Louis H. Weiland

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.

Improving survival in adenocarcinoma of the duodenum.

The records of 104 patients with primary adenocarcinoma of the duodenum were reviewed. All patients were followed up to the date of this report, 91 for at least 5 years. Melena was an ominous preoperative finding. Survival was directly related to nodal status, the grade of the lesion, and the ability of the surgeon to minimize or eliminate operative mortality. Fifty percent of the lesions were resectable for cure, and the 5 year survival rate for patients with resectable lesions was 46 percent. All eight patients treated with segmental resections for lesions in the third and fourth portions of the duodenum survived at least 5 years. These data are a great improvement over those in previous reports and suggest that this disease may be much more treatable than previously believed.

Total pancreatectomy for ductal adenocarcinoma of the pancreas. Mayo Clinic experience.

This review reveals that, once again, surgical therapy of ductal adenocarcinoma of the pancreas has been thwarted, probably by the inherent biologic aggressiveness of this particular malignancy. The operative mortality rate (greater than 10 percent) coupled with the 5 year survival rate of 2.3 percent is eloquent testimony to this. Multicentric disease occurred in one third of the patients, whereas extrapancreatic spread was found in half of the resected specimens. At 1 year, the only statistically favorable determinants were multicentricity and female sex. The main bonus of total pancreatectomy appears to be the elimination of pancreatojejunal anastomosis with its lethal complications.

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.

Resection of primary solid hepatic tumors

Experience with surgical management of 60 solid hepatic tumors was analyzed with respect to the size and type of lesion, extent of resection, operative risk, postoperative complications and survival after resection. The present study concerns 46 primary hepatic malignancies and 14 benign lesions. Lesions varied in size from 5 to 29 cm (average 13). The extent of resection required for removal was related to both the size and location of lesions. Twelve trisegmentectomies, 33 hemihepatectomies and 15 major segmentectomies were done. There were three postoperative hospital deaths, two of which were related to extensions of tumor that precluded safe resection. Postoperative complications necessitated hospital convalescence for more than 21 days in 9 of the 57 surviving patients; the hospital stay of the remaining patients averaged 12 days. The 10, 5 and 3 year survival rates of patients who had resection of malignant lesions were 33, 36 and 65 percent, respectively. We conclude that aggressive treatment of primary hepatic malignancy is justified by acceptable operative risk and significant palliation or improved survival.

Recurrent and metastatic cystosarcoma phyllodes

During a 30 year period (1950 to 1980), 42 patients with cystosarcoma phyllodes were seen at the Mayo Clinic. Ten patients (24 percent) had recurrence of metastasis. The malignant or metastatic potential could not be identified or predicted by histologically evaluating tumor contour, stromal atypia, or mitotic activity. Spread was chiefly by a hematogenous route, and no patient with metastasis survived. Five of the 10 patients died from their disease 2 to 7 years after treatment. Simple mastectomy appears to be the surgical treatment of choice.

Adenocarcinoma and adenoma of the middle ear

Primary middle ear glandular tumors of the adenocarcinoma and adenoma types are rare. The terminology used in describing them is quite varied. Some investigators presume that a distinct recognizable group of these tumors are benign, but because of the rarity of the lesions, such conclusions have been difficult to verify. We review the literature of these lesions and report 11 additional cases. The course was documented in 25 cases in the literature; 20 of these were reported to be benign over periods of follow‐up from 1 month to 10 years, and 5 were fatal. Among our patients, 5 had a benign course, 3 died of causes related to the tumor, and 3 had persistence of their lesion and substantial consequent morbidity. We emphasize the slow growth and elusive nature of these lesions. Histologic evidence of mitoses, roentgenologic evidence of bony destruction, and cranial nerve involvement were factors consistent with a poor prognosis. The origin of these tumors may vary. A similarity to paragangliomas is noted. The ultimate course of these tumors cannot always be predicted from the histologic appearance. Early surgical removal appears to be the most successful therapy.

Diffuse intraductal papillary adenocarcinoma of the pancreas

The incidence of multicentricity in pancreatic cancer has been reported to be as high as 38%. Recent surgical and autopsy series have documented multicentric disease and the presence of carcinoma In situ in association with invasive carcinoma. Described are the clinical and pathologic findings in a 41-year-old woman who had total pancreatectomy for diffuse ductal transformation to papillary adenocarcinoma associated with a wide spectrum of extensive ductal epithelial changes. The significance of epithelial abnormalities as they relate to the occurrence of multicentric tumor is discussed, and the findings in this patient are compared with those of other distinctive clinicopathologic entities. Despite an apparently favorable outcome and 20-month disease-free follow-up in this patient, no good evidence indicates that age, extent of procedure, or lack of tumor invasion has prognostic significance in pancreatic cancer.

Nasal Manifestations of Allergic Granulomatosis and Angiitis (Churg-Strauss Syndrome)

A postauricular mastoid cutaneous fistula may be a complication of chronic ear disease or ear surgery or both. Simple closure is often unsuccessful because of the necrotic skin edges, and it may result in a larger fistula. This paper illustrates a method of closing a large postauricular mastoid cutaneous fistula. The steps include excising the fistula, everting the mastoid epithelium toward the external auditory meatus, covering the undersurface of the everted skin edges with an anteriorly based periosteal flap, covering the flap with bone paté, placing a free graft of abdominal fat, and closing the defect with a rotational skin flap. This technique closes the fistula and obliterates the mastoid cavity.