Human Papilloma Virus Positive Oropharyngeal Squamous Cell Carcinoma and the Immune System: Pathogenesis, Immunotherapy and Future Perspectives.

Oropharyngeal squamous cell carcinoma (OPSCC), a subset of head and neck squamous cell carcinoma (HNSCC), involves the palatine tonsils, soft palate, base of tongue, and uvula, with the ability to spread to adjacent subsites. Personalized treatment strategies for Human Papillomavirus-associated squamous cell carcinoma of the oropharynx (HPV+OPSCC) are yet to be established. In this article, we summarise our current understanding of the pathogenesis of HPV+OPSCC, the intrinsic role of the immune system, current ICI clinical trials, and the potential role of small molecule immunotherapy in HPV+OPSCC.

Postsurgical timing of restorative therapy: a review.

Knowledge of wound healing is necessary for the clinician when determining the time of prosthodontic treatment after periodontal surgery. Wound healing and longitudinal clinical studies indicate that the clinician should wait approximately 8 weeks before proceeding with the final restoration. Restorative procedures could be considered as early as 6 weeks if (1) the patient shows good systemic health; (2) injury is not inflicted on the gingiva by the restorative technique; (3) restorative margins are supragingival; and (4) esthetics are not critical. With a thick periodontium, more common in posterior areas, the gingiva often will move coronally as the tissue matures. Thin periodontal tissues may recede postsurgically, and in areas of esthetic concern, postponement of final restoration for up to 5 to 6 months may be desirable to assure gingival margin stability. Modifiers that may affect time and quality of healing, such as the patient's smoking frequency and age, should be considered when scheduling restorative treatment after periodontal surgery.

Chondromyxoid fibroma.

Chondromyxoid fibroma (CMF) is the least common cartilage-producing tumor. In Dahlin and Unni's series of 8,542 bone tumors, 39 of which were CMF, none were found in the femoral shaft. In this case, a CMF in the femoral shaft presented initially as a pathologic fracture. Attempts at curettage and autogenous bone graft failed, and en bloc resection and segmented allograft reconstruction were eventually required.

Reproductive hormones and bone mineral density in women runners.

We examined the relationships among reproductive hormone concentrations and bone mineral density (BMD) in 43 women runners classified as eumenorrheic (n = 24), oligomenorrheic (n = 8), or amenorrheic (n = 11). Results were compared with a eumenorrheic nonrunner control group (n = 11). Serum 17 beta-estradiol, progesterone, and dehydroepiandrosterone sulfate concentrations were determined in daily blood samples for 21 days, and integrated concentrations (areas under the curve) were calculated. BMD was assessed at the lumbar spine and proximal femur by dual-photon absorptiometry. As expected, 17 beta-estradiol, progesterone, and lumbar spine BMD were higher in the control and eumenorrheic runner groups than in the oligomenorrheic and amenorrheic runner groups (P less than 0.05). Progesterone concentration was significantly correlated with lumbar spine BMD in the eumenorrheic runners (r = 0.61). None of the steroid hormones was significantly related to BMD in the oligomenorrheic/amenorrheic group. The present data suggest that circulating levels of gonadal steroid hormones affect axial BMD in eumenorrheic runners.

Endometrial morphology in asymptomatic postmenopausal women.

Few data are available regarding endometrial histologic features in asymptomatic perimenopausal and postmenopausal women. This study encompasses endometrial biopsy specimens obtained from 801 such women before enrollment in a multicenter study of estrogen-progestin replacement. One endometrial cancer was found (0.13%); four additional biopsy specimens showed atypia (total 0.63%). The endometrium was atrophic in 373 (46.9%), proliferative in 133 (16.7%), secretory in 54 (6.8%), and hyperplastic in 41 (5.2%). Insufficient tissue for diagnosis was obtained in 195 (24.5%). We conclude that the yield for neoplasia is so low that screening endometrial biopsy is not justified in asymptomatic perimenopausal and postmenopausal women.

Flank mass and pain in a 72-year-old man.

This patient had retroperitoneal multiseptated masses, which extensively invaded the right flank and thigh musculature. The radiologic, pathologic, and clinical findings were consistent with a retroperitoneal pseudomyxoma from an appendiceal mucocele.

Osteoclastic giant cell tumor of the pancreas. Aspiration cytology, light microscopy, and ultrastructure with review of the literature.

The osteoclastic giant cell tumor of the pancreas is a rare primary neoplasm that by light and electron microscopy mimics giant cell tumor of bone. In the proper clinical setting, this lesion can be diagnosed by fine needle aspiration. Review of 10 cases reveals a female predominance, a median survival of 12 months, and a tendency for local invasion, rather than lymphatic or distant metastasis, and for invasion of large veins. An epithelial origin is favored for this malignant neoplasm, which expresses varying degrees of mesenchymal differentiation.

The prevalence of actinomycetes-like organisms found in cervicovaginal smears of 300 IUD wearers.

The association of Actinomyces with IUD wearers has been widely documented and the possibility of the recognition of actinomycetes-like organisms in routine Papanicolaou-stained cervicovaginal smears has been reported. We conducted a retrospective study of IUD wearers to determine the prevalence and significance of actinomycetes-like organisms found in such smears. Three hundred smears from current IUD wearers were rescreened for actinomycetes-like organisms. Of this group, 200 patients were from a public health family planning clinic, and 100 were private patients. The incidence for the public health group was 25.5% and for the private patient group, 8%. A case history of actinomycosis is included. Findings such as other infectious agents, abnormal cytology and symptoms are also discussed. Although the presence of Actinomyces probably represents an opportunistic infection, the threat of pelvic actinomycosis with serious complications poses a management problem to the clinician when Actinomyces is reported in a routine Papanicolaou smear. Our findings lead us to question the practicality of the earlier recommendations of IUD removal and antibiotic therapy.

PIP: 300 Papanicolaou smears from current IUD wearers were rescreened to determine the prevalence of actinomycetes. Of the 300 patients, 59 showed actinomycetes-like organisms in cervicovaginal smears. Of the 59 positive cases, 51 (of 200, 25%) were from public health clinics and 8 (of 100, 8%) were from private patients. Of 21 patients complaining of irregular bleeding, only 4 had positive actinomycete cultures. In cases positive for the organisms there was no correlation of prevalence found with the phase of the menstrual cycle or with menstruation itself. A case history of actinomycosis is included. Although the presence of Actinomyces probably represents an opportunitistic pathogenic infection, management of this infection is important to eradicate the threat of pelvic actinomycosis. In the case history described, however, antibiotic therapy failed, and a complete abdominal hysterectomy was performed.

The pathologic behavior of primary vaginal carcinoma and its relationship to cervical cancer.

The surgical pathology files at the University of Alabama Medical Center for 1958 through 1973 contain records of 157 cases of vaginal carcinoma. Of the 141 patients on whom complete records are available, 37 had primary and 104 secondary vaginal carcinoma. Only 3 of the primary vaginal malignancies were adenocarcinoma; the rest were epidermoid. The microscopic appearance of these carcinomas was frequently lateral spreading or papillary, but in a few instances the growth pattern was submucosal. Prognosis appeared to be related to the stage of the disease. Vaginal carcinomas associated with cervical cancer clustered either within 1 year or 5 years after the therapeutic treatment. In this paper, the relationship between primary vaginal cancer and cervical cancer is discussed.

Massive orbital invasion by small malignant lesions.

In diagnosing and treating small malignant lesions of the eyelids, physicians should be alert for possible extension of the cancer into the orbit, endangering not only the patient's sight but his life as well. Important signs and symptoms include bone thickening, disturbances of ocular motility, intermittent epiphora, and positive results of radiologic studies. From histopathologic study of the resected carcinomatous tissues, it is apparent that the creeping, cicatrizing, ulcerated, and invasive patterns of basal cell carcinoma predominate in this group of eyelid tumors, all of which are aggressive lesions; however, the histologic type is quite variable and no definite trends can be established.

Surgical treatment of hydatid cysts of the central nervous system in the pediatric age (Dowling's technique).

Single hydatid cysts of the brain are rarely seen by pediatric neurosurgeons who do not reside in certain countries, i.e. Australia, Uruguay, and Argentina. It is, however, of considerable importance that every pediatric neurosurgeon be aware of the manner of diagnosis of this condition and surgical management of these patients. Out of 35 cases of hydatidosis of the CNS and its covering observed over a 42-year period, there were 29 hydatid cysts of the brain and one of the spinal cord. Emphasis is placed on the former. Surgically, the hydatid cyst can be removed intact. The essential steps of the technique are: (1) a large flap; (2) careful handing during all the operative steps avoiding monopolar coagulation; (3) opening of the atrophic cortex overlying the cyst over an area whose diameter should be no less than three quarters of the diameter of the cyst, and (4) letting the cyst come out by just lowering the head of the operating table and instillating warm saline between the cyst and surrounding brain. In this series of hydatid cysts of the CNS, there was no operative mortality. The 20 cases in which the cyst was removed unbroken with Dowling's technique are alive and only two have sequelae of the preoperative lesion (blind). In the 11 cases in which Dowling's technique was not used and the cyst broke during ventriculography (3) or surgery (7, one broke spontaneously), only 7 are alive and well and there were 4 late deaths.