Orbital exenteration for advanced periorbital non-melanoma skin cancer: prognostic factors and survival.

PurposeTo describe prognostic factors and survival outcomes in patients who underwent orbital exenteration for periocular non-melanoma cutaneous malignancies.MethodsThe authors performed an institutional review board-approved retrospective review of all patients who underwent orbital exenteration for non-melanoma periocular cutaneous malignancies at a tertiary care hospital system over a 10-year period. Patient demographics, tumor, and treatment data were recorded. Survival outcomes included disease-free survival (DFS) and overall survival (OS). Log-rank tests were used to test for difference in survival curves among various potential prognostic indicators, and multivariate analysis was performed using Cox's proportional hazards model.ResultsForty-nine patients with an average age of 70.3 years were followed with a median follow-up of 17.5 months. At 2 years the OS was 78% while the DFS was 61%. The mean DFS for basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and sebaceous gland carcinoma (SGC) were 52.6, 39.2 and 28.1 months, respectively. Multivariate analysis demonstrated that only positive final surgical margin was predictive of worse outcome (P=0.002). Recurrences were most frequent in the first 2 years.ConclusionsDespite the relatively more aggressive nature of periocular malignancies that have invaded the orbit, orbital exenteration offers an overall 2-year DFS of ~60%. BCC had the greatest mean survival time, however this was not statistically significant. We found worse prognosis with positive final surgical margins and recommend a multidisciplinary surgical approach to achieve complete resection when indicated.

Glomus tumors: report on eleven cases and a review of the literature.

INTRODUCTION: Glomus tumor is a well known pathology in hand surgery; in addition to sites in the upper limbs, it can also affect the lower limbs and develop in other parts of the body. MATERIALS AND METHODS: Seven females and four males with glomus tumors underwent surgery between 1990 and 1998 at our hospital. These cases were retrospectively studied, and immunohistochemical staining was carried out for vimentin, factor VIII and CD34. RESULTS: At the time of diagnosis, the mean age of the patients was 49 years, with a mean follow-up of 18.5 months. Regarding tumor site, there were six digital, one wrist, two neck and two lower limb locations. In this series, familial incidence was observed in two cases, i.e., two sisters with tumor occurrence at the same digital site. Tumor size varied from 0.2 to 5 cm. In agreement with the findings in the literature, the present results showed only a low incidence of locations other than in the upper and lower limbs. Moreover, no multiple locations or degenerative malignancy were observed, both of which are known to be rare. In all cases, the histological aspect of these tumors was typically benign. Immunohistochemical studies of the tumor cells were positive for anti-vimentin antibody in all cases, negative for anti-factor VIII in all cases and irregularly positive for anti-CD34 antibody. DISCUSSION: It was not possible to confirm the specificity of the anti-CD34 antibody for glomus tumor in this series. The hypothesis of the endothelial origin of glomus tumor can probably be dismissed in the absence of the expression of anti-factor VIII and anti-CD34 antibodies.

[Mucoepidermoid carcinoma of salivary glands: the prognostic value of tumoral markers]. / Cancer mucoépidermoïde des glandes salivaires: signification pronostique des marqueurs tumoraux.

INTRODUCTION: Mucoepidermoid carcinoma is one of the most frequent malignant lesions of salivary glands. The treatment is based on clinical, paraclinical and histological data. Several studies on the prognostic value of molecular markers for these cancers were made with contradictory results. The aim of this retrospective study was to analyze the prognostic value of molecular markers of salivary gland mucoepidermoid carcinoma. MATERIAL AND METHODS: Sixteen patients were treated for mucoepidermoid carcinoma of principal and/or accessory salivary glands between 1994 and 2003. An immunohistochemical study of archive specimen was performed. Nine markers were specifically studied: 4 proteins/oncoproteins (p53, bcl2, c-erb-B2 and cd117), 2 markers of proliferation (PCNA and Ki67), 1 growing factor receptor (EGFR), 1 epithelial adhesion molecule (E-cadherin), and 1 angiogenic cytokine (PDGF). RESULTS: Nine men and 7 women were included, with a mean age of 43.7 years (14-80). The mean diameter of tumors was 3.1 mm (1-14), and the parotid gland was the most frequent location. The mean global survival rate was 57.3 months with a median of 55 months. The 2 to 5 years survival expectation rate were 82.5% and 46.4% respectively. The mean survival rate for women was superior to that of men (P=0.043). The expression of p53 and the high expression rate of EFGR were bad prognostic factors (respectively P=0.049 and P=0.012). The expression of PCNA was linked to the location (mainly the salivary gland) and to the diameter of the tumor (respectively P=0.037 and P=0.029). The degree of EFGR positivity and the histological grade were linked (P=0.027). DISCUSSION: The strong expression of EGFR was statistically linked to the histological tumor grade. The degree of PCNA positivity seemed to be associated to the preferential location in the main salivary glands and to the diameter of the tumor. The strong expression of p53 and EGFR were bad prognostic factors. These retrospective results need to be confirmed by prospective randomized and larger studies. EGFR and p53 were significant negative prognostic factors. EGFR was highly correlated to the histological grade, making it an interesting target for further investigation.