Squamous cell carcinoma of middle rectum: Literature review

INTRODUCTION

Squamous cell carcinoma SCC of the rectum is a distinct entity. We report a very rare case of squamous cell carcinoma of the middle rectum.

PRESENTATION OF CASE

The patient was a 62-year-old woman who presented with a history of rectal bleeding and discomfort. Colonoscopy revealed a polypoid tumour of the middle rectum. Biopsies of this mass revealed a poorly differentiated SCC of the rectum. CT scan of the chest, abdomen and pelvis was negative for distal metastases. The patient received combined chemo-radiation followed by surgical excision. The postoperative period was uncomplicated.

DISCUSSION

The pathogenesis of rectal SCC remains unclear and diagnosis is often delayed. Diagnostic criteria have been proposed. MRI of the rectum and trans-rectal endoscopic ultrasound R-EUS provide essential information to plan a therapeutic approach. The squamous cell carcinoma antigen level is not suitable for initial diagnosis of rectal SCC. Most authors conclude that the surgery is the gold standard treatment. Tumour stage is the most important prognostic predictor of SCC.

CONCLUSION

Squamous cell carcinoma of the rectum is a distinct entity. Before the final choice of treatment is made, digestive surgeons should bear in mind this rare tumour.     

The Use of Examination Under Anaesthesia and Panendoscopy in Patients Presenting with Oral Cavity and Oropharyngeal Squamous Cell Carcinoma

INTRODUCTION

Although examination under anaesthesia and panendoscopy (EUAP) has traditionally been used in the assessment of patients presenting with oral cavity and oropharyngeal squamous cell carcinoma (SCC), the era of modern medicine with its advanced imaging techniques has meant that the indications for this technique have potentially reduced.

SUBJECTS AND METHODS

In an attempt to quantify the current use of EUAP in the UK, a structured telephone questionnaire was undertaken of 50 maxillofacial units. Information was gathered regarding whether the technique was adopted on a routine or selective basis. Likewise perceived disadvantages were sought.

RESULTS

Twenty-two units (44%) carried out EUAP on all patients presenting with oral cavity and oropharyngeal SCC. Of the remaining 28 units, all employed EUAP on a selective basis, the most commonly for the assessment of the primary tumour. The most common perceived disadvantage of carrying out EUAP routinely was its potential to increase the waiting time to definitive treatment.

CONCLUSIONS

These results suggest a gradual move towards the selective use of EUAP in patients presenting with oral cavity and oropharyngeal SCC.     

Three fatal cases of squamous cell carcinoma arising in chronic perineal hidradenitis suppurativa

INTRODUCTION

Hidradenitis suppurativa (HS) is a chronic, inflammatory and suppurative disorder of skin bearing apocrine glands. The most severe complication is squamous cell carcinoma (SCC) and we here present three cases, all of which proved fatal, and review the past 40 years of published cases.

PATIENTS AND METHODS

Three advanced cases of SCC arising in chronic HS have been referred for reconstructive surgery over the past 8 years. Another 28 cases published over the past 40 years were identified using a Medline search (search items in combination: hidradenitis, squamous, carcinoma).

RESULTS

The male:female ratio was 4:1, most (61%) were perineal or buttock. We found no reports of SCC arising in axillary disease. The symptomatic history of HS prior to SCC diagnosis ranged from 3–50 years with a mean of 25 years. Age at diagnosis of SCC ranged from 27–71 years, and 15 patients (48%) died within 2 years of SCC diagnosis.

CONCLUSIONS

We advocate that hidradenitis suppurativa arising in extra-axillary sites is a pre-malignant condition, and should not be treated conservatively; curative resection is the mainstay of management.     

Delayed diagnosis of oral squamous cell carcinoma following dental treatment

Introduction

Oral squamous cell carcinoma (SCC) can present with a wide range of clinical appearances. Consequently, an oral SCC, particularly in its early stage, may not be considered suspicious by a clinician, thereby delaying diagnosis. Delayed diagnosis of an oral SCC could result in more advanced disease at the time of treatment, leading to more extensive and costly treatment, greater morbidity and poorer survival. The aim of this study was to identify cases of oral SCC treated at Southern Heath (Melbourne, Australia) with a history of prediagnosis dental treatment, and to determine the delay between dental treatment and appropriate surgical assessment of the oral SCC.

Methods

Patients were identified from the head and neck tumour database at Southern Health who met the inclusion criteria and relevant data were recorded.

Results

Twelve patients met the inclusion criteria and 83% of cases involved the mandible. Dental extraction was the most common prediagnosis treatment performed (75%). The average delay from dental treatment to surgical assessment was just over eight weeks and all patients were found to have stage IV disease. Most patients had received extensive surgical resections (83%), neck dissections (75%) and adjunctive therapy (83%).

Conclusions

Oral SCC can sometimes be difficult to diagnose, which can result in more extensive treatment and greater morbidity. Health professionals and patients need to be aware that non-healing oral lesions, even after dental treatment such as a dental extraction, need to be considered as suspicious and an appropriate surgical referral should be made.     

Primary squamous cell carcinoma of breast with ipsilateral axillary lymph node metastasis: An unusual case

Introduction

Pure squamous cell carcinoma of the breast [SCCB] is rare.

Presentation of Case

We report a case of primary squamous cell carcinoma of breast with ipsilateral axillary lymph node metastasis in a 58year old woman.

Discussion

It is a breast carcinoma entirely composed of metaplastic squamous cells that may be keratinized, non-keratinized or spindled. The pure squamous cell carcinoma usually present with central cystic cavity, which we found in our case, also supported by immunohistochemical evidence.

Conclusion

Although a rare breast cancer subtype, SCCB is of considerable interest due to its pathological heterogeneity and differences in clinical behavior and less reported occurrence of nodal metastasis.     

The first leg video endoscopic groin lymphadenectomy in vulvar cancer: A case report

INTRODUCTION

The current management of vulvar cancer depends on the extension of disease, and includes primary tumor resection with safety margin as well as inguinofemoral lymph node staging. We report the case of the first leg videoendoscopic inguinal lymphadenectomy performed in a woman with a squamous cell vulvar carcinoma.

PRESENTATION OF CASE

A 74 years old female referred to our institution complaining of vulvar mass associated with bleeding and swelling from external genitals, vaginal burning sensation and dysuria for 5 months. A vulvar–vaginal examination under narcosis reported a right major labium lesion of 5 cm with an irregular and ulcerated surface, easily bleeding on palpation, involving anteriorly the clitoral region and with a histological finding of a poorly differentiated squamous cell invasive carcinoma of the vulva ulcerating the surface epithelium. We performed, after adequate informed consent, a radical vulvectomy with a standard right inguinofemoral lymphadenectomy and a contralateral simultaneous video endoscopic inguinal lymphadenectomy-Leg procedure.

DISCUSSION

Our minimally invasive VEIL-Leg approach, performed for the first time in literature in a woman with vulvar cancer, could reduce the presence of high risk factors represented by surgical incision and by procedure-related complications, including wound infection and breakdown, hematoma, cellulitis and hernia formation.

CONCLUSION

A multicenter prospective randomized study will be helpful to clarify how this procedure could replace the standard laparotomic approach to inguinal lymphadenectomy in the vulvar cancer treatment and staging.     

Diagnostic and Prognostic Significance of Serum and Tissue Galectin 3 Expression in Patients with Carcinoma of the Bladder

Background

Galectins are group of proteins found in the cytoplasm, nucleus, cell surface and extracellular matrix. Galectin 3 (Gal-3) displays pathological expression in a variety of processes such as tumorigenesis.

Patients and Method

70 patients classified into the control group, cystitis group, transitional cell carcinoma group, and squamous cell carcinoma group were enrolled in this study which aimed to detect the serum level and the intensity of tissue expression of Gal-3.

Results

Both serum level and tissue expression of Gal-3 were statistically higher in bladder cancer patients compared to the other groups. Gal-3 level expression increased from low to high grade urothelial tumors, with a statistically significant increase of its level and expression between muscle invasive and non-muscle invasive Ta urothelial tumors.

Conclusion

The serum Gal-3 level is sensitive and specific for the diagnosis of bladder cancer. The prognostic significance of tissue expression is to be confirmed.Key Words: Galectin 3, Bladder cancer, Transitional cell carcinoma, Squamous cell carcinoma, Schistosomiasis     

Aerosol steroids for the treatment of peristomal mucocutaneous breakdown due to severe eczema

INTRODUCTION

We describe a novel treatment of mucocutaneous peristomal junction breakdown in a patient with severe eczema using aerosol steroids, where conventional methods failed to achieve healing.

PRESENTATION OF CASE

Observation and photographic evidence showing resolution of severe peristomal eczema in a patient, in whom systemic steroids were contraindicated, using a topical aerosol steroid. We found complete resolution of peristomal eczema and symptoms within four weeks.

DISCUSSION

Topical aerosol steroids are better tolerated than alcohol based steroid preparations, achieve improved stoma appliance adherence in comparison to oil based steroid preparations and reduce systemic side effects in comparison to systemic oral steroids.

CONCLUSION

Aerosol steroids appear to be a safe and effective way to treat refractory peristomal eczema and may be of use in other peristomal inflammatory conditions including contact dermatitis.     

A useful flap combination in wide and complex defect reconstruction of the medial canthal region: Glabellar rotation and nasolabial V-Y advancement flaps

BACKGROUND:

Reconstruction of medial canthal defects after tumour excision is difficult owing to the thin skin of the region and the concavity of the anatomical landmarks, which enclose complex structures such as the medial canthal ligament and the lacrimal system. Local reconstruction methods for this region include secondary healing, full-thickness skin grafts, and skin flaps from the frontal, transnasal, glabellar and upper eyelid regions.

OBJECTIVE:

To demonstrate a useful combination of two local flaps in wide defects of the medial canthal region.

METHODS:

Between 1998 and 2012, a combination of glabellar rotation and nasolabial V-Y advancement flaps were used in 11 patients with wide complex defects after excision, including periosteum, of invasive basal cell carcinoma.

RESULTS:

All patients were tumour free and underwent functional and aesthetic reconstruction of the medial canthal region. There were no major complications, and no relapses were observed.

CONCLUSION:

This technique achieves good match in colour and texture, and has satisfactory results both aesthetically and functionally. In addition, donor area morbidity is minimal and surgical technique is simple.     

Mammoplasty for symmetry in breast reconstruction and histologic assessment

Background

In breast reconstruction, complementary surgery on the contralateral breast is sometimes necessary to obtain a satisfactory aesthetic result. This complementary mammoplasty for symmetry gives the surgeon the opportunity to verify the state of the mammary glandular tissue to rule out a possible occult tumour in the contralateral breast. Our objective was to determine the prevalence of borderline lesions and of in situ and invasive carcinoma in specimens of the contralateral breast in a mammoplasty for symmetry in patients with breast cancer.

Methods

We conducted a retrospective study of 145 breast reconstructions with mammoplasty for symmetry conducted at the Tours Regional Teaching Hospital in France.

Results

The glandular histologic result after mammoplasty was normal in 45.5% of patients, with benign pathologies in 38.9% and borderline lesions in 15.6% of patients. No invasive or in situ carcinoma was detected.

Conclusion

Systematic histologic analysis of glandular mammary tissue sampled after reduction mammoplasty in the particular context of breast reconstruction after breast cancer makes it possible to discover lesions that were not seen in presurgical evaluation. The early management of these borderline occult lesions could reduce the incidence of breast cancer in these at-risk patients.     

Role of specimen US for predicting resection margin status in breast conserving therapy

Aim

To assess the diagnostic accuracy of specimen ultrasound (US) for predicting resection margin status in women undergoing breast conserving therapy for US-detected cancer, having the histological findings as the reference standard.

Patients and methods

A total of 132 consecutive patients (age range, 34–87 years; mean, 51 years) underwent breast-conserving surgery for US-detected invasive breast cancer. All surgical specimens underwent US examination. The presence of lesion within the specimen and its distance from the specimen margins were assessed considering a threshold distance between the lesion and specimen margins of 10 mm. US findings were then compared with the pathological ones and specimen US. Sensitivity, specificity, diagnostic accuracy, positive (PPV) and negative predictive values (NPV) for predicting histological margin status were evaluated, having the histological findings as the reference standard.

Results

The histological examination detected invasive ductal carcinoma in 96/132 (73%) cases, invasive lobular carcinoma in 32/132 (24%), mucinous carcinoma in 4/132 (3%). The pathological margin analysis revealed 96/132 (73%) negative margins and 36 (27%) close/positive margins. US examination detected all 132 breast lesions within the surgical specimens. 110 (83%) negative margins and 22 (17%) positive margins were found on US. Sensitivity, specificity, diagnostic accuracy, PPV and NPV of 44%, 94%, 80%, 73% and 82%, respectively, were found for specimen US.

Conclusions

Specimen US represents a time and cost saving imaging tool for evaluating the presence of US detected-breast lesion within surgical specimen and for predicting the histological margin status.     

Laparoscopic Surgery for Anorectal Malignancies Other than Carcinoma

Objective:

Numerous concerns have been raised relative to the appropriateness of laparoscopic surgery for cure of rectal adenocarcinomas. However, because of their rarity, little information exists about the role of laparoscopy for other anorectal malignancies. We report the outcome of five patients who underwent laparoscopic surgery for other anorectal malignancies.

Methods:

All patients who underwent laparoscopic surgery for treatment of non-carcinomatous anorectal malignancy were assessed by means of endoscopic, radiological and histopathologic diagnostic tests.

Results:

Two patients with anorectal melanoma and one with anal leiomyosarcoma underwent laparoscopic abdominoperineal resection. A laparoscopic loop ileostomy was performed for an HIV-positive patient with rectal Kaposi''s sarcoma. Another patient with anorectal melanoma had intraoperative identification of distant liver metastasis and therefore underwent diagnostic laparoscopy instead of an intended abdominoperineal resection. There were no intraoperative laparoscopic complications. During the follow-up period three patients who underwent abdominoperineal resection were alive, one of whom had rectal melanoma and developed liver metastasis without local recurrence. The two patients with distant liver metastasis and rectal Kaposi''s sarcoma died 46 days and five months after surgery, respectively. There were no port-site or local recurrences.

Conclusion:

Laparoscopic abdominoperineal resection for non-carcinomatous anorectal malignancies is technically feasible and avoids many of the concerns associated with attempted curative laparoscopic resection of carcinoma.     

Plattenepitheliale Läsionen der Harnblase

Background

Squamous cell carcinoma (SCC) and transitional carcinoma with squamous differentiation (SCC/TCC) are rare in western countries. Chronic inflammation and irritation of the urothelium are common risk factors for the development of SCC and TCC/SCC. Tumour biology of squamous cell cancer and precancerous squamous lesions is different from transitional cell cancer (TCC). Recent advances in molecular analysis of benign and malignant squamous cell lesions indicate that they are closely associated and might lead to improved bladder cancer subclassification in the future.

Aim

At present, the clinical management and therapy of SCC remains challenging, as scientific evidence based on prospective clinical trials is not available. We performed an analysis of available literature on natural history, treatment, and prognosis of SCC, SCC/TCC and metaplastic lesions. Furthermore, recent findings in molecular cancer biology are discussed with a focus on their relevance for SCC carcinogenesis.     

Clinicopathological analysis of ten patients with metaplastic squamous cell carcinoma of the breast

Purpose

Primary squamous cell carcinoma (SCC) and metaplastic squamous cell carcinoma (MSCC) are rare types of breast cancer with specific histological features. They are characterized by rapid progression, a tendency toward cyst formation, and negativity for hormone receptors. Many studies have concluded that SCC of the breast carries a poor prognosis, based on the fact that conventional chemotherapy for ductal carcinoma of the breast is ineffective against SCC. This is a retrospective study of patients in a single center with SCC or MSCC.

Methods

We searched the records of the Tokyo Metropolitan Komagome Hospital for patients diagnosed with breast SCC or MSCC between 1979 and 2006. Squamous cell carcinoma was diagnosed when 100% of the malignant cells showed a squamous component (pure SCC) and MSCC was diagnosed when more than 50% of the malignant cells showed a squamous component. We analyzed the clinicopathological features, treatment methods, and outcomes of these patients.

Results

We identified 10 (0.28%) patients with SCC or MSCC from among 3565 patients with malignant breast tumors treated at our hospital during this period. Nine patients had adenocarcinoma with squamous metaplasia, and one had pure SCC. Ultrasound showed a central cystic-necrotic component in seven tumors, and all of the tumors were negative for hormone receptors and HER2. Recurrence developed in two patients with lymph node metastasis, but not in the other eight patients. The 5-year survival rate and median survival time were 85.7% and 97 months, respectively.

Conclusions

Squamous cell carcinoma or MSCC of the breast with features of the triple-negative subtype seems to be associated with a poor prognosis; however, nodenegative patients are likely to have a favorable prognosis.     

Duodenal seromyectomy in the management of adherent colonic carcinoma in elderly patients

Objective

To determine if partial denudation of the duodenum by seromyectomy can achieve tumour clearance in elderly patients with adherent primary colonic carcinoma.

Design

A case series.

Setting

An urban tertiary care centre.

Patients

Seven elderly patients with Dukes’ class C primary adenocarcinoma of the ascending colon adherent to the duodenum but without distant metastases. The follow-up ranged from 29 to 41 months.

Interventions

Right hemicolectomy and seromyectomy of the duodenum at the site of adhesion.

Main outcome measures

Patient survival and tumour recurrence.

Results

One patient died 29 months postoperatively of myocardial infarction but without tumour recurrence. Another patient had a solitary metastasis in the right liver lobe 7 months postoperatively. She was disease free 34 months after a right hemihepatectomy. The other 5 patients were alive and disease free at their last follow-up.

Conclusion

Duodenal seromyectomy with postoperative chemotherapy for locally advanced adherent colonic cancer seems to be an acceptable management strategy for elderly patients in whom major en bloc resections present a greater than average risk of death.     

Caustic burn caused by intradermal self administration of muriatic acid for suicidal attempt: optimal wound healing and functional recovery with a non surgical treatment

Background

Caustic burns are burns of third and fourth degree caused by strong acids or strong bases. Muriatic acid is often used for suicidal attempt by ingestion. We describe a case of a caustic skin lesion caused by intravenous failed attempt of suicide by injection of Muriatic acid in a woman affected with bipolar-syndrome. Generally, caustic burns are treated by cleansing, escarectomy and coverage with skin grafts.

Case report

We treated the patient with a non invasive technique with collagenase and hyaluronic acid sodium salt cream (Bionect start^®), hyaluronic acid-based matrix (Hyalomatrix^®) and Vacuum-Assisted Closure (VAC) Therapy^®.

Results

We obtained complete healing in 6 weeks.

Conclusions

Combined use of non invasive techniques seems to ensure only advantages for both the patients and the Health System. It reduces health care costs and risks for the patients such as nosocomial infections. Patient’s compliance is high, as its quality of life. Complete healing of the wound is fast and recovery of function is full.     

Clinicopathological analysis of eyelid malignancies - A review of 85 cases

Background:

Resection of eyelid malignancies leads to complex reconstructive problems due to the functional and aesthetic importance of an eyelid. Hence, a large number of such cases are referred to plastic surgery facilities. Eyelid malignancies are of varied histological types and the western and Asian data have considerable variations in case distribution and presentation. This study is an attempt to characterise these tumours in the Indian population.

Materials and Methods:

The present study is a retrospective analysis of 85 consecutive cases of eyelid malignancies that reported to a tertiary health care facility in central India over a 15-year period starting from January 1996 up to December 2009. The cases were analysed for their age of presentation, sex distribution, tumour location, delay in seeking treatment, recurrence rate and variations with respect to the pathological subtype.

Observations:

Mean age of presentation for all the malignancies was 59 years. The median age of presentation was 65 years for basal call carcinoma (BCC), 58 years for sebaceous gland carcinoma (SGC), 55 years for squamous cell carcinoma (SCC) and 45 years for malignant melanoma. There was slight female preponderance as 56.28% of the patients were females. The most common location of the tumour was lower lid (58.2%) for all the malignancies. BCC was the most common malignancy (48.2%) followed by SGC (31.2%) and SCC (13.7%). Mean duration of symptoms was 9 months (range 3-21 months). The most common presenting complaint was mass with ulceration across all histological subtypes. Other associated complaints included itching, discharge from eye, pain and ptosis. The mean size of tumour at diagnosis was 2.34 ± 0.4 cm for BCC, 2.19 ± 0.6 cm for SGC and 1.99 ± 0.7 cm for SCC. The mean rate of growth of BCC was 1.39 cm/year. The corresponding values for SGC and SCC were 3.63 and 4.89 cm/year, respectively. The rate of follow-up was 89% at 3 months, 71% at 6 months, 62% at 1 year and 31% at 5 years. Recurrence rate was 1.9% for BCC and 12.7% for SGC. Surgical methods used included wedge excision and primary closure, excision and skin grafting, and tarso-conjunctival flap.

Conclusions:

We recommend that the surgeons treating eyelid malignancies in India should have a high index of suspicion for SGC. A wider margin of 10 mm is recommended for SGC excision as opposed to 5 mm for BCC.KEY WORDS: Basal cell carcinoma India, eyelid, malignancy, sebaceous gland carcinoma     

Primary intraosseous ACC of mandible of possible salivary origin: A rare clinical entity

INTRODUCTION

Adenoid cystic carcinoma (ACC) is a malignant tumor mainly of salivary origin which is well known for its deceptively benign histologic appearance characterized by indolent, locally invasive growth with high propensity for local recurrence and distant metastasis.

PRESENTATION OF CASE

An unusual case of a 23-year-old woman was reported in our hospital. After investigations, it showed that it is a second primary intraosseous lesion of mandible that occurred subsequently after ACC of parotid gland. After diagnosis was established, resection of tumor and reconstruction with a free fibula flap was performed. Ten months follow-up showed no signs of recurrence or metastasis.

DISCUSSION

Among the salivary neoplasms, adenoid cystic carcinoma is very rare and intraosseous lesions are even rarer. We found a total of 26 cases of primary ACC of the mandible reported in the literature. Pain and swelling were the most frequent symptoms.

CONCLUSION

This case illustrates two key facts. First, not all cystic lesions are necessarily metastatic or recurrence. Second is, even though the exact origin of this tumor is unknown, central salivary gland tumors should be considered in the differential diagnosis of cystic lytic lesions in the mandible.     

Ameloblastic fibro-odontoma

INTRODUCTION

Ameloblastic fibro-odontoma (AFO) is a quite rare, mixed odontogenic tumour generally seen in the early stages of life. Frequent signs of this tumour are asymptomatic swelling, delayed tooth eruption and mixed radiological appearance within well-defined borders. Management of the lesion includes enucleation of the tumour and long-term follow-up.

PRESENTATION OF CASE

A 10-year-old girl was referred to our oral and maxillofacial surgery clinic with an incidental radiological finding of radiopaque mass in the posterior region of maxilla. OPG showed unerupted tooth bud of upper right second molar and was being prevented from eruption by the odontome. Under general anaesthesia, the lesion was enucleated and the permanent right upper second molar tooth bud removed.

DISCUSSION

Mixed odontogenic tumours are a group of rare and interesting lesions which can mislead the clinician to variety of differential diagnosis. Adequate clinical and radiological investigations, proper surgical excison, accurate histopathological diagnosis, and long term follow up will ensure the right treatment plan for the patient.

CONCLUSION

The possibility of a mixed rare tumour should be kept in mind by the clinician where they deal with the swellings of posterior maxilla in children. Histological assessment revealed a final diagnosis of ameloblastic fibro-odontoma.