原发直肠肛管小细胞癌1例报告并文献复习

背景与目的：原发直肠肛管小细胞癌（SCC）是直肠肛管肿瘤罕见的类型，占比不超过1%。与常见的直肠肛管腺癌相比，直肠肛管SCC的临床症状以及影像学表现不具有特异性，诊断较为困难，术后极易发生复发和远处转移，预后差，其总体病死率极高。由于直肠肛管SCC的罕见性和特殊性，目前国内外文献报道较少，缺乏相关的研究数据和治疗经验，对其认识不够深入，尚无统一的最佳治疗方案，这给临床对其诊治带来了一定的困扰。笔者通过收治1例原发直肠肛管SCC患者，分析诊疗经过，探讨直肠肛管SCC的诊断和治疗方法，以期为该类疾病诊断和治疗提供相应的临床经验和新的思路。 方法：回顾性分析1例原发直肠肛管SCC患者的临床资料，对患者的病史特点、一般情况、影像学检查、病理组织形态和免疫标记物特征进行分析诊断，根据其特点制定相应的治疗策略，并结合相关文献复习。 结果：患者表现出便血的临床特点，影像学检查考虑为直肠肛管恶性肿瘤，经过2次肠镜下组织活检病理提示为SCC，遂行腹腔镜辅助Miles手术，术后病理诊断为直肠肛管SCC。患者术后通过辅以盆腔放疗和“顺铂+依托泊苷”EP化疗方案的综合治疗，定期复查胸部CT、全腹CT、盆腔MRI、结肠镜检查、血清肿瘤标志物等均未发生肿瘤复发和远处转移，已无瘤生存13个月，目前继续随访观察中。 结论：原发直肠肛管SCC是一种罕见的疾病，总体生存率低。直肠肛管SCC的临床症状、影像学表现与常见的直肠肛管腺癌相似，不具有特异性，肠镜下的组织活检取材较为困难，确诊需要结合病理组织形态和多种免疫组化标记物。手术切除是治疗局部进展期直肠肛管SCC最为主要且有效的方法，应尽早的进行手术治疗，术后辅以盆腔放疗和“顺铂+依托泊苷”EP化疗方案的综合治疗，能改善患者的预后，延长生存期。     

Small Cell Carcinoma ex-Pleomorphic Adenoma of the Parotid Gland

Small cell carcinoma (SCC) is a high-grade malignancy usually encountered in the lungs but also seen in almost any site including the salivary glands. SCC is important to recognize because it often metastasizes widely and is treated with systemic chemotherapy. Carcinoma ex pleomorphic adenoma is a malignant epithelial neoplasm arising in a pre-existing benign mixed tumor (i.e., pleomorphic adenoma, PA). While virtually any salivary carcinoma can arise from a PA, to our knowledge SCC ex-PA has not been described. We report a case of a woman presenting with fullness of the right neck and a parotid gland mass. The tumor was resected and evaluated grossly, by light microscopy, and by immunohistochemistry. Grossly, a 1.6 cm well-circumscribed nodule was identified within the parotid. Microscopic examination revealed foci of SCC associated with high-grade adenocarcinoma, in the background of a PA. The SCC was immunoreactive for cytokeratin in a dot-like pattern and neuroendocrine markers synaptophysin and CD56. Despite the focal nature of the SCC in the parotid, a pure SCC metastasis was present in one neck level II lymph node. The patient was free of disease with 8 months of follow-up. Our case illustrates that: (1) although rare, in the salivary glands SCC may arise from lower grade neoplasms including PAs; (2) SCC ex PA may metastasize as pure SCC even if the primary SCC component was focal; (3) adequate sampling of PAs is crucial to prevent missing a rare SCC that must be treated with chemotherapy.     

Partial Penectomy for Patients With Squamous Cell Carcinoma of the Penis: The Memorial Sloan-Kettering Experience

Background To present our institution’s experience with squamous cell carcinoma (SCC) of the penis, with analysis of oncologic efficacy and survival. Methods Between 1989 and 2005, we identified 32 consecutive patients (median age, 61 years) with SCC of the penis managed with partial penectomy. Clinicopathologic variables were examined, and overall and disease-specific survival were determined. Results Pathologic stage of the primary tumor was pTis in 1 patient (3%), pT1 in 11 (34%), pT2 in 16 (50%), and pT3 in 4 (13%). Pathologic grade was well differentiated in 9 patients (28%), moderately differentiated in 20 (63%), and poorly differentiated in 2 (6%). Twenty-five patients (78%) underwent inguinal lymph node dissection, with 15 (60%) demonstrating nodal metastases. Twenty-two patients (69%) underwent pelvic lymph node dissection; 21 were negative for pelvic nodal metastases, and 1 had grossly positive nodes. One patient developed local recurrence. After a mean follow-up of 34 months, overall survival was 56%. Numbers of patients alive and disease-free were 9 and 11 in the low-stage and advanced-stage groups, and 8 and 12 in the well and moderately differentiated groups, respectively. Both patients with poorly differentiated disease died of disease within 12 months from presentation. Conclusions Partial penectomy for SCC of the penis provides excellent local control, with low recurrence rate, and acceptable maintenance of urinary and sexual function. Outcomes are generally poor, however, for patients with regional metastases, even in moderately differentiated disease. Future studies are needed to identify a reliable method of predicting regional metastases.     

Comparison of the Clinical Profile and Outcome for Squamous Cell Carcinoma and Adenocarcinoma of the Distal Esophagus and Cardia in India

This retrospective review aimed to assess the clinical profile and outcome of squamous cell carcinoma as compared with adenocarcinoma of the lower third of esophagus and cardia following a transhiatal esophagectomy. A total of 169 patients were analyzed retrospectively in this series from 1989 to 1994. There were 100 patients with squamous cell carcinoma (SCC) and 69 patients with adenocarcinoma (ADC). All tumors were assessed by an esophagogram, upper gastrointestinal endoscopy, and abdominal ultrasonography. The surgical procedure performed in all cases was a transhiatal esophagectomy (THE). The mean age of the patients with SCC and ADC was comparable (48 ± 14 vs 54 ± 12 years). Male/female ratio was 1.0 : 1.4 in the SCC group while in the ADC group it was 8.8 : 1.0. The main symptom in both the groups was grade II dysphagia (62% in SCC and 60% in ADC). The mean length of the tumor was 6.6 ± 4.5 cm in the SCC group and 4.2 ± 3.3 cm in the ADC group. The resectability rate of the SCC group was significantly higher (76%) than in the ADC group (55%). The 6-month and 1-year survival for the SCC patients was not significantly different from the ADC patients (83.7% and 49.3% vs 85.0% and 54.0%). The 5-year survival achieved in SCC was higher than in the ADC group (11.6% vs 7.2%) but the difference was not statistically significant. Adenocarcinoma arising from the distal esophagus and cardia was more common in males, and also occurred in a higher age group and had a lower resectability rate than squamous cell carcinoma. No case of Barrett's esophagus was encountered. The short- and long-term survival in both tumors were similar. Received: May 9, 2000 / Accepted: November 20, 2000     

人乳头状瘤病毒(HPV)和P53蛋白在尖锐湿疣与阴茎癌中的表达

目的： 探讨ＨＰＶ 及Ｐ５３蛋白在尖锐湿疣和阴茎鳞癌中的表达情况。　方法： 在常规病理确定诊断后,用ＳＰ免疫组化法显示标本内的ＨＰＶ 抗原和Ｐ５３ 蛋白。　结果：尖锐湿疣２１ 例,ＨＰＶ标记均阳性,Ｐ５３ 蛋白标记５例见低度表达。阴茎鳞癌１９ 例,ＨＰＶ 标记阳性２例,Ｐ５３ 蛋白标记１２例见过度表达（阳性率６３％ ）,其中６ 例强阳性。　结论：尖锐湿疣与ＨＰＶ 感染有关,少数见Ｐ５３ 蛋白低度表达;而阴茎鳞癌中常见Ｐ５３蛋白过度表达,少数可能与ＨＰＶ感染有关。     

膀胱小细胞癌的诊断与治疗(附6例报告)

目的：探讨膀胱小细胞癌的临床特点及诊治疗效。方法：对6例膀胱小细胞癌患者的临床资料进行回顾性分析。结果：6例患者，男4例，女2例，平均年龄63岁（51～71岁）。肿瘤分期T2N0M02例，T3N0M0 1例，T4N0M0 2例，T4N2M1 1例。肿瘤电切加化疗1例，根治性膀胱全切2例，姑息膀胱切除加化疗2例，肿瘤电切、髂动脉栓塞及全身化疗1例。4例死于肿瘤复发或转移，平均存活时间7个月（2～15个月），2例分别随访18个月及21个月仍存活。结论：膀胱小细胞癌预后差，治疗应以手术结合放化疗。     

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.     

Carcinoma Cuniculatum Arising in the Tongue

Carcinoma cuniculatum (CC) is a rare, distinct clinico-pathological variant of squamous cell carcinoma (SCC) that is defined histologically by the characteristic infiltrative pattern of a deep, broad, and complex proliferation of stratified squamous epithelium with keratin cores and keratin-filled crypts. Herein, we present a case report of CC of the oral tongue and discuss its diagnosis, management, and outcome, as well as briefly review the world literature. To our knowledge, this is the first documented case of CC of the tongue to be reported in the English literature. We draw attention to its clinico-pathological features and highlight that awareness of this entity as a distinct variant of SCC facilitates its correct management.     

Voriconazole increases the risk for cutaneous squamous cell carcinoma after lung transplantation

Lung transplant recipients (LTR) are at high risk of cutaneous squamous cell carcinoma (SCC). Voriconazole exposure after lung transplant has recently been reported as a risk factor for SCC. We sought to study the relationship between fungal prophylaxis with voriconazole and the risk of SCC in sequential cohorts from a single center. We evaluated 400 adult LTR at UCLA between 7/1/2005 and 12/22/2012. On 7/1/2009, our center instituted a protocol switch from targeted to universal antifungal prophylaxis for at least 6 months post‐transplant. Using Cox proportional hazards models, time to SCC was compared between targeted (N = 199) and universal (N = 201) prophylaxis cohorts. Cox models were also used to assess SCC risk as a function of time‐dependent cumulative exposure to voriconazole and other antifungal agents. The risk of SCC was greater in the universal prophylaxis cohort (HR 2.02, P < 0.01). Voriconazole exposure was greater in the universal prophylaxis cohort, and the cumulative exposure to voriconazole was associated with SCC (HR 1.75, P < 0.01), even after adjustment for other important SCC risk factors. Voriconazole did not increase the risk of advanced tumors. Exposure to other antifungal agents was not associated with SCC. Voriconazole should be used cautiously in this population.     

Cytokeratin 20, AN43, PGDH,and COX-2 expression in transitional and squamous cell carcinoma of the bladder

Bladder tumors from Egyptian patients with a high prevalence of bilharziasis were immunohistochemically analyzed for the expression of cytokeratin 20 (CK20), AN43, prostaglandin dehydrogenase (PGDH), and cyclooxygenase-2 (COX-2). The tumors included 26 transitional cell carcinomas (TCC), 10 squamous cell carcinomas (SCC) and 2 tumors of mixed TCC/SCC histology. Of the 28 TCC tumors, 21 (75%) expressed CK20 and 25 (89%) expressed AN43. CK20 was not expressed in any of the 10 SCC tumors and AN43 was expressed in 2 of them. PGDH was expressed in 18 (64%) of the 28 tumors with TCC histology and 1 of the 10 SCC. A subset of 21 tumors (16 TCC and 5 SCC) was tested for COX-2 expression. COX-2 was detected in 69% of the 16 TCC tumors examined but was not seen in the SCC tumors. As tumors increased in stage, the expression of these proteins changed. CK20, AN43 and PGDH decreased but COX-2 expression increased in higher stage tumors. The histologic phenotype of these cancers is reflected in their expression of these proteins and is modified further as tumors progress in stage.     

Comprehensive Assessment of Immuno-oncology Biomarkers in Adenocarcinoma,Urothelial Carcinoma,and Squamous-cell Carcinoma of the Bladder

BackgroundIn patients with rare histologies of bladder cancer, including adenocarcinoma of the bladder (ACB) and squamous-cell carcinoma (SCC), there are limited standard therapy options, defining an unmet medical need.ObjectiveIn this comparative comprehensive genomic profiling (CGP) study, genomic alterations (GAs), and immuno-oncology (IO) biomarkers have been analyzed.Design, setting, and participantsWithin the Foundation Medicine database, 143 cases with centrally reviewed pure ACB, 2142 with pure urothelial carcinoma (UC), and 83 with pure SCC were subjected to CGP. All patients developed advanced disease following a primary diagnosis of bladder cancer.InterventionCGP using a hybrid capture–based assay and immunohistochemistry (IHC).Outcome measurements and statistical analysisTumor mutational burden (TMB) was determined on 1.1 Mbp of sequenced DNA, and microsatellite instability (MSI) was determined on 114 loci. Programmed cell-death ligand-1 (PD-L1) expression was determined by IHC (Ventana SP-142 assay), with >1% tumor cells (TCs) or tumor-infiltrating lymphocytes (TILs) scoring positive.Results and limitationsPure ACB patients were younger and more often female than pure UC and pure SCC patients. UC and SCC had a significantly higher median TMB than ACB (p < 0.001). Rare CD274 (PD-L1) amplification cases were more frequently seen in SCC than in UC (5% vs 1%), and were not seen in ACB. MSI high status was very uncommon in all tumor types (0–1%). The frequencies of PD-L1 expression in both TCs and TILs was higher in UC and SCC (both 30%) than in ACB (18%). The results are limited by their retrospective nature and lack of clinical data annotation.ConclusionsDeep sequencing revealed significant differences in IO biomarkers among the three major subtypes of bladder carcinomas. UC and SCC revealed higher frequencies of PD-L1 expression and higher TMB than ACB, and SCC has the highest frequency of CD274 amplification. The presence of pure SCC features should not disqualify patients for inclusion in IO trials.Patient summaryTumor samples from patients diagnosed with advanced pure adenocarcinoma of the bladder (ACB) or pure squamous-cell carcinoma (SCC) have been analyzed in terms of frequency of putative immunotherapy biomarkers. The results indicated that pure SCC of the bladder was characterized by genomic features that portend similar response possibilities to immunotherapy compared with the classical pure urothelial carcinoma. Conversely, for pure ACB there might be different therapeutic opportunities, such as targeted therapies against peculiar genomic alterations in selected patients.     

Sinonasal undifferentiated carcinoma,nasopharyngeal-type undifferentiated carcinoma,and keratinizing and nonkeratinizing squamous cell carcinoma express different cytokeratin patterns

Sinonasal undifferentiated carcinoma (SNUC) is a highly aggressive malignant neoplasm that is often difficult to distinguish from other poorly differentiated carcinomas arising in the sinonasal tract. To search for a differential cytokeratin (CK) expression that could be useful for diagnostic purposes, we compared the expression of a large panel of CKs in a series of 6 SNUCs, 10 poorly differentiated squamous cell carcinomas (SCCs), 10 nonkeratinizing squamous cell carcinomas (NKSCCs), and 5 nasopharyngeal-type undifferentiated carcinomas (NPTCs). SCC, NKSCC, and NPTC frequently showed immunoreactivity for CK5/CK6, CK8, CK13, and CK19. In addition, SCC and NKSCC expressed CK14, which was not detected in NPTC, and SCC expressed CK7 (60% of cases) and CK4 (30% of cases), which were absent in NKSCC and NPTC. Three NKSCCs were associated with a Schneiderian papilloma, and the results of the immunostaining were similar in the two components, with the exception of CK4 and CK7, which were expressed by the papilloma and not by the carcinoma. In contrast to other carcinomas, SNUC was characterized by the exclusive expression of CKs of simple epithelia, such as CK8 (100% of cases), CK7 (50% of cases), and CK19 (50% of cases). Thus, there are significant differences in the pattern of CK expression between SNUC, SCC, NKSCC, and NPTC, which could be of diagnostic aid. Moreover, these findings support the hypothesis that SNUC is a separate entity from SCC and NPTC of the sinonasal tract.     

Lip carcinoma: clinical presentation,surgical treatment,and outcome: a series of 108 cases from Denmark

Objective: Lip carcinomas are among the most common malignant tumours of the head and neck region but reports on the course and outcome of this disease are mainly based on Mediterranean, South American, and Oceanian populations. The aim of the study was to describe the treatment and outcome of patients with lip carcinoma at a Danish department of plastic surgery.

Method: We conducted a single institution retrospective cohort study including patients with primary cancer of the lips including squamous cell (SCC), basal cell (BCC), and basosquamous carcinomas (BSC) in a 5-year period.

Results: We included 108 consecutive patients. Median age was 72 years (range 28 -98) and 58% were male. Seventy patients (65%) were diagnosed with SCC, 36 (33%) BCC, and 2 (2%) BSC. The majority of lesions were stage T1 (84%) and T2 (11%). An unexpected total of 35 (32%) patients experienced wound healing problems; whereof 19 (54%) classified as mild (not demanding treatment), 10 (29%) as moderate (non-functional surgical corrections or medical treatment of infection needed) and 6 (17%) experienced severe dehiscence (requiring surgical intervention for functional improvement). Total defect size ≥20?mm and full thickness excision was directly correlated to the risk of early postoperative complications (p-value: 0.03 and 0.04). Three patients (2/36 with BCC; 6% and 1/70 with SCC; 1%) developed local recurrence and five patients with SCC (5/70; 7%) developed regional lymph node metastases. One patient (1%) died from metastatic SCC.

Conclusion: This study confirms that lip carcinoma is associated with a risk of recurrence and mortality. However, the risk of wound complications is notable compared to other series.     

Carcinoma Cuniculatum of the Oral Cavity: A Series of 6 Cases and Review of Literature

Carcinoma cuniculatum (CC) is a rare variant of squamous cell carcinoma (SCC) that is characterized by minimal cytologic atypia and a unique deeply infiltrative growth pattern resembling rabbit burrows (cuniculi). With less than 75 cases reported in the head and neck, the clinical and pathologic spectrum of this entity remains poorly understood. A retrospective review of the clinical and pathologic features of archival cases of oral CC was performed. A total of six cases of oral CC were identified. Age ranged from 25-77 years; the male-to-female ratio was 5:1. All patients had a long-standing history of tobacco and betel-quid consumption. The tumors were distributed in the gingivobuccal sulcus (n = 2), the tongue (n = 2), buccal mucosa (n = 1), and the palate (n = 1). Histology in all cases typically revealed a tumor composed of well-differentiated squamous epithelium, devoid of atypia, lining deeply infiltrative, large-sized, branching, keratin-filled cavities, resembling rabbit-burrows. Dense lymphocytic infiltrates and discharging micro-abscesses were regular features. Underlying bone invasion and lymph node metastasis were observed in 1 patient. One patient with a tongue tumor developed locoregional recurrence at 10 months while none developed distant metastasis. Oral CC is a rare and under-recognized variant of SCC with locally aggressive behavior. Lack of familiarity with this variant exacerbated by the absence of cytologic anaplasia makes CC susceptible to multiple negative biopsies and erroneous diagnoses. Awareness of this clinicopathologic entity is essential to allow its accurate diagnosis and optimal management.     

Oat-cell carcinoma of the prostate. Diagnosis, prognosis and therapeutic implications

BACKGROUND: Any carcinoma of prostatic origin which is not an acinary adenocarcinoma of the prostate is considered to be an atypical carcinoma. One member of this group of atypical prostatic tumors is the oat-cell carcinoma, or small cell carcinoma (SCC) of the prostate. This variety of carcinoma constitutes the histologic basis of <1% of all prostatic neoplasms. METHODS: Between 1992 and 1997, four patients were diagnosed with SCC of the prostate at our hospital. In 3 of the 4 cases, the histopathological diagnosis was pure SCC, and in the 4th case there was a component of prostatic adenocarcinoma associated with the SCC. At the time of diagnosis, extracapsular extension of the tumor was present in all 4 cases, with T3 or higher stages in all of them (T(3A)N(0)M(1), T(3A)N(0)M(0), T(3B)N(0)M(1), and T(4)N(0)M(0)). Because of the presence of extracapsular extension, radiotherapy and radical surgery were ruled out for all 4 patients. They were all offered systemic chemotherapy with cyclophosphamide (1 g/m(2)), doxorubicin (50 mg/m(2)) and vincristine (1.2 mg/m(2)). This therapeutic protocol was carried out in only 2 cases. RESULTS: Survival was <1 year in the 3 patients with pure SCC, and the patient with a mixed tumor is alive with detectable disease 9 months after diagnosis. CONCLUSIONS: This poor vital prognosis in SCC stresses the need for early diagnosis a timely and appropriate therapeutic intervention in this condition.     

单中心腹腔镜下肝癌肝切除术457例分析

目的探讨腹腔镜肝癌肝切除术的切除方式、血流阻断技术应用及临床疗效。方法回顾性分析自2002年1月至2016年12月457例接受腹腔镜肝癌肝切除术病人的临床资料,并予以评价分析。利用软件SPSS 22.0版本进行分析。手术时间、术中出血量采用均数±标准差表示,t检验;术后并发症及其他指标采用频数及%表示,χ2检验。P0.05差异具有统计学意义。结果 15年间共行腹腔镜肝癌肝切除457例,其中解剖性肝切除术183例,切除范围:单肝段15例(8.2%),两肝段112例(61.2%)和大范围肝切除56例(30.6%)。腹腔镜下肝切除采用悬吊法有15例;单用Pringle手法167例;选择性入肝血流阻断65例,其中不解剖肝门的入肝血流阻断10例;Pringle手法联合肝下下腔静脉阻断80例。该组病例总的手术时间为(270.7±91.4)min,术中出血量为(413.2±257.5)ml,中转开腹手术41例。术后并发症发生率为27.8%,术后3个月内死亡率0.65%,术后平均住院时间(7.2±3.1)d。结论腹腔镜肝癌肝切除术在临床已经广泛开展,各类血流阻断技术安全有效的应用到术中出血的控制,并且对大范围和肝段肝切除亦切实可行。     

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.     

Clear-Cell differentiation and lymphatic invasion,but not the revised TNM classification,predict lymph node metastases in pT1 penile cancer: A clinicopathologic study of 76 patients from a low incidence area

ObjectivePrediction of lymph node (LN) metastases in penile invasive cancer relies on clinical features and histologic characteristics of the primary tumor. Correct prediction, however, is difficult, as only 50% patients undergoing lymphadenectomies will have LN metastases. In 2009, the tumor, nodes, metastases (TNM) classification for staging of early penile cancers was revised. We tested the predictive accuracy of the revised TNM classification in a low incidence area for penile carcinoma.Materials and methodsThe presence of LN metastases in 76 men with pT1 penile cancers was correlated with the 2009 TNM subclassification, which is based on a combined evaluation of tumor grade and lymphatic invasion, but also with individual parameters, such as histologic grade, lymphatic invasion, perineural invasion, invasion depth, growth pattern and human papilloma virus (HPV) status.Results76pT1 penile cancers were reclassified into 31pT1a squamous cell carcinomas (SCC) and 45pT1b (41 SCC; 4 clear-cell carcinomas); 12/22 men (55%; 8 SCC, 4 clear-cell carcinomas) undergoing lymphadenectomy for enlarged inguinal lymph nodes had metastases, 54 patients without enlarged LN and lymphadenectomies had no LN metastases during follow-up of median 47 months. Statistically, clear cell differentiation of the primary carcinoma was highly associated with metastases (100% clear-cell carcinomas vs. 11% SCC) and poor survival (50% vs. 5.5%). Among conventional SCC, only lymphatic invasion showed a highly significant association with metastases with 100% specificity. The 2009 TNM classification, tumor grade alone, perineural invasion, growth pattern, invasion depth or HPV status could not predict LN status. Lymphadenectomy for enlarged LN resulted in 100% sensitivity and 42% predictive probability for identifying metastases and a 16% false positive rate. Statistically, survival correlated significantly with clear-cell differentiation and with lymphatic invasion in both clear-cell carcinomas and conventional SCC.ConclusionsPenile clear-cell carcinomas are more aggressive cancers than SCC. Our observation suggests a benefit of a prophylactic lymphadenectomy for patients with clear-cell carcinomas. Among conventional SCC, only lymphatic invasion predicted LN metastases. Neither tumor grade alone nor perineural invasion, growth pattern, depth of invasion, and subgrouping according to the revised TNM classification correlated with metastases. Clinical evaluation of the LN status was superior to histologic risk stratification.     

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     

Fellow-led SICU morbidity and mortality conferences address patient safety,quality improvement,interprofessional cooperation and ACGME milestones

BackgroundMorbidity and mortality conferences (MMCs) promote patient safety, spur quality improvement (QI) projects, and enhance interprofessional cooperation. The use of MMCs to address the Accreditation Council for Graduate Medical Education's (ACGME's) six core competencies and specialty-specific milestones for surgical critical care (SCC) fellows has yet to be explored.MethodsWe developed a monthly, interprofessional, case-based MMC program managed by SCC fellows. We assessed participants’ experiences through post-conference surveys and semi-structured interviews.ResultsAfter nine conferences, 95.1% of participants (n = 143) agree or strongly agree that the MMC improved their knowledge and clinical assessment skills. The MMC spurred two QI projects, increased interprofessional cooperation, and addressed all six ACGME core competencies and 16 specialty-specific milestones.ConclusionsInterprofessional, case-based MMCs are an effective educational tool for SCC fellowship programs. They promote patient safety, QI, and interprofessional cooperation, and address ACGME core competencies and specialty-specific milestones for SCC fellows.