Cancer is the disease of aging and Korea is one of the fastest aging country in the world. Older patients have decreased organ function and stress tolerance, therefore are at high risk of functional decline and developing complication from cancer and cancer treatment. Before beginning cancer treatment, it is important to assess patients' life expectancy, whether the patient is likely to die of cancer or of other comorbidity, and also the risks with cancer treatment. In order to estimate patient's physiologic age, it is recommended to perform geriatric assessment and implement appropriate geriatric intervention together with meticulous supportive care, when planning cancer treatment for older patients. In a resource limited country such as Korea, two step approach of applying screening tool followed by geriatric assessment can be more efficient. Geriatric assessment is used to predict toxicity from cancer treatment such as surgery, radiotherapy, and chemotherapy, predict survival, and also to aid treatment decision. Number of randomized trials are ongoing to compare usual care versus oncogeriatric care, and with these results we expect to improve outcome of older patients with cancer.

The recently released the $8^{th}$ edition of the American Joint Committee on Cancer (AJCC) Staging Manual introduces significant modifications from the prior $7^{th}$ edition. In this paper, the contents of the new changes in the decision of cancer of the head and neck is summarized except changes in staging of skin and thyroid cancer. In addition to the 8th edition, 1) Addition of extracapsular involvement in metastatic lymph nodes (N category) 2) Oral cancer T classification change, 3) Staging of the pharyngeal cancer was divided into 3 chapters: high-risk human papilloma virus (HR-HPV) associated oropharyngeal cancer (OPC), non HR-HPV associated OPC and hypopharynx cancer (HPC), and nasopharynx cancer (NPC) 4) Changes in T and N classification in NPC, 5) In the case of cancer of unknown primary, P16-positive case is defined as HR-HPV related OPC, and EBV-positive case is defined as NPC. The process that led to these changes highlights the need to collect high-fidelity cancer registry-level data that can be used to confirm prognostic observations identified in institutional data sets. Clinicians will continue to use the latest information for patient care, including scientific content of the 8th Edition Manual. All newly diagnosed cases through December $31^{st}$ 2017 should be staged with the 7th edition. The time extension will allow all partners to develop and update protocols and guidelines and for software vendors to develop, test, and deploy their products in time for the data collection and implementation of the 8th edition in 2018. The 8th edition strikes a balance between a personalized, complex system and a more general, simpler one that maintains the user-friendliness and worldwide acceptability of the traditional TNM staging paradigm.

Background and Objectives: Voice change after thyroidectomy may develop without injury of recurrent laryngeal nerve. Psychogenic or emotional factors related to voice change after thyroidectomy has been rarely studied. In this study, we sought to analyze the impact of anxiety on early state of post-thyroidectomy voice change. Materials and Methods: We made a retrospective chart review of 36 patients who underwent thyroidectomy for papillary thyroid carcinoma and voice exam before surgery, 2 weeks after and 1 month after surgery. All patients included in the study answered a questionnaire for State-Trait Anxiety Inventory ; STAI-KYZ (form Korean YZ). Clinico-pathologic factors and parameters of voice analysis were reviewed to analyze correlation to the anxiety index. Results: No differences were identified between clinicopathologic factors and preoperative parameters of voice analysis between patients with higher and lower level of anxiety. Noise to harmonic ratio (NHR) was higher in those patients with higher level of anxiety, 2 weeks after surgery (p=0.043). However, none of the parameters showed any difference 1 month later. Conclusion: With limited number of patients and short period of follow up, significant impact of preoperative anxiety on postoperative voice change after thyroidectomy could not be identified in this preliminary study.

Background and Objectives: Gastric acid reflux is known to be the most important cause of contact granuloma. Therefore, anti-gastric acid reflux medication has been used as the first line treatment although there are other treatment methods such as surgery or steroid injections. Actually, the role of surgery in the treatment of contact granuloma has not been established clearly. The purpose of this study was to evaluate the effectiveness of surgical treatment for contact granuloma. Materials and Methods: We retrospectively reviewed the medical records of 14 patients who were diagnosed with contact granuloma and treated with surgery from 2011 to July 2016 at Hanyang University hospital. Results: Of 14 patients, 9 (64.3%) were male and 5 (27.4%) were female. The mean age was 53.8 (${\pm}6.1$) years. The main symptoms were voice change followed by globus, dyspnea, and asymptomatic. Mean Reflux Finding Score (RFS) before surgery was 13.5 and mead Reflux Symptom Index (RSI) was 10.4. The causes of surgery were inadequate response to proton pump inhibitor (PPI) in 4 cases, airway obstruction with large granuloma in 8 cases, and differential diagnosis in 2 cases. Of 14 patients, recurrence occurred in 8 (53.3%) patients after surgery. In 8 recurrent cases, 5 patients showed complete remission and 3 patients showed partial remission with PPI medication. Conclusion: The role of surgery in the treatment of contact granuloma might be limited due to high recurrence rate.

Verrucous carcinoma was first described by Ackerman who reported a case of verrucous carcinoma of the oral cavity. While it is primarily occurred in oral cavity, larynx is the second most affected site, accounting for nearly 35% of cases. It is a rare variant of well-differentiated squamous cell carcinoma and comprises 1% to 4% of all laryngeal carcinomas. It is characterized by locally invasive, slow growth and the surface shows papillary fronds with prominent hyperkeratosis. Because of the benign appearance and difficulty of the tissue diagnosis, it is often undiagnosed or misdiagnosed. The primary treatment modality is surgery and the extent of surgical resection may be guided by T stage. We experienced a case of verrucous carcinoma of larynx in a patient with hoarseness lasted for about 2 years and had difficult to diagnosis and treatment. Therefore we report this case with a brief review of literature.

Neurilemmomas are benign tumors originating from Schwann cells, and may occur in various nerves; however, they rarely originate from the lingual nerve. When a lingual nerve neurilemmoma develops in the submandibular space, it can be challenging to diagnose it preoperatively, and this tumor can be misdiagnosed as a usual submandibular gland tumor owing to the rarity and a lack of knowledge about lingual nerve neurilemmomas. Therefore, it is important to consider neurilemmoma in the differential diagnosis in cases where the characteristics of the tumor do not correspond with the typical findings of submandibular gland tumors, in order to avoid inadvertent sacrifice of the nerve because of incorrect diagnosis of a salivary gland tumor. Herein, we report a lingual nerve neurilemmoma in the submandibular space, along with a literature review, to highlight the clinical significance and improve understanding of this type of tumor.

Tuberculosis is primarily a pulmonary disease and extrapulmonary involvement of the oral cavity is an infrequent occurrence accounting for 0.2 - 1.5% of all extrapulmonary sites. The authors report a case of primary tuberculosis of the oral tongue in a 60-years-old male patient who visited the clinic for ongoing tongue pain that he experienced for several months. The lesion was initially indistinguishable from the malignancy, but differential diagnosis was performed on the biopsy with Ziehl-Neelseen stain. After treatment with anti-tuberculosis, the oral lesion healed completely without surgery.

Epithelial-myoepithelial carcinoma (EMC) is a rare type of low-grade malignant tumor that account for approximately 0.5% to 1% of salivary gland neoplasm and arises most commonly in the parotid gland (80%). We introduce three cases of parotid EMC arose as painless cystic mass in male patients over 70 years old. All patients were diagnosed as benign tumors (pleomorphic adenoma) by image and pathologic study (fine needle aspiration) before surgery, but the final histopathologic results were EMC. All three patients underwent parotidectomy without adjuvant radiotherapy. There were no complications such as facial paralysis. No complications or recurrences were observed during follow-up for 6 to 9 months. Since the reports of EMC are still relatively few, we report our three cases with the clinical and pathological review.

Foregut cystic developmental malformations are rare developmental anomalies. It is important to diagnose the diseases and manage them properly because these cysts may generate feeding or respiratory difficulties depending on the size and location of the lesions. A newborn was referred for a congenital cervical swelling to our clinic on the second day of his life. Neck SONO and MRI showed an about 6cm sized cystic mass at left submandibular area. Aspirations and sclerotherapies were done repeatedly due to recurred cystic mass. Under the suspicious of cystic hygroma, the mass and submandibular gland were excised. Histologically, it was a benign cyst including gastrointestinal and bronchogenic mucosa and pancreatic tissue. Foregut cyst was suggested for the final diagnosis and the patient was discharged at 9 days after the operation without a complication. He has visited our out-patient department. Although several image studies have been introduced to find out foregut cyst, it is difficult to go through differential diagnosis because of similarity of other benign tumor. Further studies for early diagnosis of cervical foregut cyst are needed for preventing possible related problems.

Background. Lymphoma of the vocal fold is extremely rare due to low lymphoid content in the larynx. To date, fewer than 100 cases of laryngeal lymphoma have been reported; however, none of these literatures are concerned about exclusive laryngeal involvement of recurred lymphoma which initially appeared in other body sites. Specific consensus about management for these patients yet to exist, due to its rare occurrence; however, the main modality of treatment is chemotherapy alone or in combination with radiation therapy. Case. Herein, we report a case of a 51-year-old female patient who had recurrent T-cell lymphoma developing in bilateral vocal folds. The patient was originally diagnosed of T-cell lymphoma in right colic flexure 10 years ago, and was cured by chemotherapy. Immunohistochemical stain revealed the histologic type of recurred tumor in the vocal folds that are identical to the previously cured lymphoma. Conclusion. To the best of our knowledge, this was the first case that recurrent lymphoma occurred solely in the vocal folds. Despite its rarity, lymphoma should be put in the index of suspicion among those patients with decreased vocal fold mucosal wave without definite vocal fold mass who had a history of cured lymphoma.

Solitary fibrous tumor (SFT) is an uncommon spindle cell neoplasm that is usually presented as a pleural origin localized tumor. There are few cases, found in thyroid. Twenty six cases found in thyroid have been reported since 1993, and two of these were malignant. We report another malignant case in this study; a 55 years old man visited out-patient clinic due to palpable mass of anterior neck, and pathologically diagnosed as malignant SFT of thyroid after surgical resection. In this study, we focus on the clinical features of this uncommon disease along with other literature reviews.

The tumor in accessory parotid gland (APG) is rarely occurred and its incidence is about 7.7% of all parotid gland neoplasms, but has a higher frequency of malignancy than major salivary glands. The mucoepidermoid carcinoma is the most common malignancy in APG, while B-cell lymphoma is less than 2%. It is often appeared as superficial mass in mid-cheek area. This lesion requires differential diagnosis with epidermoid cyst, lipoma, neurogenic tumors, Stensen's duct stone, lymphadenopathy and hemangioma etc. The mucosa associated lymphoid tissue (MALT) lymphoma, which is also termed extra-nodal marginal zone B-cell lymphoma tends to be localized disease for long time and has a relatively indolent course. We recently encountered a 69-year-old man with superficial solitary mass on the right cheek area that finally diagnosed as MALT lymphoma in APG. We report the rare and unique case with brief literature review.

We present a metastatic carcinoma from the breast to the neck soft tissue around common carotid artery, with a rare finding of voice change. A 60 year-old female patient presented with voice change for 7 months. Neck ultrasound revealed a soft tissue mass between internal jugular vein and common carotid artery. Result of fine needle aspiration biopsy was a metastatic carcinoma. Computed tomography and magnetic resonance image revealed $2.5{\times}3.0cm$ sized irregular marginated soft tissue mass in right lower neck encasing common carotid artery and internal jugular vein. Surgical resection was performed and pathologic result with immunohistochemical analysis confirmed the diagnosis of a metastatic invasive ductal carcinoma originated from breast.

Dysplastic epiglottis is extremely rare congenital malformation, which usually occurs in association with other laryngeal anomalies. Hypoplasia is the most common type in epiglottic malfomations. Other abnormalities include rudimentary, aplasia and bifid etc. Mostly, they are found in infancy and early childhood, and diagnosis at adulthood is extremely rare. A 69-year-old man with chronic cough and globus sense visited our clinic. Laryngoscopic findings revealed a unique form of epiglottis. He had no history of laryngeal trauma, tumors, head and neck surgery, and radiation. There was no another anomaly in the laryngo-pharynx. Because of a mass-like lesion at the apex of epiglottis, we performed the laryngeal microsurgery. The pathology revealed as granulation tissue. We report a rare and unique case of dysplastic epiglottis in elderly patient with a brief literature review.

Bronchogenic cysts are congenital malformations of the bronchial tree, a type of bronchopulmonary foregut malformation. The presentation of the bronchogenic cyst is variable, making pre-operative diagnosis difficult. They aremostly asymptomatic orarefound incidentally when the chest is imaged. They can present as lower neck massesor mediastinal masses that may enlarge. They cause mass effect due to local compression and may result in tracheo-bronchial obstruction leading to air trapping and respiratory distress. The treatment is somewhat controversial, and in general,these lesions are treated using the transcervical or transbronchial approach. When these cysts arelocalized in the upper mediastinum, it may be possible to removethemusing the transcervical approach. In our three cases, the patientscomplained of mild dysphagia, foreign body sensation, and dyspnea. We report three cases of a large bronchogenic cyst in the lower neck and the upper mediastinum treated using the transcervical approach.

Langerhans cell histiocytosis (LCH) is a heterogeneous disease, characterized by accumulation of dendritic cells with features similar to epidermal Langerhans cells. It is a rare entity that may involve various organ levels such as the skeletal, pulmonary, hematopoietic and lympho-vascular systems. The patient was a 1-year-old female presented with fever associated with otorrhea and palpable cervical lymph node for 4 days. Neck ultrasonography and Computed tomography imaging revealed multiple enlarged lymph nodes suggesting suspicious malignant morphology. Lymph node biopsy was performed under general anesthesia. Histological and immunophenotypic examination showed the lymph node to be consistent with LCH. The patient was given chemotherapy.

Mammary analogue secretory carcinoma (MASC) is a rare malignant tumor of the salivary gland, which was first described in 2010. In this case report, we describe a 62-year-old woman with a MASC of the parotid gland, who initially presented with an asymptomatic preauricular mass. At first, computed tomography (CT) and fine needle aspiration cytology were performed; these suggested a possible Warthin's tumor but also some suspicious malignant findings. For the main treatment, adequate parotidectomy was conducted via modified Blair incision to remove the tumor. Postoperative pathology report revealed a MASC of the parotid gland. Specific MASC findings were observed upon immunohistochemical examination.

Background. Ever since the first report of deltopectoral flap in pharyngo-esophageal reconstruction in 1965, various methods of flap reconstruction have been introduced, allowing surgical eradication of tumors that were once thought to be inoperable. Despite these advancement, many literatures emphasize distant metastasis and second primary malignancies as the most important factors that contribute to the low 5-year survival rate of the patients. Specific consensus about defining second primary cancer is still debatable, due to small number of reports regarding second primary tumors arising in flaps used for reconstruction of defects in the head and neck region. Case. We report a case of a 72-year-old male patient who, under the diagnosis of hypopharyngeal cancer, underwent total laryngectomy with partial pharyngectomy, extended right radical neck dissection with extended left lateral neck dissection, right hemithyroidectomy and radial forearm free flap reconstruction on June 16, 2003. After 37 cycles of radiation therapy, the patient exhibited no sign of recurrence. The patient revisited our department on June 14, 2016 with chief complaint of dysphagia that started two months before the visit. Radiologic studies and histology revealed squamous cell carcinoma in neopharynx, one that had been reconstructed with forearm free flap. Conclusion. Until now, only a handful of reports regarding patients with second primary cancer in reconstructed flaps have been described. Despite its rarity, diagnostic criteria for second primary cancer should always kept in consideration for patients with recurred tumor.

Schwannoma, also known as a neurilemmomas or neurinomas, is benign peripheral nerve sheath tumors arising from the Schwann cells. About 25~45 % of all schwannomas are found in the head and neck region, and the majority are found in the parapharyngeal space. Schwannoma of the larynx is very rare with an incidence of 0.1~1.5% in all benign laryngeal tumors. Recently, we experienced a case of a pedunculated schwannoma arising from the left aryepiglottic fold in a 80-year-old patient. The tumor was completely excised under direct laryngoscopy with the use of a $CO_2$ laser and subsequently confirmed as schwannoma. So, we report this case with a review of the literatures.

Mammary analogue secretory carcinoma (MASC) of the salivary gland is a newly classified pathologic entity since 2010. Prior to its recognition, MASC was diagnosed as low-grade cystadenocarcinoma, acinic cell carcinoma, and mucoepidermoid carcinoma. MASC shares common histological and genetic characteristics with secretory carcinoma of the breast and has a distinct feature of the ETV6-NTRK3 fusion gene. Treatment of MASC in salivary gland is mainly wide surgical resection of the tumor. Prognosis of MASC is similar to other low-grade salivary gland carcinomas. Herein, we report a case of MASC developed in a parotid gland with a review of the literature.