[A rare cause of dyspnea on exertion. A 76-year-old retired woman].
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BACKGROUND: Proliferative verrucous leukoplakia (PVL) is a multifocal and progressive lesion of the oral mucosa, often associated with papillomavirus, seen mainly in older females, and characterized by a high recurrence rate and high rate of transformation into verrucous or oral squamous cell carcinoma (OSCC). The aim of this study was to analyse the clinical characteristics of a substantial group of patients with PVL, evaluating the characteristics of those who developed cancer, and comparing them with a group of patients with OSCC but no preceding PVL. METHODS: A group of 30 patients with PVL was studied for the clinical aspects and characteristics, age, sex, location, recurrence, the appearance of new lesions, and the frequency of development of oral cancer. A disease control group was formed with 110 patients with OSCC chosen randomly from among those treated in the same Service in this period of time. The patients were grouped as PVL and no cancer (Group 1); PVL developing cancer (Group 2) and patients with OSCC without clinical lesions associated with PVL (Group 3). RESULTS: The average age of the PVL patients (Groups 1 and 2 combined) was 70.97 +/- 12.73 years, of which 80% were women. Only 23.3% were cigarette smokers. The area most frequently affected with PVL was the lower gingiva. Recurrence after treatment was seen in 86.7%, and new lesions appeared in 83.3%. Many (63.3%) developed cancer (Group 2). Comparison of Groups 2 and 3 patients showed that those with PVL developing cancer were more likely to develop gingival carcinoma and also to be older, more often females, and less likely to smoke tobacco. CONCLUSION: Cancer developing in patients with PVL manifested particularly on the gingiva.
Systematic errors occur in the reports of disease frequency derived from health surveys based on questionnaire interviews. Five hundred and thirty-three persons with clinically and histologically confirmed disease in a case-control study of cancer were interviewed in their homes by carefully trained interviewers using a standardized questionnaire interview schedule. Comparisons of the information obtained by interview about past history of cancer with cancer registry and hospital medical record information about the same people revealed serious underestimates of correct frequency and wide variation in the rates of correct reporting. The findings reported here and elsewhere add support to an essential requirement in medical survey research: the completeness and accuracy of responses in health interview surveys must be verified and the methods of verification must be reported before the results can be interpreted with confidence.
Seven cases of sweat-gland carcinomas showing eccrine ductal differentiation (ductal carcinomas) are presented. The tumors had a variable histological appearance, but were basically characterized by the following histological elements: (a) tubular structures, sometimes cystic or having a "tadpole" appearance; (b) solid islands of squamous, basaloid, or clear cells; (c) periodic acid-Schiff-positive endoluminal and/or intracellular material; and (d) infiltrating growth. Immunocytochemically, tumor cells were positive for keratin and negative for actin. Endoluminal material contained carcinoembryonic antigen in five of seven cases. Although it is not yet clear whether carcinomas exhibiting eccrine ductal differentiation may represent a specific histotype or a group encompassing several distinct clinicopathological entities, the histological analysis of the cases suggested that the wide spectrum of their histological appearances may be due to variable grades of differentiation.
We describe four cases of unusual superficial cutaneous cysts that have a lining epithelium composed of apocrine cells immediately adjacent to keratinizing squamous epithelium with an intact granular layer. Two of the cysts were on the nipple of the breast and two of the cysts were on the face. The lumina of all four cysts contained keratin. Immunoperoxidase staining for carcinoembryonic antigen in the facial cysts showed positive staining within the apocrine cells of the lining epithelium in one case. The pathogenesis of these lesions is uncertain. We suggest that these unusual cysts be called hybrid epidermoid and apocrine cysts.
Eight patients with severe arteriovenous malformations of the head and neck region have been treated by superselective embolization utilizing Ivalon and surgery. Six of those patients underwent surgical resection of the malformation following embolization with apparent lack of recurrence of the vascular tumor. The approach of superselective embolization is different because it is an attempt to occlude the malformation from the inside out, that is, occluding the smallest vessels first, and utilizes the increased vascular demand of the tumor. The increased blood flow to the malformation is seen to change, since new vessels dilate instantly following occlusion of major feeders. The malformations fill from the ipsilateral side first, but frequently from the contralateral vessels as well. The futility of surgical ligation of large incoming filling vessels is pointed out. Complications other than what may occur with any transfemoral arteriogram included skin slough, particularly when the "glue" was utilized to an excess of extracranial sites.
Maffucci's syndrome in a 17-year-old girl is reported. Since the entity was first described in 1881 by Maffucci, 105 additional cases have been recorded. Several series have reported a small but significant percentage of cases (up to 18%) with malignant change. Our case, although not particularly unique in comparison with other cases of this syndrome, is presented because of the infrequent occurrence of this syndrome.
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Until recently, cancer of the skin in blacks has been thought to be quite rare. This paper reviews some of the recent findings from several large series of black patients with skin cancer at our institution. Surgical management of representative cases is illustrated.
Four patients with squamous cell carcinomas (SCCs) presenting as subcutaneous nodules of the head were referred for Mohs micrographic surgery. In each case initial histologic sections showed no connection between the tumor and epidermis, raising the possibility that each was a metastasis from an occult SCC. Careful searches for occult SCCs were unrevealing. Subsequent step sections through the entire tumors revealed narrow connections to the overlying epidermis in three of the four cases.
Pilar sheath acanthoma is a recently recognized entity. The tumor is a benign follicular neoplasm, occurring on the skin of the upper lip. This paper reports the 10th recorded case.
Various techniques have been developed to localize radioactive sources in brachytherapy implants. The most common methods include the orthogonal film method, the stereo-shift film method, and recently, direct localization from a series of contiguous CT transverse images. The major advantage of the CT method is that it provides the seed locations relative to anatomic structures. However, it is often the case that accurate identification and localization of the sources become difficult because of partial source artifacts in more than one transverse cut and other artifacts on CT images. A new algorithm has been developed to combine the advantages of using a pair of orthogonal scout views with the advantages of using a stack of transverse cuts. In the new algorithm, a common reference point is used to correlate CT transverse images and two orthogonal scout CT scans (AP and lateral). The radioactive sources are localized on CT transverse images. At the same time, the sources are displayed automatically on the two CT scout scans. In this way, the individual sources can be clearly distinguished and ambiguities arising from partial source artifacts are resolved immediately. Because of the finite slice thickness of transverse cuts, the longitudinal coordinates are more accurately obtained from the scout views. Therefore, the longitudinal coordinates of seeds localized on the transverse cuts are adjusted so that they match the position of the seeds on scout views. The algorithm has been tested on clinical cases and has proved to be a time saving and accurate method.
The angiomas studied at the Clinica Infantil "La Fe" in a four and a half years period are reviewed. The different therapeutic approaches are considered. Thirteen cases selected at random have been treated with local injections of steroids, with a 84% satisfactory results. The technique seems to be simple and without complications. It is recommended in the management of the parotideal, small size, subcutaneous and those angiomas in which the therapy could be followed by sequelae and in those where other therapy has failed.
The state of the local immunity system of the oral cavity was studied by the level of saliva immunoglobulins in patients with different processes on their mucous membranes: herpetic infection, respiratory allergosis and malignant tumors of the mouth cavity and the laryngopharynx. The suppression of the production of sIgA, was accompanied by the enhanced production of antibodies to the most widespread herpesviruses (herpes simplex virus, cytomegalovirus and Epstein-Barr virus). The maximum levels of serum IgG to herpesviruses were determined in patients with malignant tumors. The role of herpesviruses in the pathogenesis of immunodeficient states is discussed.
Five-year-experiences have shown that a considerably intensified tolerance of the skin and an absorption equability of tissues and bones and muscles are obtained with the hard ray roentgen irradiator, RT 305, for half-value depths from 20 mm to 70 mm H-2O and half-value thickness to about 7 mm Cu. By means of a rod anode tube of 300 kV with a super-normal filtration to 3.5 mm Pb, a hard and nearly monochromatic radiation, which already possesses the above mentioned advantages of the ultra-hard ray therapy with an effective energy about 0.2 MeV, appears. The application of this hard ray therapy is given preferably for disease foci in the environment of bone tissues, i.e. in the head and throat, the vertebral column, the osseous pelvic ring and the extremities and as the conventional roentgen therapy ist not able to give it. The hard ray therapy seems to be particularly adapted for the postoperative irradiation of the cancer of the breast with the ribs lying in the region of the irradiation fields, with the sternum and the bones of the shoulder girdle. With regard to these radiotherapeutic possibilities, corresponding cases are demonstrated.
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The paper reports the authors experience at the Regina Elena Institute for the Study and Treatment of Tumours in Rome during the period 1987-1989 concerning the setting up of a register for primary malignant tumours of the head and neck. This experience has allowed various parameters to be assessed from the initial diagnosis through the subsequent diagnostic and therapeutic procedures [correction of iter]. The stage of disease was assessed in 134 patients using a TNM system proposed by UICC for tumours located in the oral cavity, oro- and hypo-pharynx and maxillary sinuses. At the end of the period a complete definition was made of some typical aspects of the disease in question: firstly, the high incidence of patients with advanced stages of disease found at the first diagnosis, and secondly, the significant delay in confirming the diagnosis of the tumour in spite of the ease with which the area may be explored. In conclusion, the authors comment on current systems of TNM classification, underlining the need for a more correct interpretation and assessment of findings related to neoplastic orofacial pathologies.
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