1/9. carcinoma arising in thyroglossal duct remnant: case reports and review of the literature.Two cases of thyroglossal duct cyst carcinoma are presented and the world literature is reviewed. There are only 74 cases reported to date. In nearly all the cases the clinical diagnosis was thyroglossal cyst. Although the great majority of the tumours were papillary adenocarcinomas, 13-15 per cent were of other histological types. The treatment has been quite variable, but the most common initial treatment was Sistrunk's (1928) operation. Following the establishment of the diagnosis of malignancy, thyroidectomy was done in several cases, but it failed to show any evidence of malignancy in most of the thyroids removed, which establishes firmly the de novo origin of these tumours from the thyroglossal duct remnant. In only one case had tumour disseminated to distant organs, the lung, liver, etc. The scepticism as to whether some of the carcinomas associated with thyroglossal duct remnants may not in fact represent metastases from a small primary tumour of thyroid gland is examined. It appears that, though a possibility of primary or metastatic tumour in the thyroid does exist, the probability does not appear to be high. From our own experience it is suggested that local excision followed by radiotherapy, irrespective of recurrence, may be worth considering for the treatment of such carcinomas.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |
2/9. Severe dermatologic reactions at multiple sites after paclitaxel administration.OBJECTIVE: To report a case of a severe dermatologic reaction at the infusion site, as well as at multiple distant sites, after paclitaxel administration. CASE SUMMARY: A 53-year-old white male with cancer of the base of the tongue was treated with paclitaxel 100 mg/m2 infused over 3 hours and carboplatin dosed at an AUC of 6 mg/mL x min infused over 30 minutes via a peripheral vein on the left arm. After 4 doses of paclitaxel, the patient developed erythematous patches on both forearms and both thighs. The lesions on the left arm worsened into a necrotic ulcer, exposing underlying tissues. All of the lesions healed after paclitaxel was withheld from subsequent cycles. Based on the Naranjo probability scale, it is probable that paclitaxel was the causative agent for these lesions. DISCUSSION: Most of the previously reported paclitaxel-induced dermatologic reactions occurred following extravasation. There are few reports of generalized dermatologic rashes. These rashes are thought to be due to delayed hypersensitivity either to paclitaxel or the solubilizing agents. Our patient had dermatologic toxicity at the infusion site, as well as at multiple other sites, that developed about 6 weeks after the first paclitaxel infusion. CONCLUSIONS: Generalized dermatologic toxicity after paclitaxel administration is uncommon and seems to be immunologically mediated. This toxicity could be secondary to paclitaxel or the additives. The use of paclitaxel is increasing in various malignancies. Newer formulations are under development. Until these formulations are available, clinicians should report any dermatologic reactions in order to identify the cause of toxicity and develop safer administration technique.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |
3/9. Metastatic anaplastic carcinoma of the thyroid mimicking squamous cell carcinoma: report of a case of a challenging cytologic diagnosis.BACKGROUND: The probability of anaplastic transformation in a differentiated thyroid carcinoma (DTC) is <2%. Admixture of DTC and undifferentiated carcinoma can occasionally be found in thyroidectomy specimens, or the undifferentiated tumor may develop in metastatic foci months or years after removal of the primary tumor. CASE: Anaplastic transformation of a metastatic DTC was diagnosed at autopsy in a 71-year-old female. At the time of her total thyroidectomy for follicular carcinoma, she already had several lung nodules, which diminished in size upon 131I treatment. Five years later the patient developed a new, pleura-based lung mass. The mass extended along the paraspinal soft tissue and involved the kidney. Fine needle aspiration biopsy of the paraspinal mass resulted in a diagnosis of metastatic squamous cell carcinoma. Two months later the patient died. Histologic evaluation of the lung nodules and pleura-based mass revealed areas of follicular carcinoma intermixed with a various patterns of undifferentiated carcinoma. The paraspinal and kidney mass consisted entirely of anaplastic tumor, including areas of squamoid differentiation. CONCLUSION: In patients with a history of DTC who develop a rapidly growing mass elsewhere, a possibility of metastatic DTC with anaplastic transformation must be considered.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |
4/9. Combined median mandibulotomy and Weber-Fergusson maxillectomy.Monoblock surgical resection in combination with radiotherapy remains the most effective method of treatment for advanced carcinoma of the maxillary sinus. Extension of antral carcinoma into the infratemporal and pterygopalatine fossae decreases the probability of achieving an all-encompassing resection via the classic anterolateral Weber-Fergusson approach because of limited posterior access. Temporal and lateral infratemporal fossa approaches have been described and involve either mobilization of the zygomatic arch or a lateral mandibular osteotomy, respectively. We report the use of a median labiomandibulotomy combined with the Weber-Fergusson approach for lesions extending posteriorly. The labiomandibulotomy with paralingual extension along the floor of the mouth allows rotation of the coronoid process laterally and exposes the infratemporal fossa to its posterior margin. We present two cases in which this approach was used to extirpate lesions that had extended posteriorly. Relevant anatomy, operative technique, potential complications, and limitations, as well as a comparison with other methods of exposure, are discussed.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |
5/9. cobalt-57 bleomycin scanning for lung cancer detection: a prospective study in thoracic surgery.patients displaying an abnormal chest X-ray, in some cases, cause a difficult diagnostic problem. A differential diagnosis between benign and malignant lesions is important to determine the choice of treatment i.e. whether or not to perform a thoracotomy. In a prospective study, we have examined the role of 57Co-bleomycin scanning for prethoracotomy assessment of 60 patients with a high clinical probability of lung cancer. For these patients, a sensitivity of 89%, a specificity of 84% and an accuracy of 88% were found. However, as a consequence of the six false-negative scans (two in-situ carcinomas and four stage I carcinomas), bleomycin scanning cannot be regarded as adequate for obviating thoracotomy in patients with a high clinical probability of lung cancer but a negative scan. Nevertheless, the technique is useful for the assessment of tumour size and for the detection of hilar, mediastinal and extra-thoracic metastases, with consequences for TNM staging. It has been found that the tumour dimension correlates well with the actual anatomo-pathologic size determined after surgical examination (r2 = 0.65 and p less than 0.01). Therefore, with an accuracy around 90% for the diagnosis of lung cancer, 57Co-bleomycin scanning offers a major tool for use in clinical investigation.- - - - - - - - - - ranking = 2keywords = probability (Clic here for more details about this article) |
6/9. Nasopharyngeal masses in adults.Nasopharyngeal masses in adults present a perplexing problem because of the concern for malignancy. A retrospective review of the records, radiographs and biopsy histology of 57 patients presenting in one year with nasopharyngeal masses at the massachusetts eye and ear Infirmary suggests that persistent pain, epistaxis, trismus, or cervical mass are uncommon in patients with benign histology and should alert the clinician to the probability of malignancy. A high index of suspicion on the part of the clinician is essential for the successful recognition of early lesions. The roles of conventional radiography, polytomography, and computed tomography scans are discussed. patients with malignant lesions are contrasted with those having benign lesions.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |
7/9. Recurrent squamous cell carcinoma of the skin.A retrospective analysis of all patients having the diagnosis of squamous cell carcinoma of the skin at a single hospital over a ten-year period was performed. These lesions are less common than both basal cell carcinomas and malignant melanomas. Noninvasive squamous cell carcinomas were not observed to recur. There was a 20% incidence of recurrence in 86 patients with invasive squamous cell carcinoma. The presence of solar changes in the skin did not obviate recurrence. The larger, less differentiated lesions had a greater probability of recurrence. When the depth of invasion of the lesions were determined, it was found that only the lesions that penetrated to Clark's Level IV or V recurred. Squamous cell carcinomas that penetrate to this depth have the potential to recur and metastasize to regional lymph nodes and should be considered malignant lesions, even if they are associated with actinic skin changes.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |
8/9. Management of recurrent penile cancer following partial or total penectomy.The initial management of localized penile carcinoma determines the probability of recurrence. Although potentially disfiguring, the management of recurrent carcinoma of the penis requires aggressive surgical resection of both the primary lesion and nodal sites to effect the best chance for long-term survival.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |
9/9. Pacemaker function during irradiation: in vivo and in vitro effect.With an ageing population in australia, one would expect the probability of treating cancer patients who have a cardiac pacemaker to increase. In this paper the effect of ionizing radiation and electromagnetic interference on pacemaker function is discussed. A case of a cancer patient, with pacemaker, treated with radiotherapy without ill effect, is described. Concurrently, four pacemakers were tested in vitro with gamma radiation from a 60 cobalt machine and no adverse effect was found. A list of precautions is recommended.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |