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1.  The chameleon in the neck: Nodular fasciitis mimicking malignant neck mass of unknown primary 
INTRODUCTION
Difficulties with the correct diagnosis and treatment of nodular fasciitis in head and neck region has been reported in the literature. Nodular fasciitis was mistaken for sarcoma, papillary thyroid carcinoma, Burkitt's lymphoma, pleomorphic adenoma, or as a vascular lesion.
PRESENTATION OF CASE
We present a patient with a single node in the neck with accelerated growth, which clinically appeared as a malignant epithelial tumor with unknown primary. The en bloc removal of the tumor and selective neck dissection was performed with bilateral tonsillectomy and biopsy of the tongue base. The histopathology revealed the tumor to be nodular fasciitis. No malignant cells were detected.
DISCUSSION
Due to very rapid growth, its rich cellularity and high mitotic activity, nodular fasciitis can be mistaken as a malignant tumor. Trauma and/or infection is advocated to be a trigger for the formation of nodular fasciitis, although the exact aetiopathogenesis still remains unknown. Our patient admitted to regularly practicing martial arts with his opponent performing a specific combat maneuver applying pressure into the neck and submental region, which might have triggered the formation of the nodular fasciitis.
CONCLUSION
Nodular fasciitis is a benign and often overlooked diagnosis in the head and neck region, that can be misinterpreted as a malignant tumor both clinically and histologically. A comprehensive medical history may help to avoid unnecessary radical treatment. If a malignancy cannot be confidently ruled out, the en bloc resection of the tumor with selective neck dissection may offer a safe option with low morbidity.
doi:10.1016/j.ijscr.2012.05.018
PMCID: PMC3421146  PMID: 22858790
Nodular fasciitis; Pseudosarcomatous lesion; Neck dissection; Benign tumor
2.  A patient with primary Burkitt’s lymphoma of the postnasal space: case report 
Head & Neck Oncology  2012;4:33.
Introduction
Burkitt’s lymphoma is a highly aggressive lymphoma. The endemic form is present with Epstein - Barr virus. The most common sites are the mandible, facial bones, kidneys, gastrointestinal tract, ovaries, breast and extra-nodal sites. We present the first reported case of a primary Burkitt’s lymphoma of the postnasal space occurring in an elderly Caucasian male.
Case presentation
A 72-year-old Caucasian male farmer presented with a 6-week history of a productive cough and a painless left sided cervical swelling. Examination of the neck revealed a 5 cm by 5 cm hard mass in the left anterior triangle. A CT scan of the head and neck showed a soft tissue swelling in the postnasal space. Histology of the postnasal space mass showed squamous mucosa infiltrated by a high grade lymphoma.
Immunohistochemical staining and in situ hybridisation confirmed the tumour to be Epstein - Barr virus Ribonucleic acid negative suggesting this was a rare sporadic form of the tumour presenting in a location that is atypical for the clinical subtype and age of the patient.
Conclusion
This is the first reported case of sporadic Burkitt’s lymphoma of the postnasal space of an elderly Caucasian male in the absence of Epstein - Barr virus or human immunodeficiency virus infection and further serves to illustrate the diversity of histological subtypes of malignancies that may develop at this concealed site.
doi:10.1186/1758-3284-4-33
PMCID: PMC3414781  PMID: 22695293
3.  A patient with ulcerated calcifying epithelioma of Malherbe in the pinna: case report 
Head & Neck Oncology  2012;4:25.
Introduction
Although pilomatrixomas are frequently encountered by dermatologists and pathologists in the differential diagnosis of head and neck lesions, this is not usually the case among head and neck surgeons.
A pilomatrixoma (calcifying epithelioma of Malherbe) is a benign tumour of the hair matrix cells. Histologically it is characterised by the presence of ghost cells, basophilic cells and foreign body cells. It may sometimes be difficult to histologically distinguish it from its malignant counterpart, the pilomatrix carcinoma.
We report an interesting case of an ulcerated pilomatrixoma of the pinna in a middle-aged Caucasian female.
Case presentation
A 46-year-old Caucasian female presented with a one-month history of tender brownish lump on the pinna. Initially it was thought to represent a pyogenic granuloma. The lesion was treated by wide circular excision. Histopathological evaluation reported a benign calcifying epithelioma of Malherbe.
Conclusion
A search of the world’s literature has led us to believe that this is a rare case of a calcifying epithelioma of Malherbe of the pinna. The rapid growth and ulcerative nature of this tumour makes this case even more unique.
doi:10.1186/1758-3284-4-25
PMCID: PMC3414780  PMID: 22613633
4.  Branchial cysts within the parotid salivary gland 
Head & Neck Oncology  2012;4:24.
Cystic lesions within the parotid gland are uncommon and clinically they are frequently misdiagnosed as tumours. Many theories have been proposed as to their embryological origin. A 20-year retrospective review was undertaken of all pathological codes (SNOMED) of all of patients presenting with any parotid lesions requiring surgery. After analysis seven subjects were found to have histopathologically proven parotid branchial cysts in the absence of HIV infection and those patients are the aim of this review. Four of the most common embryological theories are also discussed with regard to these cases, as are their management.
doi:10.1186/1758-3284-4-24
PMCID: PMC3414791  PMID: 22607735
5.  The future of medical diagnostics: review paper 
Head & Neck Oncology  2011;3:38.
While histopathology of excised tissue remains the gold standard for diagnosis, several new, non-invasive diagnostic techniques are being developed. They rely on physical and biochemical changes that precede and mirror malignant change within tissue. The basic principle involves simple optical techniques of tissue interrogation. Their accuracy, expressed as sensitivity and specificity, are reported in a number of studies suggests that they have a potential for cost effective, real-time, in situ diagnosis.
We review the Third Scientific Meeting of the Head and Neck Optical Diagnostics Society held in Congress Innsbruck, Innsbruck, Austria on the 11th May 2011. For the first time the HNODS Annual Scientific Meeting was held in association with the International Photodynamic Association (IPA) and the European Platform for Photodynamic Medicine (EPPM). The aim was to enhance the interdisciplinary aspects of optical diagnostics and other photodynamic applications. The meeting included 2 sections: oral communication sessions running in parallel to the IPA programme and poster presentation sessions combined with the IPA and EPPM posters sessions.
doi:10.1186/1758-3284-3-38
PMCID: PMC3180646  PMID: 21861912
6.  At the frontiers of surgery: review 
The complete surgical removal of disease is a desirable outcome particularly in oncology. Unfortunately much disease is microscopic and difficult to detect causing a liability to recurrence and worsened overall prognosis with attendant costs in terms of morbidity and mortality. It is hoped that by advances in optical diagnostic technology we could better define our surgical margin and so increase the rate of truly negative margins on the one hand and on the other hand to take out only the necessary amount of tissue and leave more unaffected non-diseased areas so preserving function of vital structures. The task has not been easy but progress is being made as exemplified by the presentations at the 2nd Scientific Meeting of the Head and Neck Optical Diagnostics Society (HNODS) in San Francisco in January 2010. We review the salient advances in the field and propose further directions of investigation.
doi:10.1186/1758-3284-3-7
PMCID: PMC3048561  PMID: 21306627
7.  Common Head and Neck Cases in Our Consultation Referrals: Diagnostic Dilemmas in Inverted Papilloma 
Head and Neck Pathology  2009;3(3):260-262.
Papillomas of the nose and paranasal sinuses comprise three morphologically distinct variants—everted papilloma, inverted papilloma and cylindric cell papilloma in descending order of frequency. Recurrence of everted papilloma is unusual and malignant change does not occur. However, inverted papilloma is associated with multiple recurrences and malignant change. The histology of low grade squamous cell carcinoma of the nose may mimic that of inverted papilloma and low grade squamous cell carcinoma may coexist with inverted papilloma and be present in the same biopsy material. There is a high index of suspicion of concomitant malignancy in the presence of severe atypia or hyperkeratosis. Columnar cell papillomas are also associated with an increased risk of malignancy but the rarity of these lesions makes accurate assessment of malignant potential difficult. The most common diagnostic dilemma for pathologists referring cases for second opinion is the recognition of low grade malignancy versus benign inverted papilloma at presentation and in lesions which recur. Recent studies have addressed the requirement for histological parameters to predict the clinical course of these lesions and new molecular markers are being applied to tissue diagnosis. The early recognition and treatment of malignancy associated with inverted papilloma is key to decreased morbidity and improved patient survival and forms the basis of this discussion.
doi:10.1007/s12105-009-0136-z
PMCID: PMC2811634  PMID: 20596982
Inverted papilloma; Associated squamous cell carcinoma; Carcinoma in situ; Diagnosis; Nose; Paranasal sinus
8.  Clinicopathological parameters, recurrence, locoregional and distant metastasis in 115 T1-T2 oral squamous cell carcinoma patients 
The incidence of oral squamous cell carcinoma remains high. Oral and oro-pharyngeal carcinomas are the sixth most common cancer in the world. Several clinicopathological parameters have been implicated in prognosis, recurrence and survival, following oral squamous cell carcinoma. In this retrospective analysis, clinicopathological parameters of 115 T1/T2 OSCC were studied and compared to recurrence and death from tumour-related causes.
The study protocol was approved by the Joint UCL/UCLH committees of the ethics for human research. The patients' data was entered onto proformas, which were validated and checked by interval sampling. The fields included a range of clinical, operative and histopathological variables related to the status of the surgical margins. Data collection also included recurrence, cause of death, date of death and last clinic review. Causes of death were collated in 4 categories (1) death from locoregional spread, (2) death from distant metastasis, (3) death from bronchopulmonary pneumonia, and (4) death from any non-tumour event that lead to cardiorespiratory failure.
The patients' population comprised 65 males and 50 females. Their mean age at the 1st diagnosis of OSCC was 61.7 years. Two-thirds of the patients were Caucasians. Primary sites were mainly identified in the tongue, floor of mouth (FOM), buccal mucosa and alveolus. Most of the identified OSCCs were low-risk (T1N0 and T2N0). All patients underwent primary resection ± neck dissection and reconstruction when necessary. Twenty-two patients needed adjuvant radiotherapy. Pathological analysis revealed that half of the patients had moderately differentiated OSCC. pTNM slightly differed from the cTNM and showed that 70.4% of the patients had low-risk OSCC. Tumour clearance was ultimately achieved in 107 patients. Follow-up resulted in a 3-year survival of 74.8% and a 5-year survival of 72.2%.
Recurrence was identified in 23 males and 20 females. The mean age of 1st diagnosis of the recurrence group was 59.53 years. Most common oral sites included the lateral border of tongue and floor of mouth. Recurrence was associated with clinical N-stage disease. The surgical margins in this group was evaluated and found that 17 had non-cohesive invasion, 30 had dysplasia at margin, 21 had vascular invasion, 9 had nerve invasion and 3 had bony invasion. Severe dysplasia was present in 37 patients. Tumour clearance was achieved in only 8 patients. The mean depth of tumour invasion in the recurrence group was 7.6 mm.
An interesting finding was that 5/11 patients who died of distant metastasis had their primary disease in the tongue. Nodal disease comparison showed that 8/10 patients who died of locoregional metastasis and 8/11 patients who died from distant metastasis had clinical nodal involvement. Comparing this to pathological nodal disease (pTNM) showed that 10/10 patients and 10/11 patients who died from locoregional and distant metastasis, respectively, had nodal disease. All patients who died from locoregional and distant metastasis were shown to have recurrence after the primary tumour resection.
Squamous cell carcinoma of the oral cavity has a poor overall prognosis with a high tendency to recur at the primary site and extend to involve the cervical lymph nodes. Several clinicopathological parameters can be employed to assess outcome, recurrence and overall survival.
doi:10.1186/1758-3284-2-9
PMCID: PMC2882907  PMID: 20406474
9.  MT1-MMP is a crucial promotor of synovial invasion in human rheumatoid arthritis 
Arthritis and rheumatism  2009;60(3):686.
Objective
A hallmark of rheumatoid arthritis (RA) is invasion of the synovial pannus into cartilage and this step requires degradation of the collagen matrix. The aim of this study was to explore the role of one of the collagen-degrading matrix metalloproteinases (MMPs), membrane-type 1 MMP (MT1-MMP), in synovial pannus invasiveness.
Methods
Expression and localization of MT1-MMP in human RA pannus were investigated by Western blot analysis of primary synovial cells and immunohistochemistry of RA joints specimens. The functional role of MT1-MMP was analyzed by 3D collagen invasion assays and a cartilage invasion assay in the presence or absence of tissue inhibitor of metalloproteinase (TIMP)-1, TIMP-2, or GM6001. The effect of adenoviral expression of a dominant negative MT1-MMP construct lacking a catalytic domain was also examined.
Results
MT1-MMP was highly expressed at the pannus-cartilage junction of RA joints. Freshly isolated rheumatoid synovial tissues and isolated RA synovial fibroblasts invaded into a 3D collagen matrix in an MT1-MMP-dependent manner. Invasion was blocked by TIMP-2 and GM6001, but not by TIMP-1. It was also inhibited by the over-expression of a dominant negative MT1-MMP which inhibits collagenolytic activity and proMMP-2 activation by MT1-MMP on the cell surface. Synovial fibroblasts also invaded into cartilage in an MT1-MMP-dependent manner. This process was further enhanced by removing aggrecan from the cartilage matrix.
Conclusion
MT1-MMP is an essential collagen-degrading proteinase during pannus invasion in human RA. Specific inhibition of MT1-MMP-dependent invasion may form a novel therapeutic strategy for RA.
doi:10.1002/art.24331
PMCID: PMC2819053  PMID: 19248098
MT1-MMP; synovial pannus; rheumatoid arthritis
10.  The stylomastoid artery as an anatomical landmark to the facial nerve during parotid surgery: a clinico-anatomic study 
Background
The identification of the facial nerve can be difficult in a bloody operative field or by an incision that limits exposure; hence anatomical landmarks and adequate operative exposure can aid such identification and preservation.
In this clinico-anatomic study, we examined the stylomastoid artery (SMA) and its relation to the facial nerve trunk; the origin of the artery was identified on cadavers and its nature was confirmed histologically.
Methods
The clinical component of the study included prospective reviewing of 100 consecutive routine parotidectomies; while, the anatomical component of the study involved dissecting 50 cadaveric hemifaces.
Results
We could consistently identify a supplying vessel, stylomastoid artery, which tends to vary less in position than the facial nerve. Following this vessel, a few millimetres inferiorly and medially, we have gone on to identify the facial nerve trunk, which it supplies, with relative ease. The origin of the stylomastoid artery, in our study, was either from the occipital artery or the posterior auricular artery.
Conclusion
This anatomical aid, the stylomastoid artery, when supplemented by the other more commonly known anatomical landmarks and intra-operative facial nerve monitoring further reduces the risk of iatrogenic facial nerve damage and operative time.
doi:10.1186/1477-7819-7-71
PMCID: PMC2760553  PMID: 19785731
11.  The surgical resection margin 
Head & Neck Oncology  2009;1(Suppl 1):I1.
doi:10.1186/1758-3284-1-S1-I1
PMCID: PMC3226248  PMID: 19640264
12.  Head & neck optical diagnostics: vision of the future of surgery 
Head & Neck Oncology  2009;1:25.
Review paper and Proceedings of the Inaugural Meeting of the Head and Neck Optical Diagnostics Society (HNODS) on March 14th 2009 at University College London.
The aim of our research must be to provide breakthrough translational research which can be applied clinically in the immediate rather than the near future. We are fortunate that this is indeed a possibility and may fundamentally change current clinical and surgical practice to improve our patients' lives.
doi:10.1186/1758-3284-1-25
PMCID: PMC2720388  PMID: 19594907
13.  Ethical and technical considerations for the creation of cell lines in the head & neck and tissue harvesting for research and drug development (Part II): Ethical aspects of obtaining tissue specimens 
Background
Although much has been published for the development of cell lines, these were lab based and developed for scientific technical staff.
Objective of review
We discuss the ethical implications of tissue retention and present a generic consent form (Part II). We also present a simple and successful protocol for the development of cell lines and tissue harvesting for the clinical scientist (Part I).
Conclusion
Consent is also more proximate and assurance can be given of appropriate usage. Ethical questions concerning tissue ownership are in many institutions raised during the current consenting procedure. We provide a robust ethical framework, based on the current legislation, which allows clinicians to be directly involved in cell and tissue harvesting.
doi:10.1186/1755-7682-2-9
PMCID: PMC2670271  PMID: 19344502
14.  Ethical and technical considerations for the creation of cell lines in the head & neck and tissue harvesting for research and drug development (Part I): Techniques of tissue harvesting and propagation 
Background
Although much has been published for the development of cell lines, these were lab based and developed for scientific technical staff.
Objective of review
We present a simple and successful protocol for the development of cell lines and tissue harvesting for the clinical scientist. We also discuss the ethical implications of tissue retention and present a generic consent form.
Conclusion
The advantages of hospital-based cell line creation are numerous. We can be more certain that cell lines are developed from the particular tissues of interest and accurate anatomical and appropriate clinico-pathological control tissues are also harvested. We can also be certain of less cell line cross contamination.
doi:10.1186/1755-7682-2-8
PMCID: PMC2670270  PMID: 19344501
15.  Rheumatoid nodule of the thyrohyoid membrane: a case report 
Background
Rheumatoid nodules are common extra-articular findings occurring in 20% of rheumatoid arthritis patients. They develop most commonly subcutaneously in pressure areas (elbows and finger joints) and may occasionally affect internal organs including pleura, lungs, meninges, larynx, and in other connective tissues elsewhere in the body
Case presentation
We present the case of a 62-year-old male who presented with a midline neck mass. Clinically it moved on swallowing and tongue protrusion-suggesting attachment to the thyrohyoid membrane. Ultrasound examination revealed a cystic lesion in the absence of cervical lymphadenopathy in a non-smoker. The neck was explored and histological examination of the excised lesion which was attached to the thyrohyoid membrane revealed a rheumatoid nodule.
Conclusion
A rheumatoid nodule of the thyrohyoid membrane is very rare. The triple diagnostic scheme of clinical examination supplemented with ultrasound and guided fine needle aspiration for neck lumps remains valid in most cases. If excision is indicated we feel it should be performed in such a manner that the scar tract could easily be encompassed in a neck dissection excision should definitive histological examination be adverse. We suggest that when dealing with patients with established rheumatoid arthritis one should consider a rheumatoid nodule as a differential diagnosis for any swelling on the patient whether it be subcutaneous or deep.
doi:10.1186/1752-1947-1-123
PMCID: PMC2174496  PMID: 17974016
16.  How we do it: a method of neck dissection for histopathological analysis 
BMC Surgery  2007;7:21.
Background
Dissection of the lymphatic structures in the neck is an integral part of the management of many head and neck cancers.
We describe a technique of surgical dissection, preparing the tissue for more precise histological analysis while also reducing operative time and complexity.
Methods
When dissected, each level is excised between lymph nodes groups and put into a separate pot of formalin taking care to avoid rupture of any obvious pathological nodes.
Results
This makes for a simpler dissection as the surgeon progresses, as a larger more cumbersome specimen is avoided and manipulation of involved nodes is actually reduced with a reduced risk of tumour spillage.
Conclusion
We feel that our technique provides several advantages for the histopathologist as well as the surgeon. As the dissection of the specimen into the relevant levels has already been performed, time is saved in orientating and then dissecting the specimen. Accuracy of dissection is also improved and each piece of tissue is a more manageable size for processing and analysis.
This technique may also have several surgical advantages when compared with the commonly practiced techniques e.g. with reducing in-vivo specimen manipulation, hence reducing the risk of inadvertent injury to important structures and tumour spillage.
doi:10.1186/1471-2482-7-21
PMCID: PMC2174433  PMID: 17973994
17.  Collagen-induced arthritis in C57BL/6 mice is associated with a robust and sustained T-cell response to type II collagen 
Many genetically modified mouse strains are now available on a C57BL/6 (H-2b) background, a strain that is relatively resistant to collagen-induced arthritis. To facilitate the molecular understanding of autoimmune arthritis, we characterised the induction of arthritis in C57BL/6 mice and then validated the disease as a relevant pre-clinical model for rheumatoid arthritis.
C57BL/6 mice were immunised with type II collagen using different protocols, and arthritis incidence, severity, and response to commonly used anti-arthritic drugs were assessed and compared with DBA/1 mice. We confirmed that C57BL/6 mice are susceptible to arthritis induced by immunisation with chicken type II collagen and develop strong and sustained T-cell responses to type II collagen. Arthritis was milder in C57BL/6 mice than DBA/1 mice and more closely resembled rheumatoid arthritis in its response to therapeutic intervention. Our findings show that C57BL/6 mice are susceptible to collagen-induced arthritis, providing a valuable model for assessing the role of specific genes involved in the induction and/or maintenance of arthritis and for evaluating the efficacy of novel drugs, particularly those targeted at T cells.
doi:10.1186/ar2319
PMCID: PMC2212575  PMID: 17967186

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