BACKGROUND: Supraglottic squamous cell carcinoma (SCC) is a significant portion of head and neck cancers, with the management of clinically negative necks (cN0) through selective neck dissection (SND) being debated due to potential morbidities and low metastasis rates in levels IIb and IV. METHODS: This study is a retrospective, multicenter examination of the potential feasibility of limited neck dissection (LND), including only levels IIa and III in cN0 supraglottic SCC patients. It analyzed occult metastasis rates and explored relapse occurrences alongside potential predictors of lymph node metastasis. RESULTS: Among 425 patients, predominantly male (85.6%) with a mean age of 63 years, the occult metastasis rate was 28.9%, and 13.7% experienced relapses during a mean follow-up of 52 months. Advanced clinical stage, higher grading, and other risk factors emerged as predictors of occult lymph node metastasis at level IIb. CONCLUSIONS: The study supports LND potential feasibility for cN0 supraglottic SCC, suggesting level IIb dissection can be omitted in specific early-stage cases to reduce morbidity without affecting outcomes.

• Klíčová slova
• clinically negative neck, larynx, limited neck dissection, occult metastasis, supraglottis,
• MeSH
• dospělí MeSH
• krční disekce * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru patologie   MeSH
• lymfatické metastázy MeSH
• nádory hrtanu * patologie   chirurgie   mortalita   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• spinocelulární karcinom * chirurgie   patologie   mortalita   MeSH
• staging nádorů MeSH
• studie proveditelnosti MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

INTRODUCTION: Papillary thyroid carcinoma (PTC) frequently harbors the BRAF V600E mutation. Recent research suggests that aggressive behavior in BRAF V600E+ PTC may be due to an undetected mutation in the TERT gene. This study aims to observe the clinicopathological features of BRAF V600+ PTC and correlate them with surgical treatment complications. METHODS: A retrospective analysis was conducted on the BRAF V600E+ PTC cohort from July 2019 to January 2023. The histopathological features and surgical treatment (total thyroidectomy - group A, total thyroidectomy + central block neck dissection - group B) complications were correlated. Patients with TERT and TP53 mutation were excluded. Next-generation sequencing and real-time PCR were used for genetic analysis. RESULTS: Out of 121 PTCs, 65 cases showed BRAF V600E mutation with the following features: intracapsular spread (13.8%), extracapsular spread (27.7%), extrathyroidal spread (15.4%), multifocality (26.2%), angioinvasion (12.3%), and local metastasis (27.7%). The incidence of surgical complications in group A/B was: reversible recurrent laryngeal nerve (RLN) paresis 3.7/7.1%, RLN paresis permanent 0/2.4%, paresthesia 6.8/23.8%, hypocalcemia 36.4/61.9% on day 1 and 27.3/33.3% on day 3, and bleeding 2.3/9.5%. There was no significant difference in clinicopathological features between the BRAF V600E+ and BRAF V600E- PTC groups. Group B had a significantly higher incidence of hypoacalcaemia on postoperative day 1 (p = 0.047). CONCLUSION: The BRAF V600E mutation will certainly remain important in the preoperative diagnosis of PTC. The more radical surgical procedures currently recommended may be abandoned in the future, particularly elective CLND, which has a higher risk of postoperative complications.

• Klíčová slova
• BRAF V600E, Cancer, Clinicopathologic features, Complications, Mutation, Papillary Thyroid Carcinoma (PTC), Surgery, TERT, Thyroid,
• MeSH
• dospělí MeSH
• krční disekce MeSH
• lidé středního věku MeSH
• lidé MeSH
• mutace * MeSH
• nádorový supresorový protein p53 * genetika   MeSH
• nádory štítné žlázy * genetika   chirurgie   patologie   MeSH
• papilární karcinom štítné žlázy * genetika   chirurgie   patologie   MeSH
• pooperační komplikace * etiologie   MeSH
• protoonkogenní proteiny B-Raf * genetika   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• telomerasa * genetika   MeSH
• tyreoidektomie škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• BRAF protein, human MeSH Prohlížeč
• nádorový supresorový protein p53 * MeSH
• protoonkogenní proteiny B-Raf * MeSH
• telomerasa * MeSH
• TERT protein, human MeSH Prohlížeč
• TP53 protein, human MeSH Prohlížeč

OBJECTIVE: Cutaneous Squamous Cell Carcinoma (cSCC), a tumor with a significantly increasing incidence, is mostly diagnosed in the head region, where tumors have a worse prognosis and a higher risk of metastases. The presence of metastases reduces specific five-year survival from 99% to 50%. As the risk of occult metastases does not exceed 10%, elective dissection of the tributary parotid and neck lymph nodes is not recommended. METHODS: We retrospectively analyzed a group of 12 patients with cSCC of the head after elective dissections of regional (parotid and cervical) nodes by means of superficial parotidectomy and selective neck dissection. RESULTS: We diagnosed occult metastases neither in the cervical nor parotid nodes in any patient. None were diagnosed as a regional recurrence during the follow-up period. CONCLUCION: Our negative opinion on elective parotidectomy and neck dissection in cSCC of the head is in agreement with the majority of published studies. These elective procedures are not indicated even for tumors showing the presence of known (clinical and histological) risk factors for lymphogenic spread, as their positive predictive value is too low. Elective parotidectomy is individually considered as safe deep surgical margin. If elective parotidectomy is planned it should include only the superficial lobe. Completion parotidectomy and elective neck dissection are done in rare cases of histologically confirmed parotid metastasis in the parotid specimen. Preoperatively diagnosed parotid metastases without neck involvement are sent for total parotidectomy and elective selective neck dissection. Cases of clinically evident neck metastasis with no parotid involvement, are referred for comprehensive neck dissection and elective superficial parotidectomy. The treatment of concurrent parotid and cervical metastases includes total conservative parotidectomy and comprehensive neck dissection. LEVEL OF EVIDENCE: How common is the problem? Step 4 (Case-series) Is this diagnostic or monitoring test accurate? (Diagnosis) Step 4 (poor or non-independent reference standard) What will happen if we do not add a therapy? (Prognosis) Step 4 (Case-series) Does this intervention help? (Treatment Benefits) Step 4 (Case-series) What are the COMMON harms? (Treatment Harms) Step 4 (Case-series) What are the RARE harms? (Treatment Harms) Step 4 (Case-series) Is this (early detection) test worthwhile? (Screening) Step 4 (Case-series).

• Klíčová slova
• Cutaneous squamous cell carcinoma, Elective neck dissection, Elective parotidectomy, Occult metastasis, Skin cancer,
• MeSH
• krční disekce metody   MeSH
• lidé MeSH
• nádory hlavy a krku * chirurgie   patologie   MeSH
• nádory kůže * chirurgie   patologie   MeSH
• nádory příušní žlázy * chirurgie   patologie   MeSH
• retrospektivní studie MeSH
• spinocelulární karcinom * patologie   MeSH
• staging nádorů MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: An ocular adnexal apocrine adenocarcinoma (OAAA) is an extremely rare, but potentially aggressive and life-threatening tumor with ill-defined management based only on recommendations from a limited number of reported cases. The development of cervical lymphocele following neck dissection is a very rare complication, but one with well established methods for prevention and treatment. Here we describe a previously unreported case of salvage surgery including neck dissection for OAAA in addition to an emergence of cervical lymphocele. A literature review of current knowledge on both pathological conditions is included. METHODS AND RESULTS: A 58-year-old man suffering from OAAA, previously treated with multiple eye-sparing excisions and adjuvant proton therapy, underwent salvage surgery for locoregional recurrence of the tumor. A partial orbitectomy with orbital exenteration, primary reconstruction and left-sided neck dissection was performed. The procedure was complicated by a cervical lymphocele resolved after the surgical therapy. The patient remained disease-free during the one-year follow-up. CONCLUSION: OAAA is a locally aggressive tumor with potential to local or distant metastatic spread. Whole-body staging, regular clinico-radiological follow-up and stage-dependent therapy with surgery as the first-choice treatment is required. A cervical lymphocele as a complication of especially left-sided neck dissection is managed with a conservative or surgical therapy according to the level of lymph leakage, extent and localization of lesions, presence of local or systemic disorders and the period from primary surgery.

• Klíčová slova
• adnexal tumor, apocrine adenocarcinoma, cervical lymphocele, neck dissection, orbit, salvage surgery, thoracic duct injury,
• MeSH
• adenokarcinom * patologie   chirurgie   MeSH
• krční disekce škodlivé účinky   metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru MeSH
• lymfokela * etiologie   chirurgie   MeSH
• nádory prsu * chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH

The Czech Head and Neck Cancer Cooperative Group (CHNCCG) held a meeting in Tabor on 11-12 October 2019 with the aim of reaching an interdisciplinary consensus on some controversial points where international unity is absent. The meeting resulted in recommendations on resection margin size terminology (definition of terms: negative margin, close margin and positive margin) and on the adoption of terminology for neck dissections reporting according to the International Recommendation of the International Head and Neck Scientific Group and on assessment of HPV/p16 status in head and neck tumors.

• Klíčová slova
• HPV, guidelines, head and neck cancer, neck dissection, p16, recommendation, resection margin,
• MeSH
• infekce papilomavirem * MeSH
• inhibitor p16 cyklin-dependentní kinasy MeSH
• konsensus MeSH
• krční disekce MeSH
• lidé MeSH
• nádory hlavy a krku * chirurgie   MeSH
• resekční okraje MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• inhibitor p16 cyklin-dependentní kinasy MeSH

BACKGROUND: Standard treatment of oropharyngeal squamous cell carcinoma (OPSCC) is associated with high morbidity, whereas immunotherapeutic approaches using PD-1:PD-L1 checkpoint blockade only show moderate response rates in OPSCC patients. Therefore, a better stratification of patients and the development of novel therapeutic protocols are crucially needed. The importance of tumor-infiltrating B cells (TIL-Bs) in shaping antitumor immunity remains unclear; therefore, we analyzed frequency, phenotype, prognostic value and possible roles of TIL-Bs in OPSCC. METHODS: We utilized transcriptomic analysis of immune response-related genes in 18 OPSCC samples with respect to human papillomavirus (HPV) status. The density and localization of CD20+, CD8+ and DC-LAMP+ cells were subsequently analyzed in 72 tissue sections of primary OPSCC samples in relation to patients' prognosis. The immunohistochemical approach was supplemented by flow cytometry-based analysis of phenotype and functionality of TIL-Bs in freshly resected primary OPSCC tissues. RESULTS: We observed significantly higher expression of B cell-related genes and higher densities of CD20+ B cells in HPV-associated OPSCC samples. Interestingly, CD20+ TIL-Bs and CD8+ T cells formed non-organized aggregates with interacting cells within the tumor tissue. The densities of both intraepithelial CD20+ B cells and B cell/CD8+ T cell interactions showed prognostic significance, which surpassed HPV positivity and CD8+ TIL density in stratification of OPSCC patients. High density of TIL-Bs was associated with an activated B cell phenotype, high CXCL9 production and high levels of tumor-infiltrating CD8+ T cells. Importantly, the abundance of direct B cell/CD8+ T cell interactions positively correlated with the frequency of HPV16-specific CD8+ T cells, whereas the absence of B cells in tumor-derived cell cultures markedly reduced CD8+ T cell survival. CONCLUSIONS: Our results indicate that high abundance of TIL-Bs and high density of direct B cell/CD8+ T cell interactions can predict patients with excellent prognosis, who would benefit from less invasive treatment. We propose that in extensively infiltrated tumors, TIL-Bs might recruit CD8+ T cells via CXCL9 and due to a highly activated phenotype contribute by secondary costimulation to the maintenance of CD8+ T cells in the tumor microenvironment.

• Klíčová slova
• HNSCC, HPV, Tumor-infiltrating B lymphocytes,
• MeSH
• adjuvantní chemoradioterapie MeSH
• aktivace lymfocytů MeSH
• B-lymfocyty imunologie   MeSH
• CD8-pozitivní T-lymfocyty imunologie   MeSH
• dlaždicobuněčné karcinomy hlavy a krku imunologie   mortalita   terapie   virologie   MeSH
• dospělí MeSH
• infekce papilomavirem imunologie   mortalita   terapie   virologie   MeSH
• Kaplanův-Meierův odhad MeSH
• kohortové studie MeSH
• krční disekce MeSH
• lidé středního věku MeSH
• lidé MeSH
• mezibuněčná komunikace imunologie   MeSH
• nádorové mikroprostředí imunologie   MeSH
• nádory orofaryngu imunologie   mortalita   terapie   virologie   MeSH
• orofarynx patologie   chirurgie   MeSH
• Papillomaviridae imunologie   izolace a purifikace   MeSH
• prognóza MeSH
• progrese nemoci MeSH
• senioři MeSH
• tumor infiltrující lymfocyty imunologie   MeSH
• výběr pacientů MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Papillary thyroid carcinoma is typical by regional lymph nodes metastases. Therefore we decided to analyse associated risk factors. OBJECTIVE: In this retrospective study we focused on the incidence of metastatic involvement of the central compartment's lymph nodes correlated with age, size of the primary tumour, infiltration of thyroid gland capsule, positive lymphangioinvasion in order to assess risk factors. METHOD: We analysed group of 156 patients with papillary carcinoma, who have undergone total thyroidectomy and bilateral elective central compartment neck dissection. We evaluated the occurrence of metastases, size, infiltration and lymphangioinvasion based on definitive histology of the whole group and separately for subgroups of patients under and over 45 years. RESULT: We found metastatic involvement in 88 (56.4%) patients. When comparing the subgroups of patients under (73 patients) and over 45 years (83 patients), we found metastases in 56 vs. 32 (76.7% vs. 38.6%) patients. In the subgroup of younger patients we found significant higher incidence of metastases compared with the group of over 45 years, P < 0.001 (P = 0.000027). We found significant higher incidence of metastases in patients with positive capsule infiltration in the whole group, P < 0.001 (P = 0.00049); in the subgroup of under 45 years, P < 0.001 (P = 0.00091) and in patients with positive lymphangioinvasion in the whole group, P < 0.01 (P = 0.00177); in the subgroup of over 45 years, P < 0.001 (P = 0.0002). In patients with metastases we found tumour size ≥1cm more frequently in all groups. CONCLUSION: We recorded higher incidence of regional metastases in patients under 45 years, positive capsule infiltration, lymphangioinvasion. Age under 45 years itself does not correlate with less aggressive disease, to the contrary some of other analysed risk factors correlate with more aggressive disease.

• Klíčová slova
• age, metastases, papillary carcinoma, regional lymph nodes, thyroid gland,
• MeSH
• adenokarcinom patologie   chirurgie   MeSH
• dospělí MeSH
• krční disekce MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymfatické metastázy diagnóza   MeSH
• nádory hlavy a krku patologie   chirurgie   MeSH
• papilární karcinom patologie   chirurgie   MeSH
• staging nádorů MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Low risk differentiated thyroid microcarcinoma therapy is a controversial area of thyroid tumor management. Major international medical societies and reputable institutes consider lobectomy to be sufficient therapeutic intervention for the pT1a cN0cM0 stage of papillary thyroid microcarcinoma. However different views and therapeutic strategies exist and result in unnecessary overtreatment and worsening of patients quality of life. We researched the course of the differentiated thyroid microcarcinoma in patients using different therapeutic strategies: lobectomy, total thyroidectomy, total thyroidectomy with central compartment prophylactic lymphadenectomy and total thyroidectomy followed by radioactive iodine treatment. Apart from an excellent prognosis we did not find out any clinically significant differences in the course of the disease. We can conclude that lobectomy is sufficient therapeutic intervention for patients with differentiated thyroid microcarcinoma without known metastases.Key words: differentiated thyroid microcarcinoma - management - overtreatment - the course of the disease.

• MeSH
• adjuvantní radioterapie MeSH
• krční disekce * MeSH
• kvalita života MeSH
• lidé MeSH
• nádory štítné žlázy patologie   terapie   MeSH
• papilární karcinom patologie   terapie   MeSH
• prognóza MeSH
• radioizotopy jodu terapeutické užití   MeSH
• riziko MeSH
• společnosti lékařské MeSH
• staging nádorů MeSH
• tyreoidektomie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• radioizotopy jodu MeSH

The purpose of this study was to suggest general guidelines in the management of the N0 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 related 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.

• Klíčová slova
• Adenoid cystic, Carcinoma, Lymph nodes, Neck dissection, Recurrence, Risk factors,
• MeSH
• adenoidně cystický karcinom patologie   terapie   MeSH
• krční disekce * MeSH
• krk MeSH
• lidé MeSH
• lokální recidiva nádoru * MeSH
• lymfatické metastázy MeSH
• lymfatické uzliny patologie   MeSH
• management nemoci MeSH
• nádory orofaryngu patologie   terapie   MeSH
• nádory úst patologie   terapie   MeSH
• radioterapie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

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.

• Klíčová slova
• Adenoid cystic carcinoma, Clinical protocols, Elective neck dissection, Larynx, Lymph node metastasis, Neck, Oncology, Treatment,
• MeSH
• adenoidně cystický karcinom * patologie   chirurgie   MeSH
• elektivní chirurgické výkony metody   MeSH
• krční disekce metody   MeSH
• lidé MeSH
• lymfatické metastázy MeSH
• lymfatické uzliny * patologie   chirurgie   MeSH
• nádory hrtanu * patologie   chirurgie   MeSH
• výběr pacientů MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH