Incidence of primary large vessel vasculitis in Norfolk, UK from 2011 to 2020.

OBJECTIVES: To report the annual incidence of primary large vessel vasculitis (LVV) in the adult population of Norfolk County, UK, including giant cell arteritis (GCA) (in those ≥50 years) and Takayasu arteritis (TAK). METHODS: Individuals diagnosed by histology or imaging who lived in NR1-NR30 postcode districts were included. Validated criteria from 1990 and 2022 were applied for final classification. Population data were available from the Office of National Statistics, UK. RESULTS: 270 individuals were diagnosed with primary LVV over 4.7 million person-years. The annual incidence (95% CI) of primary LVV was 57.5 (50.8, 64.7)/million person-years in the adult population. 227 and 244 individuals were diagnosed with GCA over ~2.5 million person-years using 1990 and 2022 criteria, respectively. The annual incidence (95% CI) of GCA was 91.6 (80.0, 104.3)/million person-years aged ≥50 years using 1990 criteria and 98.4 (86.4, 111.6)/million person-years aged ≥50 years using 2022 criteria. 13 and 2 individuals were diagnosed with TAK over 4.7 million person-years. The annual incidence (95% CI) of TAK was 2.8 (1.5, 4.7)/million person-years using 1990 criteria and 0.4 (0.0, 1.4)/million person-years using 2022 criteria, in the adult population. The incidence of GCA rose sharply in 2017 coincident with the introduction of a fast-track pathway and fell during the pandemic when the pathway was disrupted. CONCLUSIONS: This is the first study that reports the incidence of objectively verified primary LVV in the adult population. The incidence of GCA may be affected by the availability of diagnostic pathways. The use of the 2022 classification criteria results in a rise in the classification of GCA and fall in that of TAK.

Lacrimal sac primary squamous cell carcinoma with synchronous tonsillar primary squamous cell carcinoma.

A gentleman with recurrent epiphora after two failed endonasal dacryocystorhinostomies was found to have a squamous cell carcinoma of the lacrimal sac at his third operation via an external approach. CT showed contralateral nodal involvement; however, biopsy of the node found it to be histologically distinct from the lacrimal sac lesion. A PET-CT revealed a second primary lesion located at the contralateral palatine tonsil. We discuss the histological features of squamous cell carcinomas and the impact on prognosis. This case highlights the importance of nasoendoscopy prior to lacrimal surgery. There should be a low threshold for lacrimal sac biopsy, and any anatomical or histological inconsistency should prompt further investigation.

A meta-analysis of margin size and local recurrence in oral squamous cell carcinoma.

OBJECTIVES: Excision margins for oral squamous cell carcinoma (OSCC) are poorly understood. Close (<5mm) and involved (<1mm) pathological margins are key indicators of the need for adjuvant treatment. This review aimed to assess the impact of pathological margin size on local recurrence rates. METHODS: MEDLINE and EMBASE were searched for studies that looked at local recurrence following excision of primary OSCC without adjuvant therapy. Five studies met the inclusion criteria. RESULTS: Recurrence rates were pooled to give a 21% absolute risk reduction (95% confidence interval 12-30%, p=<0.00001) in local recurrence with margins clear by more than 5mm. Unweighted pooled recurrence rates were 20% in patients with margins clear by more than 5mm. CONCLUSION: These findings suggest that a 5mm pathological margin is the minimum acceptable margin size in OSCC.