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Browsing by Author "Ferlito, Alfio"

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  • An evidence-based analysis of the management of N0 neck in patients with cancer of the parotid gland
    Publication . Vartanian, Jose Guilherme; Goncalves Filho, Joao; Kowalski, Luiz Paulo; Shah, Jatin P.; Suarez, Carlos; Rinaldo, Alessandra; De Bree, Remco; Rodrigo, Juan P.; Hamoir, Marc; Takes, Robert P.; Makitie, Antti A.; Zbaren, Peter; Andreasen, Simon; Poorten, Vincent Vander; Sanabria, Alvaro; Hellquist, Henrik; Robbins, K. Thomas; Boedeker, Carsten C.; Silver, Carl; Ferlito, Alfio
    Introduction: Management of clinically negative neck (cN0) in patients with parotid gland cancer is controversial. Treatment options can include observation, elective neck dissection or elective radiotherapy. Areas covered: We addressed the treatment options for cN0 patients with parotid gland cancer. A literature review was undertaken to determine the optimal management of this group of patients. Expert opinion: Patients with parotid carcinoma and clinically negative neck have various options for their management. The analysis of tumor stage, histology and grade is essential to better define patients at risk for occult lymph node metastasis. These patients can be managed by surgery, radiotherapy or their combination, depending on the presence of risk factors, the moment at which such risk factors are detected, patient-related clinical conditions, medical provider expertise and institutional facilities.
    2019-10Review Restricted Show more
  • Analysis of the clinical relevance of histological classification of benign epithelial salivary gland tumours
    Publication . Hellquist, Henrik; Paiva-Correia, António; Poorten, Vincent Vander; Quer, Miquel; Hernandez-Prera, Juan C.; Andreasen, Simon; Zbären, Peter; Skalova, Alena; Rinaldo, Alessandra; Ferlito, Alfio
    IntroductionA vast increase in knowledge of numerous aspects of malignant salivary gland tumours has emerged during the last decade and, forseveral reasons, thishas not been the case in benign epithelial salivary gland tumours. We have performed a literature review to investigate whether an accurate histological diagnosis of the 11 different types of benign epithelial salivary gland tumours is correlated to any differences in their clinical behaviour.MethodsA search was performed for histological classifications, recurrence rates and risks for malignant transformation, treatment modalities, and prognosis of these tumours. The search was performed primarily through PubMed, Google Scholar, and all versions of WHO classifications since 1972, as well as numerous textbooks on salivary gland tumours/head and neck/pathology/oncology. A large number of archival salivary tumours were also reviewed histologically.ResultsPleomorphic adenomas carry a considerable risk (5-15%) for malignant transformation but, albeit to a much lesser degree, so do basal cell adenomas and Warthin tumours, while the other eight types virtually never develop into malignancy. Pleomorphic adenoma has a rather high risk for recurrence while recurrence occurs only occasionally in sialadenoma papilliferum, oncocytoma, canalicular adenoma, myoepithelioma and the membranous type of basal cell adenoma. Papillomas, lymphadenoma, sebaceous adenoma, cystadenoma, basal cell adenoma (solid, trabecular and tubular subtypes) very rarely, if ever, recur.ConclusionsA correct histopathological diagnosis of these tumours is necessary due to (1) preventing confusion with malignant salivary gland tumours; (2) only one (pleomorphic adenoma) has a considerable risk for malignant transformation, but all four histological types ofbasal cell adenoma canoccasionally develop into malignancy, as does Warthin tumour; (3) sialadenoma papilliferum, oncocytoma, canalicular adenoma, myoepithelioma and Warthin tumour only occasionally recur; while (4) intraductal and inverted papilloma, lymphadenoma, sebaceous adenoma, cystadenoma, basal cell adenoma (apart from the membranous type) virtually never recur. No biomarker was found to be relevant for predicting recurrence or potential malignant development. Guidelines for appropriate treatment strategies are given.
    2019-06Journal article Open Access Show more
  • Cervical lymph node metastasis in adenoid cystic carcinoma of oral cavity and oropharynx: A collective international review
    Publication . Suarez, Carlos; Barnes, Leon; Silver, Carl E.; Rodrigo, Juan P.; Shah, Jatin P.; Triantafyllou, Asterios; Rinaldo, Alessandra; Cardesa, Antonio; Pitman, Karen T.; Kowalski, Luiz P.; Robbins, K. Thomas; Hellquist, Henrik; Medina, Jesus E.; Bree, Remco de; Takes, Robert P.; Coca-Pelaz, Andres; Bradley, Patrick J.; Gnepp, Douglas R.; Teymoortash, Afshin; Strojan, Primoz; Mendenhall, William M.; Eloy, Jean Anderson; Bishop, Justin A.; Devaney, Kenneth O.; Thompson, Lester D. R.; Hamoir, Marc; Slootweg, Pieter J.; Vander Poorten, Vincent; Williams, Michelle D.; Wenig, Bruce M.; Skalova, Alena; Ferlito, Alfio
    The purpose of this study was to suggest general guidelines in the management of the NO neck of oral cavity and oropharyngeal adenoid cystic carcinoma (AdCC) in order to improve the survival of these patients and/or reduce the risk of neck recurrences. The incidence of cervical node metastasis at diagnosis of head and neck AdCC is variable, and ranges between 3% and 16%. Metastasis to the cervical lymph nodes of intraoral and oropharyngeal AdCC varies from 2% to 43%, with the lower rates pertaining to palatal AdCC and the higher rates to base of the tongue. Neck node recurrence may happen after treatment in 0-14% of AdCC, is highly dependent on the extent of the treatment and is very rare in patients who have been treated with therapeutic or elective neck dissections, or elective neck irradiation. Lymph node involvement with or without extracapsular extension in AdCC has been shown in most reports to be independently associated with decreased overall and cause-specific survival, probably because lymph node involvement is a risk factor for subsequent distant metastasis. The overall rate of occult neck metastasis in patients with head and neck AdCC ranges from 15% to 44%, but occult neck metastasis from oral cavity and/or oropharynx seems to occur more frequently than from other locations, such as the sinonasal tract and major salivary glands. Nevertheless, the benefit of elective neck dissection (END) in AdCC is not comparable to that of squamous cell carcinoma, because the main cause of failure is not relaied to neck or local recurrence, but rather, to distant failure. Therefore, END should be considered in patients with a cN0 neck with AdCC in some high risk oral and oropharyngeal locations when postoperative RT is not planned, or the rare AdCC-high grade transformation. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
    2016-10Journal article Restricted Show more
  • Cervical lymph node metastasis in adenoid cystic carcinoma of the larynx: a collective international review
    Publication . Coca-Pelaz, Andres; Barnes, Leon; Rinaldo, Alessandra; Cardesa, Antonio; Shah, Jatin P.; Rodrigo, Juan P.; Suarez, Carlos; Eloy, Jean Anderson; Bishop, Justin A.; Devaney, Kenneth O.; Thompson, Lester D. R.; Wenig, Bruce M.; Strojan, Primoz; Hamoir, Marc; Bradley, Patrick J.; Gnepp, Douglas R.; Silver, Carl E.; Slootweg, Pieter J.; Triantafyllou, Asterios; Vander Poorten, Vincent; Williams, Michelle D.; Skalova, Alena; Hellquist, Henrik; Teymoortash, Afshin; Medina, Jesus E.; Robbins, K. Thomas; Pitman, Karen T.; Kowalski, Luiz P.; de Bree, Remco; Mendenhall, William M.; Takes, Robert P.; Ferlito, Alfio
    Adenoid cystic carcinoma (AdCC) of the head and neck is a well-recognized pathologic entity that rarely occurs in the larynx. Although the 5-year locoregional control rates are high, distant metastasis has a tendency to appear more than 5 years post treatment. Because AdCC of the larynx is uncommon, it is difficult to standardize a treatment protocol. One of the controversial points is the decision whether or not to perform an elective neck dissection on these patients. Because there is contradictory information about this issue, we have critically reviewed the literature from 1912 to 2015 on all reported cases of AdCC of the larynx in order to clarify this issue. During the most recent period of our review (1991-2015) with a more exact diagnosis of the tumor histology, 142 cases were observed of AdCC of the larynx, of which 91 patients had data pertaining to lymph node status. Eleven of the 91 patients (12.1%) had nodal metastasis and, based on this low proportion of patients, routine elective neck dissection is therefore not recommended.
    2016-04Journal article Open Access Show more
  • Cervical lymph node metastasis in high-grade transformation of head and neck adenoid cystic carcinoma: a collective international review
    Publication . Hellquist, Henrik; Skalova, Alena; Barnes, Leon; Cardesa, Antonio; Thompson, Lester D. R.; Triantafyllou, Asterios; Williams, Michelle D.; Devaney, Kenneth O.; Gnepp, Douglas R.; Bishop, Justin A.; Wenig, Bruce M.; Suarez, Carlos; Rodrigo, Juan P.; Coca-Pelaz, Andres; Strojan, Primoz; Shah, Jatin P.; Hamoir, Marc; Bradley, Patrick J.; Silver, Carl E.; Slootweg, Pieter J.; Vander Poorten, Vincent; Teymoortash, Afshin; Medina, Jesus E.; Robbins, K. Thomas; Pitman, Karen T.; Kowalski, Luiz P.; de Bree, Remco; Mendenhall, William M.; Eloy, Jean Anderson; Takes, Robert P.; Rinaldo, Alessandra; Ferlito, Alfio
    Adenoid cystic carcinoma (AdCC) is among the most common malignant tumors of the salivary glands. It is characterized by a prolonged clinical course, with frequent local recurrences, late onset of metastases and fatal outcome. High-grade transformation (HGT) is an uncommon phenomenon among salivary carcinomas and is associated with increased tumor aggressiveness. In AdCC with high-grade transformation (AdCC-HGT), the clinical course deviates from the natural history of AdCC. It tends to be accelerated, with a high propensity for lymph node metastasis. In order to shed light on this rare event and, in particular, on treatment implications, we undertook this review: searching for all published cases of AdCC-HGT. We conclude that it is mandatory to perform elective neck dissection in patients with AdCC-HGT, due to the high risk of lymph node metastases associated with transformation.
    2016-07Journal article Open Access Show more
  • Chromosome translocations, gene fusions, and their molecular consequences in pleomorphic salivary gland adenomas
    Publication . Stenman, Göran; Fehr, Andre; Skálová, Alena; Vander Poorten, Vincent; Hellquist, Henrik; Mikkelsen, Lauge Hjorth; Saba, Nabil F.; Guntinas-Lichius, Orlando; Chiesa-Estomba, Carlos Miguel; Andersson, Mattias K.; Ferlito, Alfio
    Salivary gland tumors are a heterogeneous group of tumors originating from the major and minor salivary glands. The pleomorphic adenoma (PA), which is the most common subtype, is a benign lesion showing a remarkable morphologic diversity and that, upon recurrence or malignant transformation, can cause significant clinical problems. Cytogenetic studies of >500 PAs have revealed a complex and recurrent pattern of chromosome rearrangements. In this review, we discuss the specificity and frequency of these rearrangements and their molecular/clinical consequences. The genomic hallmark of PA is translocations with breakpoints in 8q12 and 12q13-15 resulting in gene fusions involving the transcription factor genes PLAG1 and HMGA2. Until recently, the association between these two oncogenic drivers was obscure. Studies of the Silver-Russel syndrome, a growth retardation condition infrequently caused by mutations in IGF2/HMGA2/PLAG1, have provided new clues to the understanding of the molecular pathogenesis of PA. These studies have demonstrated that HMGA2 is an upstream regulator of PLAG1 and that HMGA2 regulates the expression of IGF2 via PLAG1. This provides a novel explanation for the 8q12/12q13-15 aberrations in PA and identifies IGF2 as a major oncogenic driver and therapeutic target in PA. These studies have important diagnostic and therapeutic implications for patients with PA.
    2022Journal article Open Access Show more
  • Clear cell neoplasms of salivary glands: A diagnostic challenge
    Publication . Skalova, Alena; Leivo, Ilmo; Hellquist, Henrik; Simpson, Roderick H.W.; Vander Poorten, Vincent; Willems, Stefan M.; Mosaieby, Elaheh; Slouka, David; Ferlito, Alfio
    This review focuses on the heterogenous group of clear cell neoplasms of salivary glands and attempts to identify major differential diagnostic features. Within the head and neck region, clear cells are found most commonly in salivary gland tumors, but may also be seen in tumors of squamous or odontogenic epithelial origin, primary or metastatic carcinomas, benign or malignant melanocytic lesions, or benign or malignant mesenchymal tumors. Clear cells occur fairly commonly among a wide variety of salivary gland neoplasms, but mostly they constitute only a minor component of the tumor cell population. Clear cells represent a major diagnostic feature in two salivary gland neoplasms, epithelial-myoepithelial carcinoma and hyalinizing clear cell carcinoma. In addition, salivary gland neoplasms composed predominantly of clear cells could also include clear cell variants of other salivary neoplasms, such as mucoepidermoid carcinoma and myoepithelial carcinoma, but their tumor type-specific histologic features may only be available in limited nonclear cell areas of the tumor. Diagnosing predominantly clear cell salivary gland tumors is difficult because the immunoprofiles and morphologic features may overlap and the same tumor entity may also have a wide range of other histologic presentations. Many salivary gland tumors are characterized by tumor type-specific genomic alterations, particularly gene fusions of the ETV6 gene in secretory carcinoma, the MYB and MYBL1 genes in adenoid cystic carcinoma, the MAML2 gene in mucoepidermoid carcinoma, the EWSR1 gene in hyalinizing clear cell carcinoma, and others. Thus, along with conventional histopathologic examination and immunoprofiling, molecular and genetic tests may be important in the diagnosis of salivary gland clear cell tumors by demonstrating genetic alterations specific to them.
    2022-07Journal article Restricted Show more
  • Development of head and neck pathology in Europe
    Publication . Hellquist, Henrik; Agaimy, Abbas; Stenman, Göran; Franchi, Alessandro; Nadal, Alfons; Skalova, Alena; Leivo, Ilmo; Zidar, Nina; Simpson, Roderick H. W.; Slootweg, Pieter J.; Hernandez-Prera, Juan C.; Ferlito, Alfio
    This review gives a brief history of the development of head and neck pathology in Europe from a humble beginning in the 1930s to the explosive activities the last 15 years. During the decades before the introduction of immunohistochemistry in the 1980s, head and neck pathology grew as a subspeciality in many European countries. In the late 1940s, the Institute of Laryngology and Otology with its own pathology laboratory was founded in London, and in 1964 the World Health Organization (WHO) International Reference Centre for the Histological Classification of Salivary Tumours was established at the Bland-Sutton Institute of Pathology, also in London. International collaboration, and very much so in Europe, led to the publication of the first WHO Classification of Salivary Gland Tumours in 1972. In the 1960s, a salivary gland register was organised in Hamburg and in Cologne the microlaryngoscopy was invented enabling microscopic endoscopic examination and rather shortly afterwards a carbon dioxide laser attached to the microscope became established and laryngeal lesions could be treated by laser vaporisation. During the last three decades, the use of immunohistochemistry supplemented with cytogenetic and refined molecular techniques has greatly facilitated the pathological diagnostics of head and neck lesions and has had a huge impact on research. Collaboration between different European centres has drastically increased partly due to establishment of scientific societies such as the Head and Neck Working Group (HNWG) within the European Society of Pathology and the International Head and Neck Scientific Group (IHNSG). A very large number of European pathologists have contributed to the 2nd, 3rd and 4th WHO books, and are involved in the upcoming 5th edition. Accredited educational meetings and courses are nowadays regularly arranged in Europe. Numerous textbooks on head and neck pathology have been written and edited by European pathologists. The increased collaboration has created larger series of tumours for research and new entities, mainly defined by their genetic abnormalities, are continuously emerging from Europe, particularly regarding salivary gland neoplasms and "undifferentiated" sinonasal tumours. These findings have led to a better and more precise classification and open the possibilities for new treatment strategies.
    2022Journal article Restricted Show more
  • Differential diagnosis in neuroendocrine neoplasms of the Larynx
    Publication . Hunt, Jennifer L.; Ferlito, Alfio; Hellquist, Henrik; Rinaldo, Alessandra; Skalova, Alena; Slootweg, Pieter J.; Willems, Stefan M.; Cardesa, Antonio
    The differential diagnosis of neuroendocrine neoplasms of the larynx is broad and includes lesions of epithelial, mesenchymal, and neuroectodermal origin. These lesions have overlapping clinical and pathologic aspects and must be carefully considered in the differential diagnosis of laryngeal neoplasms. The prognosis and treatment are also different among these tumor types, which necessitates making these distinctions clinically. The current literature was reviewed to provide updated information regarding the epithelial-derived tumors, including carcinoid, atypical carcinoid, small cell neuroendocrine carcinomas, large cell neuroendocrine carcinoma, and squamous cell carcinoma with neuroendocrine component. These tumors are compared and contrasted with nonepithelial-derived tumors such as paraganglioma and nonmucosal tumors, such as medullary thyroid carcinoma. The morphologic and cytologic features are discussed, along with helpful immunohistochemical and ancillary investigations.
    2017-05Journal article Restricted Show more
  • Emerging entities and new diagnostic markers for head and neck soft tissue and bone tumors
    Publication . Franchi, Alessandro; Thompson, Lester D. R.; Hernandez-Prera, Juan C.; Agaimy, Abbas; Williams, Michelle D.; Mikkelsen, Lauge H.; Bishop, Justin A.; Willems, Stefan M.; Hellquist, Henrik; Ferlito, Alfio
    Bone and soft tissue tumors of the head and neck are relatively uncommon tumors that often represent a diagnostic challenge because of the wide range of entities that must be considered in the differential diagnosis. Over the past few years, classification of bone and soft tissue tumors has evolved primarily because of substantial contributions from molecular genetics, with the identification of new markers that are increasingly used to complement histopathologic findings in the routine diagnostic workup. This review focuses on the recently described mesenchymal tumors that preferentially involve the head and neck region, with a focus on the most relevant novel immunohistochemical and molecular findings, including gene fusions and mutations, that can help in the diagnosis and in the assessment of clinical behavior.
    2021-05Review Restricted Show more