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Human leukocyte antigens and multiple basal cell carcinomas.

This study presents data on human leukocyte antigen (HLA) phenotypes of 49 unrelated patients with multiple basal cell carcinomas (five or more BCC). Previous investigators noted an association with HLA-DR1 and a negative association with HLA-DR4. However, the previously found association was weak. HLA typing for class I (HLA-A, -B, -C) and class II antigens (HLA-DR, -DQ) was done from acid citrate dextrose (ACD)-stabilized peripheral blood using the modified lymphocytotoxicity test after T/B cell separation by immunobeads. Antigen frequencies of the patient group were compared to those of healthy individuals of a local German population (n = 716). Chi-square test and Fisher's exact test were used for statistical evaluation. While a significant association with HLA-DR1 was not observed in our study, we were able to confirm a significant decrease of HLA-DR4 in the patient group (12.2% versus 25.1%; p < 0.05; relative risk, RR, 0.48). In addition, HLA-Cw7 was significantly increased in the patient group (61.2% versus 40.8%; p < 0.01; RR, 2.29). In a subgroup of patients with multiple BCC located on the trunk (n = 25), the negative association with HLA-DR4 was even stronger (4% versus 25.1%; p < 0.02; RR, 0.12), whereas HLA-Cw7 was not significant (60.0% versus 40.8%; p = 0.06). Our results showed decreased frequencies of HLA-DR4 and increased frequencies of HLA-Cw7 in cases of multiple BCC, although statistical evaluation revealed only a weak association. This might be due to possible heterogeneity in this disease, e.g., BCC of the trunk versus BCC of the face, or any other cofactors.(ABSTRACT TRUNCATED AT 250 WORDS)

Antigens, Neoplasm↗

Hypoglossal neuroma following excision of a huge recurrent acoustic neuroma and facio-hypoglossal anastomosis. A complex management problem.

A case of neuroma of the intracranial part of the hypoglossal nerve, not associated with neurofibromatosis, is presented. The patient had previously undergone surgery for the removal of a contralateral acoustic neuroma, and subsequent facio-hypoglossal anastomosis. The importance of early diagnosis, pre-operative clinical assessment and post-operative care is stressed.

Adult↗

Perineural invasion by squamous-cell carcinoma.

Perineural invasion by squamous-cell carcinoma is an ominous sign when discovered by either the pathologist or the chemosurgeon. This report details our experience with seventeen cases of perineural invasion and their successful outcome, using a multidisciplinary approach, including Mohs' surgery.

Aged↗

Imaging features and clinical significance of perineural spread or extension of head and neck tumors.

Perineural spread of head and neck tumors is a form of metastatic disease in which tumor disseminates to noncontiguous regions along the endoneurium or perineurium. Both computed tomography (CT) and magnetic resonance (MR) imaging can help detect perineural spread, although MR imaging is the modality of choice because of its multiplanar capability, its superior soft-tissue contrast, and the decreased amount of artifact from dental hardware. Perineural spread most commonly occurs in adenoid cystic carcinoma and squamous cell carcinoma. Nerve enlargement may lead to foraminal enlargement and, ultimately, to foraminal destruction, findings that are best seen at CT. Extension through the foramen ovale and involvement of the Meckel cave is best seen on coronal T1-weighted MR images, and nerve enhancement is best seen on fat-suppressed T1-weighted MR images. Other radiologic findings include obliteration of fat planes at foraminal openings, neuropathic atrophy, cavernous sinus enlargement, and replacement of the trigeminal subarachnoid cistern with soft tissue. The pathway of perineural tumor spread is predictable with knowledge of the pertinent cranial nerve anatomy; however, patients with radiologically or pathologically proved perineural spread may have normal nerve function at clinical examination. Therefore, it is imperative that the radiologist be familiar with both normal cranial nerve anatomy and the radiologic appearance and assessment of perineural tumor extension.

Cranial Nerve Neoplasms↗