Maxillary squamous cell carcinomas staged by computed tomography

In 72 patients with maxillary squamous cell carcinoma, computed tomography (CT) alone was used for T-staging according to the AJC classification. Five, 31, and 36 tumors were diagnosed as T2, T3, T4, respectively. In N0 patients with a minimum follow-up of 2 years, local control rates for T2, T3, and T4 tumors were 33% (1/3), 64% (16/25) and 38% (9/24), respectively. Addition of maxillectomy to treatment seemed to have improved the local prognoses in T3 and T4 tumors. High radiation doses of 60 Gy or more seemed to be beneficial for patients with T3 tumors and without maxillectomy. CT will be of great help in classifying tumors objectively. But more importantly, it will reveal resectability and dictate treatment of choice by delineating the tumor extent precisely.

[A case of granulocytic sarcoma (chloroma) preceding acute leukemia]

A 2-year-old boy developed proptosis of the right eye in May 1982. He was admitted to Isawa Hospital on June 9. Physical examination revealed a well developed child with slight proptosis of the right eye and swelling of the right temple. Routine serologic and blood examination revealed no abnormality except LDH, ALP and LAP. CT scan showed high density area in the anterior part of the right temporal lobe and lateral wall of the right orbit. He underwent open-biopsy of this tumor on July 15. Eosinophilic granuloma was suspected, but definite diagnosis was not made. Second biopsy was performed at right upper gingiva on August 2. Follow-up CT scan revealed tumor invaded sphenoidal and maxillary sinus. The patient was transferred to Tohoku University Hospital on August 13. On admission myeloblasts appeared in peripheral blood, and bone marrow examination revealed acute myelo-monocytic leukemia. We discussed its difficulty of differential diagnosis in literature.

Carcinoma of the paranasal sinuses. Results of a prospective pilot study

Sixty patients with paranasal sinus cancer were treated from January 1976 until July 1981 according to a standard protocol in which surgery is combined with a low dose of irradiation and a topically applied cytostatic drug. The local control rate was 65%. Mutilation was clearly reduced. The actuarial 2-year and 5-year survival rate was 76% and 65%, respectively. The actuarial 5-year survival rate for squamous cell carcinoma and undifferentiated carcinoma of the maxillary sinus was 52%. For adenocarcinoma of the ethmoid sinus the actuarial 5-year survival rate was 100%. The results of this prospective pilot study suggest that it may be possible to achieve better results with less aggressive treatment.

[Radiochemotherapy of head and neck cancers: dose reduction through the combination of cisplatin, bleomycin and tegafur]

Twenty-four cases of squamous cell carcinomas of the larynx and maxillary sinus were irradiated with or without cisplatin during a period from April 1973 through March 1984. Both bleomycin in oil and tegafur were administered irrespective of cisplatin. Therapeutic effectiveness was critically evaluated by means of serial biopsy and/or surgery. Radiotherapy alone could not bring about negative conversion of the biopsies, but ultimate negative conversion was observed in 18 out of the 24 cases when chemotherapeutics were appropriately combined. The five positives underwent surgery. In the cases of maxillary cancer, mixed infections appeared to interfere with the curative effectiveness of the radiochemotherapy. A resulting dosage reduction of 15Gy was observed in radiotherapy for negative conversion and one of 10mg for bleomycin as a result of incorporation of cisplatin.

[Acute graft-versus-host disease following a single transfusion of erythrocytes]

A 50-year-old severely immunodeficient woman with malignant non-Hodgkin lymphoma died from graft-versus-host disease due to transfusion of a single unit of packed red cells. Three days after this transfusion a maculo-papular rash appeared, followed by generalized erythroderma refractory to therapy and eventually progressing into generalized ulcero-squamous dermatitis. This case, and a review of other similar cases published elsewhere, prompt the authors to recommend prophylactic irradiation of blood products prior to their administration to patients with cellular immunodeficiency, particularly in cases of acute leukaemia or malignant lymphoma where patients receive intensive radio- and/or chemotherapy regimens. To appreciate the degree of cellular immunodeficiency in such risk patients, simple criteria should be developed to assess the efficiency of the cellular immune system.

Maxillary sinus cancer: a study of 33 cases

A retrospective analysis of 33 cases of maxillary sinus cancer seen at R.P.M.I. between 1970 and 1979 was performed. The age of the patients ranged from 18-88 years, with a median age of 60.3. The male to female ratio was 2:1.3. Twenty-seven (81.8%) of the cases were squamous cell carcinomas. Of the 33 cases, there were no cases in Stage 1, 2 cases in Stage 2, 8 and 23 in Stages 3 and 4, respectively. The 5-year survival among the patients who were available for a long-term follow-up was 36.4% (8 of 22). The 5-year survival was best for Stage 3 disease (75%) and Stage 4, without local and/or distant metastasis (57.14%). No patient with metastasis lived for more than 3 years. While poorer diagnosis could be related to the degree of local involvement and presence of metastasis, it could not be related to site of involvement, previous treatment, histological findings or delay in diagnosis. Correlation of treatment with prognosis is difficult because selection of treatment is based on a variety of factors, including stage of disease and patient acceptance of treatment. Of the 4 patients treated with surgery alone, all 4 survived for 5 years. Of the 8 patients treated with combined surgery and radiation, 4 survived for 5 years and 2 died without evidence of tumor before 2 years. Other treatments were far less successful.

Reconstruction of the total cheek defect by free myocutaneous flap

Our reconstructive method utilizing the free latissimus dorsi myocutaneous flap by microneurovascular anastomosis is a rewarding method for the patient with total cheek defect after cancer surgery of the maxillary sinus from the standpoint of morphology, function, and psychology.

Prognostic factors influencing relapse of squamous cell carcinoma of the maxillary sinus

In 95 surgically staged patients with squamous cell carcinoma of the maxillary sinus, multivariate regression analyses were employed to identify prognostic factors. Possible prognostic factors for local control were TNM stage and type of surgical procedures: T2 or T3 tumors and use of total maxillectomy showed better local control rates (P less than 0.01). High radiation doses of 40 Gy or more also seemed to be of prognostic significance: P less than 0.2 for 40 to 60 Gy, and P less than 0.1 for 60 Gy or more. The risk of cervical relapse increased when the cheek or alveolus was grossly involved (P less than 0.2). However, since cervical relapse frequently accompanied uncontrollable primary recurrence or distant spread, and since cervical relapse alone was frequently salvaged by radical neck dissection, prophylactic irradiation to the neck is not recommended. Sex, age, nodal state, addition of chemotherapy, total doses of bleomycin or 5-fluorouracil (5-FU), or intra-arterial administration of chemotherapeutic agents did not appear to be of prognostic significance.

Non-Hodgkin's lymphomas of the sinonasal region: histologic subtypes and their clinicopathologic features

The authors describe 11 patients with non-Hodgkin's lymphoma arising in the nasal cavity or paranasal sinuses. Seven were men and four were women. The median age of the women was 76 years; the median age of the men was 45 years. The most common presenting symptoms were nasal obstruction and unilateral facial swelling. The most frequent sites of disease were maxillary antrum (ten cases), nasal cavity (eight cases), and ethmoid sinus (seven cases). Eight patients had involvement of multiple sinuses. Six patients were clinical stage I E, two were II E, one was stage III E, and two were stage IV. Histologic subtypes included diffuse small cleaved cell (1 case), diffuse large cell (4 cases), and diffuse large cell immunoblastic (6 cases). Three patients having immunoblastic lymphoma had longstanding sinusitis, rhinitis, and allergies. Overall, 55% of patients died of disease. Three of four patients with the diffuse large cell subtype were free of tumor (mean follow-up 50 months). Five of six patients having immunoblastic lymphoma died of disease from 1 to 13 months following diagnosis (mean 6.4 months).

Benign osteoblastoma of the maxillary sinus

Benign osteoblastoma is an uncommon fibro-osseous neoplasm with a predilection for the vertebrae and long bones, and a 2-to-1 male-to-female ratio of occurrence. Peak incidence occurs in the second decade, with 80% of all patients being under 30 years of age. The clinical, radiographic, and histologic presentation of a large maxillary sinus osteoblastoma is reviewed. Preoperative embolization of this vascular neoplasm is advocated.

Real-time digital subtraction angiography for therapeutic neuroradiologic procedures

Procedural control during therapeutic neuroradiologic procedures is generally based on repeated angiograms to assess the degree to which embolization has reduced abnormal blood flow. Due to the complex craniofacial skeletal anatomy that is superimposed over lesions in this area, subtraction studies are usually required to see the vessels and visualize a tumor stain satisfactorily. We have used a device incorporating continuous recursive digital video filtration, which allows the operator to view a subtracted fluoroscopic image of each control angiographic sequence in real time. The advantages of this technique for therapeutic procedures are described.