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Background. Sinonasal teratocarcinosarcoma is a rare, aggressive malignancy located almost exclusively in the nasal cavity, paranasal sinuses, or anterior skull base. Histopathological diagnosis can be challenging due to the heterogeneous composition. Methods. Retrospective analysis of 3 patients with sinonasal teratocarcinosarcoma diagnosed and treated at the University Medical Center Utrecht was conducted. Results. Patients presented with nasal obstruction, epistaxis, headaches, or behavioral changes. All three patients had locally advanced disease, and one had lymph node metastases. Two patients underwent surgery followed by radiotherapy, and one underwent neoadjuvant chemotherapy followed by surgery. The follow-up duration ranged from 3 to 32 months. All three patients died due to progression of their disease. Conclusion. Sinonasal teratocarcinosarcoma is characterized by rapid, aggressive local expansion. The prognosis is poor due to a high risk of metastases and locally recurrent disease. Multimodality treatment consisting of surgery, followed by (chemo)‐radiotherapy, is essential for optimizing outcomes. Neoadjuvant therapy offers a promising treatment option.

The implementation of 7T magnetic resonance imaging for human use has the potential to further advance spatial resolution beyond that of 3T. This could result in potential advantages in the depiction of the membranous structures of the inner ear. The inner ear is particularly challenging to visualize at 7T because of its anatomic location, which can lead to susceptibility banding artifacts and signal loss.

The implementation of 7.0 Tesla magnetic resonance imaging (MRI) for human use has the potential to further advance spatial resolution beyond that of 1.5T and 3T. This could result in potential advantages in the depiction of the membranous structures of the inner ear.

The objectives of this prospective trial were to evaluate the diagnostic accuracy and predictive value of magnetic resonance imaging (MRI) and to use MRI evaluation under general anesthesia (EGA) 6 to 8 weeks after chemoradiation to determine local control.Eighty‐two consecutive patients with advanced‐stage squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or supraglottic larynx were treated with selective targeted chemoradiation. All patients who completed treatment and survived had a minimum follow‐up of 3 years. MRI and EGA were performed from 6 to 8 weeks after treatment. Posttreatment MRI findings were compared with pretreatment MRI findings and were graded for risk of local recurrence/residual disease on a 4‐point scale. The diagnosis of treatment failure was based on tissue biopsies, which were obtained during EGA or later during follow‐up. The predictive value of MRI was analyzed by using a Cox proportional hazards model.Only 1 patient with MRI Grade 0 or 1 findings (discrete mass < 10 mm; n = 62 patients) had residual disease 6 to 8 weeks after treatment that was detected during EGA. In 5 patients with MRI findings of Grade 2a and 2b (mass > 10 mm; n = 20 patients), residual disease was detected. After 2 years, 23 patients had a local failure (28%). Twelve local failures were found among 62 patients who had MRI findings of Grade 0 and 1. Posttreatment MRI emerged as an independent predictive factor (hazard ratio, 3.0; P = .014) for local control.Posttreatment MRI studies provided predictive information on local control in addition to pretreatment predictors. In patients with focal masses < 10 mm, the combination of response evaluation under general anesthesia and posttreatment MRI from 6 to 8 weeks after chemoradiation hardly provided more information on the local control than posttreatment MRI alone. Cancer 2006. © 2006 American Cancer Society.

Concurrent chemoradiation is being used increasingly to treat patients with advanced‐stage head and neck carcinoma. In the current study, a clinical nomogram was developed to predict local control and overall survival rates for individual patients who will undergo chemoradiation.Ninety‐two consecutive patients with UICC TNM Stage III/IV squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, and supraglottic larynx were treated with selective‐targeted chemoradiation (acronym: RADPLAT). All living patients had a minimum follow‐up of 2 years. In addition to general factors, the following parameters were analyzed in a multivariable analysis: primary tumor volume, lymph node tumor volume, total tumor volume, lowest involved neck level, comorbidity, pretreatment hemoglobin level, pretreatment weight loss, and unilateral/bilateral intraarterial infusion. Relevant factors for local control and survival were analyzed using the Cox proportional hazards model.At 5 years, the local control and overall survival rates for the whole group were 60% and 38%, respectively. Primary tumor volume (hazard ratio [HR], 1.03; P = 0.01) and unilateral infusion (HR, 5.05; P = 0.004) were found to influence local control significantly. Using tumor volume as a continuous variable, an adjusted risk ratio of 1.026 was found, indicating that each 1‐cm3 increase in volume was associated with a 2.6% decrease in probability of local control. Primary tumor volume (HR, 1.01; P = 0.003), comorbidity (American Society of Anesthesiologists [ASA] physical status 1 vs. > 1; HR, 2.47; P = 0.01), lowest involved neck level (HR, 3.45; P = 0.007), and pretreatment weight loss > 10% (HR, 2.04; P = 0.02) were found to be significant predictors of worse overall survival. Variables from the multivariable analysis were used to develop a nomogram capable of predicting local control and overall survival.Tumor volume was found to play a significant role in predicting local control and overall survival in patients with advanced‐stage head and neck carcinoma who were treated with targeted chemoradiation. The nomograms may be useful for pretreatment selection of patients with advanced‐stage head and neck carcinoma. Cancer 2004. © 2004 American Cancer Society.

The Tumor Node Metastasis (TNM) classification system describes head and neck tumors using anatomic or unidimensional criteria and may therefore fail to define the actual three-dimensional tumor bulk. To investigate this we measured variability of tumor volumes (Vvol) in T3-staged head and neck tumors. Patient material consisted of pretreatment computerized tomography (CT) scans of 71 patients, seen between 1990 and 1995, with T3 head and neck carcinoma involving different subsites. Computerized tomographic scans of 42 patients displayed distinct tumor boundaries and were free of motion and/or dental artifacts. Using these scans, tumor volumes were measured using the summation-of-areas technique, and Vvol was determined. Following are the tumor-volume measurements: T3 larynx carcinoma (n = 12) Vvol, 1.7–17.0 mL (median 3.7 mL); T3 oropharynx carcinoma (n = 13) Vvol, 10.0–41.2 mL (median 18.3 mL); T3 hypopharynx carcinoma (n = 10) Vvol, 8.9–67.8 mL (median 17.4 mL); T3 nasopharynx carcinoma (n = 3) Vvol, 3.7–30.1 mL; T3 maxillary sinus carcinoma (n = 4) Vvol, 56.0–103.1 mL. T3-Staged tumors of the head and neck show considerable variability of tumor volumes. Incorporation of tumor volume data may further refine the TNM staging system. © 1997 John Wiley & Sons, Inc. Head Neck 19: 6–13, 1997.

This study was undertaken to determine whether pretreatment computed tomography (CT) findings can predict local control in pyriform sinus carcinoma treated with definitive radiotherapy (RT). Twenty-three patients with pyriform sinus carcinoma (T1: n = 5; T2: n = 18) were treated with high-dose RT and followed for a minimum of 2 years. Tumor volumes and extent were determined on pretreatment CT studies. The specific CT parameters assessed were analyzed as predictors of local control. There was a significant decrease in local control rate for tumors over 6.5 mL (1 of 4 [25%]) relative to tumors under 6.5 mL (17 of 19 [89%]; p = .021). Sensitivity and specificity for local control using this cutoff were 94% and 60%, respectively. Tumor score, as a measure of anatomic extent, was also found to be a significant predictor of local control (p = .033). The local control rate was not influenced significantly by the presence of “minimal” apex disease (&lt;10 mm in greatest dimensions as measured on CT) but decreased significantly when “bulk” apex disease (10 mm) was present (p = .027). Laryngeal cartilage sclerosis was not a significant predictor of outcome. Computed tomography can stratify pyriform sinus carcinomas into groups more or less likely to be locally controlled with definitive RT. © 1998 John Wiley & Sons, Inc. Head Neck 20: 159–168, 1998.

•Asymmetry of the thyroid cartilage is a morphologic variant of unknown etiology associated with male sex and older age.•Asymmetry of the TC laminae was observed significantly more often on the left side.•Trauma to the thyroid cartilage may result in fractures, but (micro-)fractures of the cartilaginous parts are difficult to detect on computed tomography.•Trauma to cartilaginous parts of the thyroid cartilage may result in asymmetry.•In two cases of nonfatal manual strangulation, TC asymmetry likely resulted from the assault.