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The management of the extensive malignancy of the hypopharynx generally combines with total laryngectomy. The authors report a case of scanty differentiated papillary thyroid carcinoma, extended to the hypopharynx, with partial involvement of thyroid, cricoid and first tracheal ring cartilage and unilateral vocal fold palsy treated with an "atypical" partial tracheo-laringectomy combined with total circular pharyngectomy. The defect has been replaced with an antero lateral tight free flap suitably modeled to restore the pharyngeal and laryngeal lumen. A modified Montgomery T- tube has been inserted to avoid larynges-tracheal stenosis. This unusual technique allowed to restore a stable airway and satisfying deglutition and an adequate voice. With this case presentation the authors want to subline that when the tumor type is less aggressive than squamous cell carcinoma, it is possible to perform a partial larynx preservation also in the case of circular pharyngectomy. Obviously the residual laryngeal skeleton have to be sufficient to restore laryngeal lumen.

Introduction: Minimal access thyroid surgery, using various techniques, is increasingly being reported. The present study reviews our experience with thyroid surgery using a minimally invasive approach in a group of patients with papillary thyroid carcinoma., Methods: A total of 15 female patients with a thyroid nodule, not exceeding 2 cm, proven to be a papillary thyroid carcinoma at preoperative evaluation, underwent a total thyroidectomy with non endoscopic minimally invasive approach., Results: None of the patients presented intraoperative central lymphnode involvement. The cytologic preoperative diagnosis was confirmed by histology in all cases. One case of transient recurrent nerve palsy was observed immediately after surgery. No permanent nerve lesions were documented at 4 months. The hospital stay ranged from 48 to 72 hours. The iodine 131 uptake ranged from 0 to 2.13%, similar to that obtained with open thyroidectomy. All patients were satisfied for cosmetic result., Conclusions: The preliminary results of this study showed that non endoscopic minimally invasive thyroidectomy could be proposed in patients with T1 papillary carcinoma. In our experience the results obtained with this technique are similar to that obtained with open thyroidectomy, with the great advantage of a minimal neck wound and shorter hospital stay. However a higher number of cases and a longer follow-up are needed to confirm the safety of this procedure on the management of papillary cancer of the thyroid.

The present study employed immunohistochemical methods to study the cytokeratin (ck) and vimentin expression in 40 cases of laryngeal squamous cell carcinoma. Specific monoclonal isoform antibodies and mixes of antibodies vs. a specific molecule were used in order to determine what cytokeratins were present as accurately as possible. In this sampling two ck patterns were identified based on whether the ck pair 8/18 was present or not. The ck 8/18 positive cases were further broken down into three sub-groups based on the expression of one of the following: the ck 4/13 pair, ck 1/10 pair or vimentin. A statistically significant relationship was found between these sub-groups, the site at which the neoplasm arose and the tendency toward regional metastases. Moreover, it was found that the presence of ck 13 in a squamous cell carcinoma is correlated with the less aggressive forms, as indicated in the literature.

The Authors reviewed a group of 28 pts with early-stage supraglottic carcinoma (T1-T2N0), classified according to UICC (1987), and treated exclusively with radiotherapy (RT) between 1980 and 1991. Until 1990 RT was employed for such tumors when surgery was refused or controindicated, while since 1991 primary irradiation (with surgery in reserve) has been considered the treatment of choice. The total dose ranged from 66 to 70 Gy on the larynx and up to 50 Gy on neck nodes. RT was applied in a daily fraction of 2 Gy five times a week. No significant early complications were observed. Only 1 pt showed residual cronical oedema in the arytenoid region. In none of the pts was tracheostomy necessary. The local control rate obtained after 30 months was 85.7% (24/28). Salvage surgery (horizontal supraglottic laringectomy, HSL) was performed in 3 out of 4 pts with local failure and achieved complete control of the disease. In the last pt the surgery was controindicated because of poor general health conditions. The actuarial survival rate after 5 years is 86.2%. The present series was compared to a group of 152 pts with T1-T2N0 supraglottic cancer treated surgically (HSL) at the same Istitution. In these pts local control and the actuarial survival rates are 85.6% and 89% respectively. According to recent Literature data, the present findings confirm that RT may be administered for the treatment of selected early stage (T1-T2N0) supraglottic squamous cell carcinoma of the larynx with oncologic results equivalent to those obtained with radical surgery. The importance of imaging techniques (TC, MRI) in the correct staging of the tumor is emphasised.

Primary malignant lymphomas of the major salivary glands are rare and usually arise in the parotid gland (2% of all neoplastic disorders). In this report clinical records of 28 cases of NHL of salivary glands (27 in the parotid gland and one in the submandibular gland) are reviewed and problems related to diagnosis and management strategies are discussed. The 5-year overall survival rate was 72% and did non differ from the survival of other NHL of the head and neck. Statistical evaluation of prognostic factors (age, histology, clinical stage, grading, bulky and surgical approach--biopsy versus parotidectomy), are presented. Analysis of these factors showed that prognosis was not influenced by age, histology, clinical stage and grading of disease. Poor survival was significantly correlated to bulky lesions (tumor size greater than 6 cm). In our experience surgical treatment did not significantly affect survival rate. It is concluded that diagnostic surgical procedures in case of suspected NHL of the parotid gland are fine needle aspiration biopsy. (FNAB) or incisional biopsy. The treatment of choice is radiotherapy associated with chemiotherapy in cases of localized-bulky or disseminated disease.

HIV-related lesions of the parotid region. A case of parotid enlargement in a 43-year-old male with unsuspected HIV infection is reported. Lesions consisted in lymphonodal changes, epi-myoepithelial islands and cysts lined by squamous epithelium. It is suggested that it is possible to recognize an unsuspected HIV infection, when the first clinical involvement is in the parotid region.