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Clear-cell variants of follicular carcinoma are rare subtypes of thyroid cancer. There is no unified view of the histopathological features of clear cell variants, but follicular carcinomas composed predominantly of clear cells are distinguished from clear cell variants. In clinical practice, it is important to determine whether clear cell variants arise primarily from the thyroid gland or are thyroid metastases of other clear cell carcinomas, such as renal cell carcinoma. We present a case in which a patient with initially suspected anaplastic thyroid carcinoma due to a rapidly progressive anterior neck mass was diagnosed with a clear cell variant of follicular carcinoma after a tissue biopsy. The patient was treated with lenvatinib, then his performance status improved, and he was discharged from the hospital. On day 188 after discharge, a contrast-enhanced computed tomography (CECT) scan of the neck showed further shrinkage of the tumor. However, a CECT scan of the chest revealed multiple lung metastases. On day 233 after discharge, the patient developed severe pneumonia resulting from tracheal rupture due to intratumoral necrosis. It was difficult to decide whether lenvatinib should have been discontinued or reduced when lung metastasis appeared. It is necessary to accumulate additional cases to make informed decisions about continuing lenvatinib therapy.

The objective of this study was to investigate the accuracy of fine needle aspiration cytology (FNAC) and biopsy for the clinical diagnosis of minor salivary gland tumours (MSGTs). This retrospective study of 32 MSGT cases was conducted over a 5-year period. Clinical features including age, sex, and location of the tumour were obtained from the patient clinical records. All cases were also assessed histologically according to the 2017 World Health Organization Classification of Head and Neck Tumours. The results of FNAC and biopsy were correlated with those of histopathology, and their sensitivity, specificity, and diagnostic efficacy were calculated using histopathology as the gold standard. Eighteen malignant MSGTs (56.3%) and 14 benign MSGTs (43.8%) were diagnosed by pathological diagnosis. The most common malignant tumour was mucoepidermoid carcinoma (seven cases, 38.9%). Most benign cases were pleomorphic adenomas (13 cases, 92.9%). FNAC was performed for 23 cases and biopsy for 13 cases. The sensitivity and specificity of FNAC were 66.7% and 91.0%, respectively, while those of biopsy were 90.0% and 100.0%, respectively. Although FNAC is a minimally invasive and cost-effective procedure, it is less accurate than biopsy in the assessment of MSGTs. Repeated FNAC or biopsy should be considered in negative and unsatisfactory FNAC cases.

平成17年4月から平成22年3月までに被膜間摘出術を施行した頸部神経鞘腫の10例を対象とし，年齢，性別，術前の神経症状，由来神経，腫瘍の大きさ，術後の神経症状を検討した。年齢は，16歳から66歳で平均42.1歳であり，性別は，男性4例，女性6例であった。由来神経は舌神経，迷走神経由来が各1例，副神経が3例，腕神経叢が3例，頸神経が2例であった。腫瘍の大きさと術前の神経症状の関係は認められなかったが，術後の神経症状に関しては腫瘍が大きい方が出現しやすいことが推測された。また，手術操作が術後の神経脱落症状に関係していると考えられた。

頭頸部癌に対し，化学放射線同時併用療法が広く行われるようになってきている。機能・器官・形態の温存の面から，手術的治療よりも患者のQOLを保つことが出来ると考えられているが，最近では治療後の合併症で日常生活に支障をきたし，必ずしも手術療法より患者のQOLが保たれているとはいいがたい面もある。実際に治療後の患者がQOLを保つことができているかを検討するために，当科で化学放射線同時併用療法を受けた頭頸部癌患者に対し，その後の合併症，治療中の問題点，改善点，満足度などについてアンケート調査を行ったので報告する。結果として一番問題となる症状は口渇であったが，経過観察期間が長くなるにつれて症状は改善傾向にあった。満足度に関しては「満足」，「ほぼ満足」が9割を超えており，改善点はあるものの患者の治療後のQOLは保たれているものと考えられた。今後も改善できる点は改善を行い，治療中，治療後の患者のQOLの向上に努めていくべきと考えられた。