Biomedical subjects
Publications and source records attributed to S Bahadur.
Chordomas are rare tumours which arise from notochordal remnants. A primary cervical chordoma of extranotochordal origin, sparing osseous structures, was excised by a bilateral neck dissection. The patient was disease-free two and a half years later.
Mucosal melanoma of the upper aerodigestive tract is a rare disease with a relentless inexorable course. This lesion involved the nasal cavity, maxillary sinus and palate in two cases each all of whom underwent a radical excision. The disease did not respond to radiotherapy in two patients with nasopharyngeal involvement. One other patient died of distant metastasis within five weeks of diagnosis. Despite surgery offering variable disease free periods, the prognosis remains guarded.
During a 10 year period 30 patients with carcinoma of the soft palate were treated. There were 22 cases in stages I and II. A curative dose of irradiation was used in 25 cases, four of whom required surgical salvage. Another five cases were treated by a combined modality of surgery and postoperative radiation. Seven cases had nodal metastases. A mean two-year disease-free survival of 83 per cent was obtained. The probability of five-year disease free survival was 65 per cent.
This paper is a retrospective study of 15 patients with parapharyngeal neurofibromas operated over a six year period. No patient presented with a neurological deficit. CT scans revealed a well encapsulated moderately enhancing mass in ten cases. The tumour was removed by a transcervical approach in ten cases while in five a cervical-transpharyngeal route with mandibulotomy was used; in three of the latter group the tumour was retropharyngeal. In two cases a recurrence was successfully excised. It was realized that a mandibulotomy was required when the internal carotid was displaced medially, or if the tumour extended to the base of skull or when its vertical diameter exceeded 8 cm.
Neuroendocrine carcinoma of the skin is an uncommon neoplasm. A case of one such tumour in the head and neck region is being presented. This case is the youngest known patient. The literature has been reviewed. The current concepts in diagnosis and management of this tumour are discussed.
Lipomatous tumours of the parapharyngeal space are rare. A case of lipoma of the parapharyngeal space is reported for its rarity, characteristic radiological findings, and effect on growth of the facial bones.
The results of single modality treatment using surgery or radiotherapy alone in advanced head and neck cancers are known to be unsatisfactory. The present study analyses 252 cases with stage III and IV resectable cancers of the head and neck region selected to be treated by a combined regime of pre- or post-operative radiation and radical surgery. Only 193 patients completed the treatment protocol. There were 58 cases (33.5 per cent) who failed either at primary or regional sites or both. Nine cases (five per cent) developed distant metastasis. Absolute and determinate four year disease-free survival was 55 per cent and 61 per cent respectively. Early lesions (stage I and II) have been excluded from the study. The study indicates that a reduction in primary and regional failures correlates well with a combined therapy, though prolonged treatment may affect patients' compliance to some extent.
Four regimens of prophylactic antibiotics were utilized in 122 consecutive patients of stages III and IV carcinoma of the upper aero-digestive tract undergoing major resections in a randomized single-blind study. Ampicillin, gentamicin, cephalexin and metronidazole were used in different combinations for periods of 5 or 10 days. A cephalexin-metronidazole protocol for 10 days was associated with lowest post-operative infection rate. Oral-oropharyngeal resection and use of pectoralis major myocutaneous flap were the most important factors contributing to infection.
Primary subglottic carcinoma is rare with a uniformly poor prognosis. We present our experience of eight such cases treated over a period of ten years. One patient had a mucoepidermoid carcinoma while the rest had a squamous cell carcinoma. A combination of surgery and radiotherapy was employed in five cases, while one case each underwent radiotherapy only, surgery only and salvage surgery following radical irradiation. Three cases died of locoregional failure within a year. The remaining five patients have been disease-free for six months to 3.5 years.
Hypopharyngeal carcinoma is an aggressive cancer with a guarded prognosis. Results of 64 patients with-hypopharyngeal cancer, 59 of whom were in stage III or IV, undergoing curative therapy during a six-year period were analysed. A combined modality resulted in a 62% and 38.4% 2-year disease free survival incases with pyriform sinus and postcricoid tumours respectively. Results of radiotherapy failed salvage surgery were much poorer for either site.
The peritumoural region of a squamous cell carcinoma of the tongue when examined with light and electron microscope showed nodular bodies in the submucosa with all the distinctive features of 'sporangium and 'spores' of rhinosporidiosis. The occurrence of rhinosporidiosis in the tongue along with malignancy has not been reported hitherto. Some interesting observations and causal relationships are discussed.
It is difficult to predict the tumour invasion into the mandible by oral cancer pre-operatively, and consequently the decision to preserve or sacrifice the mandible is largely individualistic. The present study of 44 cases analyses the reliability of pre-operative parameters to assess mandibular involvement. Clinical, radiological and scintigraphic features have been compared with the detailed histology of the bone. This study confirms the usefulness of superior marginal resections in lesions which are close to but not involving the mandible, as well as for superficial lesions which are actually seen to involve the mandible but their CT and bone scans are negative for tumour invasion.
In a nine-year period 50 nasopharyngeal angiofibromas, of whom 13 had recurrent tumour, were treated surgically at the All India Institute of Medical Sciences, New Delhi. A new staging system according to the regions involved was used; 31 patients in whom the tumour was limited to the nasopharynx (Stage I) and those with superior spread into the ethmoid or sphenoid sinuses (Stage IIA) had their tumours removed by a transpalatal route, alone or in combination with other approaches. Tumours with lateral extensions into the pterygopalatine or infratemporal fossae or the cheek (Stage IIB), and those with simultaneous superior and lateral spread (Stage III) underwent a transmaxillary excision (19 cases). In two of the three cases with intracranial extension (Stage IV), the tumour was removed successfully from below. There was no mortality. The usefulness of the transmaxillary approach, especially in recurrent cases, is emphasized. No adjuvant modalities were employed in this series and blood loss was acceptable.
Olfactory neuroblastoma is a rare tumor. The role of CT Scan, morphological details and the electron microscopic findings have been highlighted in the diagnosis of the lesion. The present patient, in which the tumor had recurred following surgical excision, was treated successfully with a combination of radiation, further surgery, and maintenance chemotherapy. We also feel that such a planned multidisciplinary approach is justified as the initial treatment for all advanced lesions in view of high recurrence rates reported following use of radiotherapy or surgery alone.
It is a well known fact that disease in head and neck cancer remains confined above the clavicle in a majority of cases for a considerable length of time. The causes of death in head and neck cancer patients are known to be due to lymph node metastasis, fungation, asphyxia, cachexia, invasion of major vessels and infection. Distant metastasis occurs late in the disease. However, many reports have appeared in the literature which indicate a high incidence of distant metastasis in head and neck malignancies. Merino et al. (1977), in a clinical study, have indicated an incidence of 10.9 per cent. Studies based on autopsy findings, however, quote a much higher figure (30 per cent, Papac, 1984; 57 per cent, Gowen and Dessuto Nagy, 1963). Dennington and Caster (1980) reported that at least seven per cent of patients with head and neck cancer have distant metastasis when first seen. The present study was designed to find out the incidence of distant metastasis in our head and neck cancer patients.
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Twenty-five patients with previously untreated squamous cell carcinoma of the buccal mucosa were treated by two chemotherapeutic regimens. The first regimen consisted of administration of methotrexate (50 mg) intravenously at weekly intervals for 3 weeks. The second regimen consisted of bleomycin and methotrexate (BLM-MTX): Bleomycin 30 mg was given intravenously twice weekly and methotrexate 25 mg intravenously twice weekly for 2 1/2 and 2 weeks, respectively. Twenty-two of 25 cases were subjected to radical surgery following chemotherapy. When the two groups are compared, the number of cases responding to chemotherapy is about equal (70% and 73.4%). The observations suggest that the buccal cancers are highly sensitive to initial treatment with chemotherapy, and the authors recommend its use as preoperative adjunct therapy in patients who present with stage III and IV (Mo) disease.
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