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Diffuse-type neurofibroma (DN) associated with neurofibromatosis type 1 (NF1) involving the external auditory canal (EAC) is uncommon. In DN, it is generally difficult to remove tumors without destroying normal anatomical structures because of the infiltrative and hypervascularized nature of these tumors. A 38-year-old male with NF1 visited our department because of slowly progressive hearing loss on the right side. His EAC was obstructed with a soft borderless mass around the external ear. We performed ultrasonic surgical aspirator skin to just below the surface and also into the surrounding soft tissues without clear borders. An intraoperative rapid diagnosis of neurofibroma was made. We used an ultrasonic surgical aspirator to dissect the infiltrative tumor material. This was effective and caused no damage to the adjacent epidermis or to the auricular cartilage. Subsequently, we performed an M-meatoplasty to enlarge the entrance of the EAC. His hearing acuity recovered postoperatively to the normal range. The postoperative histological diagnosis was DN. At 5.5 years postoperatively, there has been no sign of re-growth. Thus, ultrasonic surgical aspirator resection and subsequent M-meatoplasty appears to be a good surgical approach for DN involving the EAC. [ABSTRACT FROM AUTHOR]

The tyrosine kinase inhibitor lenvatinib has been confirmed as an effective treatment option for patients with unresectable thyroid carcinoma. We conducted a retrospective analysis of the significance of the effect of continued lenvatinib treatment for the longest duration possible at a reasonable daily dose and with a minimum discontinuation period in 42 patients with unresectable thyroid carcinoma treated with lenvatinib between 2015 and 2020. A Cox proportional hazard model-based analysis revealed that the overall survival of the patients treated with a <8 mg/day mean dose of lenvatinib was significantly better than that of the patients treated with 8-24 mg/day (hazard ratio [HR] 0.38 for 1.14-4.54 mg/day, and HR 0.01 for 4.56-7.97 mg/day) adjusted for various factors (e.g., sex, age, drug interruption period). The cumulative dose of lenvatinib administered tended to be higher in the patients treated with low doses (< 8 mg/day) than in the patients treated with relatively high doses (8-24 mg/day). Considering its adverse events, the continuation of lenvatinib treatment with an adequate daily dose and drug interruption may help prolong the survival of patients with unresectable thyroid carcinoma., Competing Interests: No potential conflict of interest relevant to this article was reported.

Although the lung is the most common site of distant metastases from head and neck squamous cell carcinoma (HNSCC), the number of reports about the effects of pulmonary metastasectomy for the treatment of lung metastasis from HNSCC is limited. Metachronous pulmonary metastases were detected in 45 HNSCC patients at Kumamoto University Hospital from 1998 to 2018. Twenty-two patients underwent an operative resection (Ope group) and 23 underwent chemotherapy (Chemo group). The 3-year overall survival (OS) rate and median OS were evaluated. The effects of adjuvant chemotherapy after pulmonary metastasectomy and of new drugs (cetuximab and nivolumab), in the chemo group were also assessed. The 3-year OS rates and median OS were: Ope, 66.1% and 31.5 months; Chemo, 39.7% and 18 months, respectively. In the Ope group, addi-tional recurrences were significantly fewer in the patients who underwent adjuvant chemotherapy post-surgery versus the patients who underwent surgery alone (p = 0.013). In the Chemo group, the 3-year OS rate of the patients who received new drugs was significantly better than that of the patients who did not (p = 0.021). Adjuvant chemotherapy after pulmonary metastasectomy may be a preferable treatment option for preventing recurrences. Cetuximab and nivolumab have a potential to improve OS., Competing Interests: No potential conflict of interest relevant to this article was reported.