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Malignant peripheral nerve sheath tumors of the head and neck
Otolaryngology Head and Neck Surgery Volume 1t7
Number 2
103
Malignant Peripheral Nerve Sheath Tumors of the Head and Neck THOM R, LOREE, MD, FACS, WESLEY L. HICKS, Jr., MD, JAMES H. NORTH Jr., MD, FACS, and BRUCE A. WERNESS, MD, Buffalo, N.Y., and Ft. Gordon, Ga.
Background: Malignant peripheral nerve sheath tumors (MPNST) may occur in the head and neck region. They may be associated with neurofibromatosis or occur in a sporadic manner. Our experience with this disease allows for an assessment of the response to intervention and an analysis of prognostic factors affecting patient outcome. Study design: A retrospective review of 17 patients with M P N S T of the head and neck managed at Roswell Park from 1962 to 1995 was performed to identify clinical and pathologic factors that influenced outcome. P53 mutation status and proliferation index were assessed by immunohistochemistry using antibodies to P53 and K 1=67, respectively. Results: There were nine males and eight females with a median age of 43 years (range 4 to 75 years). Seven patients had a history of neurofibromatosis, while 10 patients had the sporadic form of the disease. Radiotherapy was implicated as a possible etiologic factor in four patients. The neck was the most frequently involved site. Overall survival at 5 and 10 years was 51% and 41%, respectively. Survival was improved for females (p < 0.1) and for patients with lower grade tumors (p < 0.025). Tumor site in the head and neck had no impact upon survival. Survival was worse for patients with neurofibromatosis when compared with those with the sporadic form of the disease (29% versus 68% at 5 years) (p < 0.025). Local recurrence correlated with tumor size and the status of the margins of resection. No local recurrences occurred in the patients who had negative margins of resection and received adjuvant radiotherapy. Nodal recurrence occurred in one patient. Tumor grade was predictive of the development of distant metastases. Conclusions: MPNST of the head and neck is an uncommon tumor that carries a worse prognosis when encountered in patient with neurofibromatosis. Negative margins of resection are essential for obtaining local control, and the addition of adjuvant radiotherapy appears beneficial even in this group. Salvage surgery for local recurrence is possible in a subset of these patients. 104
Toluidine Blue Staining as a Screening Test for Occult Malignancies of the Upper Aerodigestive Tract CHRISTOPHER H. RASSEKH,MD, CHRISTOPHERTHOMPSON, MD, HADI SEIKALY, MD, and JAMES HOKANSON, Galveston, Tex., and Edmonton, Alberta, C a n a d a
Objective: Numerous studies have shown that patients with carcinomas of the upper aerodigestive tract are at an
Scientific Posters
P193
increased risk for second malignancies. Many surgeons have historically recommended routine screening of these patients with panendoscopy. Intravital staining of the mucosa of the upper aerodigestive tract (UADT) with toluidine blue has been used to detect occult tumors. The goal of this study was to determine the efficacy of toluidine blue staining as an adjunct to routine screening panendoscopy. Methods: We prospectively studied 54 patients with squamous cell carcinoma of the UADT. Twenty-nine patients had the mucosa stained without a preliminary wash. Subsequently, 24 patients had staining done after the mucosa was washed with acetic acid. Results: No occult tumors were found. Several nonspecific stains (false negatives) and premalignant lesions were found. There were no complications, but we have abandoned this technique as a routine because of the low yield and increased operating time and costs. Conclusions: We still advocate the routine use of screening panendoscopy for these high-risk patients until a subset of highest risk patients can be identified or a better screening tool is available. 105
Cancer of the Larynx: Correlation Among Epidemiology, Clinical Feature, Staging, and Diagnostic Delay MICHEL B. CAHALI, MD, MARCIA STATOE MURAKAMI, MD, IVAN DIEB MIZIARA, MD, and JOSE RENATO ROXO GUIMARAES, MD, Sao Paulo, SP, Brazit
The authors studied the records of 108 cases of cancer of the larynx registered at the Department of Otolaryngology-Medical School of University of Sao Paulo from 1985 to 1995. A high number of female patients was observed (18), with an elevated relation between men and women (5:1), showing a tendency already described in other countries. This fact may be related to an increment on the use of tobacco among the female patients (72, 2%). The disease affected women younger than men, suggesting that the effect of carcinogenic agents occurs earlier in female patients. The difference as to the tumor's extension in relation to sex was slight, not allowing us to establish any association between these two factors. Dysphonia was the most common symptom observed (85, 2%), independently of the site of the tumor. Dysphagia, dyspnea, and weight loss were similarly incident (32, 4%; 34, 3%; and 29, 6%, respectively), with dysphagia occurring more frequently in tumors that affected the supraglottis and dyspnea occurring more frequently in glottic and subglottic tumors. As to staging, 45 (8%) presented in stage IV at first consultation, and only 13 (5%) in stage I. No association was observed among the tumor size (according to the TNM classification), presence of lymph nodal involvement, and diagnostic delay, considering the period between the beginning of symptoms and the first consultation at the hospital. In relation to the first symptom referred by the patients, the ones who complained of dysphonia looked for medical help later. There was no correlation between histo-
Number 2
103
Malignant Peripheral Nerve Sheath Tumors of the Head and Neck THOM R, LOREE, MD, FACS, WESLEY L. HICKS, Jr., MD, JAMES H. NORTH Jr., MD, FACS, and BRUCE A. WERNESS, MD, Buffalo, N.Y., and Ft. Gordon, Ga.
Background: Malignant peripheral nerve sheath tumors (MPNST) may occur in the head and neck region. They may be associated with neurofibromatosis or occur in a sporadic manner. Our experience with this disease allows for an assessment of the response to intervention and an analysis of prognostic factors affecting patient outcome. Study design: A retrospective review of 17 patients with M P N S T of the head and neck managed at Roswell Park from 1962 to 1995 was performed to identify clinical and pathologic factors that influenced outcome. P53 mutation status and proliferation index were assessed by immunohistochemistry using antibodies to P53 and K 1=67, respectively. Results: There were nine males and eight females with a median age of 43 years (range 4 to 75 years). Seven patients had a history of neurofibromatosis, while 10 patients had the sporadic form of the disease. Radiotherapy was implicated as a possible etiologic factor in four patients. The neck was the most frequently involved site. Overall survival at 5 and 10 years was 51% and 41%, respectively. Survival was improved for females (p < 0.1) and for patients with lower grade tumors (p < 0.025). Tumor site in the head and neck had no impact upon survival. Survival was worse for patients with neurofibromatosis when compared with those with the sporadic form of the disease (29% versus 68% at 5 years) (p < 0.025). Local recurrence correlated with tumor size and the status of the margins of resection. No local recurrences occurred in the patients who had negative margins of resection and received adjuvant radiotherapy. Nodal recurrence occurred in one patient. Tumor grade was predictive of the development of distant metastases. Conclusions: MPNST of the head and neck is an uncommon tumor that carries a worse prognosis when encountered in patient with neurofibromatosis. Negative margins of resection are essential for obtaining local control, and the addition of adjuvant radiotherapy appears beneficial even in this group. Salvage surgery for local recurrence is possible in a subset of these patients. 104
Toluidine Blue Staining as a Screening Test for Occult Malignancies of the Upper Aerodigestive Tract CHRISTOPHER H. RASSEKH,MD, CHRISTOPHERTHOMPSON, MD, HADI SEIKALY, MD, and JAMES HOKANSON, Galveston, Tex., and Edmonton, Alberta, C a n a d a
Objective: Numerous studies have shown that patients with carcinomas of the upper aerodigestive tract are at an
Scientific Posters
P193
increased risk for second malignancies. Many surgeons have historically recommended routine screening of these patients with panendoscopy. Intravital staining of the mucosa of the upper aerodigestive tract (UADT) with toluidine blue has been used to detect occult tumors. The goal of this study was to determine the efficacy of toluidine blue staining as an adjunct to routine screening panendoscopy. Methods: We prospectively studied 54 patients with squamous cell carcinoma of the UADT. Twenty-nine patients had the mucosa stained without a preliminary wash. Subsequently, 24 patients had staining done after the mucosa was washed with acetic acid. Results: No occult tumors were found. Several nonspecific stains (false negatives) and premalignant lesions were found. There were no complications, but we have abandoned this technique as a routine because of the low yield and increased operating time and costs. Conclusions: We still advocate the routine use of screening panendoscopy for these high-risk patients until a subset of highest risk patients can be identified or a better screening tool is available. 105
Cancer of the Larynx: Correlation Among Epidemiology, Clinical Feature, Staging, and Diagnostic Delay MICHEL B. CAHALI, MD, MARCIA STATOE MURAKAMI, MD, IVAN DIEB MIZIARA, MD, and JOSE RENATO ROXO GUIMARAES, MD, Sao Paulo, SP, Brazit
The authors studied the records of 108 cases of cancer of the larynx registered at the Department of Otolaryngology-Medical School of University of Sao Paulo from 1985 to 1995. A high number of female patients was observed (18), with an elevated relation between men and women (5:1), showing a tendency already described in other countries. This fact may be related to an increment on the use of tobacco among the female patients (72, 2%). The disease affected women younger than men, suggesting that the effect of carcinogenic agents occurs earlier in female patients. The difference as to the tumor's extension in relation to sex was slight, not allowing us to establish any association between these two factors. Dysphonia was the most common symptom observed (85, 2%), independently of the site of the tumor. Dysphagia, dyspnea, and weight loss were similarly incident (32, 4%; 34, 3%; and 29, 6%, respectively), with dysphagia occurring more frequently in tumors that affected the supraglottis and dyspnea occurring more frequently in glottic and subglottic tumors. As to staging, 45 (8%) presented in stage IV at first consultation, and only 13 (5%) in stage I. No association was observed among the tumor size (according to the TNM classification), presence of lymph nodal involvement, and diagnostic delay, considering the period between the beginning of symptoms and the first consultation at the hospital. In relation to the first symptom referred by the patients, the ones who complained of dysphonia looked for medical help later. There was no correlation between histo-