Refractory Sjogrens syndrome: Is parotidectomy justified?

Primary and secondary Sjogrens syndrome (SS) is the classification used, according to the American-European Consensus Group Criteria. Salivary and lacrimal gland dysfunctions are the usual hallmark of the disease, but the involvement of other exocrine glands and extraglandular manifestations of the disease do occur. In rare cases, few patients are refractory to the conventional therapy and due to the sudden increase in size of a mass and the esthetic and psychological concerns of a "cancerous growth," the surgical treatment modalities have to be modified. There is a significant lack of contemporary literature on the indications for surgery in refractory SS, and the option should be given in patients with esthetic concerns, risk of malignancy, and to improve the overall quality of life.

Role of immunoreactive patterns of lymph nodes in neck dissection cases of oral squamous cell carcinoma: a clinical and histopathological study.

OBJECTIVES: Metastasis in oral squamous cell carcinoma (OSCC) can occur in a variety of ways, and draining lymphatics and lymph nodes serve as a common route. Prior to metastasis, lymph nodes elicit an immune response to either wall off or create a favorable environment for homing of tumor cells. This immune response to tumor stimuli is visualized by recognizing various immunoreactive patterns exhibited by the lymph node. The present study aims to evaluate the role of immuno-morphologic patterns of the lymph node in neck dissection for cases of OSCC. MATERIALS AND METHODS: Our retrospective study included 50 neck dissection cases of OSCC and a total of 1,078 lymph nodes. The grades of primary tumors with eight different immunoreactive patterns were compared. Vascularity and metastasis in lymph nodes were also evaluated. RESULTS: The lymphocyte predominant pattern was the most common immunoreactive pattern found in 396 of 1,078 lymph nodes. Patterns of lymphocyte predominant (P=0.0005), sinus histiocytosis (P=0.0500), paracortical hyperplasia (P=0.0001), cortical hyperplasia (P=0.0001), and increased vascularity (P=0.0190) were significantly associated with tumor grade. CONCLUSION: The present study adds to the understanding of lymph node immunoreactivity patterns and their correlation with tumor grade. We recommend further study of lymph node patterns for all sentinel lymph node biopsies and routine neck dissections for OSCCs.

Awareness regarding oral cancer and oral precancerous lesions among rural population of Belgaum district, India.

Belgaum district of Karnataka state is well known for high production and consumption of tobacco in Southern India. This study aimed to investigate the rural population's awareness of oral cancer, precancerous lesions and their risk factors. Data were collected via face to face interviews using a pretested and validated questionnaire. The questionnaire comprised two parts: part one had questions concerning socio-demographic data and part two consisted of 25 questions pertaining to people's attitudes to and awareness of risk factors for oral cancer and precancerous lesions. One researcher interviewed participants and recorded the responses verbatim. Of the participants, 17% identified all the symptoms of oral cancer and 27.8% identified all the symptoms of oral precancerous lesions. Approximately 90% of the participants had never noticed statutory warnings on tobacco and alcohol products. Awareness was especially poor in people of lower socio-economic status. This study highlights a need for education concerning the risk factors for oral cancer, its clinical manifestations and the impact of adverse habits on long term health. Health education campaigns emphasizing oral cancer need to be integrated with broader public health messages.

Head and neck squamous cell carcinoma in chronic areca nut chewing Indian women: Case series and review of literature.

BACKGROUND: Head and neck squamous cell carcinoma (HNSCC) is an important public health problem in India. Several risk factors such as tobacco, human papilloma virus, alcohol, areca nut usage have been extensively studied as causative agents. Though Areca nut chewing is known cause of oral cancer, its association with hypopharynx cancer has not been previously reported. Since areca nut is mostly consumed along with tobacco, it is uncommon to find patients who consume the areca nut alone. MATERIALS AND METHODS: This is a prospective case series of ten women who presented to us with HNSCC with history of chewing of areca nut alone for several years. We have excluded all those cases where areca nut was consumed along with tobacco in any form. The data were prospectively collected with regard to clinical parameters, duration and frequency of areca nut usage, the socio-economic status and education level. RESULTS: All ten females had varying degree of submucous fibrosis and coexisting squamous cell carcinoma either in the oral cavity or hypopharynx. Submucous fibrosis was characterized by burning mouth, unhealthy oral mucosa, buried third molars, trismus, poor oral hygiene, etc. The disease presented in an advanced stage in majority of the cases. All patients were unaware of areca nut's deleterious effects. CONCLUSION: Areca nut chewing is an important risk factor for HNSCC in females. Despite plethora of information, little importance is given to areca nut control in cancer prevention campaigns in India.

Second primary head and neck squamous cell cancers with aggressive behavior in patients with chronic myeloid leukaemia.

Patients with chronic myeloid leukaemia (CML) are at considerable risk of developing second primary neoplasms. However, mucosal squamous cell cancers (SCCs) of the head and neck have not been reported. We review the data of 7 patients with mucosal SCC of the head and neck that presented as metachronous second primary tumours in patients with CML. All 7 patients were men (median age 48 years, range 31-67) (site:oral cavity n=6, hypopharynx n=1). The median interval between diagnosis of CML and head neck cancer was 6 years (range 2-15). Treatment was curative in 4 and palliative in 3. At median follow up of 14 months (range 2-44), 3 patients had died of head and neck cancer, 1 of CML, and 3 were alive and free of disease. Mucosal cancers of the head and neck can occur in long-term survivors of CML. They are aggressive and tend to recur.

Fluorescence spectroscopy for noninvasive early diagnosis of oral mucosal malignant and potentially malignant lesions.

BACKGROUND: We report the results of a clinical in vivo study to evaluate the potential of fluorescence spectroscopy for differential diagnosis of oral mucosal malignant and potentially malignant lesions. MATERIALS AND METHODS: The study involved 26 healthy volunteers and 144 patients enrolled for routine medical examination of the oral cavity at the outpatient department of the Tata Memorial Hospital, Mumbai. In vivo autofluorescence spectra were recorded using a N2 laser based portable fluorimeter developed in-house. The different tissue sites investigated belonged to either of the four histopathologic categories: 1) squamous cell carcinoma (SCC), 2) oral sub-mucous fibrosis (OSMF), 3) leukoplakia (LP) and 4) normal squamous tissue. A multivariate statistical algorithm capable of direct multi-class classification was used to predict pathological designations. RESULTS: With respect to histopathology as the "gold standard", the diagnostic algorithm was found to provide an accuracy of 82, 76, 81 and 85% based on leave-one-patient-out cross-validation in classifying the oral tissue spectra into four different pathology classes - SCC, OSMF, LP, and normal squamous tissue - respectively. When the algorithm was employed for delineating the normal oral tissues from all the abnormal oral tissues including SCC, OSMF and LP put together, a sensitivity of 98% and a specificity of 100% were obtained. CONCLUSION: The results suggest that it is possible to objectively classify the oral tissue into different pathology classes based on their in vivo autofluorescence spectra. Thus, the technique can potentially improve oral screening efforts in low resource settings where clinical expertise and resources are limited.