Cancer in thyroid nodules. A community hospital survey.

There is little available evidence of the efficiency of preoperative screening for cancer in solitary thyroid nodules in the community hospital setting, and limited composite data for comparison. A three-year survey was made in a 480 bed community hospital to determine the percentage cancer index (PCI) found in patients operated on for solitary thyroid nodules. Cancer was diagnosed in ten of 153 patients with a PCI of 6.5%. For comparison, an extensive literature review revealed a mean PCI ranging from 13.8% to 27.9%, depending on the preoperative selection process. Periodic surveys of PCI in solitary nodules in community hospitals would yield pertinent information in relation to the general "state of the art" and encourage attainment of a PCI as high as feasible.

Acquired hypertrichosis lanuginosa. Rare manifestation of urinary bladder carcinoma.

Hypertrichosis lanuginosa developed in a patient with carcinoma of the bladder. After regional lymph node metastases became evident, soft, fine, blond hair developed on his entire body, with the exception of the soles and the palms. Extensive endocrinologic evaluation demonstrated depressed testosterone levels and elevated levels of leutinizing hormone, changes not thought to be related to the hair growth. To our knowledge, this patient constitutes the second reported case of this rare syndrome in association with bladder carcinoma.

Toxic cure: Hyperfractionated radiotherapy with concurrent cisplatin and fluorouracil for Stage III and IVA head-and-neck cancer in the community.

PURPOSE: To evaluate efficacy and toxicity of the Duke University chemoirradiation regimen for locally advanced head-and-neck cancer in a regional community cancer center. METHODS AND MATERIALS: Between June 1998 and June 2002, 50 patients with Stage III or IVA squamous cell carcinoma of the head and neck were treated definitively with concurrent combined modality therapy (CMT). Patients received accelerated, hyperfractionated radiotherapy (AFRT), 1.2-1.25 Gy b.i.d., to a median prescribed dose of 70 Gy. Chemotherapy consisted of cisplatin 12 mg and fluorouracil 600 mg/m(2) daily for 5 consecutive days during Weeks 1 and 6, followed by two cycles after AFRT. Patients with N2-N3 neck disease (n = 21; 42%) were considered for neck dissection depending on their response to AFRT and chemotherapy. Twenty-nine patients with Stage III and IVA disease treated between 1991 and 1997 with definitive RT alone served as historical controls. RESULTS: Forty-nine patients (98%) in the CMT group completed the prescribed AFRT and 38 (76%) completed four cycles of chemotherapy. Three of 8 patients who underwent neck dissection had a pathologically complete response. The median follow-up for all patients was 23 months. The actuarial progression-free survival rate at 2 years was 75% for the CMT group vs. 40% (p <0.01) for the RT group. The overall survival rate was 80% and 43% (p <0.01), respectively, for the CMT and RT groups. Acute Radiation Therapy Oncology Group Grade 3 toxicities for the CMT group were mucosal (n = 50; 100%), skin (n = 9; 18%), and hematologic (n = 3; 6%). Late Grade 3-4 toxicities consisted of pharyngeal stricture (n = 7; 14%), laryngeal chondritis (n = 3; 6%), osteoradionecrosis (n = 2; 4%), and peripheral neuropathy (n = 1; 2%). CONCLUSION: This aggressive regimen of AFRT with concurrent cisplatin and fluorouracil with or without neck dissection is feasible in the community setting for patients with Stage III and IVA head-and-neck cancer. Early results indicated excellent survival, albeit with universal acute mucosal, and considerable, although acceptable, late toxicity.

Large cell lymphoma presenting as a coronal penile lesion.

Although the majority of penile malignancies are primary epithelial carcinomas, consideration of secondary involvement, especially from lymphoma, is important, since there are alternatives to the standard therapeutic approach of penile amputation.