Polyclonal chromosomal evolution in a benign mixed salivary gland tumor.

Banding analyses of a human benign pleomorphic adenoma in the parotid gland revealed a polyclonal pattern where structural rearrangements predominated. These deviations were different from the anomalies previously observed in 100 mixed tumors. The reason found for the differences in all likelihood was x-ray treatment of tuberculous lymphadenitis in the neck during childhood. Implications regarding origin and development of pleomorphic adenomas are discussed.

Nodal radiotherapy in refractory tuberculosis in an AIDS patient.

A 25-year-old female with transfusion-associated acquired immunodeficiency syndrome (AIDS) treated with zidovudine (AZT) developed cervical lymph node enlargement. The histological study disclosed granulomas and the culture revealed M. tuberculosis. The patient was treated with isoniazid, rifampicin and pirazynamide and the lymphadenomegaly resolved. Five years later, with a CD4 cell count of 245, the lymph node enlargement reappeared, the biopsy and special studies confirming tuberculosis (TB). She was then given ciprofloxacin, azithromycin, ethambutol, amikacin and pirazynamide without success. In two instances the enlarged nodes were surgically removed. Facing progressive obstruction of both the airway and the esophagus, localized radiotherapy (1800 cGy in nine fractions) to the right aspect of the neck was delivered with dramatic resolution of the node enlargement; however, dissemination of the infection leading to a severe lung infiltration and respiratory failure ended the life of the patient.

Keloidal basal cell carcinoma after radiation therapy.

We report a case of keloidal basal cell carcinoma (BCC) that developed after radiation therapy. A 67-year-old Japanese man had received radiation therapy of an unknown amount for three years for the treatment of right cervical lymph node tuberculosis at the age of 7. Within the area of chronic radiation dermatitis, on the right preauricular region, he presented with a skin-colored to erythematous, firm nodule. Histopathologically, this nodule showed features of keloidal BCC. The stroma characteristically demonstrated the prominent, keloidal, thickened collagen bundles standing out against the surrounding actinic-damaged dermis, and well-circumscribed, keloidal collagen bundles that proliferated in a nodular form almost corresponding to a clinically firm, nodular lesion. There was no radiation fibrosis around the keloidal BCC. We discuss the differences between keloidal BCC and morpheiform BCC, and consider keloidal BCC to be a rare variant of BCC from a clinico- pathological basis.

[Radiogenic carotid stenosis. The problem of radiation induced arterio-sclerosis (author's transl)]. / Radiogene Karotisstenose. Zum Problem der strahleninduzierten Arteriosklerose

Amongst late radiation damage, lesions of the cerebral arteries are relatively rare. The relationship between the radiation and arterio-sclerosis is discussed in connection with a 63-year old female patient with an atheromatous carotid stenosis; at the age of 5 years she received high dose rate radiation for cervical node tuberculosis. From animal experiments and an increasing number of human observations, it is concluded that radiation may be a predisposing and accelerating local factor in the formation of arterio-sclerosis. Amongst the recognised cases of radiogenic carotid stenosis or occlusion, the latent period averages 30 (9-57) years.

[Effect of low-energy helium-neon laser on the biological properties of Mycobacterium tuberculosis]. / Vliianie nizkoénergeticheskogo gelii-neonovogo lazera na biologicheskie svoistva mikobakterii tuberkuleza.

The results of experimental studies of M. tuberculosis biological properties tested in guinea pigs which were subjected to different doses of helium-neon laser radiation are given. The functional evidence is compared with the results of electron microscopic study of the irradiated culture. The investigation revealed that laser radiation caused changes in biological properties of M. tuberculosis. A decrease in growth properties and virulence was found to be related to a radiation dose. It is suggested that a drop in the biological activity of M. tuberculosis under laser radiation be associated with its influence on the Mycobacterium lipid layer which contains a cord-factor and responsible for their virulence.

Benign and malignant thyroid nodules after neck irradiation.

A total of 444 persons were examined for the presence of thyroid nodules on average of 43 years after having been treated with x-rays for cervical tuberculous adenitis. Of this total, 101 subjects had undergone surgery for thyroid nodules: 25 for carcinoma (6%) and 76 for benign nodules (17%). Carcinoma occurred with the same frequency in multinodular and uninodular glands. Because of the uneven age distribution in the current series, it could not be decided whether there was a higher susceptibility of the young thyroid to the induction of thyroid carcinoma or benign nodules. The dosage range for the whole series was 0.40 to 50.90 Gy (40-5090 rad). There was a positive correlation between the absorbed radiation dose and the probability of developing benign and malignant thyroid nodules, even after doses of 20 Gy or more. The risk of developing thyroid carcinoma was equal for men and women, while the female-to-male ratio for benign nodules was 2.9:1, indicating that risk factors associated with females are of less importance in irradiated than in nonirradiated populations. The median latency for carcinoma was 40 years, suggesting that the increased risk of thyroid carcinoma after irradiation remains for the rest of the patient's life.

Hyperparathyroidism subsequent to neck irradiation. Risk factors.

A follow-up examination of 444 persons treated with x-rays for tuberculous cervical adenitis was performed to determine if the risk for hyperparathyroidism (HPT) following radiation exposure can be related to the age at treatment, the dose of x-rays, or the sex of the patient. The overall incidence of HPT was 14%. There was no definite age-dependent difference in susceptibility to the induction of HPT. The doses of radiation among the 63 subjects who developed HPT ranged from 0.6 to 45.7 Gy (60-4570 rad). There was a statistically significant positive correlation between the dose of radiation and the probability of developing HPT. After doses of 14 Gy (1400 rad) or more 29% of the subjects had developed HPT. After neck irradiation women had twice the relative risk of men of developing HPT. This sex ratio was lower than in the series of nonirradiated HPT patients treated at the same institution during the time of the follow-up study.

Irradiation as an etiologic factor in tumours of the thyroid, parathyroid and salivary glands.

Irradiation to the head and neck region, usually of low dosage, results in an increased frequency of thyroid, parathyroid and salivary gland tumours. The authors have reviewed their experience with these tumours. Fifty of 475 patients with carcinoma of the thyroid had received previous irradiation. Papillary or mixed papillar-follicular carcinoma occurred most commonly. Eleven of 100 patients with primary hyperparathyroidism had been irradiated and had a parathyroid adenoma. Twenty of 662 patients with salivary gland tumours had previously been irradiated. Mucoepidermoid carcinoma was the most common tumour. Patients who have been irradiated and have a palpable abnormality of the thyroid or the salivary glands should be treated surgically. The various noninvasive tests are of little value in distinguishing between a benign and a malignant tumour. Those with hypercalcemia, considered to be due to primary hyperparathyroidism, should be treated by exploration of the neck, identification of the four parathyroid glands and excision of an adenoma with biopsy of the three remaining glands. If more than one gland is abnormal, a subtotal parathyroidectomy is recommended.

Hyperparathyroidism in persons treated with X-rays for tuberculous cervical adenitis.

Follow-up examinations of one hundred persons treated with x-rays for tuberculous adenitis between 1930 and 1946 have been carried out to determine if there is an increased incidence of hyperparathyroidism (HPT) after radiation exposure. Neck explorations were done in patients with hypercalcemia and signs and symptoms compatible with HPT. Individuals with thyroid masses were also operated upon when examination of fine needle specimens gave suspicions of malignancy. Eleven subjects were found to have developed parathyroid adenoma or hyperplasia. Four other individuals have hypercalcaemia but are asymptomatic. The mean absorbed dose in the parthyroid glands varied between 75 and 2,200 rads. Six individuals received more than 1,200 rads; four of them later developed HPT, while no HPT occurred below a dose of 300 rads. The high incidence of HPT among patients who had been heavily exposed to radiation suggests a cause and effect relationship between radiation treatment and development of HPT.

[Radiation associated cancers among head and neck cancer patients].

During a 31-year old period from 1953 to 1983, 2533 patients with head and neck cancers reported to our clinic. There were 16 cases among them of second malignant cancers who were irradiated previously to the benign head and neck lesions. There were also 146 cases of multiple primary cancers including 17 multiple primary intraoral cancer patients and 46 cases of radiation associated cancers. Forty-six radiation associated cancers included three histologically confirmed radiation induced cancers and three histologically confirmed late recurrent cancers.

Radiation-induced cancers of the head and neck region.

A total of 65 patients with radiation-induced cancers of the head and neck region were treated and evaluated. The primary disease for which the radiotherapy had been applied was benign disease in 48 patients (including tuberculous lymphadenitis in 39 patients), and malignant tumors in 17 patients (including 9 laryngeal cancers and 5 thyroid cancers). The radiation-induced cancers included 35 cases of hypopharyngeal cancer, 15 of thyroid cancer, and 13 of cervical esophageal cancer. The mean duration from radiotherapy until the diagnosis of cancer was 12.8 years in the patients with malignant primary tumor and 32.9 years in those with benign primary diseases. Most of the patients underwent surgery for their cancer. The clinical course was poor and the outcome extremely poor, especially in those patients with field carcinogenesis. It is emphasized that excessively high dosage and wide radiation field should be avoided, and that radiotherapy for young patients with malignancies requires extremely careful management.

Radiation-induced laryngeal angiosarcoma after cervical tuberculosis and squamous cell carcinoma: case report and review of the literature.

Primary laryngeal angiosarcoma (LA) is quite rare with only 13 cases reported in English literature to date. A case of LA after radiation therapy for tuberculosis and squamous cell carcinoma is reported. A 70-year-old woman had a history of radiation therapy for left cervical tuberculosis at the age of 28. At 60 years of age a squamous cell carcinoma of the larynx was found and chemotherapy and radiotherapy, consisting of a total dose of 68.4 Gy, were administered. At the age of 68, recurrent squamous cell carcinoma was suspected from several biopsies, and a total laryngectomy with right thyroidectomy was performed. The tumor cells formed vascular spaces and expressed some endothelial markers, such as CD34, CD31, and Ulex europaeus agglutinin I, but no epithelial markers, such as cytokeratins or epithelial membrane antigen. No residual squamous cell carcinoma was found. In the present case, it was suspected that irradiation to the larynx for cervical tuberculosis and squamous cell carcinoma induced angiosarcoma. The patient was still alive despite multiple skin and soft tissue metastasis 3 years and 6 months after the radical operation. Distinction of postirradiation angiosarcoma from pseudoangiosarcomatous carcinoma seems difficult but is important because irradiation is not effective and an initial radical surgery is the only effective treatment. Although irradiation is a common treatment for laryngeal squamous cell carcinoma, this is only the second case of radiation-induced LA in English literature.

[Development of a thyroid carcinoma after irradiation of the head/neck region]. / Entwicklung eines Schilddrüsenkarzinoms nach Bestrahlung des Kopf-/Halsbereiches.

HISTORY AND CLINICAL FINDINGS: A 73-year-old woman was hospitalised because of increasing dyspnoea and hoarseness after a bout of acute tracheobronchitis. She had been receiving levothyroxine for a growing grade III nodular goitre. At the ages of 26 and 29 she had been treated for cervical lymph node tuberculosis with local excision and percutaneous radiotherapy of 8 Gy each time. On examination she was found to have a bulging neck profile and a hard, practically immobile node in the left lobe of the thyroid. INVESTIGATIONS: Laboratory tests showed a euthyroid metabolic state, while ultrasound demonstrated a mass. 40 mm in diameter, scintigraphically a cold nodule. A fine-needle biopsy was cytologically highly suspicious of neoplasm. TREATMENT AND COURSE: Surgical exploration of the neck and mediastinum revealed an insular follicular carcinoma (10 cm in diameter), involving the right recurrent laryngeal nerve and surrounding the brachiocephalic trunk. The latter had to be removed and a Gore-Tex graft was interposed. Postoperative radiotherapy was given (150 mCurie I131). CONCLUSION: An enlarging nodular goitre, occurring after a latent period of years following radiotherapy to the neck region for benign and (or) malignant disease, especially when it had been administered in childhood or young adulthood, should raise the suspicion of a radiogenic thyroid carcinoma. Definitive diagnosis by fine-needle biopsy is essential.