J. Olofsson

Adenocarcinoma of the ethmoid sinuses. A review of 28 cases with special reference to wood dust exposure

Adenocarcinoma makes up only a small percent of all nasal and paranasal sinus carcinomas, and is most often found in the ethmoid sinuses. Adenocarcinoma of the ethmoid sinuses is known to be associated with exposure to wood dust. Twenty‐eight patients with ethmoid adenocarcinomas were collected, mainly during the last decade from a region with approximately 900,000 inhabitants and with a large amount of furniture industries. There were 4 women and 24 men in the study. Twenty of the men were exposed to dust from hardwood for 20 to 55 years (mean, 40 years) which is in accord with other reports and supports data on the increased risk for workers of developing adenocarcinoma of the ethmoid sinuses when exposed to dust from hardwood. Radiologic diagnosis is necessary to delineate the extent of these tumours, and computerized tomography (CT) especially furnishes important information. Most patients received preoperative radiotherapy followed by surgery, 50% of them survived 5 years, which is in accord with other reports.

DNA content, malignancy grading and prognosis in T1 and T2 oral cavity carcinomas.

Microscopic malignancy grading using the 8-factor system proposed by Jakobsson et al. (1973), the 4-factor system set up by Glanz and Eichhorn (1985), and DNA cytofluorometry were applied to thirteen T1 and thirty-seven T2 squamous cell carcinomas of the oral cavity, 9 with and 41 without metastases. There was a significant correlation between the presence of lymph node metastases (N1) and the malignancy scores (P less than 0.05) and tumour DNA ploidy (P less than 0.01, chi-square). The total number of patients with initial and late lymph node metastases correlated significantly with polyploid nuclei (P less than 0.05) and with malignancy scores (P less than 0.001), which also correlated with regional recurrences (P less than 0.01, chi-square). No remaining tumour after preoperative radiotherapy indicated less risk for local recurrence than if tumour persisted (P less than 0.01, chi-square). The cumulative survival (Kaplan-Meier) was worse for patients with nodal involvement (N1) than for those without (N0) (P less than 0.01), and for patients with poorly differentiated tumours compared with moderately well differentiated (P less than 0.05) and to well differentiated (P less than 0.001). The prognosis was worse for patients with high malignancy scores than those with low (P less than 0.001). DNA diploid tumours had a better prognosis than DNA non-diploid, but the difference was not significant.

Adenoid cystic carcinoma of the larynx: a report of four cases and a review of the literature.

Adenoid cystic carcinoma (cylindroma) is a well‐recognized tumor that is frequently encountered in the major salivary glands, the lacrimal glands and in the minor salivary glands of the oral cavity and upper respiratory tract. Only 60 cases of adenoid cystic carcinoma have been described arising in the larynx. Four new cases are reported and the literature is reviewed. In the larynx, these tumors arise almost exclusively in the subglottic and supraglottic regions—areas having large numbers of seromucinous glands of the minor salivary gland type. These malignant tumors, whether occurring in the larynx or elsewhere, tend to grow quite slowly with prolonged non‐specific symptomatology and protracted clinical course. Despite their slow growth, in a majority of cases, they eventually lead to the death of the patient.

DNA measurement – an objective predictor of response to irradiation? A review of 24 squamous cell carcinomas of the oral cavity

DNA measurements on biopsy material from 24 squamous cell carcinomas of the oral cavity given preoperative radiotherapy indicate that DNA aneuploid tumours respond better to radiotherapy than do diploid and polyploid tumours. The mean S-phase value was higher (16.1%) for 8 tumours that were eradicated by preoperative radiotherapy than for 13 that did not respond (8.1%). These factors correlated better with the response than did histological and clinical (T) classifications. DNA-ploidy and S-phase estimation can complement the histological diagnosis, and may prove valuable when planning treatment.

Oncocytic lesions of the larynx.

Oncocytic cysts of the larynx, comprising 0.5–1 % of all laryngeal specimens, are benign lesions with a tendency to multifocal involvement occurring in patients over the age of 50. The pathological findings should be interpreted as oncocytic metaplasia with or without ductal or adenomatous hyperplasia. Surgical excision is the treatment of choice. Seven laryngeal oncocytic cysts are reported.

Amyloidosis of the Larynx

Amyloidosis of the larynx is a rare disease, accounting for less than 1% of all benign laryngeal tumours. Three cases of this type of lesion are reported--one of the vocal cord, one of the false vocal cord and one of the subglottis and trachea. In 2 of the patients the amyloidosis was localized, while the third was later found also to have an epipharyngeal solitary plasmacytoma with amyloid deposits and in addition amyloidosis of the nasal cavity. However, the amyloidosis in this patient may still be regarded as being localized, as the clinical examination and laboratory tests afforded no evidence of generalized disease. Amyloidosis of the larynx may be manifested as a localized tumour or as a diffuse infiltration. The symptoms and signs will, of course, depend on the site of the amyloid deposit. When the vocal cords are involved hoarseness may result, and this was the most prominent sign in the present cases. The treatment of laryngeal amyloidosis is primarily by endoscopic excision. Amyloid substance has specific staining properties. The Congo red reaction with a green birefringence in polarized light and Phorwhite BBU using fluorescence microscopy are regarded as the most reliable staining reactions. Electron microscopy has revealed a typical fibrillar structure of amyloid.

The DNA content and nuclear size in normal, dysplastic and carcinomatous laryngeal epithelium. A spectrophotometric study.

The aim of the present study was to obtain a more objective evaluation of nuclear hyperchromasia and polymorphism in laryngeal epithelium. The method is based on a photometric assay of nuclear size and DNA content in Feulgen stained slides. The DNA content of hyperchromatic nuclei should exceed the mean for nuclei of normal epithelium by more than twice the standard deviation. In comparison with lymphocytes (2N) the DNA content in hyperchromatic nuclei corresponds to 3.3 N. The mean DNA contents of normal, dysplastic and carcinomatous laryngeal nuclei were 69, 71 and 118 A.U. The mean nuclear area for normal, dysplastic and carcinomatous epithelial cells were 48, 41 and 73 micrometer2. The higher the degree of atypia displayed by the cells the greater was the variability of the DNA content and the nuclear size. The investigation shows that the method may provide a more objective basis for evaluating hyperchromasia and polymorphism.

DNA Pattern in Oral Cavity Carcinomas in Relation to Clinical Stage and Histological Grading

Cytofluorometric DNA analysis was performed in 88 squamous cell carcinomas of the oral cavity. 48% (42/88) of the tumours were DNA non-diploid. The frequency of DNA non-diploid tumours seemed to correlate with the increasing size of the tumour, and the decrease of histological grading, and certainly with the presence of lymph node metastases (p less than 0.001). DNA non-diploid tumours often had shorter duration of symptoms. The S-phase level seemed to increase the less differentiated the tumour but did not correlate either to tumour size or to duration of symptoms. Polyploid nuclei were more common in poorly differentiated tumours (9/10) as compared to well differentiated ones (17/33) (p less than 0.05) and seemed to be more common in tumours with metastases (20/26) than in those without (40/62).

PHOTOMETRIC EVALUATION OF LARYNGEAL EPITHELIUM EXHIBITING HYPERPLASIA, KERATOSIS AND MODERATE DYSPLASIA

Photometric examination of vocal cord epithelia disclosed no difference in the nuclear DNA content or nuclear area of normal and keratotic laryngeal epithelia. For 2 out of 3 epithelia displaying hyperplasia the values were slightly elevated. There seem to be no morphologic or photometric grounds for considering either hyperplasia or keratosis to be premalignant. Eight patients with moderate dysplasia were selected; 3 with and 5 without subsequent development of severe dysplasia or carcinoma in situ. In all 8 cases the DNA values were not increased, but in 6 there was an increased variation about the mean. There were no morphologic or photometric differences between the epithelia subsequently developing severe dysplasia or carcinoma in situ and those that did not. The 3 patients developing severe dysplasia or carcinoma in situ were then followed for 112, 27 and 106 months and showed no evidence of invasive carcinoma. The other 5 patients with moderate dysplasia were followed for 48 to 123 months without any sign of recurrent disease. There are no photometric grounds for considering moderate dysplasia as a precancerous lesion. Long-term investigation is required to ascertain the risk that carcinoma in situ or invasive carcinoma will develop in patients with laryngeal hyperplasia, keratosis and moderate dysplasia.

Chondrosarcoma of the larynx.

A chondrosarcoma arising in the posterior cricoid plate is presented. The tumour gave rise to increasing inspiratory stridor: laryngectomy was performed. The tumour consisted of loose cartilaginous tissue with great predominance of highly differentiated cartilage cells and only small areas with nuclear polymorphism. This complicated the differential diagnosis between chondroma and highly differentiated chondrosarcoma. From the fact that the patient died from massive pulmonary metastases 3 1/2 years later, it is evident that the degree of malignancy of cartilaginous tumours should be determined even on small polymorphic foci. The DNA histogram for the foci of the laryngeal tumour with atypia differed distinctly from those for benign chondroma and normal cartilage, but resembled those of the pulmonary and splenic metastases and of a nasal chondrosarcoma. Photometric examination may provide an aid in the difficult differential diagnosis between chondroma and highly differentiated chondrosarcoma.