Phosphaturic mesenchymal tumors are rare neoplasms predominantly originating in the trunk and extremities. Malignant variants are exceedingly rare, and can present significant diagnostic challenges to the pathologist and otolaryngologist alike. This report describes the first case of malignant phosphaturic mesenchymal tumor involving the larynx, and emphasizes the importance of vigilance in both histopathologic and clinical actions so that appropriate treatment can be provided in a timely manner. The clinical presentation, radiologic and histologic features, and management are discussed.
The clinical and pathologic features of ten mammary sarcomas are discussed. Tumor size, contour, degree of cellular atypia, and mitotic activity were specifically evaluated to determine if they are important indiced of clinical behavior. Results indicate that infiltrating margins, 2-3+ stromal atypia, and eight or more mitoses per 10 HPF are characteristics of neoplasms associated with a poor prognosis. Tumor size was an unreliable criterion. A classification of breast sarcomas is presented with an appeal to avoid use of the term "stromal sarcoma" as a specific pathologic diagnosis. Since a diagnosis based upon cell of origin and correlated with the above morphologic features is fundamental to an intelligent therapeutic approach to this rare group of neoplasms, future reports dealing with this subject should include these details.
Verruca vulgaris of the larynx (VVL) is a distinctly uncommon lesion related to the human papillomavirus (HPV). The clinical and pathologic features of a case involving the true vocal cords of a 37-year-old woman are presented and compared with the seven cases previously reported in the English language literature. Papillomavirus capsid antigen was detected in the excised tissue on immunostaining, and viral particles were seen by electron microscopy. In situ hybridization with biotinylated DNA probes clearly demonstrated HPV types 6/11. To our knowledge, this is the first case of VVL in which the virus associated with VVL has been genotyped. The results were unexpected because verruca vulgaris of the skin, lips, and oral cavity is associated with HPV types 2 and 4. This implies that verruca vulgaris can be caused by HPV types other than 2 and 4. In addition, since HPV types 6 and 11 are also the same genotypes associated with multiple papillomatosis of the larynx, it further indicates that VVL is virologically more related to multiple papillomatosis of the larynx than to its counterpart on the skin, lips, and oral cavity. The clinical and pathologic features that distinguish VVL from other similar lesions of the larynx are also discussed.
A case of squamous cell carcinoma of the tongue arose in the plaque form of oral lichen planus. The literature on lichen planus is reviewed with emphasis on the issue of malignant transformation. Squamous carcinoma develops in 0.3% to 3% of patients with oral lichen planus (range, 0% to 10%). The average age of individuals with this complication is 50 to 55 years; 50% to 60% are men. Forty-four percent to 60% of patients have the erosive form of the disease, 28% to 34% plaque type, and 16% to 28% reticular. The mean interval from onset of the oral lesions to the development of cancer is nine to 12 years (range, three months to 40 years). Forty-six percent to 54% of the cancers occur on the buccal mucosa, 30% on the tongue, 16% on the lower lip, and 8% in miscellaneous sites. Twenty-four percent to 50% of the individuals also have cutaneous lichen planus.
Well-differentiated neuroendocrine carcinoma (also known as "carcinoid") of the larynx is an exceedingly rare tumor that has an epithelial origin. These tumors are malignant and have a low, but definite, risk of metastasis. Although it can be challenging, this tumor should be differentiated from moderately differentiated neuroendocrine carcinoma (also known as "atypical carcinoid"). The clinical and pathologic features of this tumor, as well as treatment and prognosis, are reviewed in detail.
Neural cell adhesion molecules (N-CAMs) are expressed in neuromuscular tissues, neuroblastoma, and small cell lung carcinoma. Adenoid cystic carcinoma may invade the skull by either direct extension or neural involvement, particularly along the second and third divisions of the trigeminal nerve (V2 and V3). Eighteen patients with adenoid cystic carcinoma that invaded the skull base were studied. The tumors were graded into predominantly solid (3), cribriform (11), or tubular-trabecular (4) patterns, and neural involvement was evaluated histologically. Paraffin sections were examined by use of monoclonal antibodies for N-CAM and Ki-67, a proliferation marker, with the avidin-biotin-peroxidase method. Fifteen (83%) tumors showed perineural involvement; in the remaining three cases no nerves were present for histologic examination. Fourteen (93%) of 15 tumors with perineural involvement were reactive with N-CAM. Proliferation, measured by the presence of nuclear Ki-67, was markedly increased in tumors with predominantly solid patterns. We demonstrated that N-CAM is expressed in adenoid cystic carcinoma. The role of N-CAM as a neurodeterminant that facilitates the spread of adenoid cystic carcinoma along nerves, however, remains unanswered and warrants further study.
thoughts first. Or maybe He just wanted to hear what the man had to say. The lawyer answered brilliantly: You shall love the Lord your God with all your heart, and with all your soul, and with all your strength, and with all your mind; and your neighbor as yourself (10:27). What do you do when someone who is in error about many things in his life answers a question correctly? Should you look for a minor error to bring up so that those around will not see you as sanctioning the false teacher? Do you admit he is right about that but quickly point to all the things he is wrong about? Do you say, You are speaking the truth, but we both know you really dont believe or practice what you said? Let us take our cue from Jesus. He told the man he was correct in what he said: Do this, and you will live (10:28). We say, But wait, Lord, what about all the other things the man needs to do? If a person loves God and his neighbor, he will submit to God in all the other areas of his life. After all, Jesus said, If you love Me, keep My commandments. Most of the difficulties of interpretation on difficult Scriptures could be solved quickly if the beginning point was overwhelming love for God and each other.
To determine if perineural invasion (PNI) of small nerves affects the outcome of patients with squamous cell carcinoma (SCC) of the upper aerodigestive tract.Retrospective clinicopathological study of patients with at least 2 years of follow-up and with negative margins and no prior, synchronous, or metachronous SCC.Academic otolaryngology department.One hundred forty-two patients who had SCC of the oral cavity, oropharynx and hypopharynx, or larynx resected between 1981 and 1991.Surgery with or without adjuvant therapy.Local recurrence was examined with respect to PNI, nerve diameter, and microvascular or microlymphatic invasion. Perineural invasion was correlated with lymph node metastasis, extracapsular spread, and survival.Perineural invasion of nerves less than 1 mm in diameter was present in 74 patients, lymphatic invasion in 53, and vascular invasion in 9. Perineural invasion was significantly associated with local recurrence (23% for PNI vs 9% for no PNI; P=. 02), and disease-specific mortality (54% mortality for PNI vs 25% for no PNI; P<.001). With extralaryngeal tumors, PNI was associated with nodal metastasis (73% vs 46%; P=.03). Perineural invasion was not associated with extracapsular spread (P=.47). Microvascular invasion, lymphatic invasion, and nerve diameter were not significantly related to local recurrence.Perineural invasion of small nerves is associated with an increased risk of local recurrence and cervical metastasis and is, independent of extracapsular spread, a predictor of survival for patients with SCC of the upper aerodigestive tract.
Abstract The clinical, light, and ultrastructural features of a myoepithelioma occurring on the hard palate of a 24‐year‐old woman are presented and compared with 41 myoepitheliomas of the head and neck described in the English literature. These 42 tumors (39 benign and 3 malignant) occurred in individuals from 14 to 81 years of age, affected both sexes about equally, and most often presented as a slowly enlarging, asymptomatic mass. The parotid gland and palate were the most common sites of occurrence. The tumors are typically circumscribed and encapsulated, vary from 1 to 5 cm in the greatest dimension, and are composed of spindled and/or plasmacytoid myoepithelial cells. Prognosis correlates with histologic appearance and parallels that of the pleomorphic adenoma. Conservative excision with a margin of uninvolved tissue is curative. The differential diagnosis and histogenetic relationship with other closely related neoplasms are discussed.
