C.-M. Eneroth

Adenoid Cystic Carcinoma of the Palate

A histological re-classification of 383 tumours primary in the palate showed an adenoid cystic carcinoma in 37 cases. The relative incidence of this type of tumour is considerably higher in the palate than in the submandibular and parotid glands. A distinct difference is present between the prognosis in tumours at these three sites. Thus, the prognosis is best when the adenoid cystic carcinoma is located to the palate, and worst when it is located to the submandibular gland. The 37 adenoid cystic carcinomas of the palate were divided into two histologically characteristic types of differentiation: one with predominance of the cribriform component, and one with predominance of the solid component. A long-term clinical follow-up study disclosed a much better prognosis in tumours with predominance of the cribriform component, as compared to the extremely poor prognosis in tumours with predominance of the solid component. It is pointed out that a histological grading of adenoid cystic carcinoma into high-grad...

Aspiration Biopsy of Salivary Gland Tumours: I. Correlation of Cytologic Reports from 652 Aspiration Biopsies with Clinical and Histologic Findings

Critical analysis of cytologic reports from aspiration biopsy of salivary glands in 652 cases showed that positive diagnosis had been made in 92 per cent of the cases with tumour. In 8 per cent of cases the cytologic method can be expected to give false negative reports concerning tumour. The possibility of false positive tumour diagnosis can be disregarded, however, if the cytologist is fully familiar with the morphology of salivary gland cells in various pathologic conditions. Recognition of the malignancy of salivary gland tumours by cytologic technique is discussed and also the possible risk of local or distant spread of tumour following aspiration biopsy.

Cytologic Diagnosis on Aspirate from 1000 Salivary-Gland Tumours

Cytologic reports from aspiration biopsy in 1000 salivary gland lesions have been compared with clinical and histological observations.The cytologic reports on the aspirated material yielded a positive tumour diagnosis in roughly 92% of the cases with histologically verified tumours. In addition to simple confirmation of tumour presence information concerning the histologic type of tumour was obtained in about 70% of the material. The main reason for this lower figure was difficulty in recognizing cystadenolymphoma and the malignant variants of the salivary gland tumours. After a morphologic study of smears from cystadenolymphoma we have been able to increase our accuracy in diagnosing this type of tumour. The possibility of recognition of the malignant salivary gland tumours by cytologic technique is discussed.

Histological Malignancy Grading Of Squamous Cell Carcinoma Of The Palate

The histological point system grading of malignancy applied in the present study to squamous cell carcinoma of the palate gives a considerably more accurate measure of the ultimate prognosis than the earlier used system solely based upon an estimation of the degree of the differentiation of the tumours. It seems justified to consider this type of histological evaluation as an improved basis for the choice of therapy in individual cases.

Mucosal malignant melanomas of the head and neck with special reference to cases having a prolonged clinical course.

A histological re-examination and re-classification of primary mucosal tumours of the head and neck region, treated at Radiumhemmet and Karolinska Sjukhuset during the period 1927-1970, revealed that 41 tumours were malignant melanomas. All these 41 tumours were located in the nasal cavity, paranasal sinuses and oral cavity and not a single case of primary mucosal malignant melanoma was found in other locations of the head and neck region. In the present study, the long-term prognosis has been analysed. The follow-up period was at least 5 years and ranged up to 48 years. It was found that mucosal malignant melanomas had a very poor prognosis with a five year survival rate of 17% (7 of the total 41 cases) and a ten year survival rate of 7% (3 of the total of 41 cases). The unpredictability of the clinical behaviour of this tumour type is elucidated by cases with a prolonged clinical course despite a primary relatively limited surgery, repeated local recurrences and regional lymph node metastases in an early stage of the disease. Thus, there is always a never-ceasing risk of death in the tumour disease when once a malignant melanoma has occurred. For this reason a meticulous and lifelong follow-up of tumour patients is stressed, and also the value of repeated surgery of local recurrences and regional lymph node metastases.

Malignant Tumours of the Submandibular Gland

A histological reclassification of 187 primary tumours in the subman-dibular gland showed a malignant type of tumour in 62 cases. A long-term clinical follow-up study showed that the malignant submandibular tumours have a poor prognosis as compared to corresponding tumours of the parotid gland. It has been shown that adenoid cystic carcinomas can be classified into low-grade and high-grade malignant types. In rapidly growing tumours (such as epidermoid carcinoma, solid undif-ferentiated carcinoma and the high grade malignant type of adenoid cystic carcinoma) the poor prognosis is already evident from a 5-year follow-up. The present study shows that a much longer follow-up is, on the other hand, necessary to disclose the definite prognosis in the more slowly growing low grade malignant type of adenoid cystic carcinoma. In view of the high incidence of malignant tumours of the submandibular gland there is a great risk that any lump in this region may, actually, be malignant. The importance of the earliest p...

Muco-Epidermoid Carcinomas of the Salivary Glands

It has been questioned whether there is a benign variety of muco-epidermoid carcinoma (M.E.C.) with histologically highly differentiated structures. to find out whether such a definitely benign variety really exists a histological investigation was made of 23 muco-epidermoid carcinomas with a malignant course. These 23 cases were selected from 124 which, after histological reclassifica-tion of 2 867 parotid, submandibular and palate tumours, were classified as M.E.C. in 7 of the 23 cases the histological study revealed highly or moderately differentiated structures, and in 3 cases the primary tumour as well as the lymph node metastases were undoubtedly very high differentiated. These morphologically benign structures in cases with a malignant course would contradict the existence of a benign variety of M.E.C, and consequently tumours with highly differentiated structures should be denoted as carcinomas in preference to the sometimes suggested term of muco-epidermoid tumour.

The Role of the Parasympathetic and Sympathetic Inner-Vation for the Secretion of Human Parotid and Submandibular Glands

Human parotid and submandibular glands have been studied histo-chemically and ultrastructurally, with the aim to achieve a morphological basis for establishing the relative importance for salivary secretion of the parasympathetic and sympathetic nervous system. The two glands are innervated by parasympathetic and sympathetic nerves, which are, no doubt, both of functional importance. The secretion which remains after damage of the parasympathetic nerves, due to surgical trauma or pathological conditions, is in all probability mediated largely by sympathetic nervous activity.

Closure of Antro-Alveolar Fistulae

Numerous therapeutic principles and surgical techniques for the closure of antro-alveolar fistulae are described in the literature. It is, however, difficult to make any direct comparison between different methods, since only a few large series have hitherto been reported, in which the surgical technique has been uniform, and the results have been given.The present series comprises 110 cases of antro-alveolar fistulae, operated on by Rehrmanns method from 1955 until the end of September 1960. The main object of the investigation was to check the reliability of this method in a relatively large series, by thorough follow-up examination. It has been found that when the primary operation has consisted of repair of the fistula by Rehrmanns method, the results have been extremely good, i.e., primary healing has been achieved in about 94% of the cases, and definite healing in altogether about 99%. It is pointed out that this method is, in addition, more easily than others combined with radical operation on th...

Muco-Epidermoid Carcinoma of the Palate

A histological reclassification of 383 tumours in the palate showed a muco-epidermoid carcinoma in 27 cases. The relative incidence of this type of tumour is considerably higher in the minor salivary glands of the palate than in the major salivary glands. The characteristic combination of mucous-secreting cell proliferations and epidermoid differentiation is of diagnostic significance. The tissue structure of origin is present in the terminal portion of the excretory ducts of the salivary glands and it can be concluded that the muco-epidermoid carcinomas develop from the covering epithelium in these ducts. The relatively greater number of such ducts in the palate compared with the major salivary glands might explain the relatively high frequency of mucoepidermoid carcinoma of the palate. A histological grading of the muco-epidermoid carcinomas was based solely upon the cellular structure and the 27 mucoepidermoid carcinomas were divided into two histologically characteristic types of differentiation: one ...