No abstract

Objective: To determine the incidence of lymph node metastases in the submuscular recess (level 2B) in selective neck dissections. The goal was to evaluate the oncologic need for dissection in this area owing to the increased morbidity from devascularization of the spinal accessory nerve.Methods: A prospective analysis of 74 patients who underwent 80 neck dissections from July 2002 to March 6, 2004, was undertaken. Seventy-six of the 80 neck dissections were performed in patients with squamous cell carcinoma, whereas the remainder were done for papillary carcinoma of the thyroid. All submuscular recess specimens were sent separately from the remainder of the neck dissection. The location of the primary tumour, staging, presurgical radiation status, and the number of nodes in both specimens were recorded.Results: Forty six percent (37 of 80) of the neck dissections were positive for malignancy. Of the 80 neck dissections, 8.75% (7) had positive nodes in the submuscutar recess. All patients with disease in the submuscular recess were preoperatively staged as N2B or greater.Conclusion: Our data suggest that dissection of the submuscular recess in patients with squamous cell carcinoma of the head and neck may be warranted only in patients with N2B disease or greater. SOMMAIREObjectifs: Determiner incidence des metastases ganglionnaires dans le recessus sous-musculaire (niveau 2B) lors des evidements cervicaux selectifs. Le but etait d'evaluer la necessite oncologlque de dissequer cette zone pour eviter la morbidity associee a la devascularisation du nerf spinal accessoire.Methodes: Nous presentons une etude prospective de 74 patients qui ont subi 80 evidements entre iuillet 2002 et mars 2004. Soixante-seize des 80 evidements etaient chez des patients porteurs de carcinome epidermoide et les autres pour un carcinome papillaire de la thyroide. Tous les echantillons de recessus sous-musculaires ont ete separes du reste de I'evidement. Nous avons enregistre la localisation de la tumeur primaire, le stade, I'utilisation de radiotherapie pre-operatoire et le nombre de ganglions dans chacun des specimens.Resuitats: Nous avons retrouve du carcinome chez 46% (37 sur 80) des evidements. De ces 80 evidements, 8.75% (7) avaient des ganglions positifs dans le recessus sous-musculaire. Tous ces patients avaient un stade clinique d'au moins N2B avant I'intervention.Conclusion: Nos donnees suggerent que la dissection du recessus sous-musculaire chez les patients avec un carcinome epidermoide, n'est necessaire que chez les patients avec au moins un stade N2B.

Nodular fasciitis (NF), a benign proliferation of fibroblasts, commonly presents as a solitary, well-circumscribed, rapidly growing soft tissue mass. It is most commonly located in the upper extremities, particularly on the volar aspect of the elbow, and on the chest and trunk. In adults, NF is rarely found in the head and neck region. Although benign, it can often be confused with a more malignant process and therefore must be properly diagnosed histologically. The cause of NF is unknown but an association with trauma may be present. Treatment is most commonly by local surgical excision, and recurrence is rare. A case of NF over the zygoma in a 60-year-old man not associated with trauma is presented.

A predominant theory of the much debated histogenesis of Warthin tumor (WT) is that it arises from heterotopic salivary ductal inclusions (SDI) in parotid lymph nodes (LN). If this were the case, we might expect to see an increased number of SDI in the lymph nodes of patients with WT compared to controls. To test this, we compared the prevalence of SDI in patients with WT versus those with pleomorphic adenoma (PA). Cases of WT and PA were retrieved from the case files of the Department of Pathology at the QEII Health Science Centre, Halifax, NS, Canada. We then compared the prevalence of SDI in parotid LN between patients diagnosed with WT versus PA. 46 WT and 52 PA met our inclusion criteria. WT was significantly associated with an older age at surgery (62.5 years vs 50.2 years, p = 0.001). 71.7 % of WT and 32.7 % of PA had inclusions in any LN. The presence of inclusion is a significant predictor for WT versus PA (p = 0.019). Where smoking status was available, 92.5 % of WT patients were smokers/ex-smokers, versus. 55.1 % of PA (p = 0.034 for current smokers). Among PA, 44 % of smokers had inclusions compared with 22.7 % of non-smokers. SDIs are more frequent in parotid LN from patients with WT than PA. The high proportion of smokers among WT patients is consistent with prior studies. The results support the hypothesis that WT arises from SDIs. Individuals with more SDIs may be predisposed to WT.

We describe a case of multiple intra-articular masses in the glenohumeral joint of a 15-year-old patient. The patient was treated with arthroscopic excision of the masses and synovectomy. Histological and immunohistochemical studies were consistent with those of a nodular fasciitis. Follow-up examination did not reveal recurrence at 6 months. In this article we report the first case of articular nodular fasciitis in the glenohumeral joint with unusual imaging findings.