Case report: HIV-related rapidly progressive carcinoma of the cervix AIDS--CT and MRI findings

The computed tomography (CT) and magnetic resonance imaging (MRI) findings of a case of a large rapidly progressive invasive carcinoma of the cervix in an HIV-positive women are presented. It produced retroperitoneal and lymph node metastases that were large, necrotic and rapidly growing. These findings are now recognized as being diagnostic of AIDS.

Unusual cause of orthopnoea: primary tracheal tumour mimicking left ventricular failure

An 84 year old woman who was a heavy smoker presented with clinical features suggestive of acute exacerbation of chronic obstructive lung disease complicated by left ventricular failure. She responded poorly to treatment and then the finding of stridor, only when she was in the supine position, led to the diagnosis of a primary tracheal tumour, a rare but important cause of unexplained shortness of breath.

Risk factors for squamous intraepithelial lesions on Pap smear in women at risk for human immunodeficiency virus infection

To determine risk factors for squamous intraepithelial lesions (SIL) on Pap smear, 253 women at risk for human immunodeficiency virus (HIV) infection had Pap smear, HIV antibody testing, CD4+ cell measurements, and human papillomavirus (HPV) genome detection by Southern blot hybridization. Associated with SIL (P < .05) on univariate analysis were genital HPV (SIL prevalence in HPV-positive subjects, 36.3%; odds ratio [OR], 9.3; 95% confidence interval [CI], 4.2-20.3) and HIV infection (SIL prevalence in seropositive subjects, 21.9%; OR, 2.5; 95% CI, 1.2-5.1). No demographic or behavioral variables were associated with risk for SIL. Multivariate analyses identified genital HPV infection (OR, 6.78; 95% CI, 2.9-15.7), detection of known high-risk HPV types (OR, 11.8; 95% CI, 4.1-34.1), strong HPV Southern blot signal strength (OR, 10.8; 95% CI, 3.5-33.7), and severe HIV-related immunosuppression (OR, 3.1; 95% CI, 1.04-9.5) as independent risk factors associated with SIL. Thus, severe immunosuppression due to HIV infection increases the risk for SIL mediated by HPV infection.

Respiratory failure with diffuse patchy lung infiltrates: an unusual presentation of squamous cell carcinoma

The case history is presented of a patient with squamous cell carcinoma of the lung with diffuse bilateral pulmonary shadowing mimicking bronchioloalveolar cell carcinoma which led to type I respiratory failure.

Free flap failure in a patient with a long standing, infected, squamous cell carcinoma

A 40-year-old patient presented with a long history of a pilonidal sinus, which had been operated on several times during the last 20 years. On clinical examination the patient had a large tumour in the sacral and perineal region, with involvement of the rectal wall. General surgeons first attempted to excise the tumour with wide healthy margins, and close the wound by local flaps. After partial flap necrosis and wound dehiscence, the patient underwent a reconstruction with a free latissimus dorsi myocutaneous flap. During the anastomosis it was noted that the recipient vessel walls were brittle, mainly at the arterial site, so the arterial anastomosis had to be done three times. Despite this the artery thrombosed again 12 hours later. Biopsy specimens were taken from the anastomotic sites and studied under light microscopy. There were signs of acute intramural inflammation, with many polymorphonuclear leukocytes present in microabscesses, and spots of necrosis in the elastic layer at the site of the recipient artery. In conclusion, the long lasting infection was considered to be the main factor that caused the anastomosis to fail, leading to thrombosis, through alteration of the vessel walls. The anomalies in the vessel walls were found at some distance from the clinically diseased area, further than is usually found in acute infection. The use of primary arteriovenous vein graft anastomosis can be made on undamaged vessels, and possibly a less traumatic anastomosis such as the "sleeve" type, should be considered for similar cases.

Mutagen sensitivity as a risk factor for second malignant tumors following malignancies of the upper aerodigestive tract

BACKGROUND

Second malignant tumors in patients successfully treated for an initial cancer of the upper aerodigestive tract are an important cause of morbidity and mortality. Biologic markers capable of identifying high-risk subgroups of patients who could be targeted for intensive clinical surveillance, therefore, have immense therapeutic and prognostic relevance. We previously demonstrated in a pilot study of 84 patients with cancers of the upper aerodigestive tract that mutagen sensitivity was a significant predictor of risk of developing second malignant tumors.

PURPOSE

We extended the study to include 278 patients diagnosed with previously untreated cancers of the upper aerodigestive tract from 1987 to August 1993.

METHODS

For each patient, base-line (pretreatment) mutagen sensitivity was measured in vitro in 50 metaphases established from peripheral lymphocyte cultures. Patients with an average of more than 1 chromosomal break/cell were deemed mutagen hypersensitive. Cox proportional hazards analysis was used to predict the risk of developing second malignant tumors associated with mutagen sensitivity.

RESULTS

Overall, 44% of the case group exhibited mutagen hypersensitivity. There were no differences in the distribution of mutagen hypersensitivity by site, sex, stage of disease, or smoking status. There were 17 synchronous and 11 metachronous cancers, of which 15 (54%) were smoking-related malignancies. Sixteen (13.1%) of the mutagen-sensitive patients developed second malignant tumors, compared with 12 (7.7%) of the nonsensitive patients. The mean break/cell value (+/- SD) for patients developing second malignant tumors was 1.17 (+/- 0.54), compared with 0.98 (+/- 0.44) for patients with only one cancer (P = .04). Mutagen hypersensitivity conferred a relative risk of 2.67 (95% confidence interval = 1.22-5.79) of developing second malignant tumors.

CONCLUSIONS

Mutagen hypersensitivity increases the risk of developing second malignant tumors.

IMPLICATIONS

Future research should focus on the molecular mechanisms underlying mutagen sensitivity.

Laser ablation of squamous cell carcinoma in situ of the anal canal. A case report

A case of squamous cell carcinoma in situ of the anal canal was discovered incidentally during a hemorrhoidectomy in a man. The anal canal was evaluated by colposcopy prior to ablation of the lesion with a CO2 laser. To our knowledge, this technique has not been reported previously.

[Two cases of esophageal fistula, in which a fibrin glue preparation was effective]

Two successful cases of endoscopic therapy for esophageal fistula are reported herein. The first case was a 61-year-old man who underwent irradiation, chemotherapy and endoscopic laser beam therapy for esophageal cancer (Im T4N0M0 Stage III). Gastrografin -esophagogram revealed a fistula between esophagus and mediastinum after these therapy. Closure of the fistula was attainable using fibrin glue with a double-channel-fiber scope. The second case was a 43-year-old man who underwent chemotherapy and irradiation for lung cancer (S1,S2 T4N2M0 Stage IIIB) which invaded to mediastinum, trachea and esophagus. Bronchogram revealed a esophago-tracheal fistula one month later. We performed the same procedure as the first case, and confirmed reduction of the fistulous size. The endoscopic fibrin glue injection is an easy, safe and effective technique for the fistula even caused by malignancies, and contributes to the quality of life of these patients.

Hypopituitarism and hyponatremia in a case with nasopharyngeal carcinoma

We report a case of nasopharyngeal carcinoma (NPC) accompanied by hyponatremia and polyuria which was induced by tumor invasion into the pituitary gland. Magnetic resonance imaging showed the pituitary gland pushed upward by NPC. Hypopituitarism due to an intracranial tumor and the extracellular volume excess due to chemotherapy caused hyponatremia and polyuria. As the intracranial tumor was diminished by chemotherapy and irradiation, pituitary hormones were normalized. In patients with T4 NPC, pituitary-adrenocortical function should be endocrinologically evaluated before treatment.

Squamous cell carcinoma arising in vulval lichen planus

We report two cases of squamous cell carcinoma arising in vulval lichen planus. Patients with lichen planus should be examined for evidence of genital involvement. If this is present, such patients should be closely monitored, and any atypical lesions biopsied.

Squamous cell carcinoma arising in Hashimoto's thyroiditis

The case of a 76-year-old white woman with squamous cell carcinoma of the thyroid gland arising in a background of Hashimoto's thyroiditis is presented. Squamous cell carcinoma of the thyroid gland is a very rare and aggressive tumor, and only a few cases are reported as arising in Hashimoto's thyroiditis. Although Hashimoto's thyroiditis alone does not necessarily predispose patients to malignancy, the finding of a prominent nodule in such a patient should suggest the possibility of malignancy, and an aggressive search and treatment regimen, including surgical intervention, should be pursued.

Laryngeal carcinoma presenting as platypnea

Platypnea, or dyspnea in the upright position relieved by recumbency, is most commonly associated with cardiac or pulmonary disease. We describe a patient who presented to the emergency department with platypnea due to a laryngeal carcinoma. A tumor of the upper airway should be considered in any patient presenting with platypnea.

Tumor-associated tissue eosinophilia and long-term prognosis for carcinoma of the larynx

Tumor-associated tissue eosinophilia (TATE) has been previously reported to be associated with a favorable prognosis for a variety of carcinomas, including head and neck cancer. We have examined this relationship in a series of 104 patients with laryngeal cancer who were observed for 5 years or more. Patients were followed up for a minimum of 5 years or until death. The original laryngeal biopsy histologic slides were examined and graded for TATE. Tumor-associated tissue eosinophilia was absent in 73 of the 104 biopsy specimens, and 25 of these 73 patients died directly of laryngeal carcinoma within 5 years. In all, 31 patients had TATE and only 3 subsequently died of laryngeal carcinoma within 5 years (P = 0.009, chi-square test). It appears, therefore, that TATE is associated with a good long-term prognosis for laryngeal carcinoma.

Combat injury with chronic osteomyelitis complicated by squamous cell carcinoma

Penetrating injuries of the extremity are common in combat. The patient described in this paper sustained such an injury in Vietnam. He exhibited the frequent complication of chronic osteomyelitis and eventually the rare complication of squamous cell carcinoma.

Influence of inductive chemoradiotherapy on salivary polymorphonuclear leukocyte (SPMN) functions in oral cancer

Salivary polymorphonuclear leukocyte (SPMN) functions were examined in 18 patients with oral squamous cell carcinoma and in 20 healthy individuals. SPMN obtained from patients before therapy exhibited significantly less FMLP-stimulated chemotactic activity (132.4 +/- 17.5 cells/0.26 mm2) than that in SPMN from controls (177.1 +/- 11.6 cells/0.26 mm2), although no difference in phagocytosis was observed. When stimulated with PMA or FMLP, control SPMN generated superoxide (O2-) at levels of 50.3 +/- 10.5 pmol/min/10(4) cells and 88.4 +/- 15.4 pmol, respectively, while SPMN from untreated patients generated significantly reduced O2- in the presence of PMA or FMLP (24.3 +/- 3.5 pmol and 59.5 +/- 9.8 pmol, respectively). Only slightly lower chemiluminescence was observed in SPMN from untreated patients however, compared to controls, values being 68.0 +/- 18.9 vs 81.3 +/- 14.9 peak mV by PMA and 62.4 +/- 13.7 vs 64.4 +/- 12.9 peak mV by FMLP. Compared to Candida killing in control subjects (24.9 +/- 3.1%). SPMN from patients before treatment exhibited significantly reduced activity (18.7 +/- 4.9%). Further suppression of the SPMN functions examined was observed after chemoradio-therapy. Suppressed SPMN function in cancer patients, especially that associated with chemoradiotherapy, may therefore play a part in oral candidiasis.