Patterns of tumor infiltrating lymphocytes in adenoid cystic carcinoma of the head and neck

Adenoid cystic carcinoma (ACC) is a rare malignancy in the head and neck. The prognosis remains poor and late recurrences often occur after 5 years and later. To date, there are no reliable prognostic markers for ACC. In several solid tumors, tertiary lymphoid structures (TLS) are associated with improved survival. This study aims to investigate the role of distribution patterns of tumor infiltrating immune cells (TIL) in ACC. A cohort of 50 patients from three different cancer centers was available for analysis. Sections were stained for CD3, CD4, CD8 and CD20 and evaluated with regard to their distribution of TIL. Patterns were determined as infiltrated-excluded, infiltrated-inflamed and presence of tertiary lymphoid structures. About half of the cases showed an infiltrated-excluded TIL pattern and only a minority of six cases had TLS present within the tumor. Within the inflamed phenotype CD3+ cells were by far the most abundant lymphocyte subtype, and within this compartment, CD8+ T cells were predominant. There was no influence on overall or disease-free survival by any of the TIL patterns. This indicates that ACC is a tumor with very low immunogenicity and even abundance of lymphocytes does not seem to improve prognosis for this disease. Therefore, the observed lack of response towards immunotherapy is not surprising and other methods to induce recognition of ACC by the immune system must be found

Cochlear implantation after canal wall down mastoidectomy - Outcomes after partial mastoid obliteration

Objective: To describe and evaluate the partial mastoid obliteration of the so-called radical mastoid cavity after canal-wall down mastoidectomy (CWD) for cochlear implantation (CI) compared to overclosure of the external ear canal as two stage procedures. Methods: Out of 1020 patients undergoing cochlear implantation between January 1st, 2003 and June 15th, 2016 at the Department of Otolaryngology, Head & Neck Surgery, University Hospital Cologne, eight patients underwent obliteration of the radical cavity prior to cochlear implantation. In four additional patients, the external ear canal was overclosed prior to cochlear implantation. Results: Patients undergoing partial mastoid obliteration (five female, 4 left ears) and overclosure of the external ear canal (one female, 3 left ears) averaged 56 years and 61 years, respectively. The radical cavities had been present for 21.8 years on average before partial obliteration and for 19.5 years before overclosure. Cochlear implantation following mastoid obliteration was performed after a mean period of 5.1 months and 3.8 months after overclosure. After partial mastoid obliteration, complete insertion of all electrodes was achieved and the clinical courses were uneventful for all patients. Likewise, no patient revealed any complications after overclosure of the external ear canal. Conclusion: Partial mastoid obliteration with bone pate and cartilage after canal wall down mastoidectomy can be advocated as a feasible alternative technique that allows for a safe subsequent cochlear implantation. (C) 2018 Elsevier B.V. All rights reserved

Expression of podoplanin correlates with prognosis in nasopharyngeal carcinoma

Purpose Podoplanin is a membrane-bound glycoprotein that plays a role in lymphangiogenesis. Several studies suggest a role of podoplanin in head-and-neck cancer. The purpose of the current study was to evaluate the role of podoplanin as a prognostic marker in nasopharyngeal carcinoma. Methods In a monocentric retrospective analysis, data of 42 patients with primary diagnosis of nasopharyngeal carcinoma (diagnosed between 2004 and 2017) were examined regarding the relationship between the immunohistochemically analyzed podoplanin expression status and corresponding clinical and oncological parameters. Results The mean age was 56.6 years. The majority (61.9%) had an advanced tumor stage (T3-T4). The 5-year overall survival was 54%. 33% showed a positive expression of podoplanin. In patients with tumors with podoplanin expression, 5-year overall survival was 15%, while in patients with tumors without podoplanin expression, 5-year overall survival was 75% (p = 0.017, univariate analysis). In multivariate analysis, podoplanin expression was shown to be the only independent prognostic marker for nasopharyngeal carcinoma (p = 0.025). Conclusion This retrospective study shows that podoplanin expression is a potential prognostic marker for nasopharyngeal carcinomas. In the future, clinical use could filter out more aggressive courses and allow therapy escalation in those cases

Pharyngeal fistulas after total laryngectomy with and without tracheostoma plasty according to Herrmann

Pharyngeal fistula (PF) is one of the most common complications after total laryngectomy (TL). The tracheostoma plasty technique according to Herrmann (TPH) represents an alternative surgical technique to shape the tracheostoma. The aim of this study was to determine whether the performance of a TPH affects the incidence of PF after TL. A secondary aim was to identify potential risk factors for the development of PF with regard to TPH. Retrospective evaluation of records of 151 consecutive patients at two tertiary care centers with regard to the occurrence and risk factors of PF after TL with and without TPH. 60 patients with TPH and 91 patients without TPH contributed to the results. The overall incidence of PF was 21.2% (32 out of 151). 23.3% (14 out of 60) of patients with TPH and 19.8% (18 of 91) of patients without TPH developed a PF (p = 0.91). Binary logistic regression analysis revealed significant influence of salvage surgery on the risk to develop PF (odds ratio = 2.9; 95% CI 1.16-7.23; p = 0.026). The occurrence of PF was not significantly influenced by any other investigated factors including performance of TPH. Performance of TPH after TL does not increase the incidence of PF. Thus, TPH can be considered as a safe alternative surgical technique for the shaping of the tracheostoma following TL

Analysis of the dura involvement in cholesteatoma surgery

Objective: The involvement of the dura is a rare yet potentially life-threatening complication during cholesteatoma surgery. Thus, the knowledge about treatment and consequences of this issue is of great importance to every ear surgeon. Methods: This retrospective study analyzed the dura involvement with regard to the type of defect, reconstruction method used, and the post-operative complications of 1291 pediatric and adult cholesteatoma surgeries performed at an academic tertiary care center over a twelve-year period. Results: From a total of 1291 cholesteatoma surgeries, we identified 84 patients (6.5%) with dura involvement intraoperatively, most of them adult patients. The majority of the reported cases were bony defects and exposed dura without CSF leakage (79.73%, 67 out of 84). In 14.28% of the cases (12 out of 84) a meningo(encephalo)cele or dura defect with liquorrhea were detected. In 30 surgeries (35.7%, 30 out of 84) no reconstruction of the lateral skull base was considered necessary. The most common material used for reconstruction was conchal cartilage (25.0%, 21 out of 84), followed by polydioxanone (PDS)-foil (11.9%. 10 out of 84), bone pate (9.5%, 8 out of 84) and a combination of materials (17.9%, 15 out of 84). Revision surgery of the reconstruction was necessary in 16.7% (14 out of 84) of the cases. Long-term evaluation (mean of 19.3 months) showed no complication related to the skull base defect. Conclusion: During cholesteatoma surgery, bony and dura defects can be managed effectively, with good long-term reliability. No intracranial or mastoidal complications are expected. (C) 2017 Elsevier B.V. All rights reserved

The diagnostic value of computed tomography in delayed complications after cochlear implantation

Background Delayed complications after cochlear implant (CI) surgery can result in the need for revision surgery. Temporal bone computed tomography (tCT) is frequently used in the diagnostic work-up for these patients. Aims/objectives We aimed to test for the value of tCT in delayed complications after CI surgery. Material and methods Retrospective chart review including all patients with CI who were consecutively enrolled in our academic tertiary care centre and received a tCT due to delayed complications between January 2008 and December 2017. Results A total of 85 patients with a mean age of 28 years at CI surgery were identified. Mean time between CI and tCT was 4.3 years. Reasons for performance of tCT were device malfunction (20%), cephalgia (20%), scalp hematoma/seroma (15.3%), device failure (11.8%), vertigo (10.6%), local infection (7.1%), trauma (5.9%), meningism (3.5%), tinnitus (3.5%) and facial palsy (2.4%). No abnormalities in tCT were detected in 82.4%. However, an abnormal tCT was a predictor for surgical therapy (p < .001). Conclusions and significance We recommend the performance of tCT in CI patients with delayed complications to identify or rule out pathology in order to choose the most ideal and relevant individual treatment

Analgesia after tonsillectomy with controlled intravenous morphine — overdue or exaggerated?

Objective: To assess the value of a morphine Patient Controlled Intravenous Analgesia (PCIA) after Tonsillectomies (TE). Methods: 30 adult patients were treated with oral analgesics (protocol group) and compared to 30 patients treated with a morphine PCIA for the first 3 Postoperative Days (PODs) after TE. Average and maximum pain severities (Numeric Rating Scale – NRS: 0–10) on PODs 1–3, analgesic score, quality of life, patient satisfaction and side effects were defined as outcome measures. Results: Average pain severities of the protocol and the PCIA group were of similar magnitude (NRS) (POD1: 4.48 vs. 4.71 [p = 0.68], POD2: 4.75 vs. 4.22 [p = 0.32] and POD3: 4.44 vs. 4.25 [p = 0.71]). Maximum pain intensities on POD1 (p = 0.92), POD2 (p = 0.51) and POD3 (p = 0.36) were also comparable between both groups. Patients with a PCIA consumed significantly more opioids (p = 0.001) without significant more side-effects. Conclusion: The PCIA did not provide a superior pain control compared to oral analgesics. In view of the considerable effort and the high opioid consumption, it cannot be recommended as a standardized application for pain control after TE

Surgical Treatment for Early Stage Glottic Carcinoma with Involvement of the Anterior Commissure

Objective. Assessment of the value of transoral laser microsurgery (TLM) compared with open surgery (OS) for early stage squamous cell carcinoma of the glottic larynx with special regard to involvement of the anterior commissure (AC). Study Design. Case series with chart review. Setting. Tertiary care otolaryngology clinic. Subjects and Methods. Review of clinicopathological data of all patients with previously untreated T1a, T1b, and T2 glottic squamous cell carcinoma of the larynx who were consecutively enrolled over a 10-year period (January 1, 1992, to December 31, 2002). Results. Local recurrence rate was 20.4% (10 of 49) for TLM and 10.7% (3 of 28) for OS. Comparison of the TLM and OS groups regarding local recurrence rates revealed a significant difference only for tumors invading the AC (P = .046). Within the TLM group, tumors with involvement of the AC showed a significantly higher recurrence rate (38.1%; 8 of 21) compared with tumors without involvement of the AC (7.1%; 2 of 28; P = .008). In the OS group, involvement of the AC revealed no significant difference (P = .45). The overall survival in both groups was comparable in both groups (TLM, 93.9%; OS, 89.3%; P = .47). Conclusion. TLM and OS are equally effective surgical treatments for early stage glottic cancer without involvement of the AC, with selection of treatment based on pretreatment endoscopy. However, TLM is associated with less morbidity. In case of invasion of the AC, OS yields lower recurrence rates

Novel therapeutic approaches for salivary gland carcinomas

Novel therapeutic options for the treatment of salivary gland malignancies have emerged due to the improvement and distribution of molecular pathological testing methods and the availability of targeted therapies. Since they are less toxic, these new agents are a valuable alternative to conventional cytotoxic chemotherapy. On the one hand, there are new entity-specific therapies such as NTRK inhibitor therapy for secretory carcinomas and axitinib therapy for adenoid cystic carcinomas. Moreover, cross-entity therapeutics such as antiandrogenic therapy, HER2 inhibition, and PI3K inhibition are also coming to the fore. For metastatic/recurrent salivary gland carcinomas that cannot be treated with targeted therapy, platinum-based chemotherapies continue to be therapy of choice