Karl Segal

Hurthle cell carcinoma of the thyroid gland. A tumor of moderate malignancy

Hurthle cell carcinoma is a rare thyroid cancer histologically related to the well‐differentiated malignancies of the thyroid gland. This report presents the evaluation of 30 years experience in treating 17 patients (out of 549 thyroid cancer patients) with Hurthle cell carcinoma. All 17 patients were treated surgically. Six patients (35.3%) died of their thyroid disease. Survival rates for 10 and 15 years were 63.7% and 25%, respectively. These rates are above those of high‐grade malignancies and below those of low‐grade malignancies of the thyroid gland. Nonsurgical treatment, including radioactive iodine therapy, is disappointing; thus, initial radical surgery is recommended as the treatment of choice. Cancer 57:1613–1617, 1986.

Angiogenesis in follicular tumors of the thyroid.

Experimental evidence suggests that tumor growth beyond a certain size and tumor ability to metastasize depend on the degree to which the tumor can stimulate an angiogenic response.

Vocal cord palsy: possible late complication of radiotherapy for head and neck cancer.

Cranial nerve palsies are uncommon complications of radiotherapy for head and neck cancer. A review of the literature reveals that cranial nerve damage after radiotherapy has been reported for the optic, oculomotor, trigeminal, abducens, cochlear, vagus, spinal accessory, and hypoglossal nerves. The hypoglossal nerve appears to be the most commonly affected, and the recurrent laryngeal nerve is seldom involved. The case histories of three patients who developed vocal cord palsy from 21 to 34 years after a course of curative or postoperative radiotherapy for carcinoma of the head and neck are presented. Two patients had bilateral palsy, and in the third patient, bilateral damage cannot be excluded. Physical examination and radiographic investigations on admission and on follow-up did not demonstrate any evidence of tumor recurrence, cervical or distant metastases, or second primary tumors. The distinction between irradiation-induced palsy and that due to malignancies is emphasized.

Laryngeal carcinoma in patients 40 years of age and younger.

Between 1950 and 1985, 570 patients with squamous cell carcinoma of the larynx were diagnosed and treated in the Otolaryngology Department of the Beilinson Medical Center. Of these, 20 patients (2.8%) were aged 40 years or younger. Twelve patients (60%) had glottic carcinoma in Stage I (T1NOMO) when initially diagnosed, one patient had supraglottic carcinoma in Stage I (T1NOMO) and seven patients (35%) had laryngeal carcinoma in Stage II (T2NOMO) and III (T3NOMO). Patients with T1NOMO received only radiotherapy. Three patients with T2NOMO underwent total laryngectomy and also received postoperative radiotherapy. Four patients with the tumor in T3NOMO received pre‐operative and postoperative radiotherapy in addition to total laryngectomy. The 5‐year survival rate for T1NOMO and T2NOMO was 100% and for T3NOMO 66%. Although a high percentage of the young patients presented for treatment with advanced disease, the survival rate compared the same or favorably with rates in older patients. This supports the concept of aggressive treatment when there is a recurrence or second primary, particularly because it is well tolerated in the young age group who do not exhibit many of the conventional risk factors and therefore, have a better prognosis.

Well-differentiated thyroid carcinoma

PURPOSE This study presents our experience with 728 patients treated in our department for well-differentiated thyroid carcinoma between 1954-1994. MATERIALS AND METHODS The retrospective evaluation of the prognostic implications of the clinical and pathological findings was performed. Age, sex, histological variants, tumor size, and locoregional and distant spread were evaluated as risk factors in relation to the prognosis. RESULTS During follow-up, which ranged from 1 to 31 years, 125 locoregional and/or distant metastases developed (17.2% of the patients), 87 of which occurred in the first 10 years after initial therapy. Thirty-two patients with papillary cancer and 20 with follicular cancer died of causes related to malignancy of the thyroid. CONCLUSION The experience gained in our department has led us to adopt an aggressive approach in the treatment of patients with well-differentiated carcinoma of the thyroid gland.

Malignant external otitis in nondiabetic patients

The purpose of this study is to point out that contrary to traditional belief, there is a small but significant group of nondiabetic patients with malignant external otitis. Thirty patients with a diagnosis of malignant external otitis were treated and followed up at the Department of Otolaryngology—Head and Neck Surgery, Beilinson Medical Center, between 1987 and 1991. Nine of these patients did not have clinical or laboratory evidence of diabetes. This study analyzes this group and concludes that the diagnosis of malignant external otitis should be considered by the treating physician in nondiabetic patients presenting with a Pseudomonas aeruginosa infection of the external ear canal. Severe pain and edematous closure of the canal, together with typical granulation tissue and failure to respond to medical treatment, are specific characteristics of this group.

Chondroma of the tongue. Report of two cases.

Lingual chondromas are very rare tumors. It can be assumed that chondromas of the tongue develop from heterotopic embryonal cartilage. Chondromas are usually seen on the lateral borders of the tongue. Because chondrosarcomas can appear in this location, wide excision of the lesions should be performed. The CO2 laser facilitates the excision, providing a dry surgical field. Two cases of lingual chondroma are presented and their probable cause discussed.

Acute myelogenous leukemia presenting as facial nerve palsy. A case report

A case is presented of a 5.5-year-old girl admitted with acute mastoiditis and facial nerve palsy. The final diagnosis of leukemic infiltration of the mastoid bone, middle ear and VIIth cranial nerve was made only after surgery and histological examination. Similar cases described in the English literature are reviewed and treatment is discussed. Chemotherapy or combined chemo- and radiotherapy are the treatment of choice in known leukemic patients without symptoms of superimposed infection of the ear or the mastoid process. Surgical management is restricted to cases in which tissue for histological diagnosis is required or drainage of acute infection is needed.

Thyroid Cancer in Patients 70 Years of Age or Older Retrospective Study of 50 Patients

This report presents our experience with 50 thyroid cancer patients 70 years of age or older, out of 606 patients of all ages. Comparing this series to those describing thyroid cancer patients of all ages, we found that thyroid carcinoma in the 70 + age group presents at a more advanced clinical stage, behaves more aggressively, and has a higher death rate. These findings are attributed mainly to the higher incidence of undifferentiated carcinoma and the more aggressive course of the differentiated types of carcinoma in the older age group. If suspected thyroid nodules are managed by initial radical treatment, carcinoma can be diagnosed earlier and patients will survive longer.

Complete cricotracheal separation following blunt trauma to the neck

We report a case of complete cricotracheal transection with wide separation of the ends, a rare injury. Because of the good general and respiratory condition of the patient on admission, the pathognomonic signs of laryngeal injury were not noticed, causing an unnecessary delay in treatment. Deteriorating respiratory status with progressing cervical subcutaneous emphysema brought up the diagnosis of laryngotracheal injury. Treatment was immediate and included tracheotomy and primary end-to-end anastomosis.