Advanced squamous cell carcinoma involving both upper and lower lips and oral commissure with simultaneous reconstruction by local flap: a case report

Pulmonary embolism in young people

Ziele: Es gibt eine anhaltende Diskussion über die Auswirkungen der hormonalen Kon-trazeption auf die Inzidenz von venösen Thromboembolien (VTE) bei jungen Frauen. Spezifische Daten für die Größe des Problems und ihre Veränderungen in den letzten Jahren in Deutschland sind nicht verfügbar. Daher untersuchten wir die Häufigkeit von VTE bei hospitalisierten jungen Menschen und analysierten geschlechtsspezifische Unterschiede.

Patienten und Methoden: Detaillierte Listen aller Lungenembolien (LE), kodiert als I26, und tiefer Venenthrombosen (TVT), kodiert als I80, bei Patienten im Alter von 10 bis 39 Jahre, die in den Jahren 2005 bis 2011 ins Krankenhaus eingeliefert worden waren, stellte das Statistische Bundesamt zur Verfügung.

Ergebnisse: Beginnend im Alter von 12–13 Jahren wurde für Frauen im Vergleich zu Männern eine höhere Anzahl von LE und TVT als Hauptdiagnose dokumentiert. Dieser geschlechtsspezifische Unterschied verschwindet im Alter von 32–33 Jahren. Dieser Unterschied in der Gesamtzahl der LE als Hauptdiagnose zwischen Männern und Frau-en innerhalb dieses Lebensabschnitts von 20 Jahre erhöhte sich von 318 in 2005 auf 606 im Jahr 2010 und sank auf 505 im Jahr 2011. Die Differenzierung in LE mit und ohne akutes cor pulmonale zeigte insbesondere eine spezifische Erhöhung der LE ohne akutes cor pulmonale bei jungen Frauen innerhalb dieser sieben Jahre. Ähnliche Änderungen konnten nicht für TVT als Hauptdiagnose gezeigt werden.

Schlussfolgerung: Die präsentierten Daten aus der deutschen DRG-Statistik zeigen einen dysproportional höheren Anstieg der Hospitalisierung junger Frauen mit Lungenembolie als Hauptdiagnose in den vergangenen Jahren. Die möglichen Ursachen der hormonalen Kon-trazeption für diesen Anstieg müssen weiter aufgeklärt werden.

Lip Reconstruction after Tumor Ablation

Approximately 25% of all oral cavity carcinomas involve the lips, and the primary management of these lesions is complete surgical resection. Loss of tissue in the lips after resection is treated with a variety of techniques, depending on the extension and location of the defect. Here we review highly accepted techniques of lip reconstruction and some of new trials with significant clinical results. Reconstruction choice is primarily depend to size of the defect, localization of defect, elasticity of tissues. But patient's age, comorbidities, and motivation are also important. According to the defect location and size, different reconstruction methods can be used. For defects involved less than 30% of lips, primary closures are sufficient. In defects with 35-70% lip involvement, the Karapandzic, Abbe, Estlander, McGregor or Gillies' fan flaps or their modifications can be used. When lip remaining tissues are insufficient, cheek tissue can be used in Webster and Bernard advancement flaps and their various modifications. Deltopectoral or radial forearm free flaps can be options for large defects of the lip extending to the Jaws. To achieve best functional and esthetic results, surgeons should be able to choose most appropriate reconstruction method. Considering defects' size and location, patients' expects and surgeon's ability and knowledge, a variety of flaps are presented in order to reconstruct defects resulted from tumor ablation. It's necessary for surgeons to trace the recent innovations in lip reconstruction to offer best choices to patients.

Unusual growth of upper lip squamous cell carcinoma: a case report

INTRODUCTION

Squamous cell carcinoma is the most common type of lip and oral cavity cancers. In majority of cases it follows quite common course, and after the surgery it does not produce any harm. This case presents unusual and unexpected growth of upper lip squamous cell carcinoma with severe cosmetic problems, and possible health threats.

CASE PRESENTATION

A 46-year-old woman noticed on her upper lip "a spot, the size of a wheat grain", which grew rapidly and reached the size of 0.6 cm during a two-week period. The lesion was red, hard and painful, attached to the skin. It was surgically removed, and primary histopathological finding was follicular keratosis. Recurrent tumor appeared seven days after the operation, with the extreme swelling of the upper lip. The patient was sent to a tertiary hospital, where fungal or bacterial infection was excluded. The change on the patient's upper lip reached the size of 5 × 2 cm, as soft, reddish nodular tumor. Squamous cell carcinoma was diagnosed after the histopathological audit. With the second surgical intervention the tumor was removed and the defect reconstructed.

CONCLUSIONS

Prognosis of this type of tumor, apart from its size and differentiation level, depends on infiltration in tumor-surrounding tissue, perineural and perivascular spread. Therefore, it is always necessary to analyze the removed skin especially on margins.

Role of neurotransmitter Substance P in progression of oral squamous cell carcinoma

BACKGROUND

Oral squamous cell carcinoma (OSCC) is the most frequent type of head and neck cancers.

OBJECTIVES

In the present study, we evaluated the expression and distribution of Substance P (SP) in different grades of OSCC and role of SP in its proliferation and progression.

SUBJECTS AND METHODS

Forty OSCC biopsies were immunohistochemically analyzed by using SP antibody, including 29 male and 11 female cases. 35% were well differentiated, 35% moderately differentiated and 30% poorly differentiated OSCC. The majority of patients were in the age range of 41-80 years. 62% of the cases were positive for SP. SP positivity was expressed in the cytoplasm of the tumor cells. Most of the positive cases were from the tongue region.

RESULTS

93% of moderately differentiated, 92% of poorly differentiated and 8% of well-differentiated carcinomas were SP-positive, but SP expression intensity was highest in poorly differentiated cases (+3). More positive patients were males (68.96% of all male patients) with moderately and poorly differentiated OSCC. Among all positive cases, 48% were poorly differentiated, 48% moderately differentiated and 4% well differentiated.

CONCLUSION

Strong expression of SP in poorly and moderately differentiated cases suggests a role of SP in the progression and development of tumor. Expression of SP in the current study increased as the proliferation of cells increased. Prevalence of oral cancer in males may be due to the fact that they smoke and use pan, chewing gum, beetle nut etc. in this region. SP antagonists can help in the reduction and inhibition of oral cancer. SP has a diagnostic value with sensitivity of 92.5% and specificity of 93.7%. The positive predictive value is 96.2% and the negative predictive value 88.2%.