Liposarcoma of the retropharyngeal space

Liposarcoma is a common soft tissue malignancy that occurs infrequently in the head and neck. Liposarcoma of the retropharynx is exceptionally rare, only four cases being described in the literature. We present a case in which retropharyngeal liposarcoma occurred in a patient who had had multiple previous subcutaneous lipomas excised. This paper explores this very unusual presentation and discusses the difficulties in the diagnosis and management of this rare tumour

Unilateral autoimmune inner ear disease in a patient with lung cancer treated with nivolumab

A 69-year-old male presented with early stage non-small cell lung cancer in 2016. The tumor was resected; however, the patient experienced recurrence 2 years later and subsequently received paclitaxel/carboplatin concurrently with radiotherapy. Within weeks of completing this treatment, he developed a symptomatic pancoast tumor secondary to disease progression and commenced second line nivolumab. Following the second dose of nivolumab, he developed acute unilateral right hearing loss. He commenced intravenous methylprednisolone followed by a slow taper of oral prednisolone. With steroids, he noted a gradual improvement in hearing, confirmed by audiology. Restaging imaging post-nivolumab demonstrated a complete metabolic response. Two prior cases have reported bilateral sensorineural hearing loss post-immune checkpoint inhibitor (ICI). We postulate the hearing impairment relates to the development of autoimmune inner ear disease. To our knowledge, this is the only case of a patient experiencing unilateral loss of hearing following an ICI

Trans Tracheal Approach to the Oesophagus: Case Report

Hypopharyngeal squamous cell carcinoma (SCC) is a rare form of malignancy and treatment approach is most commonly with chemo-radiotherapy or total pharyngolaryngoesophagectomy. We report a case of hypopharyngeal SCC managed with local resection and larynx preservation in a 77-year-old-woman. Total pharyngolaryngoesophagectomy renders patients with an alteration in both voice and ability to swallow hence carrying signifi cant post-operative morbidity. We review the literature for similar larynx-preserving operations and illustrate a novel approach to the management of this rare malignancy.</p

An Ep-ICD based index is a marker of aggressiveness and poor prognosis in thyroid carcinoma.

BACKGROUND:Nuclear accumulation of the intracellular domain of epithelial cell adhesion molecule (Ep-ICD) in tumor cells was demonstrated to predict poor prognosis in thyroid carcinoma patients in our earlier study. Here, we investigated the clinical significance of Ep-ICD subcellular localization index (ESLI) in distinguishing aggressive papillary thyroid carcinoma (PTC) from non-aggressive cases. METHODS:Using domain specific antibodies against the intracellular (Ep-ICD) and extracellular (EpEx) domains of epithelial cell adhesion molecule, 200 archived tissues from a new cohort of patients with benign thyroid disease as well as malignant aggressive and non aggressive PTC were analyzed by immunohistochemistry (IHC). ESLI was defined as sum of the IHC scores for accumulation of nuclear and cytoplasmic Ep-ICD and loss of membranous EpEx; ESLI = [Ep-ICD(nuc) + Ep-ICD(cyt) + loss of membranous EpEx]. RESULTS:For the benign thyroid tissues, non-aggressive PTC and aggressive PTC, the mean ESLI scores were 4.5, 6.7 and 11 respectively. Immunofluorescence double staining confirmed increased nuclear Ep-ICD accumulation and decreased membrane EpEx expression in aggressive PTC. Receiver-operating characteristic (ROC) curve analysis showed an area under the curve (AUC) of 0.841, 70.2% sensitivity and 83.9% specificity for nuclear Ep-ICD for differentiating aggressive PTC from non-aggressive PTC. ESLI distinguished aggressive PTC from non-aggressive cases with improved AUC of 0.924, 88.4% sensitivity and 85.5% specificity. Our study confirms nuclear accumulation of Ep-ICD and loss of membranous EpEx occurs in aggressive PTC underscoring the potential of Ep-ICD and ESLI to serve as diagnostic markers for aggressive PTC. Kaplan Meier survival analysis revealed significantly reduced disease free survival (DFS) for ESLI positive (cutoff >10) PTC (p<0.05), mean DFS=133 months as compared to 210 months for patients who did not show positive ESLI. CONCLUSION:ESLI scoring improves the identification of aggressive PTC and thereby may serve as a useful index for defining aggressiveness and poor prognosis among PTC patients

Does fluorodeoxyglucose PET add to the management of the neck following curative radiotherapy in head and neck cancer compared with computed tomography?

In recent times, metabolic response to chemoradiotherapy has become possible due to the clinical application of F-18-fluorodeoxyglucose PET. Its utility in the initial staging of head and neck cancer is becoming widely accepted, however, its role in the post-therapy management of the neck following chemoradiotherapy in node-positive head and neck cancer remains unresolved. This article examines the role of PET in the restaging of patients who achieve a complete response at the primary site following radiotherapy. In particular, the authors examine its potential use in the assessment of post-therapy residual nodes and its role in sparing patients from an unnecessary neck dissection in order to minimize treatment-related morbidity

Clinicopathological characteristics of thyroid carcinoma patients.

<p>Clinicopathological characteristics of thyroid carcinoma patients.</p

IHC analysis of Ep-ICD and EpEx subcellular localization in thyroid tissues.

<p>The IHC score cut-off values for positivity were defined as ≥2 for nuclear Ep-ICD positivity; ≥5 for cytoplasmic Ep-ICD positivity and ≤5 for loss of membranous EpEx expression. ESLI cut-off ≥6 was used to determine ESLI positivity for distinguishing PTC from benign cases; and a cut-off value of >10 was used to determine ESLI positivity for distinguishing aggressive PTCs from non-aggressive PTCs.</p

Kaplan Meier survival analysis for ESLI.

<p>Kaplan Meier survival analysis showing significant association with reduced disease free survival (DFS) in ESLI positive PTC patients (p = 0.039) with a mean DFS = 133 months compared to ESLI negative patients with a mean DFS = 210 months.</p

Immunohistochemical analysis of EpEx and Ep-ICD expression in papillary thyroid carcinomas and benign tissues.

<p>The representative photomicrographs show immunostaining of EpEx and Ep-ICD in paraffin-embedded thyroid benign nodule goiters, non-aggressive PTC and aggressive PTC tissues. Strong membranous EpEx immunostaining was observed in benign cases (A) and non-aggressive PTC tissues (C); reduced staining of membrane EpEx was observed in aggressive PTC cases (E, G). The benign thyroid nodules and non-aggressive PTC (D) showed predominant cytoplasm localization of Ep-ICD and no detectable nuclear Ep-ICD staining (B, D), while the aggressive PTC cases showed strong nuclear and cytoplasmic Ep-ICD accumulation (F, H). M, membrane staining; C, cytoplasmic staining; N, nuclear staining; Loss of M, loss of membrane expression. Original magnification × 400.</p

Fluorescence immunostaining with anti-EpEx and anti-Ep-ICD antibodies in aggressive and non-aggressive papillary thyroid carcinomas.

<p>Secondary antibodies are FITC-anti-mouse (green) and TRITC-anti-rabbit (red). A-F images from a non-aggressive PTC; G-L Images from an aggressive PTC. A,G) EpEx; B,H) DAPI; C, I) Ep-ICD; D) EpEx and DAPI (A & C merged); E) Ep-ICD and DAPI (B & C merged); F) EpEx, Ep-ICD, and DAPI (A, B, C merged). J) EpEx and DAPI (G & I merged); K) Ep-ICD and DAPI (H & I merged); L) EpEx, Ep-ICD, and DAPI (G, H, I merged). M, Membranous staining; C, Cytoplasm staining; N, Nuclear staining. Original magnification × 400.</p