加藤 久幸

There are many methods and types of equipment for measuring the nasal airway, but there is no consensus regarding the results of various clinical studies on nasal obstruction. In this review, we discuss the two major methods of objectively assessing the nasal airway: rhinomanometry and acoustic rhinometry. The Japanese standard of rhinomanometry in Japanese adults and children was established by the Japanese Standardization Committee on Rhinomanometry in 2001 and 2018, respectively. However, the International Standardization Committee has proposed different standards because of differences in race, equipment, and social health insurance systems. The standardization of acoustic rhinometry in Japanese adults is making progress in several Japanese institutes, but the international standardization of acoustic rhinometry has not yet begun. Rhinomanometry is the physiological expression of nasal airway breathing, whereas acoustic rhinometry is the anatomic expression. In this review, we introduce the history and methods of the objective assessment of nasal patency and the physiological and pathological issues regarding nasal obstruction.

As the laryngopharynx is closely related to swallowing, speech, and phonation, it is necessary to consider not only disease control but also a minimally invasive approach for the treatment of laryngopharyngeal cancer. Transoral surgery has been reported to be a minimally invasive method for treating these diseases. Transoral videolaryngoscopic surgery (TOVS) and endoscopic laryngo-pharyngeal surgery (ELPS) have been developed in Japan and recently emerged as treatments for patients with early stage pharyngeal and laryngeal cancers. However, securing an appropriate field of view and a narrow operating space during TOVS or ELPS are critical issues to be resolved for these surgeries. The clinical significance and safety of transoral robotic surgery (TORS) using the da Vinci Surgical System have been widely reported to provide surgeons with increased visualization and magnification, resulting in precise surgical margins and rapid functional recovery. In this context, a multi-institutional clinical study was conducted to evaluate the treatment outcomes of TORS for the treatment of laryngopharyngeal cancer in Japan, and the da Vinci Surgical System for oral robot-assisted surgery for these diseases was approved by the Pharmaceutical Affairs Agency in August 2018. This review provides an overview of the therapeutic effects of TOVS, ELPS, and TORS, with a particular focus on these therapeutic results in Japan.

Severe bronchial asthma is a challenging disorder to treat and can impair quality of life (QOL) under conventional therapeutic modalities. We report the case of a 52-year-old woman with severe asthma associated with eosinophilic chronic rhinosinusitis (ECRS) and eosinophilic otitis media (EOM). Although the patient was treated with a full dose of inhaled corticosteroid, leukotriene receptor antagonist (LTRA), theophylline, burst use of oral corticosteroids (OCS), her asthmatic condition aggravated, disrupting her daily life. ECRS and EOM symptoms were also getting worse despite treatment with topical application of corticosteroids to the nose and ears, LTRA, and occasional use of OCS. In addition to asthmatic symptom, the patient always suffered from intractable nasal obstruction and hearing disturbance, which contributed to the heavily impaired QOL. However, the administration of benralizumab showed rapid and remarkable improvement not only in her asthmatic conditions but also in the symptoms of ECRS and EOM within a month. These results suggest that the use of benralizumab for the treatment of severe asthma with intractable ECRS and EOM should be considered when the patient's QOL is severely deteriorated.

BACKGROUND: Although the American Joint Committee on Cancer TNM classification has been amended to include human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) as an independent entity, to the authors' knowledge the optimized de-escalating treatment modality has not been established to date. METHODS: The authors conducted a retrospective, nationwide, observational study in patients with HPV-related OPSCC who were treated from 2011 to 2014 in Japan to determine the best treatment modality. RESULTS: A total of 688 patients who were newly diagnosed with HPV-related OPSCC who were treated with curative intent at 35 institutions and had coherent clinical information and follow-up data available were included in the current study. In patients with T1-T2N0 disease (79 patients), both the 3-year recurrence-free survival and overall survival (OS) rates were 100% in the group treated with radiotherapy (RT) as well as the group receiving concurrent chemoradiotherapy (CCRT). The 3-year OS rates were 94.4% (for patients with T1N0 disease) and 92.9% (for patients with T2N0 disease) among the patients treated with upfront surgery. In patients with stage I to stage II HPV-related OPSCC, the 5-year recurrence-free survival and OS rates were 91.4% and 92%, respectively, in the patients treated with CCRT with relatively high-dose cisplatin (≥160 mg/m2 ; 114 patients) and 74.3% and 69.5%, respectively, in the patients treated with low-dose cisplatin (<160 mg/m2 ; 17 patients). CONCLUSIONS: Despite it being a retrospective observational trial with a lack of information regarding toxicity and morbidity, the results of the current study demonstrated that patients with T1-T2N0 HPV-related OPSCC could be treated with RT alone because of the equivalent outcomes of RT and CCRT, and patients with stage I to stage II HPV-related OPSCC other than those with T1-T2N0 disease could be treated with CCRT with cisplatin at a dose of ≥160 mg/m2 .

Background: Meningiomas often invade venous sinuses, but intravenous sinus meningiomas remain within the intracranial cavity. This case report describes an extremely rare case of tentorial meningioma with venous sinus invasion, extending intraluminally into the lower part of the internal jugular vein in a 59-year-old man.Case presentation: The patient's initial surgery involved the supratentorial component of a right tentorial meningioma, which invaded the right transverse and sigmoid sinuses. The supratentorial component of the tumour did not enlarge during the 2-month waiting period for the first surgery. The patient received postoperative radiation therapy for the residual tumour in the intravenous sinus. Despite radiation, the residual tumour developed caudally and ultimately extended into the right internal jugular vein. The average regrowth speed of the extracranial mass was 3.6 mm/month. The patient underwent surgery for the recurrent tumour located in the transverse sinus, sigmoid sinus, jugular bulb, and internal jugular vein, 46 months after the initial surgery. The pathological features of both surgeries were the same; WHO grade I meningothelial meningioma.Conclusions: To the best of our knowledge, there have been few case reports of benign meningioma with intraluminal extension into the internal jugular vein, and there have been no reports of long-term observation of such cases. Detailed observation of the present case suggests that the difference in growth speed between the intracranial and venous cavity depends on the surrounding environment.

Herein, we report a case of pharyngeal/cervical trauma sustained due to an epileptic attack that developed while the patient was brushing her teeth. The patient was a 20-year-old woman with schizophrenia and epileptic psychosis, who was hospitalized at a local psychiatric hospital. She lost consciousness while brushing her teeth and fell down. A toothbrush was observed in the pharyngeal cavity and the patient was transported to our hospital for emergency treatment. The toothbrush was visualized by endoscopy; the brush side of the toothbrush was embedded in the right piriform sinus and the handle side had migrated into the pharynx. CT revealed subcutaneous and mediastinal emphysema and the brush located beside the right brachiocephalic artery. An emergency operation was performed on the same day; a tracheotomy was initially performed under intravenous anesthesia, followed by removal of the pharyngeal/cervical foreign body through a cervical incision under general anesthesia. The toothbrush had penetrated the right piriform sinus and reached the right brachiocephalic artery along the right common carotid artery. The tracheal fistula was closed on the 11th day after surgery, with oral intake by the patient resumed on the 25th day, and the patient transferred to the hospital psychiatric ward on the 41st postoperative day. It might be difficult to provide medical care smoothly for adults with severe mental illness.

© 2018, Japan Society for Head and Neck Cancer. All rights reserved. The recent increase in the incidence of oropharyngeal cancer in the USA and northern Europe has been attributed to human papillomavirus (HPV) infection. Because the carcinogenic mechanism of HPV related oropharyngeal cancer (OPC) is different from that of other OPC, biological malignancy and treatment effects are considered to be different between the two groups. We performed a prospective study in the Japanese cooperative study group for basic research in head and neck cancer (JCSG-BRHNC) to compare the effects of first-line treatment between HPV positive or negative stage III and IV OPC. From May 2014 to March 2016, 92 patients were enrolled by 18 institutions in the whole country. Sixty-five patients (71%) were HPV-positive in the PCR. We examined the effects of primary treatment in a prognosis investigation conducted one year after registration. The results showed that 60 of the 65 HPV-positive cases successfully achieved complete response(CR), and the primary treatment success ratio was 92.3% as the ratio of CR cases without recurrence or metastasis within one year. In comparison, 15 cases (57.7 %) of 26 HPV negative patients successfully achieved CR. The effect of chemoradiotherapy was high, and even cetuximab combination radiotherapy(BRT) showed enough effects for HPV-positive cases. Also, induction chemotherapy (IC) was successful and all cases achieved CR in RT singularity cases. These results will provide a useful reference when examining clinical trials that lower the intensity of treatment for HPV-positive cases.

53歳女。前頸部腫瘤を主訴とした。甲状舌管嚢胞の診断で経過観察中であり、超音波検査では前頸部に境界やや不明瞭、内部は不均一で石灰化を伴う腫瘍(26×28×19mm大)を認めた。頸部CTでは頸部正中舌骨前面に微小石灰化を伴う腫瘍性病変を認め、甲状舌管由来の腫瘍性病変を疑い、穿刺吸引細胞診を行ったが、確定診断には至らなかった。甲状腺内の腫瘍性病変や頸部リンパ節腫脹は認めず、全身麻酔下にSistrunk法に準じて腫瘍摘出術を行ったところ、一部に嚢胞成分を認めたが、大部分は石灰化像を伴う充実性の腫瘍であった。病理組織所見では砂粒状石灰化を伴い乳頭状に増殖した蜂巣構造と、大小不同の拡張した管腔構造内に浸潤する腫瘍を認め、甲状舌管から発生した乳頭癌と診断した。

中耳から補聴器のイヤモールド印象材を手術的に除去した2症例を報告した。症例1は持続的な耳漏を主訴とする78歳男性。当初は慢性中耳炎と診断され保存的療法を受けていたが耳漏の改善は見られなかった。その後の検査で鼓室に異物を認め、その異物の素材分析により印象材であることが判明した。その後の問診で患者は約15年前に補聴器のイヤモールドを調製したことを思い出し、鼓室形成術を受けて異物除去に成功した。症例2はcanal wall down型鼓室形成術を受けた84歳女性で、左耳に印象材を注入されたが、その除去を受けていなかった。検査で乳突腔に埋入した印象材を認め、耳介後部の切開による異物を摘出した。いずれの症例でも、患者の病歴の問診、鼓膜の十分な検査、術後の補聴器フィッティング関連のリスクへの注意、ならびに不注意による補聴器フィッティング時の印象材押し込みの回避が重要になると考えられた。

今回われわれは、長期間介在した気管支異物の1例を報告した。症例は1歳4ヵ月の男児で、主訴は長期間持続する咳嗽であり、前医で肺炎と診断されて治療を受けていたが、治癒しなかった。4ヵ月後に胸部CTで気管支異物と診断された。気管支鏡で異物を摘出した。異物はセロハンテープであった。気管支異物の診断が遅れた理由は、X線透過性異物であったことと初診医が気管支異物を疑わなかったことと考えられた。(著者抄録)

<p>Determining the correspondence between points on the area–distance curve derived from acoustic rhinometry and the anatomical landmarks in the nasal and nasopharyngeal airway is important for the clinical evaluation of obstructive sleep apnea in children. In this study, area–distance curves derived from acoustic rhinometry (SER-2000; Rhino Metrics Co., Ltd., Denmark) were measured in a life-size, artificial, soft-silicon, upper-airway model of a healthy 5-year-old child (Koken Co., Ltd., Japan). We created obstacles in both the nasal cavity and nasopharynx with clay, simulating various grades of adenoid hypertorophy. On the area–distance curve, the anterior portion of the inferior turbinate corresponded to the region between the second notch and third peak, the posterior end of the nasal septum corresponded to the third peak, and the adenoid corresponded to the region from immediately after the third peak to 8 mm posterior to the fourth notch. The measured adenoidal volume matched the actual volume of the simulated adenoid; however, the measured airway volume of the nasopharynx according to acoustic rhinometry was far greater than the actual volume of the model. We conclude that the landmarks identified on the area–distance curve and the changes in adenoid volume measured with acoustic rhinometry have potential clinical application. However, acoustic rhinometry measurements of nasopharynx airway volume could be improved.</p>

At present, there are no high-impact biomarkers for deciding the course of treatment in patients with head and neck cancer. While smoking and alcohol abuse are among the most common risk factors for head and neck cancer, in the last decade, the human papillomavirus (HPV) has also been implicated in oropharyngeal carcinogenesis. HPV-related oropharyngeal cancer (OPC) is reported to be associated with a better prognosis and lower relapse rate, with increased sensitivity to both radiotherapy and chemotherapy, than HPV-unrelated OPC. However, it is mentioned in the NCCN guideline that the results of HPV testing should not change management decisions in patients with head and neck cancer, except in the context of a clinical trial. Several phase III clinical trials are currently underway to determine whether treatment can be de-intensified by replacing cisplatin with cetuximab in patients diagnosed as having HPV-related OPC. We present an overview of the current state of HPV as a biomarker of HPV-related OPC.

HPV関連中咽頭扁平上皮癌(OPC)はHPV非関連OPCに比べ、治療方法にかかわらず治療反応性や予後が良好であり、臨床的に異なる特徴を持っている。しかし、HPV関連OPCであっても多量喫煙やlate TN stageが予後不良因子となる。これらを鑑みて、HPV関連OPCの新病期分類が提唱されている。また、いかにHPV関連OPCの治療成績を保ちながら治療強度を低減し、重篤な晩期障害を減じてquality of life(QOL)を改善するかに主眼を置いた臨床試験がいくつか計画、進行中である。HPVがバイオマーカーとして有用なことは周知の事実であるが、臨床試験の結果に基づいたOPCに対する個別化治療の構築が必要であり、現段階ではHPV statusによる治療強度の低減は時期尚早である。(著者抄録)

During the process of identifying a Gram-negative coccobacillus isolated from a human clinical specimen, we found that the isolate's 16S rRNA gene had very close sequence identity with that of a variant Porphyromonas isolated from polymicrobial infections in the central bearded dragon, a species of lizard [2]. The 16S rRNA gene sequences of the human isolate and of six isolates from lizards were nearly identical (99.9-100%). Phylogenetic analysis placed all of these isolates in a single phylogenetic cluster well separated from other species in the genus Porphyromonas. The closest species was Porphyromoncts catoniae with 90.7-90.9% sequence identity, although there was less than 6% DNA similarity between the P. catoniae type strain and our representative isolates from lizards (PAGU 1787(T)) and human (PAGU 1776). These isolates could grow under anaerobic or microaerobic conditions (6% 02 atmosphere). The isolates were positive for catalase and very strong beta-hemolytic activity, but did not show black or brown pigmentation. Biochemically, the isolates could be differentiated from closely related species by pyroglutamic acid arylamidase and glycine arylamidase activity, and some others. The fermentation products mainly included succinic acid and propionic acid. The major fatty acids detected in cells of the isolates were iso-C15:0, anteiso-C15:0, and 3OH-iso-C17:0. The G + C content was 43.0 +/- 0.62 mol%. The species name Porphyromonas pogonae sp. nov. is proposed for these isolates with the type strain of PAGU 1787(T) (=MI 10-1288(T) = JCM 19732(T) = ATCC BAA-2643(T)). (C) 2014 Elsevier GmbH. All rights reserved.

© 2014 Japan Society for Head and Neck Cancer. All rights reserved. Here we report a case of mucoepidermoid carcinoma of the parotid gland accompanied by invasion through an unusual route. A 46-year-old female visited our department complaining of a growth in the external auditory canal and a purulent discharge. She had no swelling in her parotid region. Repeated biopsies of the external ear revealed inflammatory granulations and they made it difficult to point out the neoplasm. Contrast enhanced CT and MRI findings showed a solid tumor of the parotid gland that extended to the cranial side of the gland. Finally, a low-grade mucoepidermoid carcinoma that had originated in the upper pole of the parotid gland had progressed to the external auditory canal via &quot;Santorini&#039;s fissures,&quot; which is a notch in the cartilage of the auditory meatus. Both otolaryngologists and pathologists should pay attention to this kind of unusual route taken by a parotid gland tumor invasion.

症例は65歳の女性。半年前から続く咽頭違和感を主訴に近医を受診し、左口蓋扁桃の腫脹を指摘され当科紹介受診となった。左口蓋扁桃に20mm大の有茎性腫瘤を認め、生検にて紡錘細胞癌と診断された。CTおよびPET-CTによる画像診断にて、頸部リンパ節転移や遠隔転移がなく、腫瘍は左口蓋扁桃に限局し周囲組織への浸潤を認めなかったため、顕微鏡下に経口腔的中咽頭腫瘍摘出術を施行した。摘出標本の外観はマッシュルーム状の隆起性腫瘤であり、病理組織学的に紡錘形腫瘍細胞の増殖と扁平上皮癌の混在した組織像を認めた。切除断端は陰性であったが、側方断端の安全域が不充分と判断し、術後放射線治療50Gyを施行した。治療後19ヵ月経過した現在、再発や転移は認めていない。(著者抄録)

中咽頭癌の診断・治療にはHPVとの関連の解明や喫煙率の低下、IMRTや分子標的薬、ロボット手術などの新しいモダリティの出現によりパラダイムシフトが起こっている。HPV関連癌は非関連癌と比べ有意に遺伝子変異が少なく、非喫煙者に多く、予後が良好で生物学的に異なる性格を持つ癌腫との認識が必要である。現在、HPV関連癌に対して治療成績を保持・向上しつつ、治療強度を下げて患者のQOLを改善するかに主眼を置いた臨床試験が行われている。本稿では発癌要因と発症率の動向、HPV関連癌と非関連癌の分子生物学的相違、HPVの検出法、p16免疫染色の有用性、HPV感染・喫煙と予後、臨床試験について概説する。(著者抄録)

症例は40代、女性。右耳内違和感を主訴に受診。術前約20ヵ月の間に、頻回に再発を繰り返す右外耳道腫瘤に対して計6回の生検が施行された。1〜4回目では粘液を有する炎症性肉芽様組織と病理診断し、経過観察をされていた。経過中に耳下部腫脹は認めなかった。5回目の生検で悪性腫瘍の可能性を疑い、その後CTで右耳下腺に腫瘍が存在することが判明し、外耳道を含む拡大耳下腺全摘術が施行された。手術検体の病理組織像では、耳下腺上極に発生した低悪性粘表皮癌が上方に進展し、軟骨部外耳道の「サントリーニ裂溝」を穿通して外耳道へ進展していた。本例は、臨床的および病理学的に終始外耳道病変と認識されていたことで、生検組織を長期間にわたり奇異な粘液性上皮構造を含む炎症性肉芽と判断し、耳下腺腫瘍の存在を早期に認識することが困難であった。まれではあるが、本例の様な耳下腺腫瘍の非定型的な外耳道方向への進展形式について注意を払うことが必要と思われた。(著者抄録)

Background: The incidence rates of oropharyngeal squamous cell carcinoma (OPSCC) have risen steadily in the USA and in northern Europe. These increases are thought to be a consequence of persistent infection with high-risk human papillomavirus (HPV) in OPSCC patients. HPV is an emerging etiologic factor in OPSCC. In Japan, the incidence of OPSCC has significantly increased over the last three decades. However, the population of HPV-positive OPSCC patients is currently unknown. We examined the nationwide trends with regard to HPV incidence in OPSCC patients at 21 specific sites, and examined the relationship between the presence of HPV and survival in OPSCC patients in Japan. Methods: Tumor samples were obtained from patients with OPSCC prior to treatment, and HPV infection was investigated by polymerase chain reaction (PCR). Hybrid Capture 2 (HC2) was also adopted for swab examination on the surface of fresh tumors. Results: HPV was detected by PCR in 79 (50.3%) out of 157 OPSCC patients. The clinical features of HPV-positive OPSCC were low differentiation, a tendency to involve the lateral wall, and high nodal staging. The sensitivity and specificity of HC2 were 93.7 and 96.2%, respectively, indicating its utility as a screening test. HPV-positive patients had significantly better overall survival and disease-free survival than HPV-negative patients. (C) 2014 S. Karger AG, Basel

症例は78歳の女性.口腔内出血を伴う右軟口蓋腫瘤の精査目的に当科紹介となった.頸部CTでは右軟口蓋に造影効果を伴う35×25mmの腫瘍性病変を認めた.このため悪性腫瘍も疑い3度の生検を行ったが,悪性腫瘍との診断には至らず病理組織学的検査により咽頭放線菌症と診断した.ペニシリンG 300万単位/日の約4週間投与にて腫瘤は縮小し退院となった.退院2ヵ月後より右軟口蓋腫瘤の増大を認め,生検にて放線菌症と腺房細胞癌の同時併存が確認され,経口腔法による中咽頭腫瘍摘出術を施行した.術後12ヵ月経過したが再発や転移はなく経過良好である.&lt;br&gt;放線菌症は悪性腫瘍と鑑別が困難であるだけでなく,実際に悪性腫瘍と同時併存する症例があるので注意を要する.

超選択的動注化学療法を行った声門癌12例、声門上癌9例の計21例(全例男性、平均63歳)を対象に、動注療法の有用性について検討した。声門癌/声門下癌のT分類はT2:8例/5例、T3:4例/3例、T4:0例/1例、N分類はN0:12例/7例、N1:0例/1例、N2c:0例/1例であった。声門癌では、直前に9例がS-1、docetaxelの化学療法を受けており、動注回数は1回10例、2回2例で、治療効果は全例(100%)がCRであった。2例で局所再発を認めたが、喉頭全摘術で救済され、生存率は100%、喉頭温存率は83%であった。声門上癌では、3例が直前にCDDPと5-Fuの併用療法、docetaxelの化学療法を受けており、動注回数は1回3例、2回4例、3回2例で、治療効果はCR:8例(89%)、PR:1例(病巣残存で喉頭全摘術を行うも肺転移で死亡)であった。生存率は88%、喉頭温存率88%であった。全体での有害事象は、grade 2の白血球減少4例、粘膜炎9例、grade 3の粘膜炎12例を認めた。

The frequency of a supraglottic carcinoma as an occult primary of cervical lymph node metastasis is high therefore such cervical lymph node involvement is an early symptom. &lt;BR&gt;Our study will reference a difficult case of supraglottic carcinoma that ocular inspection assisted in differentiation on the tongue side of the epiglottis base which is a rare site of origin. With this case,a 59-year-old man,the chief complaint was a mass on the lower left-side of his chin. He noticed a sudden increase in size of this mass and consulted with another hospital&#039;s otolaryngology department. Aspiration biopsy cytology was performed on the mass and a squamous cell carcinoma (SCC) was diagnosed. &lt;BR&gt;He was introduced to this hospital with occult primary cervical metastatic cancer of the lymph node without having had the primary tumor identified yet by medical examination. PET-CT imaging revealed abnormal accumulation in the cervical lymph node to the left of the vallecula. We performed ａ biopsy from the lesion which seemed to be an epiglottic cyst. Because SCC was diagnosed,we took the epiglottic cyst to be the primary tumor of the cervical lymph node metastasis. We performed a horizontal partial laryngectomy and left neck dissection,followed postoperatively by radiation 60Gy treatment. There Has been to recurrence of the primary tumor nor metastasis as of two year and four months since surgical treatment.

口腔底類皮嚢胞は比較的まれな疾患であり，顎舌骨筋と嚢胞との位置関係により舌下型，オトガイ下型，舌下?オトガイ下型の3種類に分類される。術前診断の際には他の頸部嚢胞性疾患との鑑別が必要であり，主に超音波検査，CT，MRIが用いられる。しかしながら，舌骨近傍に発生した場合は正中頸嚢胞などとの鑑別が困難となることがある。&lt;br&gt;症例は19歳男性で3か月前からのオトガイ下腫脹を主訴に受診した。画像診断で類皮嚢胞に典型的な所見を呈さず，確定診断に至らなかった。頸部外切開法にて腫瘤を摘出し，病理検査および術中所見から舌下型類皮嚢胞と診断した。口腔底周囲に発生する頸部嚢胞性疾患の画像診断的特徴についての考察を加え報告する。

頸部気管に発生した腺様嚢胞癌に対して、PCPS(経皮的体外循環システム)下に摘出術を施行した症例を経験した。症例は69歳女性。咽頭の違和感と嗄声を主訴に初診。咽頭および喉頭に特記すべき所見を認めず、内科にて経過観察された。しかし喘鳴および呼吸苦が増悪し、2ヵ月後に当科にも再診した。上気道病変を疑い検索したCTと気管支鏡にて声門直下の気管内に腫瘍を認め、前壁から発生し内腔の4/5径を占拠していた。気管内挿管および気管切開は困難と考え、PCPSを使用した。手術は、第5気管輪で気管を横切開し、下方から腫瘍を確認した。術中迅速病理診断で腺様嚢胞癌の診断を得た。気管前壁側約1/3周を摘出・第1-5気管輪の高さで気管皮膚瘻とした。上方前壁側で断端陽性であった。術後放射線治療の後局所皮弁および右耳介軟骨にて硬性再建し、現在再発を認めない。気管腫瘍は比較的まれな疾患であるが、呼吸苦が増強し発見された折には既に増大しており対応に苦慮することがある。本症例も同様であり、教訓とすべきと考える。また部位によって治療法の綿密な計画と工夫が不可欠であるが、本例ではPCPSにより安全で確実な操作が可能であり有用であったと考えられた。(著者抄録)

HPV関連中咽頭癌はHPV非関連癌に比べ、化学療法や放射線療法に高感受性で予後良好である。今後、HPVの検出が中咽頭癌の治療効果予測や治療方針決定に対する有用なバイオマーカーとなり得る。今回、68例の未治療中咽頭癌のホルマリン固定パラフィン包埋ブロックからの最適なHPV検出法とその手順の探索を行った。方法はリアルタイムPCR法でハイリスク型HPVの7亜型の検出、In situ hybridization法(ISH)でHPV16/18DNAの検出、免疫組織化学検査でp16の発現を検討した。HPV陽性率はPCR、ISH、p16で各37、32、44%、PCRでHPV陽性28例の内訳は、16型が26例(93%)、56型1例(4%)、58型1例(4%)であった。3種類の検出法のうち2種以上が陽性のものを真のHPV陽性と仮定すると、感度と特異度はPCR(92%、93%)、ISH(92%、100%)、p16(100%、86%)で、陽性的中率と陰性的中率はPCR(88%、95%)、ISH(100%、96%)、p16(80%、100%)であった。HPV検出法として、まずp16でスクリーニングを行い、p16陽性例に対しISHで確定診断する方法が至適と考えられた。(著者抄録)

It is widely accepted that the most common risk factors for head and neck squamous cell carcinoma (HNC) are tobacco smoking and heavy alcohol consumption. Recent studies showed that an etiologic role of infection with human papillomavirus (HPV) has been implicated in the development of a subset of HNC. HPV-related HNC is associated with sexual behavior but not with tobacco smoking and alcohol drinking, and has a better prognosis with increased sensitivity to both radiation therapy and chemotherapy than HPV-unrelated HNC. Regarding molecular characteristics, immunohistochemical overexpression of p16 is observed in tumor cells with HPV-related HNC, therefore it is currently regarded as a reliable surrogate marker for HPV-related HNC. HPVrelated HNC is a clinical entity entirely distinct from HPV-unrelated HNC. This report presents an overview of the impact of HPV infection as a biomarker for head and neck carcinoma.

頭頸部癌の発癌に喫煙や飲酒が関わることは周知の事実であるが，近年，一部の頭頸部癌の発癌にヒト乳頭腫ウイルス（HPV）感染が関与することが注目されている。頭頸部癌におけるHPV関連癌とHPV非関連癌では患者背景や治療に対する反応性，予後などの臨床像や分子生物学的特徴が大きく異なる。すなわち，同じ頭頸部癌であっても，全く異なる発癌メカニズムと性格を有した別々の癌腫として考えられる。&lt;br&gt;HPV関連癌は活発な性行動と関連し，非喫煙・飲酒者に多く，化学療法や放射線療法に対して高感受性で予後が良好である。また，分子生物学的特徴としてCDK4 インヒビターであるp16 が高発現するため，p16はHPV感染の代替マーカーとなる。&lt;br&gt;頭頸部癌のバイオマーカーとしてHPVほどインパクトのあるマーカーは今までになく，本稿ではHPV関連癌とHPV非関連癌の特徴の差異やその意義について概説し，バイオマーカーとしてのHPV感染の有用性について述べる。