Prognostic value of facilitative glucose transporter Glut-1 in oral squamous cell carcinomas treated by surgical resection; results of EORTC Translational Research Fund studies.

Hypoxia in tumours of the oral cavity has not been extensively investigated with regard to clinical outcome and prognosis. The expression of the facilitative glucose transporter, Glut-1, has been shown to be related to hypoxia in tumours at other sites. The aim of the present study was to investigate the relationship between Glut-1 expression and clinical outcome in a series of oral squamous cell carcinomas. A retrospective series of 54 cases of oral squamous cell carcinomas with known clinical outcome and treated by one surgeon over a period of 6 years was used in the study. A representative section from each case was stained immunohistochemically with an antibody against Glut-1. The stained sections were then assessed independently by two observers using a semi-quantitative method. The relationship between these results and the clinical outcomes of local recurrence, regional lymph-node metastasis and disease-free survival were examined. Glut-1 staining was observed in most of the tissue specimens and all of the few sections with demonstrably necrotic areas histologically. Some showed more prominent staining in the epithelial islands of the tumour than others. However, the intensity of staining was variable. There was a significant relationship between those tumours which demonstrated intense staining and recurrence overall (chi(2)=6.18, P=0.032). This relationship was strongest in relation to regional lymph-node recurrence (chi(2)=10.19, P=0.005). A significant relationship between disease-related death and intense Glut-1 staining was also observed (chi(2)=11.67, P=0.002). In conclusion, the results of this study indicate a relationship between Glut-1 expression and disease progression of oral cancer and could indicate a need for neoadjuvant chemoradiotherapy for those tumours demonstrating intense Glut-1 expression.

Do frozen sections help achieve adequate surgical margins in the resection of oral carcinoma?

This retrospective study examined the notes of 82 patients who underwent an attempted curative resection of oro-pharyngeal carcinoma, and who had frozen sections taken, over a four year period. Three hundred and fifty mucosal, 179 deep tissue, and 22 nerve frozen sections had been taken. Concordance between cryostat and paraffin sections was 99.5% although no false positives or negatives for invasive tumour were found. Nine (11%) patients who had frozen sections which were reported as dysplastic or positive for invasive tumour underwent further local resection; excision was then found to be complete in 8 (10%) of these patients with further frozen sections. In 15 patients the margins of the main resection specimen were judged to be close to the tumour (<5mm), 5 patients had squamous epithelial dysplasia and 12 patients had invasive tumour at a resection margin. Ten of the 12 patients with margins containing invasive tumour had negative cryostat sections intraoperatively, which demonstrated problems with sampling which is the major drawback. During follow up, 14 patients developed local recurrence. Only one of the patients who had frozen section guided further local resection, developed local recurrence. Frozen sections help achieve tumour clearance.

Serum testosterone levels in surgeons during major head and neck cancer surgery: a suppositional study.

Serum testosterone levels are known to have diurnal variation and to decrease by up to 2% per year after the age of 40. They can also be affected by stress and aggressive behaviour as well as various medical conditions. Although studies have investigated the role of mood and stress, none has specifically evaluated the effect of operative procedures on surgeons testosterone levels, particularly those in our own specialty, one that has historically been associated with perceived 'high testosterone' levels. We devised a suppositional study, particularly pertinent for publication at the beginning of April. This was a prospective randomised study of five male consultant maxillofacial surgeons (including two with male pattern baldness) and assayed serum testosterone levels at rest, during, and after a series of major ablative and reconstructive procedures. The resting testosterone levels were found to be similar in all surgeons (220 ± 120.9 mcg/ml). During major head and neck procedures, a statistically significant increase in serum testosterone was found (up to a maximum concentration of 1062.50 mcg/ml). Multivariate analysis revealed that the likely predictors of increasing serum testosterone were: size and extent of tumour and complexity, and type of microvascular reconstruction (all P<0.001). The long-term effects of chronically raised serum testosterone warrant further investigation but recent evidence has found that it may be cerebro-protective against conditions including Alzheimer's syndrome.

A chylous cyst at the right base of the neck.

A case is presented of a cystic lesion, which presented at the base of the right side of the neck. The lesion was more obvious on forced expiration. Aspiration revealed chylous fluid and a Magnetic Resonance Imaging (M.R.I.) scan revealed a well-circumscribed cystic lesion with no deeper extension. So far, this chylous cyst has not required treatment, but is being kept under regular review.