Browsing by Author "Rinaldo, Alessandra"
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- An evidence-based analysis of the management of N0 neck in patients with cancer of the parotid glandPublication . 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, AlfioIntroduction: 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.
- Analysis of the clinical relevance of histological classification of benign epithelial salivary gland tumoursPublication . Hellquist, Henrik; Paiva-Correia, António; Poorten, Vincent Vander; Quer, Miquel; Hernandez-Prera, Juan C.; Andreasen, Simon; Zbären, Peter; Skalova, Alena; Rinaldo, Alessandra; Ferlito, AlfioIntroductionA 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.
- Cervical lymph node metastasis in adenoid cystic carcinoma of oral cavity and oropharynx: A collective international reviewPublication . 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, AlfioThe 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.
- Cervical lymph node metastasis in adenoid cystic carcinoma of the larynx: a collective international reviewPublication . 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, AlfioAdenoid 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.
- Cervical lymph node metastasis in high-grade transformation of head and neck adenoid cystic carcinoma: a collective international reviewPublication . 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, AlfioAdenoid 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.
- Differential diagnosis in neuroendocrine neoplasms of the LarynxPublication . Hunt, Jennifer L.; Ferlito, Alfio; Hellquist, Henrik; Rinaldo, Alessandra; Skalova, Alena; Slootweg, Pieter J.; Willems, Stefan M.; Cardesa, AntonioThe 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.
- How phenotype guides management of the most common malignant salivary neoplasms of the Larynx?Publication . Lopez, Fernando; Williams, Michelle D.; Skalova, Alena; Hellquist, Henrik; Suarez, Carlos; Nixon, Iain J.; Rodrigo, Juan P.; Cardesa, Antonio; Strojan, Primoz; Quer, Miquel; Hunt, Jennifer L.; Rinaldo, Alessandra; Ferlito, AlfioSalivary gland carcinomas of the larynx are uncommon. Adenoid cystic carcinoma is the most prevalent type of salivary gland carcinoma in this region, although other histologies such as mucoepidermoid carcinoma and adenocarcinomas have been reported. These tumors may present with advanced-stage due to nonspecific symptoms and their relatively slow-growing nature. The index of suspicion for a non-squamous cell carcinoma entity should be high when a submucosal mass is present. An accurate diagnosis is mandatory due to the impact each biologic entity has on treatment and outcome. Data concerning treatment and outcome are scarce, but primary surgery with utmost focus on free surgical margins is the treatment of choice. The role of adjuvant radiotherapy has not been well defined, although there is an agreement that it should be considered in advanced-stage or high-grade disease. This review considers only the most common malignant salivary neoplasms of the larynx with a focus on clinical management of these tumors.
- Lymphomas of the head and neck region: an updatePublication . Cabecadas, Jose; Martinez, Daniel; Andreasen, Simon; Mikkelsen, Lauge Hjorth; Molina-Urra, Ricardo; Hall, Diane; Strojan, Primoz; Hellquist, Henrik; Bandello, Francesco; Rinaldo, Alessandra; Cardesa, Antonio; Ferlito, AlfioThe field of haematopathology is rapidly evolving and for the non-specialized pathologist receiving a specimen with the possibility of a lymphoid malignancy may be a daunting experience. The coincidence of the publication, in 2017, of the WHO monographies on head and neck and haematopoietic and lymphoid tumours prompted us to write this review. Although not substantially different from lymphomas elsewhere, lymphomas presenting in this region pose some specific problems and these are central to the review. In addition, differences in subtype frequency and morphological variations within the same entity are discussed. The difficulty in diagnosis related to some specimens led us to briefly mention common subtypes of systemic lymphomas presenting in the head and neck region.
- Neuroendocrine neoplasms of the sinonasal regionPublication . Bell, Diana; Hanna, Ehab Y.; Weber, Randal S.; DeMonte, Franco; Triantafyllou, Asterios; Lewis, James S., Jr.; Cardesa, Antonio; Slootweg, Pieter J.; Stenman, Goran; Gnepp, Douglas R.; Devaney, Kenneth O.; Rodrigo, Juan P.; Rinaldo, Alessandra; Wenig, Bruce M.; Westra, William H.; Bishop, Justin A.; Hellquist, Henrik; Hunt, Jennifer L.; Kusafuka, Kimihide; Perez-Ordonez, Bayardo; Williams, Michelle D.; Takes, Robert P.; Ferlito, AlfioNeuroendocrine neoplasms of the sinonasal region, which are relatively uncommon but clinically very important, are reviewed here in the light of current knowledge. Using a definition for neuroendocrine based on phenotypic, histologic, immunohistochemical, and electron microscopic features rather than histogenetic criteria, sinonasal neuroendocrine carcinomas are examined with a particular emphasis on the small-cell and large-cell subtypes. This is followed by revisiting olfactory neuroblastoma because it is also a tumor that shows a neuroendocrine phenotype. Kadish clinical and Hyams histologic grading systems as prognosticators of olfactory neuroblastoma are also considered in detail. Finally, controversies regarding sinonasal undifferentiated carcinoma as a neuroendocrine tumor are discussed and a possible relationship with high-grade olfactory neuroblastoma is explored. Genetic events and current management of these tumors are also outlined. (C) 2015 Wiley Periodicals, Inc.
- Newly described entities in salivary gland pathologyPublication . Skalova, Alena; Gnepp, Douglas R.; Lewis, James S., Jr.; Hunt, Jennifer L.; Bishop, Justin A.; Hellquist, Henrik; Rinaldo, Alessandra; Poorten, Vincent Vander; Ferlito, AlfioSalivary glands may give rise to a wide spectrum of different tumors. This review concentrates on 4 salivary gland tumors that have been accepted in the recent literature as new neoplastic entities: mammary analog secretory carcinoma, cribriform adenocarcinoma of minor salivary glands (CASG), sclerosing polycystic adenosis/adenoma (SPA), and the mucinous/secretory variant of myoepithelioma. Mammary analog secretory carcinoma is a distinctive low-grade malignant salivary cancer that harbors a characteristic chromosomal translocation, t(12;15) (p13;q25), resulting in an ETV6-NTRK3 fusion. Cribriform adenocarcinoma (CASG) is a distinct tumor entity that differs from polymorphous low-grade adenocarcinoma by location (ie, most often arising on the tongue), by prominent nuclear clearing, differing alterations of the PRKD gene family, and clinical behavior with frequent metastases at the time of presentation of the primary tumor. Early nodal metastatic disease is seen in most cases of CASG; yet, they are still associated with indolent clinical behavior, making it a unique neoplasm among all low-grade salivary gland tumors. SPA is a rare sclerosing tumor of the salivary glands characterized by the combination of cystic ductal structures with variable cell lining including vacuolated, apocrine, mucinous, squamous, and foamy cells, by prominent large acinar cells with coarse eosinophilic cytoplasmic zymogen-like granules, and by closely packed ductal structures, surrounded by a peripheral myoepithelial layer and stromal fibrosis with focal inflammatory infiltrates. SPA frequently harbors intraductal epithelial dysplastic proliferations ranging from mild dysplasia to severe dysplasia/carcinoma in situ. Moreover, SPA has been proven to be a clonal process by HUMARA assay and is associated with considerable risk of recurrence. Therefore, on the basis of all these newly recognized findings, we believe that SPA is likely a neoplasm, and we suggest the name sclerosing polycystic adenoma. The mucinous variant of myoepithelioma is a myoepithelial tumor with foci of prominent cytoplasmic clearing frequently containing intracellular mucin material and having signet-ring morphology.