Polymorphous Low-Grade Adenocarcinoma of the Tongue Base Treated by Transoral Robotic Surgery

Polymorphous low-grade adenocarcinoma is a rare malignancy arising from the minor salivary glands in the aerodigestive system, most frequently the hard palate. The treatment of choice is wide surgical resection, and the efficacy of radiotherapy has not been confirmed. A 54-year-old male presenting with a mass at the base of the tongue performed transoral laser microsurgery. The pathologic diagnosis was polymorphous low-grade adenocarcinoma. Complete surgical excision was performed via transoral robotic surgery without a flap reconstruction of the surgical defect. Without complications of bleeding or injury to the hypoglossal nerve, proper surgical margins were obtained, and no recurrence was found after 6 months after surgery. The patient did not complain of dysphagia or aspiration. We conclude that, in surgery for tongue base tumors with unknown malignant potential, transoral robotic surgery can be considered for achieving a definite resection avoiding a mandibulotomy without complications of dysphagia or aspiration after confirmation of malignancy with a frozen biopsy.

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Mucinous cystadenocarcinoma of the oral tongue: malignant transformation from a mucinous cystadenoma?

BMJ Case Reports ◽

10.1136/bcr-2020-235932 ◽

2020 ◽

Vol 13 (10) ◽

pp. e235932

Author(s):

Sofia Dutra ◽

Miguel Rito ◽

Miguel Vilares ◽

Alexandra Borges

Keyword(s):

Salivary Glands ◽

Histopathological Examination ◽

English Literature ◽

Mucinous Cystadenoma ◽

Surgical Excision ◽

Mucinous Cystadenocarcinoma ◽

Low Grade ◽

Minor Salivary Glands ◽

Oral Tongue ◽

Complete Surgical Excision

Mucinous cystadenocarcinoma of minor salivary glands is an extremely rare entity that has only recently been described, with a few published cases in the English literature. A 42-year-old woman with a history of a surgically excised mucinous cystadenoma of the oral tongue, presented with a painful swelling in the oral tongue slowly growing for 1 month. On clinical examination, there was a firm, relatively well-circumscribed mass in the left posterior border of the mobile tongue. Subsequent MRI scan revealed a heterogeneous lesion composed of multiple cysts separated by contrast enhancing septa, in the posterior two-thirds of the left tongue. Imaging findings were similar to those of the previously resected mass, suggesting local relapse of the primary lesion. A complete surgical excision was performed and the histopathological examination revealed typical features of a low-grade mucinous cystadenocarcinoma of minor salivary glands.

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Transoral robotic surgery of the tongue base for obstructive sleep apnea: Preliminary results

European Annals of Otorhinolaryngology Head and Neck Diseases ◽

10.1016/j.anorl.2018.09.001 ◽

2018 ◽

Vol 135 (6) ◽

pp. 411-415 ◽

Cited By ~ 1

Author(s):

G. de Bonnecaze ◽

B. Vairel ◽

A. Dupret-Bories ◽

E. Serrano ◽

S. Vergez

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Robotic Surgery ◽

Transoral Robotic Surgery ◽

Tongue Base ◽

Preliminary Results ◽

Obstructive Sleep

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0659 A Safe and Precise Tongue Base Surgery for Obstructive Sleep Apnea: Real-Time Intraoperative Ultrasound-Assisted Transoral Robotic Surgery

SLEEP ◽

10.1093/sleep/zsaa056.655 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A251-A252

Author(s):

C Lin ◽

C Chang ◽

J Hsiao ◽

J Wu ◽

H Tsai

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Robotic Surgery ◽

Intraoperative Ultrasound ◽

Transoral Robotic Surgery ◽

Tongue Base ◽

Assessment Tools ◽

Bleeding Complications ◽

Lingual Artery ◽

Obstructive Sleep

Abstract Introduction Lingual artery (LA) injury is a devastating complication of tongue base surgery. Compared with the anatomic findings of computed tomography angiography (CTA), intraoperative blade of mouth gag might change the thickness of base of tongue (BOT) and anatomy of LA. We aimed to investigate the position of LA in the BOT with intraoperative ultrasound (IOU) imaging during transoral robotic surgery (TORS), and evaluate the bleeding complications when assisted with / without IOU. Methods Adult obstructive sleep apnea (OSA) patients who received TORS in BOT resection were recruited since 2016. Assessment tools were pre-op over-night hospital polysomnography (PSG) and anatomy-based Friedman Staging System. Ultrasound imaging was utilized to identify anatomic parameters of LA in BOT, including distance to midline, arterial depth and diameter. Results Ninety-three OSA patients (82 male, 88.2%) were analyzed. The mean age was 42.2±10.0 years old and body mass index was 29.2±4.5 kg/m2. The average apnea hypopnea index (AHI) was 58.1±21.4 events/hour. There were 66 (71.0%), 24 (25.8%) and 3 (3.2%) patients in Friedman stages II, III and IV, respectively. Seventy patients underwent TORS with IOU had shorter operation time (191.7±3.8 minutes) than 23 patients without IOU (220.1±6.6 minutes), less total blood loss (11.3±10.8 versus 19.6±26.7 ml), and more BOT tissue reduction volume (7.1±2.5 versus 3.9±1.6 ml). Significant predictors of arterial depth were higher AHI level during rapid-eye-movement (REM) sleep stage (p=0.038), bigger tonsil size (p=0.034) and more elevated Friedman tongue position (p=0.012). Postoperative complication associated with LA injury was not found in the patients with use of IOU. Conclusion When tongue retracted with blade, the distance to midline and depth of LA were altered in BOT. With IOU assisted, surgeon could identify LA position confidently. It is expectable to maximize efficiency and minimize catastrophic bleeding complications when OSA patients received TORS in BOT resection. Support nil

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Transoral Robotic Surgery for the Tongue Base

Atlas of the Oral and Maxillofacial Surgery Clinics ◽

10.1016/j.cxom.2018.11.002 ◽

2019 ◽

Vol 27 (1) ◽

pp. 59-66

Author(s):

Ghali E. Ghali ◽

Andrew T. Meram

Keyword(s):

Robotic Surgery ◽

Transoral Robotic Surgery ◽

Tongue Base

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A Rare Malignant Disease, Dermatofibrosarcoma Protuberans of the Breast: A Retrospective Analysis and Review of Literature

BioMed Research International ◽

10.1155/2020/8852182 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Yihua Wang ◽

Yu Wang ◽

Rui Chen ◽

Zhenrong Tang ◽

Shengchun Liu

Keyword(s):

Retrospective Analysis ◽

Smooth Muscle Actin ◽

Clinical Information ◽

Dermatofibrosarcoma Protuberans ◽

Surgical Excision ◽

Low Grade ◽

Pubmed Database ◽

Storiform Pattern ◽

Rare Malignancy

Dermatofibrosarcoma protuberans (DFSP) is a rare low-grade fibroblastic mesenchymal tumor derived from the dermis. The aim of this retrospective analysis was to summarize the clinicopathological data from our cases and published cases to offer more evidence for the recognition of dermatofibrosarcoma protuberans (DFSP). A total of 6 breast DFSP patients who had received treatment in our hospital were retrospectively enrolled, and detailed clinicopathological data were gathered for analysis. The median age was 29.5 years (ranging from 17 to 42 years). Most cases presented a red or brown-red, mobile, well-circumscribed, protruding, breast mass (ranging from 1 to 3 cm). For histopathology, all cases (6/6) showed a storiform pattern of spindle cells that were positive for CD34 (6/6) and Vimentin (5/6) and negative for smooth muscle actin (0/6) and S-100 protein (0/6). The majority of patients (5/6) underwent wide local excision, with 2 cases treated with radiotherapy. With a median follow-up of 36 months, all 6 patients survived without recurrence or metastasis. The PubMed database was used to search for similar cases. Eventually, 36 cases were included in this review, while cases without detailed clinical information or not reported in English were excluded from the analysis. To summarize, DFSP of the breast is an extremely rare malignancy characterized by spindle tumor cells arranged in a storiform pattern and positivity for CD34. The core needle biopsy is one of the crucial methods for its preoperative diagnosis. Management of DFSP is mainly based on surgical excision. It is prone to local recurrence, so long-term follow-up is required.

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Pulmonary Blastoma: A Rare Primary Lung Malignancy

Case Reports in Medicine ◽

10.1155/2012/471613 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 7

Author(s):

Mahmoud S. Alahwal ◽

Iqbal H. Maniyar ◽

Faiza Saleem ◽

Mariam Alshiekh

Keyword(s):

Objective Response ◽

Fetal Lung ◽

Surgical Excision ◽

Disease Recurrence ◽

Pulmonary Blastoma ◽

Complete Surgical Excision ◽

Lung Malignancy ◽

Platinum Based Chemotherapy ◽

Rare Malignancy ◽

Wall Mass

Pulmonary blastoma, a rare primary lung malignancy, is considered to be distinct from other lung tumors based on pathological features, clinical course, and prognosis. More than one hundred cases have been reported in literature highlighting an interesting fact about their distinctive biologic manner from histopathological features. Classic pulmonary blastoma is composed of a mixture of immature epithelial and mesenchymal tissue resembling fetal lung tissue. Surgery is the mainstay of treatment. The prognosis of this rare malignancy is poor and the overall 5-year survival is around 15%. Our patient presented with respiratory symptoms and was found to have right-sided chest wall mass. The patient underwent complete surgical excision followed by 6 cycles of platinum-based chemotherapy. The patient showed good subjective and objective response with no evidence of disease recurrence. We report this rare malignancy with a review of literature, and the potential to use adjuvant chemotherapy in the management of this condition.

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Radiographic and histopathologic findings of the tongue base in patients with obstructive sleep apnea after transoral robotic surgery: A preliminary study

Sleep Medicine ◽

10.1016/j.sleep.2015.02.042 ◽

2015 ◽

Vol 16 ◽

pp. S18

Author(s):

S. Hong ◽

J. Wee ◽

W. Lee ◽

C. Rhee ◽

C. Lee ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Robotic Surgery ◽

Transoral Robotic Surgery ◽

Tongue Base ◽

Obstructive Sleep ◽

Preliminary Study ◽

Histopathologic Findings

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Transoral robotic surgery for large mixed laryngocoele

The Journal of Laryngology & Otology ◽

10.1017/s0022215113000236 ◽

2013 ◽

Vol 127 (4) ◽

pp. 435-437 ◽

Cited By ~ 21

Author(s):

P G Ciabatti ◽

G Burali ◽

L D'Ascanio

Keyword(s):

Robotic Surgery ◽

Da Vinci ◽

Surgical Excision ◽

Complete Removal ◽

Transoral Robotic Surgery ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Direct Communication ◽

Post Operation ◽

Cervical Approach

AbstractBackground:A laryngocoele is an abnormal dilatation of Morgagni's ventricle in direct communication with the laryngeal lumen. Surgical excision through a cervical approach is traditionally considered the treatment of choice for large (external and mixed) laryngocoeles. This paper describes the first reported case of a large mixed laryngocoele treated with transoral robotic surgery without cervical incisions.Method:A 69-year-old female underwent transoral robotic surgery for the excision of a large mixed left laryngocoele. The surgery was performed using the da Vinci S surgical robotic system (Intuitive Surgical, Sunnyvale, California, USA).Results:No complications were observed and the patient was discharged 2 days post-operation.Conclusion:Transoral robotic surgery enabled accurate dissection with complete removal of the large mixed laryngocoele via a minimally invasive approach. The advantages of transoral robotic surgery over other techniques for laryngocoele excision are discussed.

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Gliomas of the optic nerve or chiasm

Journal of Neurosurgery ◽

10.3171/jns.1988.68.1.0085 ◽

1988 ◽

Vol 68 (1) ◽

pp. 85-98 ◽

Cited By ~ 220

Author(s):

Ellsworth C. Alvord ◽

Steven Lofton

Keyword(s):

Optic Nerve ◽

Growth Rates ◽

Surgical Excision ◽

Sufficient Information ◽

Low Grade ◽

Complete Excision ◽

Content Type ◽

Complete Surgical Excision ◽

Table Analysis ◽

Fine Print

✓ A review of the literature revealed 623 cases of optic gliomas with sufficient information to permit actuarial (life-table) analysis concerning the prognosis of this disease by the patients' age, tumor site, treatment, and presence of concomitant neurofibromatosis or extension into the hypothalamus or ventricle. All of these factors are important. The development of mathematical models led to the conclusion that these tumors, generally regarded histologically as low-grade astrocytomas, actually have a very wide but continuous range of growth rates. Some grow rapidly enough to be explained by simple exponential doubling at a constant rate, but most behave as though their growth decelerates. Decelerating growth rates make comparisons of various groups of patients difficult. No support is found for the classical hypothesis that some may be hamartomas. Inadequately treated gliomas of the optic nerve or chiasm bear about the same poor prognosis. However, tumors of the optic nerve (intracranial as well as intraorbital) have an excellent prognosis following complete surgical excision and only a slightly poorer prognosis following irradiation. About 5% of optic nerve gliomas recur in the chiasm following “complete” intraorbital excision. Patients with neurofibromatosis have about twice the recurrence rate following complete excision of an intraorbital glioma. Optic chiasmal gliomas appear to respond to irradiation with doses above 4500 rads. Patients with neurofibromatosis have about the same prognosis as patients without neurofibromatosis following irradiation of a chiasmal glioma.

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