A 25-year perspective on advances in an understanding of the biology, evaluation, treatment and future directions/challenges of penile cancer.

Squamous cell carcinoma of the penis (SCCP) is uncommon in some countries (including the U.S.), but is an important malignancy elsewhere. As a rare disease, progress has been slow compared to more common tumor types discussed in this anniversary issue and most often limited to single-center or retrospective datasets.  In this section we describe developments leading to the current standard approach with current research questions.

[Brief introduction of surgical development of esophageal cancer in Japan].

Esophageal cancer surgery originated in the early 20(th) century. However, the true meaning of trans-thoracic esophagectomy and digestive tract reconstruction began in the 1930s. Almost at the same time, Japan and Western countries began the surgical exploration of esophageal cancer. Based on the pathological type of esophageal cancer in Asia, squamous cell carcinoma is the majority, and its biological characteristics and treatment strategies are different from those of European and American patients. After more than eighty years of development, the surgical treatment of esophageal cancer in Japan has been developed from the initial attempt, deep cultivation practice to the pursuit of excellence, and explored a set of more advanced surgical techniques and diagnostic strategies, which is unique in the world. On the basis of the establishment of the Japanese Society of Esophagus, Japanese scholars have developed and irregularly updated the Japanese Classification of Esophageal Cancer and published the professional academic journal Esophagus. The Japanese Clinical Oncology Group organized a number of phase Ⅲ clinical studies on esophageal cancer, providing strong evidence for the diagnosis and treatment of esophageal squamous carcinoma. Focused on the origin, development, current situation and future of esophageal cancer surgery in Japan, this paper summarized the development of esophageal cancer surgery in Japan through literature review, interviews with senior experts and Hot topics of esophageal cancer surgery-questionnaire survey of Japanese experts.

Frederic E. Mohs, MD, and the history of zinc chloride.

The history of zinc chloride therapy before and including Frederic E. Mohs' (1910-2002) early contributions to dermatologic oncology is presented. In 1932, Mohs devised a method of cutaneous surgery that employed zinc-chloride paste to devitalize basal or squamous cell carcinoma. Because zinc chloride coagulates malignant tissue without destroying cellular architecture, he described the surgery and its preservative effect as the fixed-tissue method. This method involved the serial removal of devitalized malignant tissue and the freezing and histologic examination of each layer; the process was continued until a cancer-free plane was reached. In 1953, a modified version of the micrographic system, the fresh-tissue method, was introduced. For improved efficiency, Mohs retained the systematic mapping of a neoplasm but eliminated the chemical escharotic. Although the fresh-tissue method has become the preferred treatment mode, zinc-chloride paste therapy remains in use today. Although the history of Mohs micrographic surgery is well documented, its background has not received sufficient attention. This paper surveys the chemical synthesis of zinc chloride, the formulation of zinc-chloride paste as a cutaneous escharotic, and the extent to which Mohs' method compares with those of 19th and early 20th century predecessors.

Hallmarks in history of esophageal carcinoma.

Esophageal cancer is one of the deadliest cancers due to its aggressive behavior and poor survival. It was mentioned in the works of ancient Chinese and Arabo-islamic physicians, centuries before the recognition of high incidence in the Asian esophageal cancer belt. Till the 19th century the disease was considered incurable and the main goal of the proposed treatments was to alleviate dysphagia and pain. The introduction of esophagoscope in 1868 by Adolf Kussmaul (1822-1902) contributed to the observation of the living esophagus and to the diagnosis of esophageal pathologies, paving the way for new therapeutic approaches. In 1877, Vincenz Czerny (1842-1916) performed the first successful resection of the cervical esophagus for carcinoma, followed by Franz Torek (1861-1938) who carried out in 1913 the first successful subtotal thoracic esophagectomy and Tohru Ohsawa (1882-1984) who performed the world's first esophagectomy with an intrathoracic esophagogastric anastomosis. Nowadays, despite the advent of biomedical technology and the development of operation techniques, the surgical treatment of esophagus still remains a challenge.

Carcinoma espinocelular del oído externo con extensión parotídea: a propósito de un caso / Squamous cell carcinoma of the external ear with parotid extension: case report

El pabellón auricular y el conducto auditivo externo constituyen una región anatómica que puede ser asiento de múltiples patologías, entre ellas procesos inflamatorios, infecciosos y neoplásicos, tanto benignos como malignos. Con respecto a los tumores, los diversos tipos suelen presentarse con síntomas y signos similares y en general es difícil inferir la variedad histológica del tumor a través del examen físico, por lo cual es necesario el estudio histopatológico para determinar el diagnóstico. La mayoría de los tumores del oído externo son carcinomas; entre ellos se destacan el carcinoma basocelular, el más frecuente, y el carcinoma espinocelular. Menos frecuentemente se encuentran otros tipos de tumores como los melanomas, adenocarcinomas, carcinomas de glándulas ceruminosas, carcinomas mucoepidermoides, sarcomas, procesos linfoproliferativos, etc. Suelen ocurrir en la edad media y avanzada (50-70 años) y con mayor periodicidad en el sexo masculino. En el presente trabajo se describe un caso clínico de carcinoma espinocelular del oído externo, tratado exitosamente mediante cirugía y radioterapia, así como también se describen las características clínicas de esta enfermedad, con especial atención al compromiso del oído externo por ella.

The pinna and the ear canal are an anatomical region that can be affected by many diseases, including inflammatory, infectious and benign and malignant neoplastic processes. With regard to tumors, various types usually present with similar symptoms and usually is very difficult to know the histological type through physical examination, so histopathological examination is necessary in order to determine the diagnosis. Most tumors are carcinomas; they can be basal cell carcinoma (more frequently), or squamous carcinoma. Less frequently are other types of tumors such as melanomas, adenocarcinomas, ceruminous glands carcinomas, mucoepidermoid carcinomas, sarcomas, lymphoproliferative disorders, etc. They usually present in middle and advanced age people (50-70 years) and are more frequently in men. In this article we present a case of squamous cell carcinoma of the external ear with extention to parotid gland, successfully treated with surgery and radiotherapy, as well as we describe the clinical characteristics of this disease, with special attention to the compromise of the external ear. (AU)

Surgical treatment of head and neck cancers in the ancient world.

OBJECTIVE: This paper attempts to chart the history of head and neck cancers and their surgical treatment, starting from ancient Egypt and concluding with Galen. CONCLUSION: The ancient Egyptians appear to have treated head and neck cancers with local applications. The ancient Greek corpus contains a reference to treating pharyngeal carcinoma with cautery, but the description is too vague to establish the diagnosis conclusively. The ancient Romans moved away from surgical treatments, with Galen establishing a prejudice against surgery that would last through the Middle Ages.

[The Malady of Emperor Frederick III. and Virchow's diagnostic role]. / Die Krankheit Kaiser Friedrichs III. und Virchows Rolle.

Crownprince Frederick Wilhelm of Prussia was once the hope of the liberal movement in Germany. He embodied and lived a humanistic ideal based on the spirit of the enlightenment. Starting in January 1887 the passionate pipe smoker suffered on an unusual long hoarseness. A polyp of the vocal cord was diagnosed. Although this diagnosis seemed harmless, an odyssee was launched that made history. Rudolf Virchow-the foremost pathologist of that time-was involved in the following histological diagnosis. His role and that of the sprouting histopathology will be presented in this essay.

Lung cancer incidence trends by gender, race and histology in the United States, 1973-2010.

BACKGROUND: Lung cancer (LC) incidence in the United States (US) continues to decrease but with significant differences by histology, gender and race. Whereas squamous, large and small cell carcinoma rates have been decreasing since the mid-80s, adenocarcinoma rates remain stable in males and continue to increase in females, with large racial disparities. We analyzed LC incidence trends by histology in the US with an emphasis on gender and racial differences. METHODS: LC incidence rates from 1973-2010 were obtained from the SEER cancer registry. Age-adjusted incidence trends of five major histological types by gender and race were evaluated using joinpoint regression. Trends of LC histology and stage distributions from 2005-2010 were analyzed. RESULTS: US LC incidence varies by histology. Squamous, large and small cell carcinoma rates continue to decrease for all gender/race combinations, whereas adenocarcinoma rates remain relatively constant in males and increasing in females. An apparent recent increase in the incidence of squamous cell carcinoma and adenocarcinoma since 2005 can be explained by a concomitant decrease in the number of cases classified as other non-small cell carcinoma. Black males continue to be disproportionally affected by squamous LCs, and blacks continue to be diagnosed with more advanced cancers than whites. CONCLUSIONS: LC incidence by histology continues to change over time. Additional variations are expected as screening becomes disseminated. It is important to continue to monitor LC rates to evaluate the impact of screening on current trends, assess the continuing benefits of tobacco control, and focus efforts on reducing racial disparities.

[The road to modern esophageal surgery - from maximally invasive to minimally invasive]. / Der Weg zur modernen Speiseröhrenchirurgie - von maximal invasiv zu minimal invasiv.

520 new cases of esophageal carcinoma are diagnosed in Switzerland per year. 80% of these patients eventually die from their disease despite recent advances in surgical technique and systemic treatment. The first successful thoracic esophageal resection for carcinoma was performed in 1913, but only the introduction of modern anesthesia with oral intubation and positive pressure ventilation made thoracic operations routinely feasible. Esophageal resection can be performed open or minimally invasive. The minimally invasive esophageal resection has been proven to be safe with comparable mortality to open resection. Also, there is no difference in terms of radicality of the operation. Overall survival seems to be equal in published series, but results of prospective trials are still pending.

En Suisse chaque année sont diagnostiqués 520 nouveaux cas de cancer de l'oesophage. 80% des patients décèdent malgré les avancées notables des traitements chirurgicaux et médicaux dans ce domaine. La résection chirurgicale est le traitement de choix pour les cancers éligibles. En 1913 a eu lieu avec succès la première résection transthoracique d'un cancer de l'oesophage, mais ces interventions transthoraciques n'ont pu être réalisées dans la pratique courante qu'à compter du développement des techniques anesthésiologiques modernes incluant l'intubation orale et la ventilation par pression positive. L'intervention peut de nos jours être réalisée à ciel ouvert ou par technique mini-invasive. Cette dernière est une technique sûre, ayant un taux de mortalité comparable aux techniques à ciel ouvert dans les centres spécialisés. Aussi, il n'existe aucune différence quant à la radicalité de l'opération. Les résultats oncologiques sont comparables dans les séries publiées, toutefois les résultats d'études standardisées sont encore à venir.

[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.

International trends in lung cancer incidence by histological subtype: adenocarcinoma stabilizing in men but still increasing in women.

OBJECTIVES: Trends in overall lung cancer incidence in different countries reflect the maturity of the smoking epidemic. Further understanding of the underlying causes for trends over time can be gained by assessing the trends by sex and histological subtype. We provide a temporal analysis of lung cancer incidence in 12 populations (11 countries), with a focus on cohort-specific trends for the main histological subtypes (squamous cell carcinomas (SCC), adenocarcinomas (AdC), and small cell carcinoma). MATERIAL AND METHODS: We restrict the analysis to population-based registry data of sufficient quality to provide meaningful interpretation, using data in Europe, North America and Oceania, extracted from successive Cancer Incidence in Five Continents Volumes. Poorly specified morphologies were reallocated to a specified grouping on a population, 5-year period and age group basis. RESULTS: In men, lung cancer rates have been declining overall and by subtype, since the beginning of the study period, except for AdC. AdC incidence rates have risen and surpassed those of SCC (historically the most frequent subtype) in the majority of these populations, but started to stabilize during the mid-1980s in North America, Australia and Iceland. In women, AdC has been historically the most frequent subtype and rates continue to increase in most populations studied. Early signs of a decline in AdC can however be observed in Canada, Denmark and Australia among very recent female cohorts, born after 1950. CONCLUSIONS: The continuing rise in lung cancer among women in many countries reinforces the need for targeted smoking cessation efforts alongside preventive actions.

[Bioethics of Sigmund Freud´s death: euthanasia or appropriation?]. / Bioética de la muerte de Sigmund Freud: ¿Eutanasia o apropiación?

The death of Freud raises the ethical dilemma about euthanasia. It can be characterized as indirect active euthanasia according to the rule of double effect, or terminal sedation, or palliated death. The primacy of the principle of autonomy over non maleficence, conditioned the physician's attitude toward his patient Freud. The physician assisted death was and remains punishable in western medicine. Therefore, a fundamental tradition was infringed. In contrast, the present study attempts to characterize the final position of Freud himself to his death and called it appropriation of his finitude; he assumes his being-unto-death, that is, he now projects his being not as a being-at-his-end but as a being-unto-end, indicating thereby that he understood that the end always penetrated his whole existence.

The Kaiser's cancer revisited: was Virchow totally wrong?

On 15 June 1888, the German Emperor, Kaiser Friedrich III, died of laryngeal cancer. Three biopsies of his laryngeal lesion had been taken by the British laryngologist, Morel Mackenzie, in 1887 and diagnosed by Rudolf Virchow as "pachydermia verrucosa laryngis", confirming Mackenzie's assessment that the Kaiser's disease was benign. A fourth specimen coughed up by the patient was considered by Virchow to be nondiagnostic. A further specimen expectorated by the patient 3 months before his death was diagnosed as carcinoma by Wilhelm Waldeyer. The autopsy revealed squamous carcinoma in the larynx with a cervical lymph node metastasis. The discrepancies between the initial diagnoses and the final outcome of the Kaiser's disease gave rise to a never-ending medical controversy. Our investigations on this historical case were limited to the official German documents and publications and their English translations and to subsequent literature sources of the time, after having received confirmation that the histological slides and Virchow's original reports had been lost. Based on current surgical pathology knowledge, we propose that the tumour that challenged the diagnostic skills of the founder of pathology was hybrid verrucous carcinoma (HVC), an extremely rare, metastasizing variant of verrucous carcinoma (VC) composed of pure VC mixed with clusters of conventional squamous cell carcinoma. As we see it now, Virchow was therefore not totally wrong. Our retrospective evaluation suggests that Virchow's detailed description of the Kaiser's cancer preceded the paper that contributed to the full understanding of HVC of the larynx by 110 years.

Bioética de la muerte de Sigmund Freud: ¿Eutanasia o apropiación? / Bioethics of Sigmund Freud´s death: Euthanasia or appropriation?

The death of Freud raises the ethical dilemma about euthanasia. It can be characterized as indirect active euthanasia according to the rule of double effect, or terminal sedation, or palliated death. The primacy of the principle of autonomy over non maleficence, conditioned the physician’s attitude toward his patient Freud. The physician assisted death was and remains punishable in western medicine. Therefore, a fundamental tradition was infringed. In contrast, the present study attempts to characterize the final position of Freud himself to his death and called it appropriation of his finitude; he assumes his being-unto-death, that is, he now projects his being not as a being-at-his-end but as a being-unto-end, indicating thereby that he understood that the end always penetrated his whole existence.

Otolaryngology and the American presidency: a medical legacy.

The various medical histories of eminent members of state have been well documented and explored. Such accounts provide interesting insights into advances in treatment and management of disease. Moreover, historical cases serve as a timely reminder of how the central tenets of good medical practice do not change with time. Two American presidents, Ulysses S. Grant and Grover Cleveland, were afflicted with diseases of the head and neck, and one would subsequently die from his illness. Here we examine their diagnosis, treatment and their disease in the context of modern management.

Marjolin's warty ulcer.

Marjolin's ulcer refers to malignant change within burn scar. The French surgeon Jean-Nicolas Marjolin is honored with the eponym. Marjolin described the "warty ulcer" in the first edition of Dictionnaire de Medécine. In his description, Marjolin did not actually state that this ulcer represented malignant transformation. Credit for noting the specific association involved in Marjolin's ulcer belongs to Caesar Hawkins, an English Surgeon, who described skin cancer arising in burn and flogging scars.