Christian Micheau

Elective versus therapeutic radical neck dissection in epidermoid carcinoma of the oral. Cavity results of a randomized clinical trial

This study concerns 75 patients with squamous cell carcinoma of the oral cavity who were patients at the Gustave‐Roussy Institute between December 1966 and July 1973. These patients were divided into two groups. The first group was comprised of 39 patients who underwent elective radical neck dissection; nodal involvement was present in 49% with capsular rupture in 13%. In the second group of 36, neck disease appeared during follow up in 19 cases. Therapeutic radical neck dissection was carried out in 17; the nodes were histologically positive in 15, 9 of which had a capsular rupture. In 2 cases, local or general conditions did not permit operative intervention. In this group, the involvement rate was 47% with a 25% capsular rupture rate. However, the comparison of the survival curves by the log‐rank test did not reveal any differences, even though histologic prognostic factors were taken into account. These findings led to the conclusion that in squamous cell carcinoma of the oral cavity staged T1N0, T2N0, or T3N0 (from AJCs and UICCs clinical staging system), it seems possible, without risk, to delay neck dissection until a node is detectable, although it is reasonable to perform elective neck dissection in those cases in which the patient is unavailable for regular followup.

Prognostic factors in cervical lymph node metastasis in upper respiratory and digestive tract carcinomas: study of 1,713 cases during a 15-year period.

A prospective study of 1,713 patients with squamous cell carcinoma of the head and neck submitted to neck dissection between 1957 and 1973 is presented.

Relationship between laryngoceles and laryngeal carcinomas.

Because X‐ray evaluation of the larynx is an unreliable method of detecting laryngoceles, a study based on the systematic measurement of the ventricular depth in surgical specimens was carried out to determine the frequency of laryngoceles and their relationship to laryngeal carcinomas. The frequency of laryngoceles was found to be about 2% in the normal larynx. The frequency in laryngeal cancer specimens was about 18%. This difference demonstrated the role of cancer in the genesis of laryngoceles. A close relationship between the ventricular diverticuli and the tumors was observed on microscopic examination in half of the laryngeal carcinomas associated with laryngoceles. These carcinomas can be considered to have developed on the laryngoceles. Depending upon the degree of tumor spread and the number of laryngoceles involved, different types of carcinoma developing in laryngoceles can be recognized. This particular form of tumor can be misinterpreted as an ulcerated vestibular tumor, in which case inappropriate treatment may be tried.

Cystic metastases in the neck revealing occult carcinoma of the tonsil. A report of six cases

This study deals with a peculiar aspect of lymph node metastases observed in 6 patients with carcinoma of the tonsil. These metastases preceded the occurrence of the primary tumor. The metastases were solitary and consisted of a cystic, ovoid, and regular mass in the upper part of the neck. They exhibited the usual appearance of branchial cysts. The microscopic examination revealed in every case poorly differentiated carcinomas with the pattern of an amygdaloid cyst. As a result, the neck tumor was misinterpreted in five cases and the diagnoses were branchial cyst, amygdaloid cyst, cyst with carcinomatous change, and epidermoid cyst. For the sixth patient, the occult tonsillar carcinoma was discovered from the peculiar appearance of the neck metastasis. The authors discuss the clinical and pathologic features of these metastases.

Pitfalls in microscopic diagnosis of undifferentiate carcinoma of nasopharyngeal type (lymphoepithelioma)

Isolated cervical lymph node metastases from undifferentiated carcinoma of nasopharyngeal type (UCNT) or lymphoepithelioma (LE) pathologically may be mistaken for malignant lymphomas. The case histories of four patients in whom metastatic UCNT in lymph nodes pathologically simulated Hodgkins disease (HD) and other non epithelial malignancies are reported. Initial lymph node biopsies showed a cellular and architectural context suggestive of HD in three cases. “Lacunar” cells were seen associated with fibrosis and numerous eosinophils in Case 1; cells indistinguishable from diagnostic Reed‐Sternberg cells were recognized in Case 4. Case 3 showed some additional features suggestive of malignant histiocytosis. Subsequent biopsies revealed a primary UCNT of the nasopharynx (Case 1) and typical UCNT lymph node metastases (Cases 3 and 4). In Case 2, an immunoblastic lymphoma and a spindle cell sarcoma, respectively, were mimicked by consecutive lymph node metastases. A primary UCNT of palatine tonsil was found five years later. This report emphasizes that deceptive features of metastatic UCNT in lymph nodes may produce serious difficulties in the correct recognition of the tumor on pure histologic grounds. In order to minimize the possibility of misdiagnosis, additional cytochemical, immunohistochemical and serologic studies should be considered, especially when a young patient presents with spinal or infraclavicular lymphadenopathies and no lesion is evident in the nasopharynx.

Modes of invasion of cancer of the larynx. A statistical, histological, and radioclinical analysis of 120 cases.

A statistical comparison between histologic and radioclinical data was performed on a series of 120 cases of total laryngectomies in order to study the modes of invasion of laryngeal cancer and to quantify the differences of results as evaluated by pathological and by clinical examinations. The first part of this study deals with the spread of cancer depending on its site of origin; the second part examines spread regardless of the primary location of the laryngeal tumor. The comparative results show that it was difficult to determine the deep invasion of structures such as the preepiglottic space and the cartilages from the radio‐clinical examination, especially in cases of cancer developed on a laryngocele. This study emphazises the importance of the histological examination of laryngeal specimens as described here in order to codify the modes of invasion and, as a result, to help the otorhinolarynglologist in the choice of the best treatment.

So-called branchiogenic carcinoma is actually cystic metastases in the neck from a tonsillar primary

In 1974, we reported on six patients with squamous cell carcinoma arising in the tonsillar area who presented with a characteristic form of cystic nodal metastasis.

A new histochemical and biochemical approach to olfactory esthesioneuroma. A nasal tumor of neural crest origin

A close collaboration between E.N.T. surgeons and pathologists permitted us to obtain 6 cases of olfactory esthesioneuroma in which fresh tumor tissue was available. Histochemical and biochemical studies were made in comparison with neuroblastoma. Different reactions and assays performed revealed a similarity with sympathetic tumors. Moreover, the presence of catecholamines in esthesioneuroma provides a great help in diagnostic as does electron microscope examination. 40:314–318, 1977.

A cytochemical and immunohistochemical approach to malignant histiocytosis

Malignant histiocytosis (MH) is a true histiocytic disorder, whose identification is still based on too broad morphologic criteria. Using routine histology, cytochemical and immunohistochemical techniques on involved lymph nodes, 15 cases of MH have been investigated. Pleomorphism and cellular atypia, phagocytosis, lack of cohesiveness between proliferating cells, sinusoidal involvement, and plasmacytic infiltrate were the most common histologic features. MGG‐stained imprints from 14 cases showed a composite tumor population mainly consisting of histiocyte‐appearing cells, poorly differentiated atypical cells, and multinucleated giant cells. These cells, irrespective of cytologic features, revealed a diffuse, moderately to strongly positive reaction with acid phosphatase and nonspecific esterase. Naphtol‐AS‐D‐chloroacetate esterase, Sudan black B, alkaline phosphatase, and β‐glucuronidase reactions were completely negative. Immunoperoxidase studies in 11 cases demonstrated that tumor cells stained positively for both kappa and lambda chains. These cells were also positive for albumin. Polytypic staining for IgG was observed in two cases, and a weak staining for lysozyme was found in two other nodes. Global results confirm the value of these studies for functional profile determination of MH proliferating cells. A combined approach using a variety of cytochemical and immunohistochemical techniques should be routinely considered in MH as useful additional studies for a more precise diagnostic definition of the disease.

Dopamine-B-hydroxylase and catecholamines in an olfactory esthesioneuroma.

In a case of olfactory esthesioneuroma, of which an unfixed specimen and blood sample were available, we demonstrated immunohistochemically and biochemically the presence of dopamine‐B‐hydroxylase and catecholamines in low concentration. This result indicates that this nasal tumor is probably of sympathetic origin, in whole or in part, and provides a new aid in diagnosis. Furthermore, biochemical assay of dopamine, V.M.A., and H.V.A. excretion in urine could perhaps bring information of diagnostic and prognostic value before and after treatment.