We demonstrate that FISH is a simple and sensitive method for detecting cyclin D1 amplification and p16 deletion in head and neck cancer. Our results suggest that these two genetic aberrations together portend a poorer outcome than either of the abnormalities alone in head and neck cancer.

Glandular carcinomas of the larynx are rare tumors that constitute less than 1% of all laryngeal malignancies. A retrospective case review of 12 patients with glandular carcinomas of the larynx is presented to identify patient and tumor characteristics, therapeutic modalities, and treatment outcomes. Ten patients underwent surgical excision of the primary tumor, by either supraglottic laryngectomy, vertical partial laryngectomy, or total laryngectomy. Seven of these patients also received postoperative radiotherapy. After a median follow-up period of 23 months, 7 of the 12 patients (58.3%) died as a result of uncontrolled locoregional disease or distant metastases. The 5-year survival rate was 57% in patients who underwent combination therapy versus 50% for those patients who received surgery alone. Surgical resection is the primary treatment modality used in the majority of cases. Neck dissection is reserved for patients with clinically apparent adenopathy, adenocarcinoma, or high-grade mucoepidermoid carcinoma. Combination therapy with surgical resection and radiotherapy may be more effective in achieving tumor remission than is surgical resection alone.

No abstract

A predictable pattern of metastasis based on tumor histology and site of origin has been well documented for most cancers that arise in the head and neck region. The current study demonstrates that this predictable pattern of metastasis can be significantly impacted by previous therapy, resulting in unusual patterns of metastasis in patients with recurrent tumors. A retrospective case series of 5 patients with head and neck carcinomas who developed metastases to distant lymph nodes is presented. All patients underwent surgery and radiotherapy to the primary tumor and regional lymphatics at the time of their initial treatment. All of the patients developed a local recurrence less than a year before the detection of distant lymphatic metastases. Cytology or excision confirmed metastases to the axillary, inguinal, or anterior intercostal lymph nodes. All of the patients underwent aggressive surgery for attempted cure of the local recurrence shortly before the presence of distant lymphatic metastases was clinically recognized. The metastatic workup of patients with carcinomas of the head and neck frequently includes examination of the regional lymph nodes as well as chest radiography, liver function tests, and serum calcium determination. This evaluation may fail to detect metastases to distant lymph nodes in patients who present with recurrent or second primary cancers. Such patients should undergo careful examination of all major lymph node-bearing regions of the body when being evaluated for the presence of distant metastases.

A retrospective review of 14 patients with adenoid cystic carcinoma of the tongue treated between 1955 and 1997 was performed. Treatment consisted of surgery (n = 2), radiotherapy (n = 2), chemotherapy (n = 1), or combination therapy (n = 9). The 2-, 5-, and 10-year absolute survival rates were 92%, 79%, and 63%, respectively. Seventy-five percent of the patients who died of cancer succumbed to distant metastases. However, long-term survival was common despite a high incidence of local and distant recurrence. The presence of positive surgical margins, the incidence of regional metastases, the incidence of perineural invasion, the initial stage of disease, and the eventual development of locoregional recurrence and distant metastases did not significantly alter the survival rate. Surgical extirpation combined with postoperative radiotherapy is advocated for the treatment of adenoid cystic carcinoma of the tongue. Given the indolent nature of this disease process, surgery should be directed toward conservation of speech and swallowing function.

The present study indicates that FISH is a useful technique for detecting molecular changes such as amplification of chromosome 11q13 in HNSCC. FISH in paraffin preparations allows for accurate measurement of intensity of amplification and makes it possible for the evaluation of a large collection of archival material. The data also suggest that 11q13 amplification is correlated with poorly differentiated tumors and metastasis. Thus FISH has the potential to be a valuable diagnostic/prognostic tool in head and neck cancers.

No abstract

A recurrence of a parotid pleomorphic adenoma presenting as an external ear canal mass is reported. The route of extension was radiographically documented as an incompletely closed foramen of Huschke. The historical and developmental features of this foramen and the mechanisms of tumor extension as they relate to it are discussed.