Case report of metastatic carcinoid tumor to the neck

Since their origianl description in 1838 carcinoid tumors have interested physicians. This case represents another unusual presents another unusual presentation of a carcinoid tumor in which the cervical area has rarely been reported. In addition, it demonstrates the elusiveness of the tumor despite exhaustive diagnostic studies.

Malignant melanoma. Role of node dissection reappraised

Two hundred and fifty-nine patients with malignant melanoma have been reviewed. One hundred and fifty of these were determinate. A primary excision and dissection in continuity of the tumor, the intervening lymphatics, and the regional lymph nodes achieved a 5-year survival free of disease for 67.5% of the patients. When the nodes were clinically negative but microscopically positive, 45% survived. An electric discontinuous node dissection offers no better prognosis than does a therapeutic dissection and is not indicated in the primary treatment of malignant melanoma.

Chylous ascites following retroperitoneal lymphadenectomy

A case of postoperative chylous ascites accumulation after retroperitoneal lymph node dissection is reviewed. Although uncommon, this complication is distressing and because of the close proximity of the cisterna chyli to the renal pedicles it may be encountered with any retroperitoneal procedures involving this area. Avoidance of the complication by specific identification and ligation of these structures appears to be the best treatment. Several forms of operative and non-operative therapy have been noted and survival rates in the iatrogenic form of chylous ascites appear to be good based on a limited series of cases.

Rotational skin flaps to cover wound defect in groin

A technique of a lower relaxing incision and use of a rotational skin flap from the anterolateral thigh to close an extensive defect in the inguinal area is described. Its use is especially applicable for palliation in patients with large fungating metastases in the inguinal region.

[Computer study of the anatomo-clinical characteristics of breast carcinoma. II]

Data relating to the major and minor clinical features of breast cancer were examined in 200 cases and correlated to obtain an overall picture of the objective picture. The classic pattern was present in most cases. Some data, such as patient occupation and the extent of lymph node invasion expressed different meanings, while various parameters led to dubitative conclusions.

Lymph-node biopsy during simple mastectomy

The distribution of pectoral (external mammary) nodes identified during the operation and removed with the axillary tail of the breast was studied in 45 patients treated by simple (total) mastectomy. Up to 13 nodes may lie within the axillary tail, and these are continuous with the pectoral nodes. Lymph-nodes were identified in 90 percent of patients treated by simple (total) mastectomy without dissection of the axilla.

[Clinical aspects and treatment of testicular tumors (author's transl)]

Experience in the treatment of 167 testicular tumors is reported in 164 patients who were hospitalized during the last 15 years. Seminoma patients were irradiated postoperatibely, teratoma patients since 1965 have been subjected to radical lymphadenectomy and also irradiated postoperatively if there was confirmed evidence of metastases. The total survival rate was 58.6 percent. Cytostatic therapy was used in only a few cases: convincing remission could not be observed. The favorable results so far obtained with lymphadenectomy justify the continuation of surgical treatment.

Primary oat-cell carcinoma of head and neck

Summary--A case of primary oat-cell carcinoma of the larynx in a 68-year-old white female is described, bringing to a total of three the reported cases in the world literature. The tumor is highly malignant and notorious for the speed with which it metastasizes. Treatment should be aggressive from the beginning. We believe that even for a localized tumor of this kind, a minimal procedure should be widefield laryngectomy with elective radical neck dissection even if clinically, nodes are not palpable. Since the tumor is highly radiosensitive, radiotherapy should be used postoperatively.

Long survival after operation for cancer of the lung

A survey is presented of 293 cases of lung cancer operated on by one surgeon over a period of 35 years. Lobectomy was done in 86 cases with a mortality of 3.5 per cent. Simple pneumonectomy was done in 89 cases with a mortality of 20 per cent, and radical pneumonectomy in 118 cases with a mortality of 15-25 per cent. The survival rate after 5 or more years for lobectomy was 41 per cent (34 patients). After simple pneumonectomy 21 patients (30 per cent) lived 5 years or more, and after radical pneumonectomy 39 patients (39 per cent) lived 5 years or more. The survival of the patients in whom the excised lymph nodes were involved by growth is presented. It is pointed out that at least 1 in 3 patients with cancer of the lung treated by operation was alive 5 years later. The very good long term results are presented including the 10-year and 20-year survival rate. Two patients are still alive after 30 and 34 years respectively. One patient is alive 29 years after a lobectomy and 13 years after a contralateral lobectomy for a new primary cancer. A second new cancer occurred in 9 patients. Continuance of smoking is shown to be harmful. The factors affecting the long term freedom from recurrence are discussed. The cell type of the cancer is shown to be important. Squamous-celled growths have the best results and oat-celled and small-celled the worst, although long term survival can follow operation for both these. The occurrence of a pleural infection after operation may be favourable to long term freedom from recurrence and this way probably so in 2 patients who lived 25 and 27 years respectively and 1 patient who is still alive after 34 years. On the whole the evidence is unconvincing that much benefit may follow radiotherapy combined with operation.

Is positive pelvic lymphadenopathy a contraindication to radical surgery in recurrent cervical carcinoma?

The extent of disease at the time of surgical exploration determines whether radical surgery can be performed in the patient who has a postirradiation cervical cancer recurrence. Contraindications to extirpative surgery includes spread of disease beyond the confines of the removable organs. This includes common iliac and periaortic lymph node metastasis. Some authors have advocated aborting the procedure when pelvic nodes are involved. In a review of 170 patients undergoing radical surgery for cervical cancer recurrence, 25 percent with positive nodes survived 5-yr compared with 36 percent with negative nodes. The finding of positive pelvic lymph nodes in itself should not be the sole reason for abandoning the operative procedure.