CYP1A1 and GSTM1 polymorphisms and oral cancer risk.

The importance of both the CYP1A1 exon 7 (ile:val) and GSTM1 (0/0) polymorphisms in oral cancer susceptibility was assessed by examining polymorphic prevalences in 135 patients with oral cancer and 135 noncancer controls frequency-matched by age at diagnosis (+/- 5 years), race, sex, and institute of patient recruitment. The prevalence of the GSTM1 (0/0) genotype was approximately 51% in both cases and controls. The prevalence of the CYP1A1 (ile:val) polymorphism [including both the (ile/val) and (val/val) genotypes] was significantly higher in cases as compared to controls (17.6% versus 7.6%, respectively; crude odds ratio, 2.6; confidence interval, 1.2-5.7). No association was observed between polymorphic prevalence and levels of smoking or alcohol consumption in cases. These results suggest that the GSTM1 null genotype is not associated with oral cancer risk. These results also suggest that individuals with the CYP1A1 exon 7 ile:val polymorphism are at increased risk for oral cancer, and that this risk may not be influenced by differences in exposure to tobacco smoke.

Rhabdomyosarcoma of the oral cavity. Report of four cases.

Clinical and pathologic findings of four cases of rhabdomyosarcoma of the oral soft tissues are described that include findings from immunohistochemistry and electron microscopy. Three cases occurred in children under 16 years of age and one in a 22-year-old. Included is a brief discussion on reported gene abnormalities that may contribute to neoplastic development.

Estrogen receptor assay in polymorphous low-grade adenocarcinoma and adenoid cystic carcinoma of salivary gland origin. An immunohistochemical study.

An apparent relationship between breast cancer and salivary gland cancer has been observed, and there is one report in the literature that describes estrogen receptors in normal salivary gland and salivary gland cancers. With the use of a monoclonal antibody against estrogen receptor protein and the avidin-biotin immunoperoxidase procedure, we were unable to demonstrate estrogen receptors in formalin-fixed paraffin-embedded sections of either polymorphous low-grade adenocarcinoma or adenoid cystic carcinoma of salivary gland origin.

Basaloid squamous cell carcinoma of floor of mouth.

BACKGROUND: Only five cases of basaloid squamous cell carcinoma (BSCC), a rare tumor of head and neck, have been reported to involve the floor of mouth. METHODS: Clinicopathologic and immunohistochemical features of eight BSCC of floor of mouth were studied to evaluate the significance of the basaloid features. RESULTS: Five patients were male and three were female. Their mean age was 52 years (range, 39-59). At presentation, one patient was diagnosed with Stage II disease, four were diagnosed with Stage III disease, and three were diagnosed with Stage IV disease. Aside from typical squamous differentiation, each patient had a component of basaloid cells arranged in irregular nests, cords, or pseudoglandular spaces with a brisk mitotic rate, myxoid stroma, and marked tendency for perineural invasion. A panel of immunostains yielded the following results: keratin, +8/8; carcinoembryonic antigen, +3/8; and S-100, chromogranin, and neuron-specific enolase were negative. Mucin stains were negative in all cases. Ultrastructural characterization of three BSCC revealed squamous differentiation of the basaloid cells and a peculiar basal membrane-like material in between them. No neurosecretory granules were present. Seven patients underwent surgery; six of them were also treated with postoperative radiation therapy. In two cases, chemotherapy was added at recurrence. One nonresectable patient received radiation and chemotherapy. At the last follow-up, five patients were dead of disease within 13 months from the diagnosis. One patient died of an unknown cause. Two patients were still alive at the time of this report, 4 and 2 months after treatment. Seven patients had recurrent disease. The authors compared these data with a control group of patients with conventional squamous cell carcinoma (SCC). CONCLUSIONS: The authors' results indicate that BSCC of floor of mouth is an aggressive variant of SCC and is prognostically worse than the conventional SCC, regardless of the grade of the latter.

Oral manifestations of cutaneous T-cell lymphoma. A report of eight cases.

Cutaneous T-cell lymphoma rarely involves the oral cavity. Only 14 detailed cases of oral cutaneous T-cell lymphoma have been described in the English-language literature; this report describes eight additional cases observed among 824 patients evaluated at our cutaneous T-cell lymphoma center since 1968. Oral involvement occurs late in the course of cutaneous T-cell lymphoma and usually is associated with poor prognosis; most patients die of disease complications within 3 years of the diagnosis of oral involvement.

Search for correlation of radon levels and incidence of salivary gland tumors.

Studies were undertaken to determine if there is a statistical correlation between radon levels and the incidence of salivary gland tumors because of high levels of radon in Pennsylvania. In Part I of the study, the incidence of minor salivary gland tumors accessioned by Temple University, Emory University, and University of Southern California from 1986 to 1988 were correlated with average radon levels in the three locations with the use of standard statistical analyses. In Part II, the occurrence of malignant salivary gland tumors was obtained for each of the 67 counties in Pennsylvania from 1986 to 1988 and correlated statistically with radon levels and population figures in each of those counties. A statistically significant correlation between radon levels and incidence of salivary gland tumors could not be demonstrated in either case.

Amyloidosis of the oral cavity: report of five cases.

Five cases of amyloidosis involving structures in the oral cavity are reported. Three cases appeared to be secondary systemic amyloidosis, one case was the systemic form associated with multiple myeloma, and one case appeared to represent nodular or localized amyloidosis. All cases appeared in persons over 63 years of age, and the most common area of involvement was the tongue. The nature of so-called amyloid deposits in certain odontogenic tumors is discussed in light of recent knowledge of amelogenins and enamelins.

Cervical metastases from an occult primary site.

Less than 5% of patients with metastatic cervical carcinoma will not have a detectable primary site despite a proper work-up. Recent aids for these diagnostic problems include fine needle aspiration and immunohistochemical panels to differentiate undifferentiated carcinoma from melanoma and/or lymphoma. CT scanning can suggest areas in the upper aerodigestive tract for biopsy and can be helpful in suggesting the pathology of the enlarged lymph nodes. EBV titers are often elevated when a nasopharyngeal carcinoma is small. Aggressive treatment of the occult primary patient with metastatic melanoma, thyroid cancer, and metastatic cancer presumed to arise from the skin of the head and neck or the mucous membranes of the upper aerodigestive tract is indicated as long-term survival is often achieved.

Angiosarcoma of the axillary vein.

Angiosarcoma is a malignant tumor of vascular origin. Malignant primary vein tumors are rare. The case of a 64-year-old patient who underwent a left forequarter amputation for angiosarcoma arising from the left axillary vein, a site not previously described, is presented. Also, the literature is reviewed.

Jugular venous reconstruction: a technique to minimize morbidity of bilateral radical neck dissection.

Disfiguring facial edema and elevated intracranial pressure often accompany ligation and excision of the internal jugular veins (IJV) during simultaneous or staged bilateral radical neck dissection. To minimize this morbidity, unilateral reconstruction of the IJV was undertaken at the time of second-side neck dissection in 11 patients. Five patients underwent reconstruction with the spiraled saphenous vein (SVG) and in six patients 10 mm externally supported polytetrafluoroethylene (e-PTFE) was used. Prebypass jugular venous stump pressures (JVPs) were measured and ranged from 28/17 to 75/54 mm Hg with mean pressures of 17 to 62 mm Hg. Two patients had simultaneous neck dissections and nine had staged dissections. The staged interval ranged from 0.3 to 33 months. Six of nine staged reconstructions were right-sided and three of nine were left-sided. Low molecular weight dextran was started intraoperatively, regional heparinization was used in all but two cases, and platelet inhibitors were continued postoperatively in all patients. Additional time in the operating room was 45 minutes (mean). All patients have been followed up 2 to 18 months postoperatively. B-mode ultrasonography, Doppler spectrum analysis, CT scan with contrast, and magnetic resonance imaging were used to assess patency. Four of five SVGs and three of six e-PTFE grafts have remained functional, which resulted in an overall patency rate of 64%. Four grafts (one SVG, three e-PTFE) failed in the immediate postoperative period. All grafts in patients who had a mean JVP greater than 30 mm Hg remained patent, whereas those in patients with lower stump pressures thrombosed.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary melanoma of the middle ear.

We present a case of a 52-year-old white female with what we believe is the first documented example of a primary melanoma of the middle ear. Multiple myringotomies and two tube insertions over a 14-month period were carried out until frank hemorrhage was encountered on the last one. Middle ear exploration found the lesion to be a primary melanoma. The supposed course of her diseased ear is discussed as regards the lag between effusion and frank blood when tumor was finally hit on the last myringotomy.

Radionuclide venography in subclavian vein thrombosis complicating parenteral nutrition.

Subclavian vein thrombosis and thrombophlebitis are common complications of subclavian vein catheterization for parenteral nutrition. We report two cases that demonstrate that radionuclide venography can be used to diagnose subclavian vein obstruction before classic clinical signs develop.

Labiomandibular, transoral approach to chordomas in the clivus and upper cervical spine.

Three patients with chordomas of the clivus and the upper cervical spine underwent the removal of their tumors through a transoral approach with labiomandibular splitting and microsurgical techniques. This surgical approach provided excellent visualization of the anterior craniocervical area and allowed a gross total removal in each case. Although the lesions in our patients were chordomas, this approach could also be used for other surgical lesions in this area.

Osteogenic sarcoma of the tongue.

A 45-year-old woman had a mass in the left side of the tongue. Histologic examination of the tumor revealed it to be an extraskeletal osteogenic sarcoma. Pulmonary metastases were seen on admission. The patient had a rapid downhill course and died. Extraskeletal osteogenic sarcomas are well-recognized albeit rare neoplasms. In a search of the literature we were unable to find a single case arising in the tongue. The electron microscopic findings are also presented.

Thyroid cancer--surgical decision making.

Although there are arguments for different approaches, we have presented a format based upon the current literature and our clinical experiences for the management for thyroid nodules and cancers. The limited value of suppressive therapy in solitary nodules is stressed. Lobectomy with isthmectomy is the initial surgical procedure for dominant nodules. Total thyroidectomy for proven thyroid cancers is performed when possible. Regional lymph nodes in the central or visceral compartment are removed therapeutically by a modified technique in order to prevent significant functional loss and deformity. In the postoperative period, radioactive iodine therapy can be extremely beneficial. Postoperative thyroid suppressive therapy is useful in patients with thyroid cancer although a third or more of these tumors will eventually escape from beneficial effects. Clinical experiences of recurrent or metastatic thyroid cancer regressions following suppression therapy are difficult to document.

Craniocervical chordomas.

In a 20 year period seven cases of craniocervical chordoma were seen and treated. Since it is not possible to completely resect these lesions, the aim of treatment has been to debulk the tumor as much as feasible and employ postoperative irridation. Palliation is the most that can be hoped for, and minimal success in delaying the natural history of the tumor has been achieved. Surgery for relief of symptoms secondary to bulky recurrence is indicated for palliation, as is a repeat course of x-ray therapy. Isolated cases of long-term useful survival have followed doses in the range of 10,000 rads or more [19,20]. This therapy is usually given in smaller increments of an initial dose when there is evidence of recurrent tumor or pain [2]. However, whenever the dosage to the spinal cord or the base of the brain exceeds 4,000 rads, there is a concern about possible permanent radiation damage. These patients are difficult to care for late in the course of their disease when multiple cranial nerve paralysis, long tract signs, and intractable pain become progressively severe. Chordomas usually remain localized; however, about 10% metastasize distally. One case is presented of a large retropharyngeal mass with destruction of the second cervical vertebra that recurred locally in 3 months despite usual treatment; distal bony metastases were found 3 years after initial treatment. The histology of the lesion, its recurrence, and distal bony metastases were essentially indistinguishable from the other lesions that remained localized. Short periods of palliation from severe local pain and exquisite tenderness have been achieved by local resection of the involved bones.

Ultrastructural characterization of intermediate cells of mucoepidermoid carcinoma of the parotid.

Five cases of mucoepidermoid carcinoma of the parotid gland were studied ultrastructurally. In addition to epidermoid cells (tonofilament-rich) and mucous cells, three forms of intermediate cells were identified: mitochondria-rich cells, glycogen-rich cells, and ribosome-rich cells. Transitional forms of all cell types were observed. Ultrastructurally, cells rich in glycogen appeared to be the "clear cells" by light microscopy; cells rich in ribosomes appeared basophilic under light microscopy. Mitochondria-rich cells were lightly eosinophilic under light microscopy.

Acid phosphatase in squamous cell carcinoma.

Surgical specimens of oral squamous cell carcinoma were processed for cytochemistry of acid phosphatase using Gomori's substrate. Reaction product was deposited in the cytoplasmic dense bodies, autophagic vacuoles, cytoplasmic projections, and advancing cell borders. Results of this study suggest that acid phosphatase and its associated lysosomes seem to play a role in the invasiveness of cancer cells.