Kenneth D. Devine

Primary lymphoma of the nose including a relationship to lethal midline granuloma

Abstract From 1933 through 1962 thirty-three patients who had nasal lymphoreticular lesions previously diagnosed as lymphoma were seen at the Mayo Clinic. Of the thirty-three patients twenty-three were men and ten were women. Their ages ranged from twenty-five to seventysix years and 70 per cent were more than forty years of age. The most frequent complaints were progressive nasal obstruction and nasal, facial, or orbital swelling. The nasal involvement was bilateral in 27 per cent of the cases. Cell types of twenty-four lesions were those of typical lymphoma and those of nine lesions had a polymorphocellular composition. The growths exhibiting typical lymphoma cell types more often grossly tumorous and symptomatically of shorter duration, while the polymorphic type was more frequently ulcerative and had longer prodromata of nasal symptomatology in many cases. Radiotherapy was the treatment of choice. The five year survival rate in the thirty-three cases was 56.7 per cent and the ten year survival rate, 34.8 per cent. Patients having stage I lesions without extension to neighboring sinuses, orbit, or pharynx did much better than those with this extension or patients with stage II involvement. The most striking feature of our study was that the five year survival rate of the twenty-four patients with typical lymphoma in stage I was 41.2 per cent with an over-all survival rate of 38.1 per cent while all nine patients with polymorphic lesions survived five or more years. A relationship may exist between these nine polymorphic lesions and certain lesions reported as lethal midline granuloma, although polymorphic reticulosis is suggested as a more descriptive morphologic term.

Inverting papilloma of the nose and paranasal sinuses.

Inverting papilloma of the nose and paranasal sinuses has been classified as a true neoplasm by most authors. It is distinct from the ordinary nasal polyps in that it has a different cause, different histologic features, a higher recurrence rate, and is occasionally associated with carcinoma.

Verrucous squamous carcinoma of the oral cavity

From the Sections of Otolaryngology and Rbinology, Surgical Pathology and Plastic Surger,y, Mayo Clinic. microscopic examinations of a11 avaiIabIe tissues in these tumors were studied. V ERRucous squamous carcinoma is a morphologic type of epidermoid carcinoma with distinctive cIinica1 and pathoIogic features [I]. In 1941, FriedelI and Rosenthal [2] reported on eight patients with verrucous lesions on the bucca1 mucosa and Iower gingiva, in which tobacco chewing was thought to be an important causative factor. Ackerman [?I first described the typica microscopic findings for this Iesion of the ora cavity in 1948, aIso reIating its unique clinical course in a study of thirty-one patients. In addition, some diff&lty may he encountered in the proper pathoIogic diagnosis of this tumor unless one is aware of its typicalIy we11 differentiated composition and distinctive pattern of growth. Due to the sIow growing, yet invasive, character of this variety of ora carcinoma, a much Ionger foIIow-up period wouId appear essentia1 for a better understanding of its cIinica1 course and to determine, if possibIe, the most effective treatment. Therefore, this report concerns the study of the cIinica1 and pathologic features, treatment, and prognosis of such oral cavity Iesions encountered at the Mayo CIinic. CLINICAL DATA

Surgical treatment of squamous cell carcinoma of the base of the tongue.

One hundred two patients with squamous cell carcinoma of the base of the tongue were treated by surgery. The grade of the tumor did not influence survival; however, survival was influenced by the stage of the disease and the operation selected. Operations that provided wider access decreased the incidence of local recurrence. Of the 102 patients, 23 percent required either total or partial laryngectomy. The survival curves of the 23 patients suggest that management of the larynx is a key factor in treating larger cancers. Overall, the five‐year survival rate for the 102 patients was 42 percent. Surgery is the treatment of choice in squamous cell carcinoma of the base of the tongue.

Laryngofissure and Cordectomy for Early Cordal Carcinoma: Outcome in 182 Patients

At the Mayo Clinic from 1962 to 1974, 182 patients with early squamous cell cancer of the true vocal cord were treated by laryngofissure and cordectomy. Seven patients (4%) had recurrences: four in the larynx and three in the neck (although the larynx was free of disease). The case histories of these patients are reported. Only three (2%) of the patients died as a consequence of their laryngeal cancer. The data substantiate our belief that the laryngofissure and cordectomy operation, and its minor variations, is an expeditious and highly successful means of eradicating glottic cancers.

Intraluminal involvement of the larynx and trachea by thyroid cancer.

Abstract Involvement of the larynx and trachea by thyroid cancer extensive enough to cause an intraluminal mass is rare. In a sixty year period at the Mayo Clinic, only eighteen patients (of 2,000 with thyroid cancer) had involvement that required surgical intervention. Of these eighteen, fifteen were forty years old or older. Seven patients had follicular carcinoma; six, papillary carcinoma; four, anaplastic carcinoma; and one, medullary carcinoma. Seven patients had tracheostomy; seven, laryngectomy; three, partial removal of the larynx or trachea; and one, bronchoscopy and partial removal of the tumor for biopsy. Of the eighteen patients, two died during tracheostomy, seven lived three months to three years after operation, one lived five and a half years, and seven are still alive nine months to eight years after operation. One of the patients was lost to follow-up study. Of the ten patients who have died, two died of causes unrelated to the thyroid cancer. Of the seven surviving patients, six had laryngectomy, and one had partial laryngectomy.

Verrucous carcinoma of the larynx

Verrucous carcinoma, because of its oftentimes unusual clinical appearance, may be misdiagnosed if there is not good communication between the surgeon and the pathologist. We have reviewed our series of 20 cases of verrucous carcinoma from 1964 through 1974 and have analyzed the results of our therapy. We have concluded that verrucous carcinoma is a slow‐growing, locally invasive lesion that does not metastasize to the cervical lymph nodes. Radiation therapy does not seem to be an effective method of treatment; the recurrence rate is high. Conservative laryngeal surgery is the preferred method of treatment in these patients and should prevent loss of life and spare laryngeal function.

Papilloma of the larynx in children: A clinicopathologic study

P APILLOMA is the most common benign laryngeal neoplasm in children. Clinically laryngeal papilloma is a serious problem because of the location, the multiplicity of lesions, the persistent tendency to recurrence, and the resistance to treatment even though histologically it is a simple tumor. In children almost all papillomas are of the multiple recurring type. In the series of Holinger, Johnston and Anison [I], 81 per cent of the papillomas in children were multiple. The sex distribution shows a little tendency to favor male children [2,3]. Bjork and Weber [2] stated that new cases are becoming increasingly rare. They attribute this to improved social and hygienic conditions, although they observed more new cases during the second world war when conditions were at a low point. Cause of the disease is not known, but some evidence strongly suggests viral etiology [2,g or the operation has been done near the end of the time limit. The operator is likely to be misled into attributing a remarkable recovery to the particular method he happened to have used.” On the basis of an erroneous observation that most papihomas disappear or stop growing during puberty [23], hormonal factors were once thought to play a role in the treatment of the disease. Experience has shown this to be false. Electrocautery does not prevent relapses and overenthusiastic use causes excessive

Surgical salvage after radiation for laryngeal cancer

From January, 1962, through December, 1973, 1,084 patients with cancer of the intrinsic larynx were treated at the Mayo Clinic. of the 1,084 patients, 136 were retreated after radiation therapy failed to cure their cancer (105 glottic, 30 supraglottis and one subglottic cancers). Recurrence of glottic cancer was generally recognized later than recurrences in the supraglottic area; likewise, glottic cancers were more advanced at recurrence than supraglottic growths.

Adenocarcinoma of the Larynx

From 1949 to 1974, 27 patients with adenocarcinoma of the larynx were treated at the Mayo Clinic. Histologically, the cancers were classified as indeterminate adenocarcinoma (12 tumors), cylindroma (9 tumors), and mucoepidermoid carcinoma (6 tumors). Patients with cylindromas tended to differ from patients with other adenocarcinomas in respect to sex, symptoms, origin of the cancer, and length of survival. The prognosis of patients with any form of adenocarcinoma of the larynx is very poor.