Guidelines/algorithms of the German Society of Otorhinolaryngology, Head and Neck Surgery

Prolactin-secreting adenoma, which usually presents with amenorrhea and galactorrhea syndrome, is quite rarely diagnosed in the prepubertal age group. We reported a rare case of a prepubertal prolactin-secreting adenoma and discuss its clinical, radiological and histological features. An 8-year-old girl presented with headache, progressive visual deterioration and precocious puberty. The serum prolactin level was 57.8 ng/ml. Computerized tomography and magnetic resonance imaging revealed an invasive suprasellar tumor. The tumor was partially resected through an interhemispheric approach in a first operation, and residual tumor was resected through the right pterional approach in a second operation. The histological diagnosis was a prolactin-secreting adenoma with high cellular pleomorphism. The Ki-67 labeling index was 5.7%, indicating aggressive biological behavior. Postoperatively, the patient was prescribed bromocriptine as maintenance therapy, and the serum prolactin level became normalized. There is a tendency for diagnosis of a prepubertal prolactin-secreting adenoma to be delayed because there are no endocrinological manifestations. Therefore, the tumor tends to become larger and invasive. Although it is rarely experienced, a prolactin-secreting adenoma should be considered in the differential diagnosis of a large, invasive parasellar lesion in the prepubertal age group.     

Estimation of tumor necrosis factor-alpha in the diagnosis, the prognosis and the treatment follow-up of oral squamous cell carcinoma

This study evaluated usefulness of serum tumor necrosis factor-alpha (TNF-alpha) levels in the diagnosis and prognosis of oral squamous cell carcinoma (O-SCC). We performed a clinico-pathological estimation of 38 patients with O-SCC and determined the more valuable factors in making a prognosis. The mean serum concentration of TNF-alpha for the patients with O-SCC (14.13 +/- 13.17 pg/ml) was significantly higher (p < 0.05) than that of the healthy controls (3.49 +/- 2.97 pg/ml). The mean serum concentrations of TNF-alpha were significantly higher (p < 0.05) in the good-prognosis group (16.73 +/- 18.64 pg/ml) than in the poor-prognosis group (9.62 +/- 5.92 pg/ml). The survival curve revealed a better prognosis for patients with serum TNF-alpha-positive than for patients with serum TNF-alpha negative. There was a significant correlation (p < 0.05) with serum TNF-alpha levels and two tumor markers (SCCA, IAP). These results of the present study suggest that a evaluation of serum TNF-alpha levels in O-SCC is a valuable tool as a tumor marker for the diagnosis, prognosis and treatment monitoring of O-SCC.     

Characterization of Cu,Zn superoxide dismutase from the bathophile fish, Lampanyctus crocodilus

PURPOSE: To determine if CT scan provides morphologic criteria allowing differentiation between primary renal cell cancer of the clear type (PRCCCT) and renal metastasis (RM). MATERIALS AND METHODS: Twenty cases of PRCCCT and 20 cases of RM from various origins (excluding lymphomatous origin) were retrospectively analyzed by two independent readers. CT scans were evaluated with respect to tumor size, shape, location and number of tumors, encapsulation, contour sharpness, presence of calcification, and extrarenal involvement by tumor. RESULTS: A tumor size > 3 cm was more frequently seen in PRCCCT than in RM (100% vs 70% respectively, P < .05). Rounded shape was more frequent in PRCCCT than in RM (90% vs 50% respectively, P < .01). Encapsulation was more frequent in PRCCCT than in RM (70% vs 10%, P < .01, respectively). Calcification was depicted only in PRCCCT (35% vs 0%, P < .01). Enlarged perirenal lymph nodes were less frequent in PRCCCT than in RM (20% vs 55% respectively, P < 0.05). CONCLUSION: Results of our study show that a constellation of morphologic features suggest the diagnosis of PRCCCT rather than that of RM. Our study suggests that calcification is highly specific for the diagnosis of PRCCCT. However, percutaneous biopsy remains indicated to ascertain the diagnosis.     

Helicobacter pylori infection, gastritis, and the temperature of choice for hot drinks

A 44-year-old male presented with a solitary cerebellopontine angle (CPA) metastasis from lung cancer. His initial symptoms were vertigo and hearing loss beginning 5 months after the diagnosis of the primary cancer. Two months later, right facial paresis developed. His neurological deterioration was rapid. Magnetic resonance (MR) imaging with enhancement disclosed the CPA tumor. The tumor was partially removed through the retroauricular retromastoid approach. Histological examination of the specimen revealed adenocarcinoma. The characteristic rapidly progressive symptoms and MR imaging with enhancement are the most sensitive and essential examinations for this lesion.     

Angiosarcoma of the nasal septum

This is a report on a female patient, 37 years old, with a polypous, sessile tumor on the nasal septum covered by smooth mucous membrane. She was treated with local excision. The histological diagnosis was an angiosarcoma, confirmed by immunohistological stain with factor VIII-like antigen, thrombomodulin, and UEA. She currently remains free of the disease 12 months after diagnosis. Angiosarcoma in the head and neck area and especially the localization in the nasal septum are extremely rare. Prognosis, differential diagnosis, metastasis formation, and therapy of this tumor are presented.     

Gastrointestinal autonomic nerve tumor of the jejunum. Case report and review of the literature

Gastrointestinal autonomic nerve tumor is very rare and it is difficult to distinguish this tumor from other gastrointestinal tumors due to the absence of clinical, instrumental and macroscopic features which allow pre- or intraoperative diagnosis. Our aim was to recognize the characteristic features (preoperative, intraoperative, pathological) that would allow diagnosis of gastrointestinal autonomic nerve tumor. A case of gastrointestinal autonomic nerve tumor of the jejunum is reported. Surgical specimen was routinely processed. Immunohistochemical staining was performed according to modified immunoperoxidase Avidin-Biotin-Peroxidase Complex method. An electron microscopy study was also performed. The tumor mass showed some characteristic pathological findings: histologically, it was composed of spindle cells and epithelioid cells; immunohistochemically, a focal positivity for Neuron Specific Enolase was shown, and finally, ultrastructural examination showed neuron-like cells with long cytoplasmic processes containing microtubules and bulbouns synapse-like structures with dense core neurosecretory-type granules. Preoperatively gastrointestinal autonomic nerve tumor of the jejunum must be considered and treated as a malignant tumor. A correct diagnosis is possible only with immunohistochemical and ultrastructural studies. It is probable that this tumor is more common than previously thought.     

Surgical treatment of right atrial papillary fibroelastoma, originated from the eustachian valve--a case report

Papillary fibroelastoma is one of the most common benign primary cardiac tumor after myxoma. However, it is rare to originate from Eustachian valve. A 44-year-old woman was pointed out the right atrial tumor during admission for vasospastic angina. On two-dimensional echocardiogram, the tumor was found in the right atrium, and easily moved to the right ventricle. At operation, the tumor originated from Eustachian valve, and was resected together with the valve by means of extracorporeal circulation. The size of tumor was 57 mm in length, and the histological diagnosis was papillary fibroleastoma. The post-operative course was uneventful.     

Plasma-cell granuloma of the mediastinum]

Elastofibroma dorsi is a benign soft-tissue tumor. Its sub- and pre-scapular location and its appearance on CT and MRI generally lead to the diagnosis. We have analyzed with sonography 6 elastofibromas in 4 patients; the diagnosis was confirmed with CT scan or MRI. Some sonography imaging features supported the diagnosis of elastofibroma dorsi. In all the cases, (1) the tumor occurred typically in a sub- and pre-scapular location, and (2) showed a streaky echostructure (3). A similar symptomatic or asymptomatic mass in the opposite subscapular location is highly suggestive.     

A description of age, sex, and site distributions of colon carcinoma in three geographic areas

BACKGROUND: Site of the carcinoma within the colon in relation to age and sex may provide clues into the etiology of the disease. Incidence of colon carcinoma by age, sex, and tumor site at a population-based level are reported infrequently. The goal of this study was to describe the distribution of colon carcinoma (excluding cancers of the rectosigmoid junction and rectum) by age at diagnosis, sex, and site of the tumor within the colon. These factors were also evaluated in conjunction with disease stage at the time of diagnosis. METHODS: Data from three geographically distinct populations were used to describe rates of colon carcinoma and the distribution of tumors by age, tumor site, and stage at diagnosis. All colon carcinoma cases diagnosed within a 3-year period within the areas are included. RESULTS: Approximately 50% of all cancers in men and greater than 50% of cancers in women were in the proximal segment of the colon. Men who were diagnosed prior to age 50 and both men and women diagnosed at age 70 or older had predominantly proximal cancers. People with proximal cancers and people diagnosed prior to age 50 were more likely to have more advanced disease. CONCLUSIONS: Both men and women have more proximal cancers with advancing age, which are associated with more advanced disease. Observed trends in cancer site distributions could reflect screening practices, environmental and genetic factors, or a combination of these variables.     

Preoperative approach to the histologic diagnosis of cerebral tumors by combination of clinical and paraclinical examinations (EEG, computerized cerebral tomography, scintigraphy, and angiography)

The authors present their last series of one hundred operated cerebral tumors (19 meningiomas, 16 benign gliomas, 38 malignant gliomas, 20 isolated metastasis, 8 diversified tumors) studied on the clinical, E.E.G., isotopic scanner, computorized tomographies and angiographic point of view. The comparison of these multiple exams, permits one to determinate the malignant of benign nature of a tumor in 86 p. 100 of the cases and the precise histological nature in 56 p. 100 of the cases. The biopsy effectuated in stereotaxic conditions permits to solve the problem in uncertain cases. The interest of computorized tomography is emphasized (discovery or confirmation of a suspected tumor, definition of its extension in depth), but this recent technic is incapable of constant confirmation of the histological diagnosis; it cannot replace other confirmed methods of diagnosis. The angiography remains necessary to guide the surgical gesture.     

Race/ethnicity, social class, and prevalence of breast cancer prognostic biomarkers: a study of white, black, and Asian women in the San Francisco bay area

We assessed distributions of breast cancer prognostic biomarkers by race/ethnicity and socioeconomic position among paraffin-embedded tumor biopsy specimens from 135 US women (48 white women, 44 black women, 43 Asian women) diagnosed with breast cancer between 1966 and 1990. No racial/ethnic or socioeconomic differences in distributions were observed for tumor stage, lymph node involvement, estrogen, progesterone, and epidermal growth factor receptors, oncogenes such as Her2/neu and p53, cytoplasmic proteins cathepsin-D and ps2, and two indices of cell growth, Ki67 and DNA ploidy, adjusting for age at diagnosis, menopausal status, place of birth and, for racial/ethnic comparisons, working class composition of census block-group at diagnosis. Black and Asian women, however, were 3.5 times (95% confidence interval [CI] = 1.2, 10.1) and 3.7 times (95% CI = 1.3, 10.6), respectively more likely than white women to have a tumor size of > or = 20 mm, and Asian women were 3.4 times (95% CI = 1.1, 10.4) more likely than black women to be positive for androgen receptor, adjusting for these same factors. No differences in distributions by socioeconomic position were observed for these latter two tumor characteristics. These data suggest that racial/ethnic and socioeconomic disparities in breast cancer survival are unlikely to be explained solely by differential distributions of molecular breast cancer prognostic biomarkers.     

Magnetic resonance imaging in the diagnosis of jejunal leiomyoblastoma

We report a case of large leiomyoblastoma of the jejunum. The sagittal views in pre-operative magnetic resonance imaging (MRI) indicated that a cystic tumor with solid component was present, sequential from the small bowel. We suspected a smooth muscle tumor of the small bowel, but did not rule out the malignancy. The operative diagnosis was smooth muscle tumor of the proximal jejunum, and partial resection of the small bowel was performed. The pathological examination revealed benign leiomyoblastoma of the jejunum without metastasis. MRI contributed to the pre-operative diagnosis of the origin of this rare tumor, in a non-invasive fashion.     

Carcinoid tumor metastatic to the breast

Breast metastases from nonmammary malignant neoplasms are uncommon, accounting for approximately 2% of breast tumors. There are 13 cases reported in the literature of carcinoid tumor metastatic to the breast, and more than half of these cases were misdiagnosed pathologically and treated as primary breast carcinoma, even in cases with a medical record of carcinoid tumor. We describe a patient with a history of asthma and diarrhea who presented to the University of Arkansas for Medical Sciences, Little Rock, with an exacerbation of the asthma. The results of routine physical examination revealed a mass in the left breast. A diagnosis of carcinoid tumor metastatic to the breast was made after a partial mastectomy was performed. The differential diagnosis between primary carcinoid tumor of the breast and carcinoid tumor metastatic to the breast is often controversial in surgical pathology. Diagnoses need to be made correlating clinical and histological examination in difficult cases in which there is not a diagnosis of carcinoid tumor elsewhere. Accurate diagnosis of breast metastases is important to avoid unnecessary treatment.     

Perceptions of the oldest hearing child of deaf parents. On interpreting, communication, feelings, and role reversal

The infectious routes and etiologies of 26 cases with pyogenic liver abscess were portal spread in one, hematogenous in three, biliary in 12, transarterial embolization (TAE) in three, posthepatectomy in one and cryptogenic in five cases. Portal and hematogenous cases tend to show solitary and cystic pattern on echogram, and the majority of the bacteria detected was Klebsiella. While most biliary cases show multiple and cystic with tumor pattern on echogram, and an unhomogeneous low density in CT feature, anaerobic bacteria and candida were isolated only from the biliary or TAE cases. Most cases could be cured completely by the various kinds of abscess drainage, but two TAE cases with PTAD (percutaneous transhepatic abscess drainage) and two biliary cases with PTBD (PT-biliary drainage) and PTAD died due to a delay in establishing a diagnosis and to the severity of the condition. An early diagnosis followed by PTAD or PTBD were thought to be of prime importance.     

Solid and papillary epithelial neoplasm of the pancreas, diagnosis by cytology

In this paper, I report a rare, low-grade malignant tumor, solid and papillary epithelial neoplasm of the pancreas (SPENP). I also discuss and review 157 previously reported cases. Unlike other malignant tumors of the pancreas, this neoplasm is typically found in young women, does not have metastases, and is amenable to cure after complete surgical resection. I discuss clinical features, diagnostic procedures, and differential diagnosis. Fine-needle aspiration can be effective in obtaining a preoperative diagnosis of SPENP, since the tumor has characteristic cytologic features. Also, use of clinical data, ultrasonography studies, computed tomography, magnetic resonance imaging, arteriography, and cytologic findings in the preoperative workup are important in obtaining an accurate diagnosis. Although potentially curable, late metastases and current inability to predict aggressive behavior by some tumors require lengthy follow-up.     

Primary, pure, large-cell neuroendocrine carcinoma of the urinary bladder

We report what to our knowledge is the first case in the English-language literature of a primary, pure, undifferentiated large-cell neuroendocrine carcinoma of the urinary bladder. To date, only one case of a large-cell neuroendocrine carcinoma was reported, and it was associated with an adenocarcinoma most likely of urachal origin. On the other hand, slightly more than 100 cases of undifferentiated small-cell carcinoma of the urinary bladder were reported, approximately one-half of which were associated with poorly differentiated transitional-cell carcinoma of the conventional type. The patient in our case was a 73-year-old man with a history of prostatic cancer treated with radiation therapy. He presented with hematuria, leading to the discovery of a solitary tumor on the dorsal wall of the urinary bladder. A diagnosis of large-cell neuroendocrine carcinoma was made, supported by immunohistochemical reactivity for chromogranin, neuron-specific enolase, and synaptophysin; a variety of other hormonal markers of neuroendocrine tumors were negative. The radical cystoprostatectomy and bilateral pelvic lymphadenectomy specimen showed a transmurally invasive tumor, without regional lymph node metastases. The patient died 2 months after surgery, and the autopsy revealed disseminated metastases histologically identical to the urinary bladder neoplasm. Awareness of the occurrence of large-cell neuroendocrine carcinoma of the urinary bladder seems to be important because of the possible aggressive outcome associated with this tumor and because of differential diagnostic considerations, which include malignant lymphoma and metastasis from another primary, especially in tumors occurring in a pure form.     

A cytogenetic deletion, del(17)(q11.22q21.1), in a patient with sporadic neurofibromatosis type 1 (NF1) associated with dysmorphism and developmental delay

Pure primary ovarian carcinoid tumors are uncommon and only 21 cases have been recorded in the literature. In the past 15 years, we have seen two cases. One was a strumal carcinoid and the other, the case presented here, was a primary ovarian carcinoid tumor arising from the left ovary of a 25-year-old woman who had no carcinoid syndrome. The tumor was made up of pure carcinoid tumor without other teratomatous elements. On light microscopy the neoplasm, composed of uniform tumor cells, was arranged in solid nests or a trabecular pattern. The differential diagnosis included granulosa cell tumor. However, the strongly argyrophilic, chromogranin staining and ultrastructural presence of neurosecretory granules confirmed the diagnosis of primary ovarian carcinoid tumor. After a careful survey of the contralateral ovary and the gastrointestinal tract, the patient underwent a left oophorectomy. Her postoperative course was uneventful. The literature and the pathologic findings are reviewed and discussed, along with the differential diagnosis and treatment of primary ovarian carcinoid tumor.     

Clinical course, diagnosis and treatment of ovarian tumors and cysts in children

The experience of diagnosis and treatment of the ovarial tumor and cyst in 68 girls was summarized. Children were admitted to the hospital with an acute abdomen signs and in a planned order as well. All the patients were operated on. Children with benign ovarial tumor and cyst are alive. Four patients with malignancy have died.     

A comparison of reagent strips and the refractometer for measurement of urine specific gravity in hospitalized children

OBJECTIVE: To describe a case of Leydig cell tumor of the testis, discuss the criteria for determining its benign or malignant nature and the clinical features according to patient age and the hormone profile. METHODS/RESULTS: Scrotal US evaluation for an associated pathology incidentally detected a hypoechoic, homogeneous mass with preserved borders. Biological testicular tumor markers were determined and the suspicion of a Leydig cell tumor prompted a hormone study. The diagnosis of Leydig cell tumor was confirmed by intraoperative biopsy and radical orchidectomy was performed. CONCLUSION: In the case described, the ultrasound findings prompted the etiological diagnosis given the characteristics of the lesion. The definitive diagnosis was based on the pathological findings. Although classified as benign Leydig cell tumor, radical orchidectomy is advocated.     

Thyroid cancers. II. Medullary, anaplastic, lymphoma, sarcoma, squamous cell

Medullary thyroid carcinoma in both sporadic and familial forms is a curable disease if detected early and treated by the proper surgery. The advent of genetic screening for the RET protooncogene portends great promise in the earlier diagnosis and treatment of familial forms of MTC. New chemotherapy protocols have produced some tumor regression in patients with metastatic MTC. Improved use of Adriamycin and hyper-fractionated radiotherapy combined with debulking procedures has prolonged survival in anaplastic thyroid cancer. Thyroid gland lymphoma, if diagnosed early and treated by combined chemoradiotherapy, carries a good prognosis for survival. The best treatment for thyroid sarcomas and SCC of the thyroid is early diagnosis and aggressive surgery combined with radiotherapy.