Linfadenectomia sovraomoioidea.

Lo svuotamento linfonodale sovra-omoioideo è la dissezione laterocervicale selettiva più frequentemente eseguita in caso di carcinoma del cavo orale. Con il termine “svuotamento linfonodale selettivo” si intende l’asportazione dei pacchetti linfonodali a maggior rischio di metastasi, con la preservazione di uno o più livelli linfonodali di solito rimossi durante uno svuotamento radicale. In particolar modo lo svuotamento sovraomoioideo prevede la dissezione del I-II-III livello linfonodale (ovvero al di sopra, cranialmente, rispetto al muscolo omoioideo). La possibilità di eseguire dissezioni selettive del collo si basa sul fatto che il drenaggio linfatico delle mucose del cavo orale, in pazienti con carcinoma a cellule squamose precedentemente non trattati, segue percorsi relativamente costanti e di conseguenza le metastasi linfonodali presentano un pattern di diffusione relativamente prevedibile in base alla localizzazione del tumore primitivo. Gli studi anatomici di Rouvière, Fish e Sigel (e successivamente Shah) hanno concluso che i tumori della cavità orale metastatizzano più frequentemente ai linfonodi del collo del I, II, e III livello, mentre i tumori dell’orofaringe, ipofaringe, laringe metastatizzano più frequentemente al II, III, e IV livello. Il trattamento chirurgico delle metastasi linfonodali è stato proposto ed eseguito in origine da Von Albrecht nel 1875, ai primordi della chirurgia laringea, con la sola asportazione dei linfonodi metastatici; Gluck e Sorensen asportavano anche il muscolo sternocleidomastoideo, la giugulare interna e, talvolta, la carotide. Crile nel 1898 introdusse lo svuotamento linfonodale sistematico in monoblocco con la laringectomia, dimostrando che nella sua casistica i malati così trattati sopravvivevano mediamente quattro volte di più di quelli trattati con semplice laringectomia. In seguito, circa 70 anni dopo, Suarez e Bocca iniziarono a conservare il nervo spinale accessorio, la vena giugulare interna e il muscolo sternocleidomastoideo in caso di tumori della laringe e ipofaringee con collo clinicamente negativo per localizzazioni metastatiche linfonodali. L’origine dello svuotamento selettivo, invece, non è del tutto chiara. Molti chirurghi hanno usato questo tipo di procedura per decadi senza descriverla formalmente. Per esempio, Kocher eseguiva un’asportazione parziale dei linfonodi nei pazienti con carcinoma del cavo orale e collo N0 già alla fine del diciannovesimo secolo. Con il tempo si diffuse una procedura detta “svuotamento sovraioideo” (cioè del I livello) nei casi di linfoadenopatie occulte associate ai carcinomi soprattutto del labbro. In seguito, nel 1972, Lindberg ha dimostrato che i livelli più frequentemente coinvolti in pazienti con carcinoma del cavo orale sono in genere il II e il III; nei carcinomi del pavimento della bocca e della lingua mobile il livello più frequentemente coinvolto è, invece, il I. Più tardi Byers propose i termini “anteriore” e “sovraomoioideo” per indicare le dissezioni parziali, ma solo nel 1991 si iniziò ad usare il termine selettivo per descrivere le resezioni linfonodali limitate (Academy’s Committee for Head and Neck Surgery and Oncology). In generale lo svuotamento linfonodale laterocervicale del collo può essere eseguito secondo due diversi tempi rispetto al momento dell’asportazione del tumore primario: 1) in contemporanea all’asportazione del tumore primario ed in assenza di evidenza clinica e radiologica di metastasi linfonodali laterocervicali, ovvero in stadio cN0, al fine di eradicare eventuali metastasi occulte: viene definito svuotamento elettivo o elective neck dissection. 2) successivamente all‘intervento sul tumore primario, al manifestarsi clinico o radiologico delle metastasi linfonodali laterocervicali: viene definito svuotamento terapeutico o therapeutic neck dissection. Lo svuotamento linfonodale elettivo (cN0) è abitualmente di tipo selettivo. Lo svuotamento selettivo del collo per il carcinoma del cavo orale comprende i livelli I-III ed è altrimenti denominato svuotamento linfonodale laterocervicale sovra-omoioideo. La “depth of invasion” (DOI) è ad oggi il miglior fattore per ipotizzare la presenza di metastasi linfonodali occulte laterocervicali e quindi decidere se attuare uno svuotamento linfonodale laterocervicale elettivo (cN0) o terapeutico (al manifestarsi delle metastasi linfonodali cN+). Per carcinomi con una DOI maggiore ai 4mm, si deve programmare uno svuotamento linfonodale elettivo (NCCN Guidelines, 2018). Studi randomizzati hanno dimostrato la superiore efficacia in termini di sopravvivenza dello svuotamento linfonodale elettivo in pazienti affetti da carcinomi del cavo orale cN0, quando la profondità d’infiltrazione (DOI) è superiore ai 3 mm. Quando la DOI è compresa tra 2 e 4mm si deve valutare e soppesare quando sia attuabile l’alternativa di un follow-up stringente ed accurato, secondo le specifiche condizioni socio-sanitarie del paziente in esame. In caso di dubbia aderenza al follow-up clinico-strumentale, consigliamo di effettuare uno svuotamento elettivo sovraomoioideo. In conclusione, lo svuotamento selettivo sovra-omoioideo del collo è attualmente indicato nei pazienti con carcinoma squamoso del cavo orale senza evidenza clinica o radiologica di coinvolgimento linfonodale(cN0), da attuarsi in unico tempo con l’asportazione radicale del tumore primario

Primary Intraosseous Squamous Cell Carcinoma of the Anterior Mandible Arising in an Odontogenic Cyst in 34-Year-Old Male

Abstract: Primary intraosseous squamous cell carcinoma (PIOSCC) is a rare and aggressive malignancy arising exclusively within the jaws, without any initial connection with the oral mucosa. The etiology and the epidemiology are unclear due to the rarity of the disease, and there is no current universally accepted staging or treatment protocol. Clinically, the posterior mandible is the most a ected site, and common symptoms are swelling and pain. The diagnosis is often di cult either because it requires stringent criteria to be satisfied or because of the absence of a pathognomonic histological pattern. Aggressive surgery is the first-choice treatment, often followed by radiotherapy. The lymph nodal status seems to be the most important factor influencing the prognosis, which is usually poor, with a 5-year survival rate ranging from 30% to 40%. In the present article, we report an unusual case of cystogenic PIOSCC interesting the anterior mandible of a young 34-year-old male, which came to our attention after complaint about recurrent infective episodes a ecting a dentigerous cyst (impacted lower canine) discovered ten years before. The age, site, and extension are uncommon. Extensive surgical treatment with fibula free flap reconstruction, adjuvant therapy, and salvage surgery was carried out. The patient was disease-free at a 31-month follow-up

A Case Report of a Solitary Fibrous Tumor of the Maxillary Sinus

A solitary fibrous tumor (SFT) is a benign neoplasm, firstly described as a mesenchymal tumor of the pleura. Its incidence range in the head and neck region is about 5\u201327%, but only rarely does it affect paranasal sinuses. The differential diagnosis is challenging, owing to its erosive growth pattern and immuno-histochemical features. SFTs have an aggressive behavior and an important recurrence potential. Therefore, a radical surgical excision is the gold standard therapeutic procedure. A rare SFT originating from the right maxillary sinus is reported here. The 37-year-old patient presented to the outpatient clinic with a painful expansive lesion in the whole right maxillary region. The overlying skin was inflamed and the patient had no epistaxis episodes. The 1.5 dentary element tested negative for vitality; however, a puncture of the lesion led to a hematic spill and no purulent discharge. An endoscopic-guided biopsy was suggestive either of SFT or hemangioperictoma, excluding a malignant neoplasm. A multi-equipe surgical team was activated. The lesion was embolized in order to achieve a good hemostatic control and, after 48 h, the neoplasm was radically excised with a combined open and endoscopic approach. The patient was disease-free at 12-month radiological and clinical follow-up. Given the rarity of this lesion and the delicacy required in addressing head and neck neoplasms, we believe that the present case report might be of help in further understanding how to approach cranio-facial SFTs

Tongue cancer following hematopoietic cell transplantation for Fanconi anemia

Objectives: The aim of this retrospective study was to determine the incidence and the clinical outcome of tongue cancer (TC) in patients affected by Fanconi anemia (FA) who received an allogeneic hematopoietic cell transplantation (HCT). Materials and methods: The patient database from the Bone Marrow Transplant Center of Pescara was reviewed to enroll FA patients. Patients', donors', HCT's, and screening's data were collected as well to look for the incidence and the treatment of TC. Results: Twelve patients affected by FA were identified. Three patients died for transplant-related causes. Five of nine surviving patients were diagnosed with TC at a median of 21.7 years since transplantation and at a median age of 32.10 years. Interestingly, no patient manifested graft-versus-host-disease (GvHD). The 28-year cumulative incidence function of TC was 46.9% (95% CI, 36.9-56.9%). Two patients were treated with chemotherapy alone, two patients were treated with surgery alone, and one with surgery followed by chemotherapy. Overall, 4 patients with TC showed a clinical course characterized by a marked aggressiveness of the tumor disease which led to death due to cancer progression between 2 and 13 months. One patient is surviving 8 months after diagnosis of TC. Conclusions: Our study confirms the high incidence of tumors and in particular tongue tumors in allotransplanted FA patients. A careful screening has to be life-long maintained. Clinical relevance: Considering the rarity of FA and the frailty of FA patients, this study may add important information for the cancer management of these patients

A model for the cosmological evolution of low frequency radio sources

We present a new evolutionary model that describes the population properties of radio sources at frequencies <5 GHz, thus complementing the De Zotti et al. (2005) model, holding at higher frequencies. We find that simple analytic luminosity evolution is still sufficient to fit the wealth of available data on local luminosity functions, multi-frequency source counts, and redshift distributions. However, the fit requires a luminosity-dependent decline of source luminosities at high redshifts, at least for steep-spectrum sources, thus confirming earlier indications of a "downsizing" also for radio sources. The upturn of source counts at sub-mJy levels is accounted for by a straightforward extrapolation, using the empirical far-IR/radio correlation, of evolutionary models matching the far-IR counts and redshift distributions of star-forming galaxies. We also discuss the implications of the new model for the interpretation of data on large-scale clustering of radio sources and on the Integrated Sachs-Wolfe (ISW) effect, and for the investigation of the contribution of discrete sources to the extragalactic background. As for the ISW effect, a new analysis exploiting a very clean CMB map, yields at a substantially higher significance than reported before.Comment: 14 pages, 11 figures, accepted for publication on MNRA

Herschel-ATLAS: Dust temperature and redshift distribution of SPIRE and PACS detected sources using submillimetre colours

We present colour-colour diagrams of detected sources in the Herschel-ATLAS science demonstration field from 100 to 500μm using both PACS and SPIRE. We fit isothermal modified black bodies to the spectral energy distribution (SED) to extract the dust temperature of sources with counterparts in Galaxy And Mass Assembly (GAMA) or SDSS surveys with either a spectroscopic or a photometric redshift. For a subsample of 330 sources detected in at least three FIR bands with a significance greater than 3σ, we find an average dust temperature of (28±8) K. For sources with no known redshift, we populate the colour-colour diagram with a large number of SEDs generated with a broad range of dust temperatures and emissivity parameters, and compare to colours of observed sources to establish the redshift distribution of this sample. For another subsample of 1686 sources with fluxes above 35 mJy at 350μm and detected at 250 and 500μm with a significance greater than 3σ we find an average redshift of 2.2 ±0.6Amblard, Barton, Cooray, Leeuw, Serra and Temi acknowledge support from NASA funds for US participants in Herschel through JPL. Funding for the SDSS and SDSS-II has been provided by the Alfred P. Sloan Foundation, the Participating Institutions, the National Science Foundation, the US Department of Energy, the National Aeronautics and Space Administration, the Japanese Monbukagakusho, the Max Planck Society, and the Higher Education Funding Council for England. The SDSS Web Site is http://www.sdss.org/. The SDSS is managed by the Astrophysical Research Consortium for the Participating Institutions. The UKIDSS project is defined in Lawrence et al. (2007)

Herschel-ATLAS: The angular correlation function of submillimetre galaxies at high and low redshift

We present measurements of the angular correlation function of galaxies selected from the first field of the H-ATLAS survey. Careful removal of the background from galactic cirrus is essential, and currently dominates the uncertainty in our measurements. For our 250 μm-selected sample we detect no significant clustering, consistent with the expectation that the 250 μm-selected sources are mostly normal galaxies at z <∼ 1. For our 350 μm and 500 μm-selected samples we detect relatively strong clustering with correlation amplitudes A of 0.2 and 1.2 at 1’, but with relatively large uncertainties. For samples which preferentially select high redshift galaxies at z ∼ 2−3 we detect significant strong clustering, leading to an estimate of r0 ∼ 7−11 h−1 Mpc. The slope of our clustering measurements is very steep, δ ∼ 2. The measurements are consistent with the idea that sub-mm sources consist of a low redshift population of normal galaxies and a high redshift population of highly clustered star-bursting galaxie

Herschel*-ATLAS: deep HST/WFC3 imaging of strongly lensed submillimetre galaxies

We report on deep near-infrared observations obtained with the Wide Field Camera-3 (WFC3) onboard the Hubble Space Telescope (HST) of the first five confirmed gravitational lensing events discovered by the Herschel Astrophysical Terahertz Large Area Survey (H-ATLAS). We succeed in disentangling the background galaxy from the lens to gain separate photometry of the two components. The HST data allow us to significantly improve on previous constraints of the mass in stars of the lensed galaxy and to perform accurate lens modelling of these systems, as described in the accompanying paper by Dye et al. We fit the spectral energy distributions of the background sources from near-IR to millimetre wavelengths and use the magnification factors estimated by Dye et al. to derive the intrinsic properties of the lensed galaxies. We find these galaxies to have star-formations rates (SFR) ∼ 400–2000 M⊙ yr−1, with ∼(6–25) × 1010 M⊙ of their baryonic mass already turned into stars. At these rates of star formation, all remaining molecular gas will be exhausted in less than ∼100 Myr, reaching a final mass in stars of a few 1011 M⊙. These galaxies are thus proto-ellipticals caught during their major episode of star formation, and observed at the peak epoch (z ∼ 1.5–3) of the cosmic star formation history of the Universe

PRISM (Polarized Radiation Imaging and Spectroscopy Mission): A White Paper on the Ultimate Polarimetric Spectro-Imaging of the Microwave and Far-Infrared Sky

PRISM (Polarized Radiation Imaging and Spectroscopy Mission) was proposed to ESA in response to the Call for White Papers for the definition of the L2 and L3 Missions in the ESA Science Programme. PRISM would have two instruments: (1) an imager with a 3.5m mirror (cooled to 4K for high performance in the far-infrared---that is, in the Wien part of the CMB blackbody spectrum), and (2) an Fourier Transform Spectrometer (FTS) somewhat like the COBE FIRAS instrument but over three orders of magnitude more sensitive. Highlights of the new science (beyond the obvious target of B-modes from gravity waves generated during inflation) made possible by these two instruments working in tandem include: (1) the ultimate galaxy cluster survey gathering 10e6 clusters extending to large redshift and measuring their peculiar velocities and temperatures (through the kSZ effect and relativistic corrections to the classic y-distortion spectrum, respectively) (2) a detailed investigation into the nature of the cosmic infrared background (CIB) consisting of at present unresolved dusty high-z galaxies, where most of the star formation in the universe took place, (3) searching for distortions from the perfect CMB blackbody spectrum, which will probe a large number of otherwise inaccessible effects (e.g., energy release through decaying dark matter, the primordial power spectrum on very small scales where measurements today are impossible due to erasure from Silk damping and contamination from non-linear cascading of power from larger length scales). These are but a few of the highlights of the new science that will be made possible with PRISM.Comment: 20 pages Late

CMB-S4

We describe the stage 4 cosmic microwave background ground-based experiment CMB-S4