Striking enhancement at the site of radiation for nivolumab-induced Stevens-Johnson syndrome

Stevens-Johnson syndrome is a rare adverse cutaneous drug reaction characterized by epidermal detachment of <10% body surface area with an average mortality rate of 1-5%. The mechanism of SJS is not fully understood. Nivolumab is a monoclonal antibody directed against programmed cell death-1 protein (PD-1), a receptor with immune checkpoint inhibitory and antineoplastic activities. We present a case of SJS in a patient being treated with anti-PD-1 therapy nivolumab for metastatic squamous cell carcinoma of the oropharynx. This case is unusual because of the severe accentuation with striking enhancement at his prior radiation site and in the cutaneous region with heavier tumor burden from his metastatic disease. This reaction may give insight to the underlying pathophysiology of SJS, suggesting that immune checkpoint inhibitors can activate T-cells to target keratinocytes and that external factors may be involved in creating distinct epitopes for T-cell recognition. We hope this case adds to the body of knowledge in the pathogenesis of Stevens-Johnson syndrome and cutaneous adverse events seen with checkpoint inhibitors.

Granulocytic sarcoma of palate. Case report and review of literature

A rare case of granulocytic sarcoma of the hand and palate, also known as chloroma, occurring in an adolescent patient is presented. Diagnostic clinical criteria, along with treatment pictures, are also reviewed.

Palatal swelling as the first and only manifestation of extranodal follicular non-Hodgkin lymphoma: a case presentation

Non-Hodgkin lymphomas (NHLs) in the head and neck region are malignant lymphoid neoplasms that usually originate from B-lymphocytic cell lines. Primary extranodal manifestations of this hematolymphoid tumor in the oral cavity are rare and involve the maxillary jaw including the palatal soft tissues, the mandible, and gingival tissues in patients between 60 and 70 years of age without sex predilection. This case report of an extra-nodal NHL in the palate of a 75-year-old patient emphasizes the importance of accurate clinical, radiographic, and histologic diagnostic procedures to avoid delayed diagnosis or inappropriate treatment strategies. Chemotherapy, radiotherapy, or a combination of the two with a regular clinical and hemic follow-up is recommended.

Disseminated Kaposi's sarcoma and HCV infection: only a casual relationship? A case report

The authors present a case of disseminated Kaposi's sarcoma in a male patient, HIV negative and Hepatitis C virus (HCV) positive. Although it is well-known that in HCV positive patients the onset of cutaneous diseases such as porphyria cutanea tarda, mixed essential cryoglobulinemia, lichen planus, polyarteritis nodosa, itch/prurigo, is possible, papers on its association with disseminated Kaposi's sarcoma in HIV negative patients are rare in the literature. Such an association is probably not a matter of chance: in fact, the changes to the immune system induced by the HCV virus, in synergy with those induced by the Human Herpetic virus-8, could likewise play a role in the development of Kaposi's sarcoma as happens in patients with immunodeficiency .

Regression of the tumor after withdrawal of cyclosporine in relapsed extranodal natural killer/T cell lymphoma following allogeneic hematopoietic stem cell transplantation

The prognosis of patients with advanced-stage extranodal natural killer/T cell lymphoma, nasal type (ENKL) has been generally poor, and several anecdotal reports have suggested the role of allogeneic hematopoietic stem cell transplantation (HSCT). A potential advantage of allogeneic HSCT may be the graft-versus-lymphoma (GVL) effect. The susceptibility to the GVL effect, however, has been shown to vary according to histologic subtypes, and it has been hardly documented yet whether ENKL is susceptible to the GVL effect. Here we report a patient with advanced-stage ENKL who underwent allogeneic HSCT from an HLA one-allele mismatched related donor, whose clinical course after HSCT suggested the potent GVL effect against ENKL. A 43-year-old female underwent allogeneic HSCT for advanced-stage, chemorefractory ENKL, and achieved complete response. In 4 months after the transplantation, however, the ENKL relapsed in multiple sites. These lesions markedly responded to the discontinuation of immunosuppressive agents and disappeared. Except for a temporal exacerbation of bronchiolitis obliterans organizing pneumonia, she has been free from disease for more than a year without other treatments against lymphoma. The clinical course of the current patient suggests the potent GVL effect against ENKL. Allogeneic HSCT, including that with reduced-intensity regimens, is a promising treatment option for high-risk ENKL.

No pharmacokinetic drug-drug interaction between nevirapine and paclitaxel

We have investigated the pharmacokinetics of nevirapine and paclitaxel in a patient who used both drugs concomitantly, as there are strong theoretical indications for a potential pharmacokinetic drug-drug interaction. Plasma concentrations of nevirapine (dose: 200 mg twice daily orally) and paclitaxel (dose: 100 mg/m(2) 3-h i.v. infusion) were determined in a HIV-1-infected patient with Kaposi's sarcoma. Since both drugs are metabolized via the same cytochrome P450 isoenzymes, investigation of a drug-drug interaction was considered important. We found that the plasma concentrations of nevirapine given together with paclitaxel were similar to those given without paclitaxel. The exposures to paclitaxel (AUC(0-infinity) = 3787 h.ng/ml) and its hydroxy metabolites when co-administered with nevirapine were comparable to the mean exposure to paclitaxel and its metabolites from eight historical controls (AUC(0-infinity) = 3614 h.ng/ml) treated with the same dose. No pharmacokinetic drug-drug interaction between nevirapine and paclitaxel could be demonstrated in our HIV-1-infected patient.

Gingival Involvement in a Case Series of Patients With Acquired Immunodeficiency Syndrome-Related Kaposi Sarcoma

BACKGROUND

This case series presents the polymorphic clinical characteristics of gingival acquired immunodeficieny syndrome (AIDS)-related Kaposi sarcoma (KS), a malignancy that is gradually becoming uncommon in developed nations. An up-to-date overview of the related epidemiology, etiopathogenesis, histopathology, and treatment is provided, along with a pictorial guide to ease clinical diagnosis.

METHODS

The oral/maxillofacial pathology records at Aristotle University and the University of Geneva were retrospectively reviewed. Thirty-two cases diagnosed with oral AIDS-related KS were retrieved between 1991 and 2004. KS diagnosis was established histologically by incisional biopsies from intraoral lesions. All charts contained clinical oral examination data, radiological images, and detailed photographic records.

RESULTS

Thirteen patients (12 males and one female) presented with KS gingival involvement (40.6%). Eleven of the male patients were homosexual/bisexual men. The mean age of the patients at the time of intraoral KS diagnosis was 42.1 years, and the mean CD4 cell count was 103 (0 to 481). Gingival epidemic KS presented with various degrees of pigmentation and a wide range of clinical patterns, from relatively flat macules (early stage) to tumors with variable nodular morphology (advanced disease). Solitary or multiple gingival involvement may appear concomitantly with palatal and/or cutaneous lesions.

CONCLUSIONS

Even though the incidence of intraoral KS had fallen precipitously in developed countries after the mid-1990s, gingival KS should be considered in the differential diagnosis of every pigmented gingival lesion. Periodontists are in a unique position to identify gingival involvement of intraoral KS and facilitate early diagnosis.

A case of double cancer involving oral malignant melanoma and gastrointestinal stromal tumor (GIST)

We report a very rare case of double cancer involving palatal malignant melanoma and gastrointestinal stromal tumor (GIST), a rare tumor of the gastrointestinal tract originating from a primitive mesenchymal cell. After chemotherapy, radiation therapy, and treatment with interferon and OK-432, the GIST was resected and the melanoma disappeared. The patient has had no evidence of recurrent tumor, and the patient's clinical course has been uneventful for 1 year. This is probably the first report of synchronous double cancer involving oral malignant melanoma and GIST.

Oral mucosal melanoma: a series of case reports

INTRODUCTION

Due to the rarity of oral malignant melanomas case reports are a necessary source of information. Ten new cases are reported with a minimum follow-up of 3 years.

PATIENTS AND METHODS

Patients were treated during a period of 10 years. Clinical, demographic and pathologic findings were examined.

RESULTS

In 6 males (60%) and 4 females with a mean age of 64.3 years the tumour locations were: hard palate-maxillary gingiva (3 cases), maxillary gingiva (2), lower gingiva (2), tongue (2), hard/soft palate-buccal mucosa (1). Pre-existing melanotic pigmentation had been present in 4 patients. Four patients were in stage I, 5 in stage II, and 1 in stage III. Surgical excision was the primary treatment in 9 cases. Five patients underwent simultaneous neck dissections. All patients received radiation and multimode adjuvant therapies. After a 3-year follow-up 3 patients are still alive (50% (2/4) of those presenting in stage I and 20% (1/5) in stage II).

CONCLUSIONS

Due to the rarity of oral melanoma, individual experience is limited. The poor prognosis and the different treatments reflect this situation.

[Local sclerosing treatment with etoxiesclerol in ORL disease: Rendu-Osler disease, granuloma, angioma...]

In a previous report, we showed the efficacy of the submucous sclerosant therapy with Etoxiesclerol (Polidocanol) in two patients with Rendu-Osler-Weber disease. We confirm, in this present study, the advantages of Etoxiesclerol in the treatment of the epistaxis in the Rendu-Osler disease, in six patients, 3 males and 3 females and likewise in two patients with non-specific granuloma of nasal septum and another patient with cavernous hemangioma of soft palate.

Two cases of nasal natural killer T-cell lymphoma

Nasal natural killer T-cell lymphoma is a very aggressive and destructive disease with a poor prognosis. We hereby present two male patients in whom diagnostic problems and a mortal course were encountered. One patient (age 31 years) had progressive ulceration in the nasal area. Two biopsies that had been taken elsewhere were inconclusive. The other patient (age 40 years) was referred with a previous histopathologic diagnosis of squamous cell carcinoma. He complained of an unhealing wound in the hard palate. Biopsies were repeated in each case. Diagnosis was made by immunohistochemical examination. Both patients died shortly after the diagnosis. The importance of obtaining an adequate and deep biopsy sample and employing sophisticated immunohistochemical examination is emphasized for an accurate diagnosis.

Angiocentric T-cell lymphoma presenting as midface destructive lesion: case report and literature review

A case of angiocentric T-cell lymphoma presenting as a midface destructive lesion is reported. Angiocentric T-cell lymphoma typically manifests as an aggressive, progressively destructive, and necrotizing disorder, often with a fatal outcome. This case was characterized microscopically by the presence of an atypical lymphoid population that expressed a CD45+, CD3+ cytoplasmic, CD5+, and CD56- T-cell phenotype within a background of a polymorphous inflammatory infiltrate. Because of the rarity of the disorder, the differential diagnosis is discussed. Recent advances in clinical immunodiagnostics, the variations in therapeutic modalities, and the prognosis of the disease as reported in the recent literature are reviewed.

Successful antiangiogenic therapy of giant cell angioblastoma with interferon alfa 2b: report of 2 cases

We describe 2 cases of angioblastoma, a rare, destructive pediatric tumor, treated with interferon alfa 2b (IFNalpha2b). The first patient is a 10-month-old male who presented with an ulcerated palatal neoplasm that could not be completely resected. The second is a male neonate with a congenital tumor of the right hand that invaded the hypothenar eminence, destroying the fourth and fifth metacarpals. Biopsy in both patients was interpreted as giant cell angioblastoma. Angioblastoma is rare; there is only 1 reported case that necessitated amputation of an upper extremity, also initially recommended for our patient. Because there is little experience with chemotherapy, permission was granted to employ an antiangiogenic regimen of IFNalpha2b. The angiogenic protein, basic fibroblast growth factor (bFGF), was abnormally elevated in both patients. Both patients received IFNalpha2b. In the first child, it was used after incomplete resection, because biopsy-proven tumor was present at the margin and in the nasopharynx. Biopsies 15 months after initiation of IFN2alphab were negative for tumor. Therapy was stopped after 3 years. Eighteen months later, the patient remains disease-free. In the second child, IFNalpha2b was started after debridement of the ulcerated tumor. Over 11 months, the tumor completely regressed and there was bony regeneration of the metacarpals. The fifth digit was amputated because of damage to the metacarpophalangeal joint by the tumor. IFNalpha2b therapy was discontinued after 1 year of treatment, and the child remains disease-free 2 years and 8 months later. In conclusion, this report demonstrates that: 1) a bFGF-overexpressing low-grade tumor can respond to IFNalpha2b in a manner similar to life-threatening infantile hemangiomas, 2) urinary bFGF levels can help guide IFNalpha dosage in such patients, and 3) although bFGF-mediated tumor angiogenesis is inhibited by IFNalpha, physiologic angiogenesis seems to be unaffected.

Acute reversible cardiomyopathy and thromboembolism after cisplatin and 5-fluorouracil chemotherapy--a case report

Acute development of cardiomyopathy and occlusive thromboembolic events following cisplatin and 5-fluorouracil (5-FU) is rare but frequently lethal. The authors report the successful management of such an event in a 52-year-old man with squamous cell carcinoma of the soft palate. The possible pathophysiological mechanisms are discussed.

Transfusion-associated graft vs. host disease in a patient with high-grade B-cell lymphoma. Should cellular products for patients with non-Hodgkin's lymphoma be irradiated?

We present the case of a 64-year-old man who died from transfusion-associated graft vs. host disease (TA-GVHD) having been treated 2 years earlier for a high-grade, non-Hodgkin's lymphoma (NHL). We suggest that he was at increased risk of developing TA-GVHD as a result of the NHL and its subsequent treatment, and propose that patients with NHL should be added to those 'at risk' groups who receive irradiated cellular blood components.

[Highly malignant T-cell non-Hodgkin lymphoma (nasal type) of the hard palate]

The monomorphic clinical aspect of destructive mid-face lesions is characterised by inflammation, induration and granulomatous transformation. This feature can be caused by various infections, toxical noxa, Wegener's Granulomatosis and different neoplasms. The case of a 19 year old patient with EBV associated nasal type T-cell lymphoma located at the hard palate is presented. The diagnostic approach and difficulties in diagnosing this entity assessing by using multiple biopsies, serological and molecularbiological detection of EBV association and immunohistochemistry for atypic T-cells are elucidated. In the presented case the treatment with chemotherapy and irradiation following a well-defined therapy concept leaded to a three year recurrence-free survival so far. The comparison of the key-histological findings and the major differential diagnoses is mandatory to establish the final diagnosis of lymphoma. This is the basement for treating this disease with combined chemotherapy and irradiation for optimizing survival.

[A case in which palatal squamous cell carcinoma responded to UFT therapy]

We administered UFT to a 70-year-old female with squamous cell carcinoma of the palatal mucosa (T1 N0 M0) who had not consented to radical surgical treatment. The tumor disappeared grossly and histopathologically after 1 month, and no adverse reaction to oral administration of UFT was noted. The patient remains under observation.

Regression of AIDS-related Kaposi's sarcoma following ritonavir therapy

This paper describes a case report of an HIV-infected patient with mucocutaneous Kaposi's sarcoma (KS) with oral involvement, which presented complete clinical resolution of lesions on antiretroviral treatment with ritonavir, an HIV-1 protease inhibitor. Although it has still not been demonstrated that ritonavir has a specific antiviral action against HHV-8, a gamma herpesvirus probably involved in KS aetiopathogenesis, it has been proven that it reduces the HIV load significantly. This affects certain growth factors of KS, such as Tat protein and cytokines, and favours recovery of immune function, which correlates with protection against AIDS-defining conditions.

Photofrin-mediated photodynamic therapy of chemically-induced premalignant lesions and squamous cell carcinoma of the palatal mucosa in rats

Photodynamic therapy (PDT), an experimental cancer therapy, was studied in an animal model of chemically-induced epithelial dysplasia and squamous cell carcinoma. PDT was performed 24 hours after i.v. injection of 2.5 mg/kg bw Photofrin, and using 100 J/cm2 incident light at two activation wavelengths (514.5 nm or 625 nm). Two days after PDT, the majority of rats macroscopically showed a marked erythema of the entire palatal region. Microscopically all the rats showed oedema, haemorrhage, and necrosis of the epithelium of the intermolar area. The long-term results were not so favourable. No evidence of disease was found in 6 out of 20 rats in the 514.5 nm group and in 2 out of 20 rats in the 625 nm treated group. Epithelial dysplasia was found in 14 out of 20 rats in the 514.5 nm group, and in 18 out of 20 rats of the 625 nm treated group. Squamous cell carcinomas were found in 4 out of 20 rats treated with 514.5 nm and in 7 out of 20 rats in the 625 nm treated groups. Comparing both treatment wavelengths, better results were obtained in the 514.5 nm groups as this wavelength gave less normal tissue damage. Based on the results of this study the application of PDT for the treatment of field cancerization and squamous cell carcinoma of the oral cavity, is discussed.

Intralesional vinblastine injections for the treatment of oral Kaposi's sarcoma: report of 10 patients with 2-year follow-up

PURPOSE

This study evaluated the use of intralesional vinblastine injections for the treatment of the intraoral lesions of Kaposi's sarcoma.

PATIENTS AND METHODS

Eighteen patients were treated with up to three intralesional injections of 0.1 mg/cc vinblastine.

RESULTS

All lesions responded to the local injections; 40% required one injection; 31%, two injections; and 29%, three injections. Large, exophytic lesions usually required the multiple injections. No complications were encountered, and the patients tolerated the protocol well. Ten patients were followed for 24 months. Eight died of their general disease during this period. Four patients developed new intraoral lesions, which were treated with, and responded favorably to, the three-injection protocol.

CONCLUSION

Intralesional vinblastine injections are an effective and useful treatment alternative for human immunodeficiency virus (HIV)-associated intraoral Kaposi's sarcoma.

Use of photodynamic therapy for the treatment of squamous cell carcinoma of the soft palate

A 53-year-old white woman presented with a 5-month history of throat pain. The soft palate was biopsied and histological examination confirmed the diagnosis of infiltrating squamous cell carcinoma. She refused surgery and radiotherapy and was therefore offered photodynamic therapy which she accepted. She was treated with 20 J/cm2 at 100 m W/cm2 over a 3 cm area. She was discharged three days later having made an uncomplicated recovery, though substantial analgesia was required. Healing was complete after 2 months, with no loss of palatal function and at most recent follow-up (16 months) there was no sign of residual disease and she remained well.

Long-term remission of Kaposi's sarcoma following foscarnet treatment in HIV-infected patients

Five patients with HIV-associated Kaposi's sarcoma (epidemic KS) were treated with foscarnet 180 mg/kg/day i.v. for 10 days. Four of them suffered from severe immunodeficiency with CD4 cell counts below 30 x 10(6)/l. Three of the patients went into long-term remission of KS. One patient was free of relapse for 12 months and 2 patients are still in remission after an observation period of 13 and 20 months respectively. The results suggest a possible role of foscarnet in the treatment of epidemic KS.

Treatment-related esophageal stricture in pediatric patients with cancer

BACKGROUND

Intensive antineoplastic regimens have enhanced long-term survival in pediatric patients with cancer, but can result in long-term complications. Esophageal stricture formation is one such complication.

METHODS

We reviewed the experience with benign esophageal stricture in pediatric patients with cancer over the past 15 years in a major cancer center. Clinical course, along with endoscopic, radiologic, and manometric esophageal studies, was reviewed.

RESULTS

Esophageal strictures formed in five pediatric patients who were treated with radiation and/or chemotherapy. Stricture formation was associated with abnormal esophageal motility in four out of the five patients. Repeated esophageal dilation was performed from 3-50 times and resulted in stricture resolution in only 2 of the 5 patients.

CONCLUSIONS

Esophageal stricture formation in this population is rare, but is associated with long-term morbidity.

Successful treatment of concomitant acute myeloblastic leukaemia and adenoid cystic carcinoma of the palate

The case of a 55-year old man who was affected simultaneously by acute myeloblastic leukaemia (AML) and adenoid cystic carcinoma of the palate is reported. The carcinoma was removed after induction chemotherapy for AML and the patient subjected to consolidation therapy. No reports are evident of other cases in which acute leukaemia and other malignancies were treated simultaneously, and in which the patient was cured of both. It is suggested that this case may serve as a reference for future similar cases.

Treatment modalities for intraoral Kaposi's sarcoma: report of case

Intraoral Kaposi's sarcoma (KS) is a lesion seen commonly in patients with AIDS. These lesions can interfere with both speech and mastication. The dental team should be aware of the various treatment modalities for KS and the complications associated with these treatments. One of the treatment modalities reviewed here can be safely administered in a dental office.

HIV infection: clinical features and treatment of thirty-three homosexual men with Kaposi's sarcoma

The clinical findings of patients with oral Kaposi's sarcoma are reviewed. These oral findings commonly included candidiasis, hairy leukoplakia, gingivitis associated with human immunodeficiency virus (HIV), periodontitis, and other symptoms, including xerostomia. The other common symptoms of HIV disease that may be of importance in leading to a diagnosis are reviewed in this patient group. Treatment by local radiotherapy or by intralesional vinblastine of these oral Kaposi's sarcomas resulted in successful palliation, with more than 50% regression of the lesions in 80% of the patients treated.

Oral Kaposi's sarcoma in acquired immunodeficiency syndrome. Review of management and report of the efficacy of intralesional vinblastine

Treatment of palatal Kaposi's sarcoma (KS) with intralesional injection of vinblastine was seen to provide effective palliation. Of the ten patients studied, four had a 25% to 50% response, two 50% to 75% response, and four had 75% to 100% response with one or two intralesional injections of vinblastine. Response to treatment was followed for a mean of 3.6 months, with recurrence of lesions in two of ten patients.

Lethal cardiac toxicity after cisplatin and 5-fluorouracil chemotherapy. Report of a case with necropsy study

This article presents a patient affected with epidermoid carcinoma of the soft palate who developed a dilated myocardiopathy with aortic embolism and fatal left cardiac failure after treatment with cisplatin (100 mg/m2, day 1) and 5-fluorouracil (1 g/m2/day i.v. days 2-6). The postmortem necropsy study showed diffuse interstitial edema and intracytoplasmic vacuolization of myocytes, without inflammatory changes. These findings were interpreted as acute toxic myocardiopathy, probably due to 5-fluorouracil treatment. Although the patient also received cisplatin, metoclopramide, allopurinol, thiethylperazine, and amitriptyline, before the onset of clinical symptoms, these drugs were not considered to play an important role in the production of this cardiopathy because of the dosage, necropsy findings, and lack of previous report.

Effect of retinoids on the growth of squamous cell carcinoma of the palate in rats

The in vivo effects of retinoids on head and neck tumors were studied using Fisher 344 rats with squamous cell carcinoma implanted in the palate. Retinoids were given orally to rats, starting 2 weeks after tumor implantation. The animals were killed at 4 weeks, and the tumor volumes and body weights were measured. The animals had a greater response to all-trans-retinoic acid (58 per cent) and 13-cis-retinoic acid (60 per cent) than to all-trans-retinol (20 per cent) and 13-cis-retinal (30 per cent). Comparison of both tumor volumes and body weights among the retinoid-treated groups revealed that the body weights increased while the tumor volumes decreased. Retinoids seem to inhibit local tumor growth through their effects on host cellular and humoral immunity and through the inhibition of tumor cell keratinization.

Cisplatin-induced bradycardia

A patient who had repeated episodes of bradycardia while on cisplatin therapy is described. Cisplatin-induced bradycardia has not been reported previously. Deposition of cisplatin in the sinoatrial-node area might explain this cardiotoxic effect.

The effect of indomethacin on the growth of epidermoid carcinoma of the palate in rats

The in vivo effect of indomethacin therapy in head and neck cancer was tested using rats (Fisher 344) with implanted epithelial palatal carcinoma. Indomethacin was then given to half of the rats in their drinking water, starting two weeks after tumor implantation. The animals were then killed at four weeks and the tumor volumes were measured. It was found that four (21%) of the 19 rats were complete responders and eight (42%) of the 19 rats were partial responders. The control group showed increased tumor growth in all animals. The experimental group also demonstrated five (26%) of the 19 regional metastases. No metastases were seen in the control group. Indomethacin seems to inhibit local tumor growth, perhaps through its effects on cellular and humoral immunity and its effects on the host-tissue stroma. It also may increase tumor spread through the regional lymphatics or hematogenously. Further animal studies need to be carried out to determine the effect on cancer on a cellular and biochemical level before using it for treatment of cancer in humans.

Fatal misonidazole-induced encephalopathy: an RTOG case report

A case of fatal encephalopathy following administration of misonidazole (MISO) is reported. Anorexia and dehydration preceded signs of encephalopathy after a cumulative dose of 18 g (11 g/m2) of MISO in five weekly doses. Serum MISO levels four hours after weekly administrations were markedly elevated. Postmortem examination revealed focal cortical neuronal necrosis and hemorrhage with focal demyelination. The possible relationship of dehydration or altered drug metabolism to the development of MISO central nervous system toxicity is noted.

The effects of intra-arterial bleomycin therapy on squamous cell carcinoma of the oral cavity. Biopsy and autopsy examinations

The results of a clinico-pathologic study of 7 cases of advanced squamous cell carcinoma of the oral cavity are presented, which were treated by intra-arterial perfusion of bleomycin. In 5 cases, no histologically vital residual tumour could be found locally after therapy. The tumour area shows advanced fibrosis, and ulcerated areas have re-epithelized. The tumour cells are devitalized by keratinisation, while simple necrosis plays a minor role. Following the keratinisation there is a marked resorptive granulomatous inflammation with giant cells typical of a foreign body reaction and fibrous organisation. The special type of reaction of the tumour cells with keratinisation seems to be important for biopsy examinations and for therapeutic considerations. It explains the therapeutic success in highly differentiated squamous cell carcinomas with a tendency for keratinisation. For the first time a "cell-specific, cytocidal" therapy seems to be possible. Previous or simultaneous therapy with methods which might cause a de-differentiation of the tumour, seems to be harmful. Also with intra-arterial perfusion the lung must be considered as the target for the most serious side effects. In one case a bleomycin-induced lesion of the lung was the cause of death, in 4 cases a bronchopneumonia. Although in all cases the therapeutic chances and the prognosis were poor, 4 patients were cured of the tumour. One patient has lived without recurrence or metastases of the tumour for 20 months.