Phyllodes tumor with lobular carcinoma in situ and liposarcomatous stroma.

We describe a patient with a malignant phyllodes tumor with both lobular carcinoma in situ and liposarcomatous stromal differentiation. Although lobular carcinoma in situ and adipose differentiation have been reported as separate features rarely seen in the phyllodes tumor, we are unaware of any cases in which both of these features have been seen within the same tumor. The prognosis for this patient related not only to the malignant stromal component of the tumor but also to her increased risk of developing carcinoma in the remaining breast tissue.

Relaxation therapy for tension headache in the elderly: a prospective study.

We evaluated the effects of an 8-week progressive muscle-relaxation therapy regimen on the headache activity of 10 elderly tension-headache subjects. Posttreatment assessment at 3 months revealed significant decreases in overall headache activity (50% or greater) in 7 subjects. Significant clinical or statistical prepost differences, or both, were also found for the number of headache-free days, peak headache activity, and medication index. This is the first prospective study of tension headache in an elderly population, and, unlike previous retrospective studies, it suggests that relaxation therapy may be an effective intervention in the treatment of such headaches.

Pentazocine ulceration.

There has long been a need for a potent, nonaddicting analgesic for the treatment of certain patients who have intractable pain that cannot be controlled by the more commonly used oral analgesics. Pentazocine was introduced on the market in I967 and has been reported to be a potent analgesic, comparable to meperidine and morphine but without their addicting properties. Consequently, this drug has been used on a long-term basis, and on many occasions the injections have been given by the patient or by nonprofessionals. The result has been a few instances of misuse and overuse. We have seen 14 patients with extensive cutaneous ulcerations, subcutaneous fibrosis, and multiple fistulous tracts due to the abuse of parenterally administered pentazocine. The tissue changes have a characteristic appearance and course, and it has been our experience that conservative treatment results in a poor response. We have had the best results with aggressive excision of the involved areas and coverage of the resultant defect with split-thickness skin graft.

Experience with 1,360 primary parotid tumors.

Experience with 1,360 primary parotid tumors seen at the Mayo Clinic during two fifteen year periods, 1940 through 1954 and 1955 through 1969, is reviewed. A comparison of histopathologic classification, type of treatment indicated, recurrence rates, and survival in the two periods reveals considerably greater understanding of all factors in the later fifteen year period. The relatively high mortality still encountered among patients with high grade malignant tumors of the parotid glands indicate the nature of the challenge still to be met. Based on the data in this study, it is our opinion that superficial or total conservative parotidectomy is best employed primarily for benign tumors and that the shift to more radical operative procedures should continue in the management of malignant tumors, especially those that are less well differentiated. For experienced surgeons, exceptions might be the small superficially located tumors or the tumors in the lower pole of the gland such as Warthin's tumors. Local excision with removal of a margin of parotid parenchyma might be justifiable in such cases.

Breast restoration after mastectomy for cancer.

The clinical problems encountered in the reconstruction of breasts of patients who have undergone mastectomy for cancer are presented. The indications and contraindications for reconstruction of the breast are arbitrarily defined. Various methods are available to reconstruct the breast. We favor implantation of a preformed silicone prosthesis under the skin and subcutaneous tissue overlying either the pectoralis major muscle or the chest wall. The advantages of this procedure outweigh those of other methods. Seven cases are presented to illustrate our experience in this rehabilitative procedure. It is suggested that breast reconstruction should be offered to a much higher proportion of patients undergoing mastectomy for breast cancer.

Management of parotid gland tumors in infants and children.

Seventy-four pediatric patients with parotid gland tumors were seen during a 52-year period. Seventy percent of the lesions were benign and 30% were malignant. When the primary treatment is either subtotal or total parotidectomy, the recurrence rate was 2.3%. The facial nerve should be dissected free of parotid parenchyma and preserved, except if the lesion was malignant--a situation in which the nerve might have to be sacrificed totally or in part to ensure adequate tumor removal. No patient died of a benign or malignant lesion in this series, and the morbidity after surgical removal of primary tumors of the parotid gland in children and infants was low.

Medullary carcinoma of the thyroid gland.

One hundred thirty-nine surgically treated patients with medullary carcinoma of the thyroid gland (MTC) were seen in our institution between January, 1926 and December, 1973. The incidence of this tumor among all thyroid cancers was 8%. Twenty-nine patients had the familial form of MTC; they were subclassified, on the basis of the phenotype, into a group of 15 patients with Sipple syndrome (or multiple endocrine neoplasia (MEN) Type 2A) and a group of 14 patients with mucosal-neuroma phenotype (or MEN type 2B). Better survivorship was seen in the younger patients, in those with bilateral tumors, in familial MTC, and in patients whose tumor was confined to the thyroid gland at the initial surgery. The incidence of tumor recurrence was 34%. However, in those with adequate surgical treatment, the recurrence was only 23%. The 5- and 10-year survivorships were 80% and 67%, respectively. The best chance of cure lies in early diagnosis through the use of immunoreactive calcitonin measurement in family members at risk, and an aggressive surgical attack on the primary tumor and any cervical metastases.