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682/ops_codes.txt

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+Transplantat[5-296.14 ] Entnahme sonstiges Transplantat mit mikrovaskulärer Anastomosierung Oberschenkel und Knie[5-858.48 R] Permanente Tracheotomie[5-312.0 ] Radikale modifizierte Neck dissection in 5 Regionen[5-403.21 B] Perkutan-endoskopische Gastrostomie[5-431.2 ] Sonstige diagnostische Pharyngoskopie[1-611.x ] Direkte diagnostische Laryngoskopie[1-610.0 ] Wechsel vaskuläres Implantat Gefäße Kopf und Hals extrakraniell[5-394.3 ]

682/surgery_description.txt

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+Tumor resection, Defect reconstruction, Free flap (ALT), Neck dissection

682/surgery_report.txt

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+First re-inspect after positioning the patient. Inspection with the Kleinsasser tube. There is an exophytic mass in the area of the right tonsil lobe, passing over the soft palate to the parauvular area, filling the entire right tonsil lobe, transition to the posterior pharyngeal wall, the mass extends caudally in the area of the lateral pharyngeal wall to the hypopharyngeal level and ends just below the vallecula. The right edge of the epiglottis is just reached. Growth over the glossotonsillar groove towards the tongue, but no tongue infiltration here. The first step is transoral resection of the oral cavity, resection of the soft palate including the uvula and approximately half of the soft palate, resection of the entire tonsil lobe including the pharyngeal muscles down to the soft tissues of the neck. Resection and removal at the posterior floor of the mouth, taking the glossotonsillar groove with it. Covering of the soft palate and the posterior floor of the mouth with marginal samples, which are shown to be tumor-free in the frozen section diagnosis. Now reposition for neck dissection of the right side. A skin incision is made on the anterior edge of the sternocleidomastoid muscle, skin and subcutaneous tissue is cut, the platysma is cut, the external jugular vein and auricular nerve are exposed and preserved. Exposure of the sternocleidomastoid muscle, omohyoid muscle and digastric muscle. Exposure and preservation of the facial vein. Removal of the anterior neck preparation with careful protection and preservation of the superior thyroid artery, the hypoglossal nerve and the cervical vein. Free preparation of the internal jugular vein, exposure and preservation of the accessorius nerve, removal of the accessorius triangle and removal of level Va up to the border to Vb while carefully preserving the cervical plexus roots. Overall, no peritoneal growing metastases in the neck area. The glandula submandibularis is now extirpated and the neck dissection of neck level Ib is completed. Enter enorally via the posterior floor of the mouth. Then skeletonize the hyoid on the right side. Enter the pharynx into the vallecula cavity. Widen the pharyngotomy towards the pharyngeal side wall. Successive widening. Inclusion of the free epiglottis margin on the right, good overview of the tumor. Successive detachment, exposure and preservation of the superior laryngeal nerve. Exposure and skeletonization of the hypoglossal nerve and the lingual artery, both of which can be preserved. Exposure and preservation of the facial artery. Successive resection of the tumor with a safety margin, removal of the right lateral part of the base of the tongue to ensure the safety margin and removal of the tumor macroscopically in toto, which is thread-reinforced for definitive histology. Somewhat narrow conditions in the area of the posterior cranial pharyngeal wall on the specimen. A separate resection is therefore performed here. Similarly, if the macroscopic conditions are somewhat scarce in the direction of the vallecula, a resection is made here. Subsequently, the entire tumor is covered with marginal samples, which are completely tumor-free, with no evidence of higher-grade dysplasia; only in the area of the posterior edge of the tongue are there low to moderate-grade dysplasia. After discussing the case with the pathology department, a definitive marginal sample is taken. If the R0 situation is now present intraoperatively, the defect is measured. Performing defect reconstruction with microvascularly anastomosed ALT from the right after Doppler sonographic identification of the main perforator, here marking a graft measuring 14 x 7 cm in total. First medial incision. Exposure and identification of the rectus femoris muscle, subfascial release, exposure of the pedicle vessel. Exposure of the main perforator. Free preparation of the perforator. In case of musculocutaneous course, complete isolation of the perforator and overall configuration of the graft as a perforator flap. Partial preservation of the fascia lata around the perforator, otherwise lateral thinning of the flap. Isolation via the perforator to the vascular pedicle and placement of the excellent vital graft after isolation of the pedicle vessels. Final hemostasis. Insertion of a 10-gauge Redon drain and careful multi-layer wound closure with resection of excess skin. Neck dissection of the left side was performed at the same time. This also involved cutting through the skin and subcutaneous tissue and exposing the sternocleidomastoid and omohyoid muscles, releasing the submandibular gland and taking the caudal capsule with it. Exposure of the digastric muscle. Exposure and preservation of the facial vein, removal of the anterior neck preparation with preservation of the cervical artery, superior thyroid artery and hypoglossal nerve. Free dissection of the internal jugular vein, exposure and preservation of the accessorius nerve and, while preserving the accessorius triangle, limitation of the neck dissection in the direction of the level Va. Dissection up to the cervical plexus, which is carefully protected. Final wound irrigation and, if the wound is dry, insertion of a 10-gauge Redon drain and careful wound closure. The graft is then incorporated, combined transoral and transcervical graft suturing under difficult conditions with a complex defect. Overall, however, good fit and intact conditions on all sides. Conditioning of the superior thyroid artery, arterial anastomosis with 8-0 Ethilon, this is sufficient. Immediately good venous return with clearly leading strong vein. Conditioning of the facial vein, measurement of a coupler size 3.0 and performance of the venous anastomosis with the coupler system. Subsequent regular pedicle pulsation. Positive spreading phenomenon and vital graft enorally. No significant outflow via the second small vein, so that this is closed. Subsequent careful wound inspection and, if the wound is dry, insertion of a 10-gauge Redon drain and careful two-layer wound closure. The tracheotomy is then performed. Skin incision below the cricoid cartilage, separation of skin and subcutaneous tissue. Exposure and transection of the infrahyoid musculature. Exposure of the cricoid cartilage, exposure of the anterior surface of the trachea, transection of the thyroid isthmus. Insertion between the 1st and 2nd tracheal rings, creation of a broad-based Björk flap and incision of the tracheostoma in the typical manner. Subsequent problem-free transfer to a size 8 low cuff cannula, which is suture-fixed. The procedure was then completed with a vital graft and no indication of complications. Endoscopic PEG placement was performed at the beginning of the procedure. This was done with the gastroscope under laryngoscopic control. Easy pre-scanning into the stomach. With good diaphanoscopy, the stomach was punctured without any problems. The PEG tube is then inserted using the usual suture pull-through method. Note: The patient receives intraoperative intravenous antibiotics with Unacid 3 g, which should be continued for 24 hours postoperatively. Conclusion: Intraoperative R0 resected cT3 cN2b G2 cM0 oropharyngeal carcinoma on the right. If the graft and wound healed properly postoperatively, please perform an X-ray breischluck on the 10th postoperative day. Due to the size of the defect, a prolonged recovery of swallowing function can be expected. Adjuvant therapy is certainly necessary.

683/TumorCenter_CD8_block17_x4_y5_patient683_1.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 16441.3,
+    "Centroid Y µm": 26186.1,
+    "Num Detections": 24450,
+    "Num Negative": 24247,
+    "Num Positive": 203,
+    "Positive %": 0.8303,
+    "Num Positive per mm^2": 73.55
+  }
+}

683/history_text.txt

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+Patient with cT1b glottic laryngeal carcinoma on the right side. Due to the lack of adjustability and the main tumor mass in the area of the anterior commissure, there is now an indication for a partial laryngectomy from the outside. The patient had ample opportunity to ask questions about the procedure before the operation.

683/icd_codes.txt

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+Bösartige Neubildung der Glottis[C32.0 B]

683/ops_codes.txt

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+Partielle Laryngektomie Teilresektion frontolateral [Leroux-Robert][5-302.7 ]

683/patient_clinical_data.json

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+{
+  "year_of_initial_diagnosis": 2019,
+  "age_at_initial_diagnosis": 66,
+  "sex": "male",
+  "smoking_status": "former",
+  "primarily_metastasis": "no",
+  "survival_status": "living",
+  "survival_status_with_cause": "living",
+  "first_treatment_intent": "curative",
+  "first_treatment_modality": "local surgery",
+  "days_to_first_treatment": 9,
+  "adjuvant_treatment_intent": null,
+  "adjuvant_radiotherapy": "no",
+  "adjuvant_radiotherapy_modality": null,
+  "adjuvant_systemic_therapy": "no",
+  "adjuvant_systemic_therapy_modality": null,
+  "adjuvant_radiochemotherapy": "no"
+}

683/surgery_description.txt

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+Partial resection of larynx (Leroux-Robert) from the outside via thyreofissure

683/surgery_report.txt

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+After active patient identification, the patient is brought into the operating theater. Carry out the team time-out. Introductory consultation with anesthesia colleagues. Induction of anesthesia and intubation of the patient. Positioning of the patient by the surgeon. Skin spray disinfection and infiltration anesthesia. Skin wipe disinfection and sterile draping. First mark the planned incision after palpatory identification of the thyroid incisura and the upper edge of the cricoid cartilage. Make the incision using the broken-line technique. Sharp cutting of the cutis as well as the subcutis. Expose the prelaryngeal musculature. Locate the median line. Lateralization of the prelaryngeal musculature and exposure of the thyroid cartilage. Insertion of the sharp retractors. Incise the periosteum from the thyroid incisura to the lower edge of the thyroid cartilage. Dissection of 2 perichondrium lobules and lateralization of the same. Horizontal incision of the ligamentum conicum. Incision with the wheel and opening of the laryngeal skeleton in the median line. A tumor can now be seen extending from the right vocal process via the anterior commissure to the middle third of the left vocal fold. Initially beginning on the right side. First infiltration anesthesia glottic right. Then resection of the right vocal fold, including the vocal ligament, the vocalis muscle and parts of the thyroarytenoid muscle. In some cases, it is necessary to resect down to the perichondrium of the inner surface of the thyroid cartilage. The same procedure is also carried out on the left side. Here the resection only extends to the posterior third, taking the middle third with it. Here too, the extent of the resection is carried out via the vocal ligament and the vocalis muscle to the arytaenoid muscle. In the ventral part of the resection area, resection is also performed down to the inner perichondrium leaf of the thyroid cartilage. This is followed by hemostasis using bipolar coagulation. Removal of circular margin samples. Right: upper front, upper back, lower back, lower front; left: upper front, upper back, lower back, lower front. During the telephone frozen section examination, extensions of a squamous cell carcinoma in situ can still be seen subglottically on the right. Therefore, a definitive resection and a new marginal sample are taken and also sent for frozen section diagnostics. This is found to be tumor-free intraoperatively. Therefore, proceed to closure of the larynx. Creation of a total of 4 drill holes. Insertion of a 14 mm laryngeal wedge. Suturing with Vicryl 4.0. Creation of 2 additional drill holes to achieve adequate closure of the laryngeal skeleton. Closure of the incision in the area of the ligamentum conicum. Mobilization of the two perichondrium flaps. These are folded over the Keel and sutured in the median line. Overall very good aspect. Insertion of a sterile flap. Re-adaptation of the prelaryngeal musculature. This is also sutured with Vicryl 4.0 in the median line. Prior to this, wound irrigation with H2O2 and Ringer's solution. Subcutaneous suturing with Vicryl 4.0 and skin suturing with Ethilon 5.0. Application of a wound dressing and a wrap and completion of the operation without complications after a final consultation with the anesthesia colleagues.

684/InvasionFront_CD8_block19_x3_y12_patient684_0.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 11069.1,
+    "Centroid Y µm": 39686.8,
+    "Num Detections": 20914,
+    "Num Negative": 20791,
+    "Num Positive": 123,
+    "Positive %": 0.5881,
+    "Num Positive per mm^2": 53.55
+  }
+}

684/InvasionFront_CD8_block19_x4_y12_patient684_1.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 13510.1,
+    "Centroid Y µm": 39836.8,
+    "Num Detections": 19401,
+    "Num Negative": 19364,
+    "Num Positive": 37,
+    "Positive %": 0.1907,
+    "Num Positive per mm^2": 16.22
+  }
+}

684/TumorCenter_CD3_block19_x3_y12_patient684_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 13819.3,
+    "Centroid Y µm": 30858.4,
+    "Num Detections": 9857,
+    "Num Negative": 9684,
+    "Num Positive": 173,
+    "Positive %": 1.755,
+    "Num Positive per mm^2": 87.3
+  }
+}

684/TumorCenter_CD3_block19_x4_y12_patient684_1.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 16353.9,
+    "Centroid Y µm": 30551.6,
+    "Num Detections": 12650,
+    "Num Negative": 12210,
+    "Num Positive": 440,
+    "Positive %": 3.478,
+    "Num Positive per mm^2": 212.83
+  }
+}

684/TumorCenter_CD8_block19_x3_y12_patient684_0.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 13742.7,
+    "Centroid Y µm": 41203.2,
+    "Num Detections": 11320,
+    "Num Negative": 11283,
+    "Num Positive": 37,
+    "Positive %": 0.3269,
+    "Num Positive per mm^2": 26.64
+  }
+}

684/TumorCenter_CD8_block19_x4_y12_patient684_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 16266.4,
+    "Centroid Y µm": 41378.1,
+    "Num Detections": 19023,
+    "Num Negative": 18811,
+    "Num Positive": 212,
+    "Positive %": 1.114,
+    "Num Positive per mm^2": 99.22
+  }
+}

684/history_text.txt

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+The patient had a T1a glottic carcinoma on the right side. Due to the extremely poor adjustability of the tumor, a partial laryngeal resection from the outside was indicated.

684/icd_codes.txt

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+Glottiskarzinom[C32.0 R]

684/ops_codes.txt

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+Frontolaterale Kehlkopfteilresektion[5-302.7 ]

684/patient_clinical_data.json

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+{
+  "year_of_initial_diagnosis": 2015,
+  "age_at_initial_diagnosis": 68,
+  "sex": "male",
+  "smoking_status": "former",
+  "primarily_metastasis": "no",
+  "survival_status": "living",
+  "survival_status_with_cause": "living",
+  "first_treatment_intent": "curative",
+  "first_treatment_modality": "local surgery",
+  "days_to_first_treatment": 6,
+  "adjuvant_treatment_intent": null,
+  "adjuvant_radiotherapy": "no",
+  "adjuvant_radiotherapy_modality": null,
+  "adjuvant_systemic_therapy": "no",
+  "adjuvant_systemic_therapy_modality": null,
+  "adjuvant_radiochemotherapy": "no"
+}

684/patient_pathological_data.json

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+{
+  "patient_id": "684",
+  "primary_tumor_site": "Larynx",
+  "pT_stage": "pT1",
+  "pN_stage": "NX",
+  "grading": "G2",
+  "hpv_association_p16": "not_tested",
+  "number_of_positive_lymph_nodes": NaN,
+  "number_of_resected_lymph_nodes": 0,
+  "perinodal_invasion": null,
+  "lymphovascular_invasion_L": "no",
+  "vascular_invasion_V": "no",
+  "perineural_invasion_Pn": "no",
+  "resection_status": "R0",
+  "resection_status_carcinoma_in_situ": "CIS Absent",
+  "carcinoma_in_situ": "no",
+  "closest_resection_margin_in_cm": null,
+  "histologic_type": "SCC_Conventional-Keratinizing",
+  "infiltration_depth_in_mm": 5.0
+}

684/surgery_description.txt

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+Partial resection of larynx

684/surgery_report.txt

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+Introductory consultation with the anesthesia department. Intubation of the patient. Application of local anesthesia. Transverse skin incision over the larynx. Dissection in layers down to the prelaryngeal muscles. This is cut in the midline and dissected to the side. Exposure of the thyroid cartilage plate. Exposure of the cricoid cartilage. Exposure of the ligamentum conicum. Opening of the ligamentum conicum in the sense of a transverse incision. Opening of the thyroid cartilage in the midline with the wheel. Insertion of the retractors. It can be seen that the tumor reaches right up to the anterior commissure, but does not appear to exceed it. The anterior commissure has thus been opened beyond the tumor. Nevertheless, a marginal sample was taken from the left anterior commissure. Subsequent re-inspection of the tumor. This is easily displaceable in relation to the thyroid cartilage. Therefore, the tumor, which reaches the vocal process here and can be removed there, was cut around. In the upper area, the tumor does not reach the pocket fold. Only slight infiltration of the subglottic slope towards the lower margin. The tumor is macroscopically resected in sano on all sides. Removal of marginal samples from the upper and lower margins of the deposit as well as separately from the front and deep front. Together with the margin sample from the opposite side, these are sent for frozen section examination. Based on the intraoperative findings, the R0 resection is confirmed by pathology. Subtle hemostasis. The tube had been removed orotracheally during the operation and the patient had been reintubated to an endolaryngeal tube from the outside. Using the Seldinger technique, reintubation to an orotracheal tube at the end of the operation with a dry wound. Then closure of the larynx with two mattress sutures and suturing of the ligamentum conicum. Insertion of a wound flap. Closure of the prelaryngeal muscles in the midline. Continuous suture here. Two-layer wound closure. Application of a pressure dressing. Final consultation with the anesthetist. Completion of the procedure.

685/InvasionFront_CD3_block19_x5_y10_patient685_0.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 16066.5,
+    "Centroid Y µm": 27460.5,
+    "Num Detections": 15854,
+    "Num Negative": 15646,
+    "Num Positive": 208,
+    "Positive %": 1.312,
+    "Num Positive per mm^2": 133.71
+  }
+}

685/InvasionFront_CD3_block19_x6_y10_patient685_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 18490.2,
+    "Centroid Y µm": 27710.3,
+    "Num Detections": 18794,
+    "Num Negative": 18422,
+    "Num Positive": 372,
+    "Positive %": 1.979,
+    "Num Positive per mm^2": 205.47
+  }
+}

685/InvasionFront_CD8_block19_x5_y10_patient685_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 16241.4,
+    "Centroid Y µm": 35131.4,
+    "Num Detections": 16190,
+    "Num Negative": 16091,
+    "Num Positive": 99,
+    "Positive %": 0.6115,
+    "Num Positive per mm^2": 54.87
+  }
+}

685/InvasionFront_CD8_block19_x6_y10_patient685_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 18815.0,
+    "Centroid Y µm": 35306.3,
+    "Num Detections": 25395,
+    "Num Negative": 25282,
+    "Num Positive": 113,
+    "Positive %": 0.445,
+    "Num Positive per mm^2": 41.31
+  }
+}

685/TumorCenter_CD3_block19_x5_y10_patient685_0.json

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+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 18277.4,
+    "Centroid Y µm": 25390.9,
+    "Num Detections": 0,
+    "Num Negative": 0,
+    "Num Positive": 0,
+    "Positive %": NaN,
+    "Num Positive per mm^2": NaN
+  }
+}

685/TumorCenter_CD3_block19_x6_y10_patient685_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 20890.8,
+    "Centroid Y µm": 25160.1,
+    "Num Detections": 20912,
+    "Num Negative": 20479,
+    "Num Positive": 433,
+    "Positive %": 2.071,
+    "Num Positive per mm^2": 189.5
+  }
+}

685/TumorCenter_CD8_block19_x5_y10_patient685_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 18890.0,
+    "Centroid Y µm": 36180.8,
+    "Num Detections": 0,
+    "Num Negative": 0,
+    "Num Positive": 0,
+    "Positive %": NaN,
+    "Num Positive per mm^2": NaN
+  }
+}

685/TumorCenter_CD8_block19_x6_y10_patient685_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 21388.7,
+    "Centroid Y µm": 36405.7,
+    "Num Detections": 17698,
+    "Num Negative": 17481,
+    "Num Positive": 217,
+    "Positive %": 1.226,
+    "Num Positive per mm^2": 111.59
+  }
+}

685/history_text.txt

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+The patient has been suffering from dysphonia for 4 months. Mirror findings revealed an exophytic mass in the area of the right glottis with transition to the supraglottis. The vocal fold mobility on the right side is clearly immobile to fixed. Sampling during panendoscopy <2016> revealed a G2 squamous cell carcinoma with CT-morphologically questionable infiltration of the right arytenoid cartilage. Therefore indication for the above-mentioned procedure.

685/icd_codes.txt

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+Glottiskarzinom[C32.0 R]

685/ops_codes.txt

@@ -0,0 +1 @@
+Laserresektion Larynxgewebe mit Stützlaryngoskopie[5-302.5 ] Radikale zervikale Lymphadenektomie [Neck dissection] radikal modifiziert 5 Regionen[5-403.21 R] Temporäre Tracheotomie[5-311.0 ] Direkte diagnostische Laryngoskopie[1-610.0 ]

685/patient_clinical_data.json

@@ -0,0 +1,18 @@
+{
+  "year_of_initial_diagnosis": 2016,
+  "age_at_initial_diagnosis": 84,
+  "sex": "male",
+  "smoking_status": "non-smoker",
+  "primarily_metastasis": "no",
+  "survival_status": "living",
+  "survival_status_with_cause": "living",
+  "first_treatment_intent": "curative",
+  "first_treatment_modality": "local surgery",
+  "days_to_first_treatment": 11,
+  "adjuvant_treatment_intent": null,
+  "adjuvant_radiotherapy": "no",
+  "adjuvant_radiotherapy_modality": null,
+  "adjuvant_systemic_therapy": "no",
+  "adjuvant_systemic_therapy_modality": null,
+  "adjuvant_radiochemotherapy": "no"
+}

685/patient_pathological_data.json

@@ -0,0 +1,20 @@
+{
+  "patient_id": "685",
+  "primary_tumor_site": "Larynx",
+  "pT_stage": "pT1",
+  "pN_stage": "pN0",
+  "grading": "G2",
+  "hpv_association_p16": "not_tested",
+  "number_of_positive_lymph_nodes": 0.0,
+  "number_of_resected_lymph_nodes": 29,
+  "perinodal_invasion": null,
+  "lymphovascular_invasion_L": "no",
+  "vascular_invasion_V": "no",
+  "perineural_invasion_Pn": "no",
+  "resection_status": "R0",
+  "resection_status_carcinoma_in_situ": "CIS Absent",
+  "carcinoma_in_situ": "no",
+  "closest_resection_margin_in_cm": null,
+  "histologic_type": "SCC_Conventional-Keratinizing",
+  "infiltration_depth_in_mm": 3.0
+}

685/surgery_description.txt

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+Laser resection, Neck dissection, Tracheotomy

685/surgery_report.txt

@@ -0,0 +1 @@
+First, induction of anesthesia and intubation by the anesthesia colleagues. Entry with the Kleinsasser tube and inspection of the tumor. The tumor completely infiltrates the right vocal fold, passes into the anterior commissure and infiltrates two thirds of the left vocal fold, it grows supraglottically and infiltrates the entire pocket fold on the right side and two thirds of the pocket fold on the left side. The mucosa at the vocal process is also infiltrated. Mechanically, the ary on the right side is still mobile with the small double spoon, but less mobile than on the left side. Demonstration of the findings on <CLINICIAN_NAME> and <CLINICIAN_NAME>. It is decided to first resect the mucosa in the area of the posterior artery and send it for a frozen section. This is also done. The patient also has a rather benign cyst postcricoid on the right side. This cyst is also removed with the scissors and sent for frozen section. The frozen section showed no evidence of carcinoma in either specimen, so the decision was made to continue with the laser resection and to forgo a complete laryngectomy for the time being. Now loosening and removal of the tumor on the posterior surface, then repositioning and removal of the tumor in the area of the anterior commissure. This is relatively difficult as the patient cannot be adjusted well at the anterior commissure. Finally, the tumor is successfully released there. It must be completely lasered off the thyroid cartilage. Infiltration of the thyroid cartilage is not present on CT morphology or clinically. Then first resection of the tumor portion on the left side. Here, half of the pocket fold on the vocal fold falls. It is clear that the tumor is also growing approximately 0.5 cm into the subglottic appendix on both the right and left sides. Here, too, resection is necessary. Finally, the tumor is also resected on the right side, including the pocket fold and the subglottic slope for 0.5 cm. The arytenoid cartilage can be preserved, but the mucosa in the area of the vocal process must be completely resected. The specimen is placed on cork for final histology. Subsequently, marginal samples are taken subglottically on both sides as well as centrally, then in the area of both pocket folds and the posterior margins. All marginal samples are R0 in the frozen section. The entire surface of the tumor is covered by the margin samples and an R0 resection can be assumed. Then repositioning for neck dissection on the right side. For this, the skin incision is made relatively caudally in a skin fold that extends up to the mastoid. It is theoretically possible to extend this skin incision to the apron flap in a second operation if a functional laryngectomy should become necessary. Now the platysma is shown. Exposure of the sternocleidomastoid muscle, the omohyoid muscle, the submandibular gland and the digastric muscle. Then release of the neck preparation level II a to IV while sparing the plexus branches. Tearing of the internal jugular vein occurs in level II, which is sutured over with Vascufil 6.0. Then consultation with <CLINICIAN_NAME>. The latter was cautious about the overall indication for neck dissection in this procedure, so the neck dissection on the left side was not performed. Repositioning for tracheotomy. Perform the tracheotomy in the usual manner with formation of a mucocutaneous anastomosis in the sense of a visor tracheotomy. Then transfer intubation to a tracheostomy tube 8.0. Then insertion of a nasogastric tube. Please present the patient at the tumor conference after receiving the final histology, to plan any adjuvant therapy. No oral food for 5 days, then attempt to swallow and build up diet, if necessary speech therapy swallowing training. As he was able to remain standing on the right side and on the left side, swallowing should not cause any problems in the long term, if no adjuvant therapy is necessary, please have a control MLE in 10 to 12 weeks. If there is clear granulation tissue, then remove the granulation tissue and possibly insert a Dacron foil or PDS foil secondarily.  

686/InvasionFront_CD3_block15_x1_y7_patient686_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 6096.8,
+    "Centroid Y µm": 28010.2,
+    "Num Detections": 0,
+    "Num Negative": 0,
+    "Num Positive": 0,
+    "Positive %": NaN,
+    "Num Positive per mm^2": NaN
+  }
+}

686/InvasionFront_CD3_block15_x2_y7_patient686_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 8695.4,
+    "Centroid Y µm": 27835.3,
+    "Num Detections": 0,
+    "Num Negative": 0,
+    "Num Positive": 0,
+    "Positive %": NaN,
+    "Num Positive per mm^2": NaN
+  }
+}

686/InvasionFront_CD8_block15_x1_y7_patient686_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 3904.3,
+    "Centroid Y µm": 17523.2,
+    "Num Detections": 0,
+    "Num Negative": 0,
+    "Num Positive": 0,
+    "Positive %": NaN,
+    "Num Positive per mm^2": NaN
+  }
+}

686/InvasionFront_CD8_block15_x2_y7_patient686_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 6566.8,
+    "Centroid Y µm": 17338.1,
+    "Num Detections": 0,
+    "Num Negative": 0,
+    "Num Positive": 0,
+    "Positive %": NaN,
+    "Num Positive per mm^2": NaN
+  }
+}

686/TumorCenter_CD3_block15_x1_y7_patient686_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 3872.9,
+    "Centroid Y µm": 20938.9,
+    "Num Detections": 0,
+    "Num Negative": 0,
+    "Num Positive": 0,
+    "Positive %": NaN,
+    "Num Positive per mm^2": NaN
+  }
+}

686/TumorCenter_CD3_block15_x2_y7_patient686_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 6521.5,
+    "Centroid Y µm": 20938.9,
+    "Num Detections": 0,
+    "Num Negative": 0,
+    "Num Positive": 0,
+    "Positive %": NaN,
+    "Num Positive per mm^2": NaN
+  }
+}

686/TumorCenter_CD8_block15_x1_y7_patient686_0.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 6421.6,
+    "Centroid Y µm": 17465.8,
+    "Num Detections": 0,
+    "Num Negative": 0,
+    "Num Positive": 0,
+    "Positive %": NaN,
+    "Num Positive per mm^2": NaN
+  }
+}

686/TumorCenter_CD8_block15_x2_y7_patient686_1.json

@@ -0,0 +1,11 @@
+{
+  "patient_tma_measurements": {
+    "Centroid X µm": 8870.3,
+    "Centroid Y µm": 17465.8,
+    "Num Detections": 0,
+    "Num Negative": 0,
+    "Num Positive": 0,
+    "Positive %": NaN,
+    "Num Positive per mm^2": NaN
+  }
+}

686/history_text.txt

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+Mr. <PATIENT_NAME> is diagnosed with primary carcinoma of the tongue margin on the left. Preoperative MRI and PET-CT image diagnostics indicated a CUP syndrome with a large metastasis in the caudal parotid region. A gross needle puncture was performed in domo 4 weeks ago in LA. A metastasis at the lower parotid pole was biopsied and a squamous cell carcinoma was confirmed. Now, due to a small ulcer on the left edge of the tongue, a primary tumor in the oral cavity is suspected. Therefore indication for intraoperative panendoscopy and frozen section biopsy of the suspected ulcer as well as the procedure described above.

686/icd_codes.txt

@@ -0,0 +1 @@
+Sekundäre und nicht näher bezeichnete bösartige Neubildung: Lymphknoten des Kopfes, des Gesichtes und des Halses[C77.0 ] Zungenrandkarzinom[C02.1 L]

686/ops_codes.txt

@@ -0,0 +1 @@
+Parotidektomie partiell mit intraoperativem Fazialismonitoring[5-262.01 L] Radikale zervikale Lymphadenektomie [Neck dissection] radikal modifiziert 5 Regionen[5-403.21 L] Partielle Glossektomie transoral sonstige[5-251.0x ] Exzision erkranktes Gewebe Zunge[5-250.2 ] Plastische Rekonstruktion Zunge[5-253.1 ] Perkutan-endoskopische Gastrostomie durch Fadendurchzugsmethode[5-431.20 ] Direkte diagnostische Pharyngoskopie[1-611.0 ] Direkte diagnostische Laryngoskopie[1-610.0 ] Diagnostische Ösophagoskopie mit flexiblem Instrument[1-630.0 ] Diagnostische Tracheobronchoskopie mit starrem Instrument ohne weitere Maßnahmen[1-620.10 ]

686/patient_clinical_data.json

@@ -0,0 +1,18 @@
+{
+  "year_of_initial_diagnosis": 2014,
+  "age_at_initial_diagnosis": 52,
+  "sex": "male",
+  "smoking_status": "smoker",
+  "primarily_metastasis": "no",
+  "survival_status": "living",
+  "survival_status_with_cause": "living",
+  "first_treatment_intent": "curative",
+  "first_treatment_modality": "local surgery",
+  "days_to_first_treatment": 42,
+  "adjuvant_treatment_intent": null,
+  "adjuvant_radiotherapy": "yes",
+  "adjuvant_radiotherapy_modality": "percutaneous radiotherapy",
+  "adjuvant_systemic_therapy": "yes",
+  "adjuvant_systemic_therapy_modality": "fluorouracil + cisplatin",
+  "adjuvant_radiochemotherapy": "yes"
+}