histopathologic factors, which relate to primary tumor and cervical lymph nodes, and surgical dissection and adjuvant treatments. In addition, the indications for elective contralateral neck dissection and adjuvant radiotherapy （aRT） and strategies for follow-up are offered, which is strongly focused by clinicians to prevent later CLNM and poor prognosis subsequently.
基金This work was supported by the Shantou Municipal Key Sci & Tech Project (No.2004-102).
文摘Objective： To explore the treatment of clinically negative neck （CN0） patients with squamous cell carcinoma of the tongue. Methods： 165 CN0 patients with squamous cell carcinoma of the tongue from 1985 to 2002 were investigated retrospectively. Parts of the patients staged at T1, T2 and T3 underwent resection of primary lesion followed by neck observation, and other patients staged above T2 or at T1 but without follow-up were treated with elective neck dissection （END）. All patients were followed up for more than 3 y or until their death. Results： Lymphatic metastasis was identified histologically after operation in 33 of 120 patients treated with END, and 9 of 45 patients treated with resection of primary lesion alone. The overall rate of occult lymphatic metastasis was 25.45%, which increased with the elevating of clinical T stage. The overall rate of neck uncontrolled death was 20.00% for observation group and 5.00% for END group, and significant difference was found between them （P〈0.05）. For T~ patients in the two groups, the rate of neck uncontrolled death was 7.71% and 4.00% respectively, and no significance was found between them （P〉0.05）. When stage T2 and T3 were considered as middle stage together, significant difference （P〈0.05） could be obtained between observation （70.00%） and END group （0%）. Conclusion： The occult metastasis rate of squamous cell carcinoma of tongue increases with the elevating of clinical stage, and elective neck dissection could be considered for NO patients staged over T2 to improve neck control and survival rate; and regional resection alone of primary lesion could be considered for T1N0 patients to improve quality of life if closely followed up is conducted.
文摘Lingual lymph nodes are an inconstant group of in-transit nodes,which are located on the route of lymph drainage from the tongue mucosa to the regional nodes in neck levels I and II.There is growing academic data on the metastatic spread of oral cancer,particularly regarding the spreading of oral tongue squamous cell carcinoma to lingual nodes.These nodes are not currently included in diagnostic and treatment protocols for oral tongue cancer.Combined information on surgical anatomy,clinical observations,means of detection,and prognostic value is presented.Anatomically obtained incidence of lingual nodes ranges from 8.6%to 30.2%.Incidence of lingual lymph node metastasis ranges from 1.3%to 17.1%.It is clear that lymph nodes that bear intervening tissues from the floor of the mouth should be removed to improve loco-regional control.Extended resection volume,which is required for the surgical treatment of lingual node metastasis,cannot be implied to every tongue cancer patient.As these lesions significantly influence prognosis,special efforts of their detection must be made.Reasonably,every tongue cancer patient must be investigated for the existence of lingual lymph node metastasis.Lymphographic tracing methods,which are currently implied for sentinel lymph node biopsies,may improve the detection of lingual lymph nodes.
文摘Objective:To use the Surveillance,Epidemiology,and End Results(SEER)database to verify the findings of a recent National Cancer Database(NCDB)study that identified factors predicting occult nodal involvement in cutaneous head and neck melanoma(CHNM)while identifying additional predictors of occult nodal metastasis and comparing two distinct cancer databases.Methods:Cases of CHNM in the SEER database diagnosed between 2004 and 2014 were identified.Demographic information and oncologic data were obtained.Univariate and multivariate analysis were performed to identify factors associated with pathologic nodal positivity.Results:There were 34002 patients with CHNM identified.Within this population,16232 were clinically node-negative,1090 of which were found to be pathologically node-positive.On multivariate analysis,factors associated with an increased risk of occult nodal metastasis included increasing depth of invasion(stepwise increase in adjusted odds ratio[OR]),nodular histology(aOR:1.47[95%CI:1.21-1.80]),ulceration(aOR:1.74[95%CI:1.48-2.05]),and mitoses(aOR:1.86[95%CI:1.36-2.54]).Factors associated with a decreased risk of occult nodal metastasis included female sex(aOR:0.80[0.67-0.94])and desmoplastic histology(aOR:0.37[95%CI:0.24-0.59]).Between the SEER database and the NCDB,factors associated with occult nodal involvement were similar except for nodular histology and female sex,which did not demonstrate significance in the NCDB.Conclusion:Regarding clinically node-negative CHNM,the SEER database and the NCDB have similarities in demographic information but differences in baseline population sizes and tumor characteristics that should be considered when comparing findings between the two databases.
文摘目的 分析甲状腺乳头状癌(PTC)超声图像表现在预测颈部Ⅵ区淋巴结转移(lymph node metastasis in the cervicalregion Ⅵ,CLNM-Ⅵ)危险度的临床价值。方法 选取2022年4月~2023年6月在河北省沧州中西医结合医院接受手术治疗并经病理证实的350例PTC患者,根据术后病理结果,将患者分为CLNM-Ⅵ组和非CLNM-Ⅵ组。收集并对比两组术前超声图像表现及临床病理特征,应用Logistic回归分析PTC患者CLNM-Ⅵ危险因素,受试者工作特征(ROC)曲线分析PTC超声图像表现对CLNM-Ⅵ的预测价值。结果 单因素分析显示,CLNM-Ⅵ组男性、实性或囊实性、年龄≤45岁、低回声、甲状腺背景正常、点状强回声的构成比均大于非CLNM-Ⅵ组(P均<0.05)。Logistic回归分析显示,男性、实性或囊实性、年龄≤45岁、低回声、甲状腺背景正常、病灶内可见点状强回声是CLNM-Ⅵ的独立危险因素(P均<0.05);进一步经ROC曲线分析显示,以上预测CLNM-Ⅵ的AUC分别为0.565、0.580、0.529、0.585、0.582、0.582,联合预测AUC为0.708。结论PTC超声图像表现在CLNM-Ⅵ风险评估中具有重要意义,可为PTC的预后判断提供一定的参考依据。
文摘Background Lymph node ratio （LNR） has recently been reported as a potential prognostic marker in many malignant diseases. We aimed to analyze the potential prognostic effect of LNR on hypopharyngeal squamous cell carcinoma （HPSCC） after neoadjuvant therapy in our institution.
文摘The management of non-melanoma skin cancers metastatic to the neck is challenging due to variability in biological behavior and patterns of regional lymphatic spread.Metastatic non-melanoma skin cancers to the parotid and neck often behave aggressively,with a high incidence of local recurrence after treatment and reduced five-year survival outcomes.Patterns of lymphatic spread are different from those seen in mucosal squamous cell carcinoma,with higher prevalence of disease in the parotid and superficial lymphatics.These factors require that treatment is individualized to achieve optimal outcomes.Traditionally,the management of non-melanoma skin cancers metastatic to lymph nodes has involved surgical excision followed by adjuvant radiation therapy.However,novel systemic therapies are showing promising results and their role in the management of these cancers is evolving.
