Shan R. Baker

Chondrosarcoma of the head and neck

Chondrosarcoma is a malignancy rarely encountered in the head and neck. In an attempt to define this tumors characteristics and response to therapy, all cases of chondrosarcoma treated at the University of Michigan over the past 25 years were retrospectively studied. Fourteen cases originating in the nose and paranasal sinuses, mandible, temporal bone, and larynx were reviewed. Aggressive surgical resection was the mainstay of treatment, and resulted in an overall survival of 70%, with an average follow‐up of 3.5 years. Survival was highest in primary temporal bone lesions, and lowest in paranasal sinus lesions. Unre‐sectable lesions were not cured by other modalities. This study, therefore, continued to support the crucial role of wide surgical resection in the treatment of head and neck chondrosarcoma, but conservative resection, when needed to preserve important structures, has resulted in long‐term survival.

Surgical variables affecting postoperative swallowing efficiency in oral cancer patients: A pilot study

This study examined the correlation between swallow function at 3 months postoperatively and surgical variables including volume resected, flap volume, ratio of flap volume to volume resected, percentage of oral tongue, tongue base, and anterior and lateral floor of mouth resected, and whether or not the mandible was preserved in 30 surgically treated oral cancer patients. Swallows of measured amounts of liquid and paste (pudding) materials were examined videofluoroscopically. Nine measures of swallow function were completed for each swallow. A factor analysis of all swallow variables was done for liquid and for paste consistencies to determine whether one measure was statistically representative of all swallow measures. This analysis indicated that oral pharyngeal swallow efficiency (OPSE) represented all measures for both liquid and paste consistencies. Then the correlation between OPSE and surgical variables was defined. Only percentage of oral tongue and percentage of tongue base resected were significantly negatively correlated with OPSE. That is, OPSE decreased for both liquid and paste as percentage of oral tongue or percentage of tongue base resected increased. Results are discussed in terms of diet choices and surgical management.

In Vitro Radiation Resistance Among Cell Lines Established From Patients With Squamous Cell Carcinoma of the Head and Neck

Twenty‐five squamous cell carcinoma (SCC) cell lines from 20 patients with head and neck cancer were assessed for radiosensitivity in vitro using a 96‐well plate assay. Four non‐SCC lines were also tested. Radiation sensitivity of individual cell lines was compared using the area under the survival curve (AUC) as a measure of the mean inactivation dose. Tumor lines were tested with either a cobalt‐60 (60Co) γ‐irradiator having a dose rate of 100 cGy/minute or with a 4‐meV photon beam having a dose rate of 200 cGy/minute. The mean AUC of the 25 SCC cell lines was 188 ± 7 (SEM) cGy (range, 100 to 250 cGy) whereas the four non‐SCC lines had a mean AUC of 225 ± 9 cGy. The SCC cell lines with mean inactivation dose values greater than 188 cGy were classified as relatively radioresistant whereas those with values less than 188 cGy were considered relatively radiosensitive. In seven cases SCC cell lines were derived from patients who had already received radiation therapy. In four of these cases the tumor cell lines were radioresistant (AUC, 210 to 250) but in the other three cases the tumor lines were radiosensitive (AUC, 160 to 180). Thus, failure of a tumor to respond to radiation did not always select for radioresistant cells. The mean of the AUC for cell lines from previously irradiated patients (197 ± 11 cGy) did not differ significantly from that of the cell lines from patients who received no prior radiation therapy (182 ± 9 cGy). However, among radiation‐resistant lines those from the four previously irradiated patients were significantly more resistant (mean AUC = 235 ± 9) than seven other radioresistant lines from nonirradiated patients (mean AUC, 208 ± 4) (P = 0.0194). In four cases more than one cell line was derived from different tumor specimens in the same patient. In each of these cases the lines from the same patients were similar to one another in their degree of radioresistance. Based on these observations the authors conclude that the degree of in vitro radiation resistance is an inherent property of some squamous cell tumors.

Microcystic adnexal carcinoma

Microcystic adnexal carcinoma is a rare cutaneous neoplasm characterized by invasive, relentless, and destructive local growth. The incidence of perineural invasion and tumor recurrence is high. We report two cases of microcystic adnexal carcinoma with typical clinical features. The use of formalin-fixed, paraffin-embedded horizontal Mohs sections is described in one case. We also review the current concepts and management of microcystic adnexal carcinoma.

Clinical implications of orbital cellulitis

Periorbital and orbital cellulitis are clearly two distinct disorders with different etiologies. Periorbital cellulitis is well‐documented as a more common infectious process limited to the eyelids in the preseptal region. In contrast, orbital cellulitis represents a more severe, but less common, infection of the orbit posterior to the septum with or without subperiosteal abscess, orbital abscess, or cavernous sinus thrombosis. A retrospective review of the clinical and laboratory data of 137 cases of orbital and periorbital cellulitis was performed. Periorbital cellulitis was documented in 98 cases (71%), in contrast to orbital cellulitis which was noted in 39 (28%) patients. All patients with orbital cellulitis received intravenous antibiotics, however, surgical therapy was necessary for progression of orbital cellulitis in 49% of patients. The majority of patients underwent incision and drainage of an abscess in the orbit. Complications as a result of orbital cellulitis occurred in nine (23%) of the patients. A distinction is made between the clinical entity of periorbital cellulitis and orbital cellulitis. Separating these clinical entities on the basis of physical examination and radiographic studies is important because the medical and surgical management of these two disease processes is different.

Salivary gland malignancies in children

Malignant salivary gland neoplasms in children are rare. Such tumors usually occur in the parotid gland of older children. Sixteen cases of major salivary gland malignancy are reviewed, 14 occurring in the parotid gland and two in the submandibular gland. Adenoid cystic carcinoma was the most common malignancy encountered, occuring in five patients; four have died of disease. Low‐grade mucoepidermoid carcinoma occurred in three patients and all remain alive and free of disease. An assorted variety of other cancers occurred in eight patients. One child died of reticulum cell sarcoma of the parotid gland, and two children have died of adenocarcinoma. The remaining five patients remain alive and free of disease. Salivary gland malignancies in children appear to have similar biological activity as those occurring in adults. Such tumors must be treated according to the same principles generally accepted for management of salivary gland malignancies in adults.

Clinical consensus statement: Diagnosis and management of nasal valve compromise

Objective: To create a clinical consensus statement to address ambiguities and disparities in the diagnosis and management of nasal valve compromise (NVC). Subjects and Methods: An updated systematic review of the literature was conducted. In addition, a Modified Delphi Method was used to refine expert opinion and facilitate a consensus position. Results: After two rounds of surveys and conference calls, 36 items reached consensus, six items reached near consensus, and 10 items reached no consensus. The categories that had the greatest percentage of consensus or near consensus items were as follows: definition, history and physical examination, outcome measures, and management. Conversely, the categories with greater percentage of no consensus items were adjunctive tests and coding. Conclusion: The consensus panel agreed that NVC is a distinct clinical entity that is best evaluated with history and physical examination findings. Endoscopy and photography are useful but not routinely indicated, whereas radiographic studies are not useful in evaluating NVC. Other objective nasal outcome measures may not be useful or accepted for NVC. Nasal steroid medication is not useful for treatment of NVC in the absence of rhinitis, and mechanical treatments may be useful in selected patients. Surgical treatment is the primary mode of treatment of NVC, but bill coding remains ambiguous and confusing.

Squamous carcinoma of the head and neck in organ transplant recipients: possible role of oncogenic viruses.

A consistently increased incidence of malignancies in renal transplant recipients has been attributed to the effect of chronic immunosuppression required to prevent transplant rejection. Tumors arising in such patients offer a unique opportunity to study the interactions of the immune system and tumor development. A series of three cases of head and neck squamous cell carcinoma arising in patients after renal, cardiac, or bone marrow transplantation are reported. Patient ages at tumor diagnosis were 18, 29, and 53 years, respectively. Time from transplant to diagnosis of tumor ranged from 7 months to 12 years. Only the youngest patient lacked a history of exposure to the traditional predisposing factors of tobacco and alcohol use. Histo‐pathologic examination in all three tumors showed features of koilocytosis with hyperkeratosis and parakeratosis suggestive of papillomavirus infection. Squamous carcinoma cells from one of these patients have been successfully established in cell culture. Immune system impairments secondary to the use of antirejection drugs could allow the expression of oncogenic viruses. A recent report of human papillomavirus (HPV) DNA in a primary and metastatic perianal squamous cell carcinoma from a renal transplant recipient, as well as the reported presence of HPV in benign and malignant neoplasms of the upper aerodigestive tract suggests that HPV infection could play a role in the development of squamous carcinomas in transplant recipients. Further studies of HPV invection in cultured cell lines derived from head and neck tumors occurring in immunosup‐pressed patients are needed to define this relationship.

Antibodies to human squamous cell carcinoma.

We are studying membrane antigens of human squamous cell cancer with the use of naturally occurring autologous antibodies from patients’ sera, along with a set of other serologic reagents and monoclonal antibodies raised against cultured squamous cell lines. Twenty-eight squamous cell carcinoma cell lines have been established in our laboratory from tissues obtained from 23 patients. Antibody reactivity has been found against the autologous tumor cell line in 13 of 23 patients. One of these is of sufficient titer for detailed analysis. Four cell lines are available from this patient. UM-SCC-17A is derived from the primary laryngeal carcinoma, and UM-SCC-17B is derived from a lymph node metastasis removed during the same surgical procedure. Fibroblasts have been cultured from normal mucosa, and a B-lymphoblastoid line has been developed by Epstein-Barr virus transformation of the patients peripheral blood lymphocytes. Antibody from this patient reacts with the UM-SCC-17A and -17B tumor cell lines but does not react with the normal fibroblasts (UM-NF-17).

Prognostic factors of nasopharyngeal malignancy

Data collected from review of 99 patients with carcinoma of the nasopharynx was submitted for statistical analysis. The purpose of the analysis was to determine patient, tumor and treatment factors that influence survival. The only patient factor observed to influence survival was patient age (P = 0.05). Greatest survival was noted for patients in the age group 0 to 20 years (44%), while poorest survival rates were in patients over 60 years of age (14%). Tumor factors influencing survival included the location of regional metastases (P = 0.05). Homolateral cervical metastases was associated with survival rates approximating 30% compared with 10% when bilateral metastases were present. Survival decreased markedly as cervical metastases progressed from the upper third of the neck to involvement of the middle and lower thirds. Survival was 20% when nodal involvement was confined to the upper neck compared with 8% when metastases extended to lower cervical regions. The only treatment factor apparently influencing survival was duration of therapy (P = 0.08). Longer treatment periods offered better five‐year control rates. Higher dosage levels of radiotherapy were associated with improved survival, but not significantly so.