Robin M. Rankow

Cylindroma (adenoid cystic carcinoma). A report of fifty-eight cases.

Abstract Fifty-eight cases of cylindroma of the head and neck region, are reviewed. The cylindroma is a small cell epithelial neoplasm with a cribriform histologic pattern. This neoplasm infiltrates widely involving almost all types of adjacent tissues, is not limited by anatomic planes, and shows marked centripetal perineural extension. Although few patients can be cured, many survive for very long periods with locally recurrent or metastatic disease. Apparent cure was seen only in six cases in which the initial excision was shown to be adequate on pathologic examination. Radiotherapy was effective in temporarily controlling local recurrence and in relieving symptoms of metastases, but did not result in long term cure in any of these patients. The duration of the disease is much longer than most other adenocarcinomas. More than half of the patients who died did so more than five years after initial therapy. Almost all local recurrences were clinically apparent within eight years, but only half of the patients with local recurrence were dead within five years of the appearance of recurrent cylindroma. No case of recurrent cylindroma was cured by either resection or radiotherapy. Distant metastases did not appear after adequate initial resection. If the primary tumor was incompletely resected the incidence of distant metastases was twice that of patients who had received only radiotherapy. Two of twelve patients with submaxillary cylindroma had associated sialolithiasis.

Cancer of the sublingual salivary gland

Abstract 1. 1. Fifteen cases of malignant tumors of the sublingual salivary gland are reported, increasing to thirty-seven the reported number of these rare lesions. 2. 2. Tumors of the sublingual gland should be considered malignant until proved otherwise. 3. 3. The removal of the sublingual gland in its entirety should be the procedure of choice whenever a suspect lesion is encountered.

Actinomycosis: masquerader in the head and neck.

The diagnosis of cervicofacial actinomycosis is usually not simple, but may be essential for adequate treatment. Cases seen in a Head and Neck Service illustrate some of the many guises under which actinomycosis may be concealed, and a review of recent literature confirms its propensity to be a masquerader. A combination of techniques is necessary to diagnose, and both surgical and medical approaches are needed to treat this often distressingly persistent affliction.

Heterotopic Gastric Epithelium in the Head and Neck Region

Heterotopic gastric epithelium in the head and neck area is a little-known entity, unsuspected by clinician and pathologist alike. We have reviewed the literature and discovered 14 cases of this entity. While previous reviews of the subject have, unfortunately, included reports of cases with heterotopic intestinal epithelium, our study addresses itself to separating the two. Five new cases of gastric heterotopia are reported in 3 female and 2 male patients ranging in age from 2 1/2 weeks to 70 years. Three cystic lesions occurred in the floor of the mouth, while 2 small nudular lesions were found in the region of the larynx. The larger lesions caused obstructive symptoms. An error in embryogenesis is the only plausible explanation for such heterotopic elements as gastric fundic, antral, and mucous neck types of epithelium, often associated with a partial muscularis mucosae, in the head and neck region. Treatment consists of surgical extirpation.

Carcinoma of the maxillary sinus following thorotrast instillation

Summary The long term latent carcinogenic effect of residual radioactive thorium dioxide in the maxillary sinus is reviewed. Seven of the eleven cases noted previously in the world literature have been treated at the Columbia Presbyterian Medical Center. Despite the rarity of these cases, an additional three patients have since been treated. The relatively few cases thus far reported may be due to the long latent period from instillation to malignancy. Thirteen of the fourteen patients developed cancers of the maxilla and adjacent paranasal sinuses. Of the ten patients with malignancy treated by radical surgery at the Columbia Presbyterian Medical Center, three are alive and free of disease from seven to eighteen years. One of the three surgical survivals was a radiation failure salvaged by radical maxillectomy. One patient had benign sinusitis diagnosed thirteen years following instillation of the thorotrast, then treated by removal of all the contrast material and the mucosal lining, and has been free from evidence of malignancy for the succeeding ten years. No patient was successfully treated by irradiation alone. A program for all patients known to have intrasinusal thorotrast is proposed.

Surgical Management of Malignant Tumors of the Lacrimal Gland

Malignant lacrimal gland tumors are rare but serious and life-threatening neoplasms. Patients frequently present with symptoms of less than 1 year duration, often demonstrating rapid change during the 6 months preceding diagnosis. Pain and periorbital sensory changes are also reported by patients. Radiographically, bone destruction is a strong indication of a lacrimal gland malignancy as is ophthalmoplegia. Radical three-dimensional resection utilizing a cranioorbital approach offers the best chance for total tumor removal. Immediate reconstruction with a scalp flap is essential for primary healing, as well as esthetic balance of the orbital region.

The fate of the uncontrolled ameloblastoma

Abstract 1. 1. After a brief pathologic review, data are presented concerning thirty-eight cases of ameloblastoma seen at Presbyterian Hospital from 1921 through 1966. 2. 2. Case histories are excerpted. Emphasis is placed on the propriety of a block excision in the first operation and long periods of close follow-up. 3. 3. The high probability of recurrence after curettage is due to the pathologic characteristics of the tumor. The uncontrolled tumor may extend into soft tissue as well as into bone, requiring extensive resections that may exceed curative operability.

Coexisting benign mixed tumor and mucoepidermoid carcinoma of the parotid gland.

Multiple unilateral parotid gland tumors are very rare. A review of the literature shows only seven cases of coexisting unilateral parotid tumors. This patient had a benign mixed tumor and a mucoepidermoid carcinoma of the right parotid gland. This is the eighth reported case of multiple unilateral parotid tumors and the first to show such a combination of tumors.

Carcinoma of the maxillary sinus following Thorotrast instillation: A further report

Abstract 1. 1. Three new cases of carcinoma of the maxillary sinus developing fifteen to twenty years following instillation of Thorotrast into the maxillary sinus are presented. 2. 2. The carcinogenic effect of the radioactivity of thorium and its decay products is discussed. 3. 3. The need for investigation of radiopaque material in the maxillary sinuses is re-emphasized.

Ankylosis of the Temporalis- Coronoid Complex of the Mandible

Ankylosis of the temporalis-coronoid complex is a clinical entity. The etiology is usually direct trauma to the temporalis muscle or coronoid process of the mandible. It is difficult to differentiate diagnostically from ankylosis of the adjacent temporomandibular joint, and should always be considered in the differential diagnosis of inability to open the mouth. The treatment is always surgical and the intraoral approach is favored. The cure rate with this modality of therapy has been gratifying.