Sentinel node biopsy in early oral squamous cell carcinomas: Long-term follow-up and nodal failure analysis

Publication date: July 2018
Source:Oral Oncology, Volume 82
Author(s): A. Moya-Plana, A. Aupérin, J. Guerlain, P. Gorphe, O. Casiraghi, G. Mamelle, A. Melkane, J. Lumbroso, F. Janot, S. Temam
ObjectivesEvaluate the reliability of sentinel node biopsy (SNB) in T1/T2 cN0 oral squamous cell carcinoma (OSCC), and compare recurrence-free time (RFT) and overall survival (OS) between patients undergoing SNB and neck dissection (ND).Patients and methodsPatients with T1/T2 cN0 OSCC underwent SNB followed by systematic ND in the first cohort and SNB followed by selective ND in case of positive sentinel nodes (SN) in the second cohort.ResultsA total of 229 patients were followed (first cohort 50, second cohort 179). SNs were successfully detected in 93.9% (215/229) of cases. Median follow-up was 5.6 years. Recurrence occurred in 38/215 patients, with isolated nodal recurrence in 18/215 patients. At 5 years, the rate of recurrence-free patients was 80.0% and the rate of patients without isolated nodal recurrence was 90.4%. Negative predictive value of SNB was 92.7%. No statistically significant difference was observed between the two groups regarding RFT and OS. In 83% (10/12) of ipsilateral isolated nodal recurrences, primary tumor was located in anterior part of oral cavity. Only 43% (3/7) of SN+ patients with nodal recurrence were eligible for salvage surgery, compared to 91% (10/11) of SN- patients. SNB resulted in fewer complications than ND (8% vs 28%, p < 0.0001).ConclusionSNB is a reliable staging tool for T1/T2 cN0 OSCC, without adverse effect on patient survival and fewer complications. No late recurrences occurred in long-term follow-up. Close follow-up is mandatory for SN+ patients, who are at higher risk of nodal recurrence and have worse prognosis.



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Cerebellar degeneration in primary Sjögren syndrome

Neurological manifestations are reported as a consequence of primary Sjögren syndrome (PSS). Any part of the brain and peripheral nervous system can be involved in PSS. However, cerebellar degeneration and atrophy associated with PSS have been rarely reported. Our report describes a 22-year-old woman who presented with cerebellar ataxia, arthritis and arthralgia. Evaluation of her symptoms, autoantibodies and salivary gland pathology was in favour of the diagnosis of Sjögren syndrome. Also, her brain MRI revealed cerebellar degeneration. There are only four patients reported to be affected by cerebellar atrophy associated with PSS. Administration of high doses of methylprednisolone and cyclophosphamide leads to substantial improvement in the cerebellar symptoms of this case. In addition, after 2 months of follow-up, the patient's ataxia recovered significantly. It could be concluded that in addition to neurological degenerative disorders, in some cases cerebellar atrophy could also be associated with autoimmune conditions such as PSS.

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Campylobacter jejuni and Pseudomonas coinfection in the setting of ulcerative colitis

A 66-year-old woman presented with 2 days of fever and severe diarrhoea. She has a history of ulcerative colitis (UC), well controlled with medication. She also has a history of Ehlers-Danlos syndrome, infective endocarditis following aortic valve replacement and pulmonary embolism. She had complained of passing stool with traces of blood about 30 times per day. Stool testing for Clostridium difficile, routine culture and microscopy was done. She was started on ceftriaxone. CT scan revealed thick-walled colon consistent with UC flare. Flexible sigmoidoscopy showed active continuous colitis extending from the rectum to the proximal descending colon. Campylobacter jejuni was isolated from the stool and blood cultures yielded Pseudomonas aeruginosa. The antibiotic was transitioned to intravenous piperacillin/tazobactam and azithromycin followed by 2 weeks of intravenous cefepime. Her diarrhoea was controlled, and she was discharged for follow-up in 2 months.

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Lupus of the larynx: when bamboo nodes lead to diagnosis...

Description 

An 18-year-old patient consulted complaining of dysphonia for 3 months associated with severe weakness, headache and diffuse articular pain, with haematoma at the slightest trauma.

Laryngoscopy showed a submucosal oval lesion in the middle third of the two vocal folds resembling bamboo joint nodes (figure 1). Laboratory analysis showed the presence of antinuclear antibodies, antidouble-stranded DNA, antinucleosome, anti-SSA (117), anti-SSB (115) and anti-Sm (25) antibodies associated with thrombocytopaenia, haemolytic anaemia and severe ADAMTS-13 deficiency (under 5%). The patient was admitted to the hospital for monitoring, plasma exchange and glucocorticoid therapy. The diagnosis of systemic lupus erythematosus was made. The laryngeal lesions were bamboo nodes. The patient received Solu-Medrol 500 mg/day and prednisone 60 mg/day combined with speech therapy. The bamboo nodes partially regressed under treatment with a marked improvement of the voice. A few months later, laryngeal injection of triamcinolone 40 mg under local anaesthesia was performed with a favourable...

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Small bowel obstruction caused by vas deferens: a first documented report

Small bowel obstruction (SBO) is one of the most common causes for an acute surgical admission. Most of the time SBO is a result of common causes such as postoperative adhesions. However, rare and unusual causes of SBO do exist which can be challenging for surgeons. We report a first documented case of SBO caused by a remnant of the vas deferens in a 24-year-old patient with a history of gastroschisis and left orchidectomy. Clinical presentation, investigations, imaging and management of this case are described. To summarise, clinicians should keep an open mind in dealing with patients with intestinal obstruction due to the rare and atypical causes.

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Avascular necrosis: a growing concern for the HIV population

A 33-year-old woman with history of HIV presented with 4 months of gradually progressing right hip pain and was found to have avascular necrosis (AVN) of both femoral heads. She had no other risk factors for AVN including sickle cell disease, systemic lupus erythematosus, prolonged steroid used or trauma. She initially failed conservative management and ultimately had bilateral hip core decompressions. After decompression therapy, the left femoral head collapsed and patient underwent a left total hip arthroplasty. Her postsurgical course was complicated by the left sciatic nerve neuropathy for which she is currently being managed with duloxetine. She has yet to follow-up with her orthopaedic surgeon for further evaluation.

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Radiological appearance of primary extracranial meningioma of the pelvis in a middle-aged woman

Description 

A 47-year-old woman came with the complaints of on-and-off constipation for 6 months with the inability to pass stool for 2 days. She also complained of poor urinary stream and increased urine frequency for 1 year and had a history of hysterectomy with bilateral salpingo-oophorectomy. Her general and systemic examinations were unremarkable. Abdominal radiograph revealed diffuse opacification of the pelvis with left lateral displacement and compression of the rectal shadow (figure 1A). CT of abdomen and pelvis (figure 1B–F) revealed a large, well-defined heterogeneously enhancing lobulated lesion in the presacral region and central pelvis showing multiple coarse calcifications within. The lesion was abutting the distal sigmoid colon and rectum causing their left lateral displacement with luminal compression and loss of intervening fat plane. There was resultant dilatation of the large and distal small bowel loops suggestive of intestinal obstruction. The fat plane between the lesion and the...

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