Surgical treatment of rhinophyma associated with basal cell carcinoma: report of four cases

Rhinophyma, the end stage in the development of rosacea, is characterized by sebaceous hyperplasia, fibrosis, follicular plugging, and telangiectasis. Although it is commonly considered a cosmetic problem, it can also cause gross airway obstruction. Many patients suffer psychic trauma as a result. Basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and sebaceous carcinoma (SC) have been reported previously in association with rhinophyma. It would appear that the incidence of malignancy in rhinophyma is significantly greater than in the skin of normal noses. It is the purpose of this report to discuss and emphasize the need for histologic examination of all the surgically removed tissue in patients with rhinophyma. Early surgical treatment is advocated even in minimal rhinophyma, this can result in gratification for both the patient and the surgeon. Four illustrative cases are presented. Received: 24 March 1998 / Accepted: 19 May 1998     

Squamous cell carcinoma of the renal pelvis and ureter: incidence, symptoms, treatment and outcome

PURPOSE: Squamous cell carcinomas of the renal pelvis and ureter are rare. We report a large series of patients and compare it to patients with urothelial carcinoma. MATERIALS AND METHODS: The initial material was comprised of 808 patients with renal pelvis or ureteral cancer. A review of the histopathological material and clinical records was performed. RESULTS: Only 2 (4%) of 65 patients with squamous cell carcinoma had stage pTa/pT1/pT2 tumors compared to 460 (62%) of 743 patients with urothelial carcinoma. Median survival was much shorter for surgically treated patients with squamous cell carcinoma compared to those with urothelial carcinoma (7 vs 50 months). However, there was no significant difference in the disease specific 5-year survival rate between patients with squamous cell carcinoma and urothelial carcinoma in the same disease stage. Vascular invasion, microscopic solid tumor pattern and large tumor size had negative prognostic significance in multivariate analyses. Histopathological tumor type (squamous cell carcinoma or urothelial carcinoma) had no prognostic significance. CONCLUSIONS: The prognosis for squamous cell carcinoma is poor, but stage for stage the prognosis is not different between patients with urothelial carcinoma and squamous cell carcinoma of the renal pelvis and ureter. It can be presumed that high stage squamous cell carcinoma and urothelial carcinoma become symptomatic first at a time when the tumors already are large, deeply invasive and most often incurable. New treatment modalities are urgently needed to improve the poor prognosis in patients with advanced stage squamous cell carcinoma and urothelial carcinoma of the upper urinary tract.     

Sarcomatoid squamous cell carcinoma of the penis: a clinical and pathological study of 5 cases

PURPOSE: We analyzed clinical, morphological and immunohistochemical features in 5 cases of sarcomatoid or spindle cell squamous cell carcinoma of the penis. MATERIALS AND METHODS: The clinical and pathological files of all patients with penile carcinoma treated at our hospital between 1956 and 2002 were reviewed. Cases diagnosed as sarcomatoid squamous cell cancer were selected. RESULTS: Five of 341 patients (1.4%) had sarcomatoid penile carcinoma. Tumor stage was T2N0 in 2 patients, T2N2 in 2 and T4N3 in 1. In all patients partial or total penectomy was eventually performed. Three patients underwent bilateral inguinal lymphadenectomy. Four of 5 patients had distant metastatic disease and died within 1 year after diagnosis. One patient had exclusive hematogenous spread without lymph node involvement. Foci of distant metastatic tumor sites were the lung, skin, bone, pericardium and pleura. In 4 patients the diagnosis was based on the expression of keratin filaments in a predominantly spindle cell penile tumor or by the identification of carcinomatous and sarcomatoid areas on hematoxylin and eosin stained slides of the primary tumor. In 1 case a squamous component in a lymph node metastasis rendered the keratin negative spindle cell primary tumor sarcomatoid squamous cell carcinoma. CONCLUSIONS: Sarcomatoid squamous cell carcinoma of the penis is a subtype of squamous cell carcinoma with a poor prognosis often associated with wide hematogeneous spread. It is a rare malignancy that is often difficult to diagnose, requiring additional immunohistochemical stains.     

Complications of inguinal and pelvic lymphadenectomy for squamous cell carcinoma of the penis: a contemporary series

PURPOSE: We examined complications in a contemporary population of patients with penile cancer undergoing inguinal lymphadenectomy with or without pelvic lymphadenectomy. MATERIALS AND METHODS: The records of all patients treated for squamous cell carcinoma of the penis from January 1992 to May 2003 were reviewed. Complications and length of stay were examined. Complications were divided into early (30 days or less after surgery) and late (greater than 30 days). RESULTS: A total of 41 men were diagnosed with squamous cell carcinoma of the penis, of whom 22 underwent a total of 40 inguinal lymphadenectomies (ILs). Of the patients 13 underwent unilateral IL, 9 underwent simultaneous bilateral ILs and 10 underwent pelvic lymphadenectomy. Mean followup was 34.2 months (range 9.2 to 69.3). Early complications were lymphedema in 4 of 40 cases (10%), minor wound infection in 3 (7.5%) and minor wound separation in 3 (7.5%). Additionally, 5 of 40 patients (12.5%) had lymphoceles, which spontaneously resolved. Late complications were lymphedema in 2 of 40 patients (5%), flap necrosis in 1 (2.5%) and lymphocele in 1 (2.5%), requiring percutaneous drainage. There was no significant difference in the complication rates in patients with unilateral dissection compared to bilateral or pelvic lymph node dissection. Median length of stay was 2 days (range 1 to 9). There was no significant difference in hospital stay for unilateral dissection compared to bilateral or pelvic lymph node dissection. CONCLUSIONS: These data demonstrate the relative safety of a contemporary lymphadenectomy. We believe that these results lend support to early lymphadenectomy, including simultaneous bilateral dissections, when clinically indicated. Furthermore, these results demonstrate the benefits of a standard postoperative pathway using compression stockings, sequential compression devices and early ambulation with restricted anticoagulant use.     

老年胃癌患者围手术期并发症及其处理

目的 研究老年胃癌患者的临床特点,总结老年胃癌患者的年龄、术前各种合并症等对术后并发症发生的影响.方法 总结自2005年1月至2007年1月接受手术的181例胃癌患者的临床资料,其中老年患者(年龄大于65岁者)65例,回顾性分析老年胃癌患者的年龄、术前各种合并症与术后并发症发生的关系.结果 老年胃癌组术前合并症总发生率为83%,非老年胃癌组为59%;老年胃癌组中有52%存在2种或2种以上合并症,发生率最高的合并症为高血压,达40%;老年胃癌患者的根治率为86%,非老年胃癌组的根治率为93%;老年胃癌组术后并发症的发生率为37%,术前合并高血压、糖尿病、肺部疾病、低蛋白血症、贫血者术后并发症发生率较高.结论 老年胃癌患者手术治疗后的总并发症发生率和病死率与非老年胃癌患者相比无差异.     

肾嫌色细胞癌影像学特点与外科治疗选择

目的 提高肾嫌色细胞癌的临床诊治水平. 方法 回顾性分析25例肾嫌色细胞癌患者临床资料.男13例、女12例,平均年龄51岁.左侧13例,右侧12例.无症状肾癌16例,有腰部不适、发热、肉眼血尿等症状9例.实验室检查发现肝功能异常1例、红细胞沉降率加快1例.结合文献复习讨论肾嫌色细胞癌的影像学特点与外科治疗选择. 结果 B超检查肿瘤主要表现为低回声、有包膜、血流信号不明显.CT及MRI扫描肿瘤特征为边界清楚、质地均匀(CT平扫为70%、MR为73%),出血、坏死和囊性变少见,增强扫描多为均匀强化(CT为65%、MR为67%)及轻度强化(CT为65%、MR为93%).肿瘤直径＞4.0 cm的22例患者行根治性肾切除术、≤4.0 cm且位于肾周边的3例行肾部分切除术.肿瘤平均直径7.6 cm,剖面质地多均匀、呈灰白色或暗红色,光镜下癌细胞呈板状或条索状排列、胞质苍白或呈嗜酸性,免疫组化染色Vimentin阴性、CK18阳性.TNM分期pT1a 8例、pT1b 9例、pT2 6例、pT3a 2例.23例获随访,平均随访28个月,无瘤生存22例,1例于术后58个月发现肺转移,经干扰素-α治疗、吉西他滨及氟尿嘧啶化疗3个月后死亡. 结论 肾嫌色纽胞癌患者多无症状、分期较早.MR和CT主要表现为边界清楚、质地均匀、强化不明显.手术方式选择应遵循肾癌的外科治疗原则.患者预后多良好,手术至出现转移的时间间隔较长,建议延长术后随访时间.     

Clinical outcome of 36 male patients with primary urethral carcinoma: A single center experience

AIM: Retrospective analysis of male urethral carcinoma to assess the best therapeutic approach to the management of this tumor. METHODS: A review of 36 cases of male urethral carcinoma diagnosed and treated at our center was performed. Clinical features, treatment modality and outcomes were analysed. RESULTS: The overall median survival time was 55.16 months. The 5-year overall and disease-free survival rate for the cohort was 49% and 23%, respectively. The 5-year survival is 67% for low-stage versus 33% for high-stage tumors and is significantly different (P = 0.001). The survival was 72% for tumors of the distal urethra versus 36% for tumors of the proximal, with a P-value of 0.02. CONCLUSION: The tumor location and clinicopathological stage were the most important predictors of the disease-free and overall survival. Multimodal approach is necessary for achieving local control especially for proximal and higher stage tumors.     

偶发肾癌和症状肾癌临床诊疗特点比较的Meta分析

目的 比较偶发肾癌和症状肾癌的临床诊疗特点,阐述早期检出肾癌的重要意义.方法 检索Medline、PubMed、Cochrane Library、Web of Science、万方数据库、CNKI中文期刊数据库2000年1月1日至2016年12月31日国内外公开发表的所有关于偶发肾癌和症状肾癌临床研究的文献,按照纳入和排除标准对文献进行筛选,对纳入研究的文献进行数据提取和质量评价,采用Review Manager 5.3软件进行Meta分析.结果 共纳入23篇文献,总计肾癌患者10 065例,其中偶发肾癌患者4 251例,症状肾癌患者5 814例.两组患者在肿瘤直径上平均差(MD)为-1.58(95% CI:-2.05~-1.11),在肿瘤病理分级(G1和G2)、保留肾单位手术例数、临床分期(T1和T2)、淋巴结转移、远处器官转移上比值比(OR)分别为3.01(95% CI:2.62~3.45)、3.47(95% CI:2.72~4.44)、3.95(95% CI:3.24~4.81)、0.20(95% CI:0.11~0.35)和0.24(95% CI:0.17~0.35),差异均有明显统计学意义(P<0.000 1);在手术年龄上MD为0.23(95% CI:-1.64~2.09),差异无统计学意义(P=0.81).结论 与症状肾癌相比,偶发肾癌具有肿瘤体积小、肿瘤病理分级低、临床分期早、淋巴结转移及远处器官转移少等特点,因此早期发现肾癌对提高患者生活质量及生存率十分重要.     

Thoracic outlet syndrome in paediatrics: clinical presentation,surgical treatment,and outcome in a series of eight children

Background/Purpose: This report reviews the clinical presentation, surgical treatment, and outcome of 8 children treated for the thoracic outlet syndrome (TOS) during the last 3 years. Methods: From 1998 through 2001 31 patients were admitted to our Vascular Surgery Unit with TOS. Eight of them (25.8%) were in the paediatric age group, 8 to 16 years (mean, 13 years). No sex prevalence was found. The presenting symptoms were neurologic in 2 patients (25%) and secondary to venous flow impairment in 6 (75%). At phlebography, venous thrombosis was seen in 2 cases, and functional intermittent obstruction was seen in 4. Seven patients underwent decompressive surgical partial resection of the first rib with transaxillary or supraclavicular access. One patient was treated conservatively. Results: There were no major postoperative complications. Mean hospital stay was 2.7 days. In no patient were there signs of recurrence after a mean follow-up of 18 months (range, 3 to 36 months). Conclusions: In the authors' experience TOS in paediatric patients occurs with the same symptoms and thrombotic complications as in adults. The same surgical strategy adopted in adult patients is advisable for affected children. J Pediatr Surg 38:58-61.     

82例阴茎鳞状细胞癌临床诊断与治疗

目的：提高阴茎鳞状细胞癌的诊断和治疗水平。方法：回顾性分析1980-2005年82例阴茎鳞状细胞癌患者临床资料,结合文献复习进行讨论。结果：77例病例行手术治疗,其中阴茎部分切除术64例,阴茎全切术13例。阴茎切除加髂腹股沟淋巴结清扫14例（腹股沟淋巴结均为阳性,髂淋巴结均为阴性）。放疗3例,化疗1例,放化疗联合治疗1例。71例患者随访1～10年,5例1年内死亡,17例2～5年内死亡,49例生存5年以上,占69％,其中34例生存10年,占48％,11例失访。结论：包茎、包皮过长是阴茎鳞状细胞癌的重要诱因;HPV感染可能与阴茎鳞状细胞癌发生有关。外科手术治疗是目前治疗阴茎鳞状细胞癌的有效方法;淋巴结清扫范围应采用由浅至深逐级切除的方式;放、化疗及联合治疗疗效尚不确切。     

胆囊鳞癌、腺鳞癌的诊断和治疗(附33例病例分析和78例文献复习)

目的总结胆囊鳞癌、腺鳞癌的诊治经验。方法回顾性分析东方肝胆外科医院2007~2014年间收治的14例胆囊鳞癌、19例胆囊腺鳞癌,并对国内20例胆囊鳞癌、58例胆囊腺鳞癌进行复习。结果随访到的24例中生存时间6个月以内的8例,其中围术期死亡2例;生存时间6个月到1年内的6例;1年到2年的6例,2年到3年的2例;超过4年的2例。随访到的有6例仍健在,术后至随访时间分别为12个月、12个月、18个月、31个月、51个月、54个月。结论对于胆囊鳞癌及腺鳞癌患者的治疗应与一般胆囊癌的治疗类似,即使出现周围脏器受侵,仍应力争行根治性手术治疗。     

Combined laser treatment for penile carcinoma: results after long-term followup

PURPOSE: We evaluated local disease control, side effects and cause specific survival of penile carcinoma treated with laser therapy. MATERIALS AND METHODS: In a prospective study from 1986 to 2002 we included 67 men with a mean age of 60 years with newly diagnosed penile carcinoma. No patient was lost to followup. RESULTS: At a median followup of 42 months (range 12 to 186) 59 patients were alive and 8 had died of penile carcinoma (2) and concurrent disease (6). Of the 13 patients (19%) with local recurrence during the study period 10 underwent repeat laser treatment successfully. Side effects were few but 5 patients (7%) had postoperative bleeding. Overall cosmetic and functional results were highly satisfactory. CONCLUSIONS: The results of this study show that treating penile carcinoma with the combination of carbon dioxide and neodymium:YAG lasers can safely be done with highly satisfactory cosmetic results as well as good local tumor control.     

Anterior tongue cancer: age is not a predictor of outcome and should not alter treatment

Background: Mucosal head and neck cancers usually occur in older males after years of smoking and alcohol abuse. Despite this, approximately 5% of cases occur in young adults. The aetiology remains unclear and the anterior tongue is a prevalent site. Prognosis has been reported as worse in young patients and some have proposed a more aggressive treatment approach. Methods: Patients diagnosed with previously untreated anterior tongue squamous cell carcinoma and treated with curative intent were identified. Retrospective and prospective data were collected. Univariate and multivariate analyses were undertaken using Cox regression analysis. The outcome of patients treated with anterior tongue cancer using a cut‐off age of 40 years was compared. Results: Between 1980 and 2000, 106 males and 58 females with anterior tongue squamous cell carcinoma were treated at Westmead Hospital. Median follow up was 47 months (6?210 months). Twenty‐two patients (13.4%) were aged ≤40 years. Other than age, patient demographics, TNM stage and treatment approach were similar between the two groups. Eighty‐one per cent had either a T1 or T2 primary. In total, 139 patients (84.8%) had surgery or surgery and radiotherapy. A total of 56 (34%) patients experienced a recurrent event, with nodal recurrence occurring most often as the first site (n = 33, 59%). Young patients had a higher recurrence rate (45.5% vs 32.4%; P = 0.23). Relapse‐free survival at 5 years was 62% versus 81% (P = 0.27). Overall survival at 5 years was 65% versus 67% (P = 0.74). Conclusions: In keeping with recently published evidence, young age at diagnosis with anterior tongue cancer did not portend worse outcome. There is therefore currently no strong evidence to support a different treatment approach in young patients.     

Thyroglossal duct cysts in children: a 30-year survey with emphasis on clinical presentation,surgical treatment,and outcome

Background: Thyroglossal duct cysts (TGDC) are one of the most common congenital anomalies found in the anterior neck region of children. Sistrunk’s procedure, described in 1920 already, is still considered as the gold standard. However, clinical reality shows that in a minority of patients, marsupialization and simple cyst excision are still performed as well. Cyst recurrence is the most feared complication. The main goal of this retrospective study is to determine risk factors of recurrence. Furthermore, data on presentation characteristics, management and outcome were collected as well.

Methods: The data of 104 patients aged between 0 and 16 years who underwent surgery for TGDC at the University Hospital of Brussels between 1986 and 2016 were retrospectively analyzed. We focused on aspects of clinical presentation, intra- and postoperative treatment and long-term follow-up.

Results: Overall recurrence of TGDC was seen in twelve of the 104 cases (11.5%). Eight out of these 12 showed a preoperative infection, 4 out of 12 had intra-operative cyst rupture. Five out of the 12 patients had not been treated by the Sistrunk procedure, but by cyst excision or marsupialization only. Non-adherence to the Sistrunk procedure appeared to be the only significant risk factor of TGDC recurrence.

Conclusion: Our study shows that Sistrunk’s operation for thyroglossal duct cyst in pediatric patients is significantly superior in reducing the risk of cyst recurrence compared to other surgical treatments. Preoperative infection and cyst rupture did not influence the recurrence rates.