Adult rhabdomyoma of the larynx.

Rhabdomyomas of the larynx are rare lesions, with the "adult" type occurring more frequently than the "fetal" type. Treatment is complete surgical removal. Recurrences would suggest an incomplete surgical procedure and/or an incorrect pathological diagnosis.

An unusual presentation of a large tumor coexisting with an unusually high nonspecific immune responsiveness. A case report.

The authors present the case of a 40-year-old white man with an obstructing laryngeal mass. Despite considerable tumor size, results of repeated biopsies revealed widespread carcinoma in situ with chronic inflammation within the subcutaneous tissues, and only after extensive endoscopic "debulking" of the mass was a small focus of invasive carcinoma identified. Just as surprising was the patient's unusual degree of immune competence as estimated to be at least in the upper normal range and definitely much higher than that observed in the other patients with head and neck cancer routinely examined in our department. The immune responsiveness of the patient was evaluated by total lymphocyte count, in vivo skin testing, in vitro blastogenesis, interleukin-2 and interferon-gamma production. The authors postulate that these observations may constitute a rare demonstration of the ability of the immune surveillance system to contain malignancy under physiologic conditions.

Perineural invasion in squamous cell skin carcinoma of the head and neck.

On review of 520 patients with 967 squamous cell carcinomas of the skin of the face treated at The University of Texas M.D. Anderson Hospital and Tumor Institute at Houston during a 10 year period, 14 percent of the patients were noted to have perineural extension of tumor. Study of the patients with perineural tumor demonstrated an increased incidence of spindle cell and adenosquamous cell types, an increased incidence of cervical lymphadenopathy and distant metastasis, and significantly reduced survival curves compared with those of patients with squamous cell skin carcinoma without perineural invasion. Tabulation confirmed that the maxillary and mandibular branches of the trigeminal nerve and the facial nerve were most commonly involved. For patients with squamous cell skin carcinomas with perineural invasion, aggressive therapy is recommended, specifically, resection of involved tissues and nerves and appropriate regional lymphadenectomy followed by postoperative radiotherapy. This plan affords the best opportunity for tumor control. The indications for exploration of the middle fossa of the intracranial portion of the trigeminal nerve deserve further study.

Lateral mandibulotomy: a technique of exposure for penetrating injuries of the internal carotid artery at the base of the skull.

Injuries to the internal carotid artery are rare but are frequently fatal or associated with significant neurologic sequelae. Exposure for surgical repair of penetrating injuries to the internal carotid artery at the base of the skull is difficult because of the overlying ramus of the mandible and the facial nerve. In the past, these injuries have been treated by techniques such as occlusion of the artery with a Fogarty balloon catheter, or subluxation of the temporomandibular joint to gain access to the arterial injury. Based on techniques previously reported for extirpation of parapharyngeal space tumors, we describe lateral mandibulotomy for exposure of penetrating carotid artery injuries at the base of the skull. The technique affords relatively rapid and adequate exposure of these injuries allowing ligation, or in selected cases, arterial repair.

Verrucous-squamous carcinomas of the oral cavity. A clinicopathologic study of 104 cases.

One hundred four patients had verrucous carcinomas of the oral cavity. Our study documents, for the first time, the coexistence of foci of less-differentiated squamous carcinoma within verrucous lesions of the oral cavity (20%). We confirm previous observations that verrucous lesions tend to recur in the form of less-differentiated carcinomas. Finally, we demonstrate that surgery is indeed the treatment of choice for verrucous carcinomas of the oral cavity, although irradiation can be used to treat selected patients.

Thyroid cancer in children and teenagers.

A study of thyroid cancer in patients younger than 20 years showed most tumors to be of the differentiated type. Histological types were pure papillary adenocarcinoma (9.5%), mixed papillary and follicular adenocarcinoma (77%), pure follicular adenocarcinoma (2.7%), and medullary carcinoma (10.8%). Of the patients with differentiated carcinoma, 84% had palpable cervical lymphadenopathy and 11% had pulmonary metastasis on admission. Patients with differentiated carcinoma were followed up for a mean of 15.4 years, and patients with medullary carcinoma for a mean of 7.3 years. No patient died as a result of papillary or follicular carcinoma, but two (25%) died of medullary carcinoma. Permanent hypoparathyroidism was found in 17% of patients after total thyroidectomy.

Further observations on the treatment of recurrent respiratory papillomatosis with interferon: a comparison of sources.

Between June 1982 and March 1983, 11 patients with aggressive recurrent respiratory papillomatosis were treated with alpha or human leukocyte interferon (IFN) that was produced by and purchased from the New York Blood Center, Inc. The year before, nine of these patients had been on a similar protocol utilizing alpha-IFN that had been supplied by the Finnish Red Cross Blood Transfusion Service. Comparisons regarding response and toxicity were made and are reported. In our series we have not seen an overall difference in response of papillomatosis to these two IFNs. As many of our patients responded better to the New York product as responded worse. There is a suggestion, however, that the New York product is associated with less toxicity than the Finnish IFN.

Leukocyte interferon in patients with juvenile laryngeal papillomatosis.

Fourteen patients with aggressive juvenile papillomatosis were treated with systemic administration of alpha-type interferon (IFN). This initial dosage of 2 million units alpha-interferon/m2 was modified if a favorable response in the papilloma growth occurred, or if persistent drug-related side effects developed. Half of the patients showed a sustained response while on IFN, and two patients had a complete response. Persistent elevation in SGOT was the main dose-limiting toxicity, especially in infants below age seven years. All side effects subsided after the drug was discontinued. Further studies are recommended.