Head and neck surgery

This chapter addresses head and neck surgery. It begins with thyroglossal cyst, sinus, and fistula. A thyroglossal cyst is a fluid-filled sac resulting from incomplete closure of the thyroglossal duct. Meanwhile, a thyroglossal sinus results from persistence of the whole duct. The chapter then turns to branchial cyst, sinus, and fistula, before discussing salivary calculi, acute parotitis, and salivary gland tumours. Parotitis is inflammation of the parotid gland; most patients develop this condition as an acute episode of a chronic obstructive sialadenitis. The chapter also considers head and neck cancer, which refers to cancer of upper aerodigestive tract (UADT). In addition, it examines facial trauma and neck space infections.

Nasopharyngeal mucoepidermoid carcinoma: a case report and review of its current management

<p class="abstract">Salivary gland tumours arising at the nasopharynx is highly infrequent. Among them the commonest is mucoepidermoid carcinoma (MEC). Reports with a larger number of patients are often from Asian countries where nasopharyngeal squamous cell carcinoma is also predominant. Although nasopharyngeal MEC (NMEC) is a disease of adults, sporadic cases amongst children have been reported. We report a case of a 32 years old man presented with complaining of intermittent epistaxis over a year. His nasal endoscopy showed friable polypoid tumour at the right choanae. Histopathology revealed a NMEC and he underwent endoscopic endonasal nasopharyngectomy with adjuvant radiotherapy. The optimal treatment for NMEC is arbitrary due to the lack of evidence. However, unlike most sinonasal malignancies, NMEC has the tendency to manifest itself early and has good response to the treatment. Therefore, in this article we describe the clinical features and justifications for the selection of treatment options including surgical and non-surgical therapies and including the role of neck dissection.</p>

Case of labial sclerosing polycystic adenoma with ductal carcinoma in situ (DCIS)

Minor salivary gland tumours are enigmatic in their behaviour and presentations. Histopathological diagnosis of these tumours encompasses a large spectrum. Conventionally, small nodular tumours of the upper lip or the labial mucosa are generally adenomas, frequently pleomorphic adenomas. Here, we describe a case of a solitary nodular tumour, occurring in the upper labial mucosa, diagnosed as sclerosing polycystic adenoma (SPA) with intraductal epithelial proliferation of high grade. This is a rare lesion, which has entered into the category of salivary gland tumours recently in the 2017 WHO categorisation. We report a case of paucicystic SPA with intraductal epithelial proliferations in the labial minor salivary gland of a 56-year-old woman, which might be the first report of a case occurring in the upper labial mucosa.

Polymorphous adenocarcinoma of the submandibular gland

Polymorphous adenocarcinoma (PA) of the salivary glands is a rare malignancy that predominantly affects the minor salivary glands of the palate. Major salivary gland involvement is rare (<5%). The submandibular gland is a highly unusual location for this tumour. Recently, the WHO has updated the classification of salivary gland tumours in which the PA subtype has been modified. We report a very uncommon case of a classical variant of PA involving the submandibular gland in a 49-year-old woman managed at our institute and discuss the most recent pathological criteria for diagnosis, management strategy and prognosis of PA.

Tumours of the salivary glands

Malignant salivary gland tumours are rare and histologically diverse. The most common tumour site is the parotid gland and most tumours are benign. The aetiological factors are numerous. Presentation of a painless swelling of a salivary gland is always considered as suspicious. Ultrasonography, computed tomography, and magnetic resonance imaging are all useful imaging modalities. Fine-needle aspiration cytology and core biopsy are valuable diagnostic tools. Surgical excision represents the mainstay of treatment for resectable tumours. Radiotherapy, chemotherapy, and immunotherapy all have roles in management.

A Rare Case of Paediatric Pleomorphic Adenoma of the Parotid Gland

Pleomorphic adenomas are benign salivary gland tumours, which predominantly affect the superficial lobe of the parotid gland. The “pleomorphic” nature of the tumour can be explained on the basis of its epithelial and connective tissue origin. The tumour has a female predilection between 30-50 years of age. Slowly progressing asymptomatic swelling is the usual presentation of the tumour. Surgical excision of the tumour mass forms the mainstay of treatment, with utmost care taken to preserve the facial nerve. This case report aims to throw light on an interesting case of pleomorphic adenoma of the parotid gland in a 10 years old female patient. The patient presented with a slowly progressing asymptomatic swelling on the right side of the face, which was diagnosed to be pleomorphic adenoma of right parotid gland. The aim of the study is to discuss how to proceed regarding the further management.

Genomic context of NTRK1/2/3 fusion-positive tumours from a large real-world population

Neurotrophic tropomyosin receptor kinase (NTRK) gene fusions are rare oncogenic drivers in solid tumours. This study aimed to interrogate a large real-world database of comprehensive genomic profiling data to describe the genomic landscape and prevalence of NTRK gene fusions. NTRK fusion-positive tumours were identified from the FoundationCORE® database of >295,000 cancer patients. We investigated the prevalence and concomitant genomic landscape of NTRK fusions, predicted patient ancestry and compared the FoundationCORE cohort with entrectinib clinical trial cohorts (ALKA-372-001 [EudraCT 2012-000148-88]; STARTRK-1 [NCT02097810]; STARTRK-2 [NCT02568267]). Overall NTRK fusion-positive tumour prevalence was 0.30% among 45 cancers with 88 unique fusion partner pairs, of which 66% were previously unreported. Across all cases, prevalence was 0.28% and 1.34% in patients aged ≥18 and <18 years, respectively; prevalence was highest in patients <5 years (2.28%). The highest prevalence of NTRK fusions was observed in salivary gland tumours (2.62%). Presence of NTRK gene fusions did not correlate with other clinically actionable biomarkers; there was no co-occurrence with known oncogenic drivers in breast, or colorectal cancer (CRC). However, in CRC, NTRK fusion-positivity was associated with spontaneous microsatellite instability (MSI); in this MSI CRC subset, mutual exclusivity with BRAF mutations was observed. NTRK fusion-positive tumour types had similar frequencies in FoundationCORE and entrectinib clinical trials. NTRK gene fusion prevalence varied greatly by age, cancer type and histology. Interrogating large datasets drives better understanding of the characteristics of very rare molecular subgroups of cancer and allows identification of genomic patterns and previously unreported fusion partners not evident in smaller datasets.