Raghav Kulkarni

Small cell neuroendocrine tumour of the anterior tongue: A case report

INTRODUCTION Neuroendocrine carcinomas (NECs) are rare in the oral cavity. There is ambiguity regarding the classification of these tumours, but their aggressive nature is recognised throughout the literature. Merkel cell carcinoma (MCC) is rare and more frequent in skin, though it has also been described intra-orally. High grade neuroendocrine tumours (HGNEC) and MCCs behave aggressively and aggressive treatment strategies have been advocated. We describe the first small cell HGNEC on the anterior tongue. PRESENTATION OF CASE We present the first report of a pT1pN1M0 small cell HGNEC in a 75 year old man on the left lateral anterior tongue. This was widely resected with 20mm peripheral and deep margins to achieve disease clearance. Selective neck dissection of levels 1-4 was also carried out. DISCUSSION Histological analysis of the tumour confirmed a primary poorly differentiated neuroendocrine tumour of small cell type (small cell HGNEC). Resected node bearing tissue from levels 1-4 confirmed metastasis to a level III node with no extra capsular spread giving a pT1pN1M0 classification. Margins of 11.7mm from the invasive tumour to mucosal margin medially and 7.0mm for the deep margin despite surgical 20mm margin resection. To the best of our knowledge small cell neuroendocrine carcinoma has not been described in the anterior tongue. CONCLUSION The aggressive nature of this tumour type mandates aggressive surgical resection with margins similar to those now recommended for skin Merkel cell carcinomas. We advocate a wide excision margin of 20mm to give adequate clearance, with neck dissection in order to pathologically stage this cancer type.

First report of squamous cell carcinoma arising within an intraoral radial forearm free flap

INTRODUCTION Oral epithelial dysplasia within free tissue reconstructions of the oral cavity has been reported. We report a case where squamous carcinoma arose within radial forearm skin transferred to the oral cavity 23 years previously. After a thorough literature search we believe this is the first report of such a phenomenon. PRESENTATION OF CASE A 62-year-old man presented to our service with pain and a new mass in the left floor of mouth. The floor of mouth had been reconstructed with a radial forearm free flap (RFFF) 23 years earlier following resection of a mucosal squamous cancer. This new mass was within the reconstruction tissue. Biopsy showed multiple areas of dysplasia and a single new focus of invasive carcinoma. This new tumour was excised and reconstructed with a contralateral nasolabial flap. Formal histology showed an arrector pili muscle adjacent to invasive cancer. Some years earlier dysplasia had been noted in the free flap skin component. DISCUSSION The skin component of free tissue transfer reconstruction flaps has been shown to develop epithelial dysplastic change. This has been found to be associated with similar levels of p53 mutation and increased Ki-67 expression within this intraoral skin and adjacent dysplastic mucosa. Our case demonstrates similar levels of expression of mutated p53 and Ki-67 in in situ epithelium and in invasive tissue perhaps supporting the idea of expansion of premalignant cells into the skin flap epidermis. CONCLUSION We have shown for the first time that a new SCCa has developed within the cutaneous component of a free tissue transfer flap. With improved longevity of patients treated with primary surgery for oral cavity SCCa there is need for vigilance in monitoring for this cancer recurrence site.

Cook-Swartz Implantable Doppler: The UK experience - a retrospective analysis

domain than did Crouzon’s patients (p=0.017). Females with Apert’s syndrome had a statistically poorer QoL in the social domain than Apert’s affected men (p=0.037). Conclusions: Following a literature search, we think this is the first such study in the UK and the largest in the world to date. Overall, these patients represent a resilient group who may have responded well to previous psychological support. Management strategies should be targeted towards the social domain, particularly in female patients with Apert’s syndrome.