Perineural spread in squamous cell carcinomas of the head and neck: a clinicopathological study

Abstract

Perineural spread of tumour has been demonstrated in 24% of an unselected series of 70 patients with squamous carcinomas of the head and neck treated by surgery. Slightly more than half the patients had primary tumours arising within the buccal cavity. Clinical features suggesting perineural infiltration were found in about two thirds of the cases; the symptoms and signs were usually sensory and occurred early in the disease. The mandibular division of the trigeminal nerve was most commonly affected. Perineural spread was more likely to occur with large carcinomas, moderate or poorly differentiated, showing local invasion and lymph node metastases. The associated pathological changes are described and a high incidence of damage to nerve fibres is recorded. The practical implications of perineural spread of tumour are discussed with reference to indications for more radical surgery or for more conservative measures supplemented with other modes of treatment.

Squamous Carcinomas of the Head and Neck: Some Patterns of Spread

“…Perineural spread is a familiar feature of malignant salivary gland tumours, particularly adenoid cystic carcinomas, but its regular occurrence in squamous carcinomas of the head and neck is not well known (Ballantyne et al 1963, Dodd et al 1970, Carter et al 1979. Results from the present series indicate that perineural spread is comparatively common in large T3, T4 tumours, particularly those arising in the oral cavity.…”

“…The morphological changes associated with direct bone invasion are also seen in neoplastic invasion of the ossified regions of the laryngeal framework (Carter et al 1979). Parts of the thyroid, cricoid and arytenoid cartilages normally start to ossify in early adult life, and it has been known for many years that these patches of metaplastic bone are more susceptible to destruction by infiltrating tumour than neighbouring intact cartilage.…”

Decrease in Hemoglobin Levels Following Surgery Influences the Outcome in Head and Neck Cancer Patients Treated with Accelerated Postoperative Radiotherapy

“…Patients with positive surgical margins, perineural invasion, lymph node involvement, presence of ENE constitute a subgroup of patients with high risk of locoregional relapse. [14][15][16][17][18] Besides all of these prognostic factors, numerous reports have pointed out the prognostic value of anemia and the adverse effects of tumor hypoxia on the efficacy of anticancer treatments in recent years, indicating that decreased radiosensitivity resulting from tumor hypoxia was the most likely explanation. 1 a Low \120 g/l in women and \130 g/l in men b High C20 g/l in women and C130 g/l in men OS overall survival, DFS disease-free survival, CSS cancer-specific survival, LRC locoregional control, CI confidence interval, RT radiotherapy, ENE extracapsular nodal extension pre-radiotherapy Hb level, and interruptions during RT [1 week were important prognostic factors for outcome of radiochemotherapy treatment.…”

Significance of the juxtaoral organ (of Chievitz)

“…There is usually no invasion into the deeper layers of the nerve. 36 Clinical features are rarely helpful. In about two thirds of patients with squamous cell carcinomas of the head and neck who have perineural spread, sensory signs and symptoms occur early in the course of their disease.…”