[The visionary concept of "lymphoepithelioma" by A. Schmincke in 1921. Subsequent confusion over terminology and current approach to a solution]. / Das visionäre Konzept des "Lymphoepithelioms" 1921 und A. Schmincke. Nachfolgende terminologische Verwirrung und aktuelle Lösungsansätze.

In 1921 Alexander Schmincke established the visionary concept of a clinically and histomorphologically defined carcinoma entity of different lymphoepithelial organs that he named "lymphoepithelioma". This nowadays mainly comprises non-keratinizing oropharyngeal carcinomas frequently associated with human papillomavirus (HPV) and non-keratinizing nasopharyngeal carcinomas mostly associated with Epstein-Barr virus (EBV). The term lymphoepithelioma was originally defined by A. Schmincke and J. Ewing as a combined clinical and histological tumor entity of lymphoepithelial organs. The main reason for the longstanding terminological confusion regarding the term lymphoepithelioma is based on the fact that lateron a pure histological interpretation (lymphoepithelial differentiation) caused an artificial and nonreproducible exclusion of tumors with transitional and basaloid differentiation. For the forthcoming new WHO classification it has been suggested that squamous cell carcinoma of the head and neck should no longer be classified according to the heterogeneous histological differentiation but according to etiopathogenetic criteria (e.g. HPV-related, EBV-related, nicotine and alcohol-related). This proposed classification corresponds much better to the prognosis and therapy and would represent a late acknowledgement of Schmincke's visionary concept of a clinically and histomorphologically defined tumor entity. In addition, the ongoing terminological confusion over the heterogeneous and prognostically weak spectrum of histological differentiation would subside.

[Nasopharyngeal carcinoma in sub-Saharan Africa: a tribute to Mr. Peter Clifford].

Poorly differentiated nasopharyngeal carcinoma (NPC) is a major malignancy in certain areas of Asia. It exists also in Africa, notably among largely Arab populations in North Africa, and in "hotspots" in East Africa among "native" Africans. This article deals with the latter, as studied and defined in depth during the 1960s and 70s by the Irish-born surgeon, Peter Clifford. Through his published works, he has influenced and helped define the field of head and neck cancer as it exists in Kenya. He also did pioneering work on the African childhood malignancy, Burkitt's lymphoma (BL). Both BL and NPC have been ultimately shown to be associated with the human herpes Epstein-Barr virus (EBV). This article is written as a tribute to Peter Clifford, focusing on his work on NPC, where he first defined the disease "hotspots" in the Kenyan Highlands, studied how best to treat the malignancy in the absence of radiotherapy, looked at possible NPC predisposing factors in the Kenyan setting, and ultimately addressed how the cancer cells interact with EBV. Peter Clifford's pioneering work was cut short by accident. Although outside East Africa he remains largely an 'unsung hero' in the field, his influence has been great. It begs to be re-addressed and reconsidered.

A comprehensive analysis of Babe Ruth's head and neck cancer.

BACKGROUND: This article discusses the nasopharyngeal carcinoma (NPC) of American baseball icon Babe Ruth, as well as the diagnosis and treatment of NPC. CASE DESCRIPTION: NPC is a tumor originating from the epithelium of the nasopharynx. It is the leading form of cancer in certain well-defined populations in areas such as southern China, Southeast Asia, the Arctic, North Africa and the Middle East; it is relatively rare in the United States. Despite the fact that Babe Ruth's family was of German descent and NPC is not prevalent in Germany, reports regarding Ruth's autopsy demonstrate that his head and neck cancer was NPC. CLINICAL IMPLICATIONS: Dentists play a pivotal role in the recognition of oral signs and symptoms and in the diagnosis of NPC, as well as the subsequent oral care of patients during and after treatment.

Nasopharyngeal carcinoma: treatments and outcomes in the 20th century.

Nasopharyngeal carcinoma (NPC), although rare in Europe and North America, is not uncommon in parts of Asia such as southern China and Hong Kong. Consequently, very few oncologists in the Western world have extensive experience in treating this neoplasm. Treatment using external beam therapy and/or brachytherapy evolved greatly during the 20th century and is still evolving, particularly with the use of adjunctive chemotherapy regimes. Diagnosis of NPC has also improved with the availability of CT and MRI. This worldwide review is divided into historical, transitional and modern eras, with the latter concerning 1971-2000. Currently, the most controversial aspects of NPC are recommendations for treatment of recurrent disease and the role of chemotherapy in the overall framework of treatment. Comparison of results from different centres is not possible without an understanding of the various staging systems that are, and have been, used; a comparison is given in this review. In the future, early diagnosis, adequate radiation dose to the primary with boost to bulky disease, and regular follow-up with biopsy of any suspicious residual or recurrent disease, are likely to become key issues to improve outcome. Also, apart from direct/indirect nasopharyngoscopy, the role of follow-up CT needs to be studied for early detection of residual or recurrent disease. More clinical trials on chemo-radiation are also required, in order to study optimum doses and agents.

[A review on nasopharyngeal carcinoma in ancient Chinese literature].

Based on the clinical characteristics of nasopharyngeal carcinoma (NPC), a receptive standard was set up to screen related information with NPC from ancient literature of traditional Chinese medicine, while a rejection standard was also set up to prevent associated data in these literature with diseases such as lymphatic tuberculosis and lymphoma in the neck etc. Furthermore, a review was made on the etiology, pathogenesis and procedures used in the prevention and treatment of NPC recorded in ancient literature, according to the evaluation as above. The data showed that several hypotheses were present in ancient literature about etiology and pathogenesis of NPC, including healthy qi deficiency, cold in channels, or liver qi stagnation, pyrogenous toxin, phlegm coagulation and blood stasis etc. Therefore, prevention was emphasized and the main therapeutic and preventive methods for NPC were regulating emotions, nourishing qi and harmonizing ying (nutrient).

Historical vignette: Sir William Hingston, nasal fibromas, and the upside-down operation.

Dr William Hingston was one of Canada's most illustrious surgeons in the second half of the 19th century. Some interesting accounts are presented of his experience with "fibrous nasopharyngeal tumors" and the ingenuity he used to resect these difficult tumors.

Nasopharyngeal angiofibroma treated in 1841 by maxillectomy.

One of the earliest recorded maxillectomy procedures was carried out on a 21-year-old male in University College Hospital, London, in 1841 by Mr. Liston. The case report and operative procedure are given. The gross, radiographic and microscopic features of the resection specimen, which was preserved until the present as a museum specimen, are provided. The tumor is an advanced nasopharyngeal angiofibroma and demonstrates the mode of spread of this lesion when treatment is delayed.