Metastasierungsverhalten und Prognose von verrukösen Karzinomen -Literaturübersicht und retrospektive Studie-

Die Arbeit umfaßt erstens einen Literaturüberblick über die charakteristischen Merkmale und Besonderheiten des verrukösen Karzinoms (VK) und die Prognose bei unterschiedlichen therapeutischen Herangehensweisen. Von besonderem Interesse ist die LK-Metastasierung von VK. In der Literaturauswertung konnten dabei 18 Fälle ermittelt werden; dabei waren nur in einem Fall Fernmetastasen vorhanden. Die Prognose von VK ist gut bei einer adäquaten chirurgischen Therapie; die Mitbehandlung des Lymphabstromgebietes sollte nicht routinemäßig erfolgen. Zweiter Schwerpunkt der Arbeit ist eine Auswertung des Patientengutes der Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie der Charité (24 Patienten) und der Hals-Nasen-Ohrenklinik der Charité (13 Patienten) unter der besonderen Fragestellung des Metastasierungsverhaltens und der Prognose von VK. In 2 Fällen wurden LK-Metastasen eines VK festgestellt. In keinem Fall ist das VK als Todesursache eines Patienten bekannt. Bei 8 Patienten traten Rezidive auf. Es wurde festgestellt, daß größere Tumoren schneller und häufiger rezidivieren. Bei der Hälfte der Patienten trat das Rezidiv 4 bis 9 Monate post operationem auf. Die Früherkennung von VK ist wichtig, denn die Prognose ist umso besser, je kleiner der Tumor ist.The paper comprises first an assessment of literature about the characteristics, and the particularities of verrucous carcinoma (VC), and prognosis dependent on the different therapies. Of particular interest is the lymph node metastatic invasion of VC. The assessment of literature showed in 18 cases lymph node metastases; one VC of these had distant metastases. The prognosis of VC is excellent with adequate surgical therapy. Lymph node treatment should not be routine. Second point of the paper is the assessment of data of 24 patients with VC of the Clinic for Oral and Maxillo-Facial surgery of the Charité and 13 patients with VC of the Clinic for Otorhinolaryngology of the Charité with special attention on metastatic invasion and prognosis of VC. Two patients had lymph node metastases caused by a VC. In no case VC is known as cause of death. Eight patients had relapses. Half of these patients had relapse 4 to 9 monthes post operationem. It was established that larger tumors relapse more often and faster. Early detection of VC is necessary, because the prognosis is the better the smaller the tumor is

Middle finger moment arm values (mm).

<p>Left MCP curves, PIP and DIP curves represent flex/extension moment arms as a function of flexion (+)/ extension (-). Right MCP curves represent ab/adduction moment arms as a function of abduction (+)/ adduction (-). Solid curves (with plot markers) represent experimentally derived moment arms from anatomical attachment locations, and dotted curves represent optimally estimated moment arms from data-driven optimizations.</p

Anthropometric index finger dimensions of cadaveric specimens [20] and OpenSim model (mm).

<p>Symbol (±) indicates standard deviation in interspecimen variation. Lengths of the phalanges in OpenSim model are calculated by the distance between the origins of two coordinate systems in three-dimensional (3D) Cartesian space, e.g., the center of rotation at MCP and the center of rotation at PIP. Parentheses (Δ) in OpenSim bony dimensions express difference between model dimension and specimen dimension. Skin surface set is scaled in three-dimensions to preserve measured anatomical proportions [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121712#pone.0121712.ref036" target="_blank">36</a>–<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121712#pone.0121712.ref039" target="_blank">39</a>]. These skin surface (external dimensions) function as upper boundary constraints during optimization.</p><p>Anthropometric index finger dimensions of cadaveric specimens [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121712#pone.0121712.ref020" target="_blank">20</a>] and OpenSim model (mm).</p

Flex/extension moment arms (mm) as a function of flexion (+)/ extension (-) at the MCP joint of the all fingers.

<p>Dotted moment arm values are derived from experimentally measured muscle attachments [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121712#pone.0121712.ref005" target="_blank">5</a>], and solid moment arm values are direct measurements (n = 7 specimens with mean and standard deviation; [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121712#pone.0121712.ref020" target="_blank">20</a>]). Positive values indicate flexion moment arms, negative values indicate extension moment arms, and 0° is full extension. Blue, green, red and cyan colors represent index, middle, ring and little finger moment arms, respectively.</p

Index finger moment arm values (mm).

<p>Left MCP curves, PIP and DIP curves represent flex/extension moment arms as a function of flexion (+)/ extension (-). Right MCP curves represent ab/adduction moment arms as a function of abduction (+)/ adduction (-). Solid curves (with plot markers) represent experimentally derived moment arms from anatomical attachment locations, and dotted curves represent optimally estimated moment arms from data-driven optimizations. Positive values indicate flexion moment arms, negative values indicate extension moment arms, and 0° flexion is full extension, respectively.</p

Ring finger muscle-tendon locations, expressed in OpenSim frame (mm).

<p>Parentheses () values indicate measured muscle-tendon locations [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121712#pone.0121712.ref005" target="_blank">5</a>], transformed to OpenSim coordinate. ΔR is the Euclidean distance between OpenSim model and experimentally measured attachment sites [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121712#pone.0121712.ref005" target="_blank">5</a>].</p><p>Ring finger muscle-tendon locations, expressed in OpenSim frame (mm).</p

Middle finger muscle-tendon locations, expressed in OpenSim frame (mm).

<p>Parentheses () values indicate measured muscle-tendon locations [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121712#pone.0121712.ref005" target="_blank">5</a>], transformed to OpenSim coordinate. ΔR is the Euclidean distance between OpenSim model and experimentally measured attachment sites [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121712#pone.0121712.ref005" target="_blank">5</a>].</p><p>Middle finger muscle-tendon locations, expressed in OpenSim frame (mm).</p

Flex/extension moment arms (mm) as a function of flexion (+)/ extension (-) at the PIP and DIP joints of the all fingers.

<p>Symbols are the same as in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121712#pone.0121712.g002" target="_blank">Fig 2</a>.</p

Measured and derived flex/extension moment arms (mm) as a function of flexion (+)/ extension (-) at the MCP joint of the index finger.

<p>Dotted moment arm values are derived from experimental muscle attachments [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121712#pone.0121712.ref005" target="_blank">5</a>], and solid moment arm values are direct measurements (n = 7 specimens with mean and standard deviation (error bar); [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121712#pone.0121712.ref020" target="_blank">20</a>]). Positive values indicate flexion moment arms, negative values indicate extension moment arms, and 0° is full extension.</p

Ring finger moment arm values (mm).

<p>Left MCP curves, PIP and DIP curves represent flex/extension moment arms as a function of flexion (+)/ extension (-). Right MCP curves represent ab/adduction moment arms as a function of abduction (+)/ adduction (-). Solid curves (with plot markers) represent experimentally derived moment arms from anatomical attachment locations, and dotted curves represent optimally estimated moment arms from data-driven optimizations.</p