Rare femoral metastasis in late recurrent squamous cell carcinoma of the oral cavity

Background/Aim: Squamous cell carcinoma (SCC) is the most frequent carcinoma when dealing with malignant tumors of the oral cavity. SCC of the head and neck show cervical lymphatic metastasis, which is the most important prognostic factor for the long-term outcome of these patients. Hematogenous spread of this entity is rare, especially distant osseous metastasis. Therefore, the therapy for SCC typically consists of surgical tumor resection, neck dissection and plastic reconstruction. Most recurrences occur within the first two years postoperatively. This results in the need for close tumor follow-up. Case report: The present case report describes a 79-year-old female suffering from a recurrent SCC of the oral cavity 19 years postoperatively firstly noticed through symptomatic osseous metastasis of the right femur. Trial excision of the right femur revealed the finding of a metastatic squamous cell carcinoma. The patient received palliative radiation therapy. Conclusion: Osseous metastasis of SCC to the femur is rare. What is remarkable about this case report is the time span of 19 years between primary curative treatment, unremarkable follow up and the presence of metastatic late recurrence. Therefore long-term close follow-up in the treatment of oral cavity SCC in an interdisciplinary context is crucial

Predicting clinical outcome by indexed mitral valve tenting in functional mitral valve regurgitation

Objectives Mitral valve (MV) tenting parameters are indicators of left ventricular remodelling severity and may predict outcome in functional mitral regurgitation (FMR). We hypothesised that indexing of MV tenting area to body surface area (BSA), to mitral annulus diameter or gender-adjusted analysis of tenting parameters may improve their prognostic value.Methods We identified retrospectively 240 patients with consecutive FMR (mean age 68±10 years; men=135) from our institutional database who underwent isolated MV annuloplasty during a period of 7 years (2010–2016). Using preoperative two-dimensional transthoracic echocardiographic images, MV tenting parameters including tenting area, tenting height and annulus diameter were systematically assessed. Follow-up protocol consisted of chart review and structured clinical questionnaire. Primary study endpoint was the composite of death and adverse cardiac events (ie, MV reoperation, cardiac resynchronisation therapy implantation, ventricular assist device implantation or heart transplantation).Results BSA-indexed MV tenting area was identified as independent predictor of primary study endpoint (HR 1.9; 95% CI 1.1 to 3.5; p=0.02). After cut-off point analysis, BSA-indexed MV tenting area >1.35 cm2/m2 was significantly associated with primary study outcome (HR 2.3; 95% CI 1.3 to 4.0; p=0.003). Annulus-indexed MV tenting area showed only a tendency towards primary study endpoint prediction (HR 2.8; 95% CI 0.6 to 12.6; p=0.17). Between female and male patients, BSA-indexed MV tenting area was similar (1.42±0.4 cm2/m2 vs 1.45±0.4cm2/cm2; p=0.6) and gender was not associated with primary study outcome (HR 0.8; 95% CI 0.5 to 1.4; p=0.5).Conclusion In our FMR cohort, BSA-indexed MV tenting area showed the strongest association with negative outcomes following isolated MV annuloplasty. Patients with BSA-indexed MV tenting area >1.35cm2/m2 could potentially benefit from additional surgical maneuvers addressing left ventricular remodelling