Malignant minor salivary gland tumors: a retrospective study of 27 cases

PURPOSE: Malignant tumors of the intra-oral minor salivary glands are uncommon. The aim of this study was to give information concerning the clinical features of these tumors, the distribution of location, treatment opportunities, and outcome. METHODS: Twenty-seven patients with malignant salivary gland tumors that were treated between January 1999 and December 2008 were evaluated retrospectively. RESULTS: Of the 27 minor salivary gland carcinomas, 48.1% were adenoid cystic carcinomas (ACC), 29.7% mucoepidermoid carcinomas (MEC), 22.2% adenocarcinomas (ADCA). The most common first symptom was a painless swelling in 60% of the cases, with the second most common symptom being ulcers (28%). Four recurrences and two metastases were found. No recurrence was observed in ADCA. All four patients experiencing a recurrence developed it in the first 3 years after treatment. CONCLUSION: Wide excision with a clinical margin of 1 cm and in large tumors, positive surgical margins or perineural infiltration and postoperative radiotherapy (RT) can be recommended; but in order to give exact information concerning the possible benefit from postoperative RT, it needs large prospective multicenter studies. Long-term follow-up controls and in particularly longer than 5 years in ACC including yearly chest X-rays should be offered to these patients because of late metastasis and recurrences

Identification of women with early breast cancer by analysis of p43-positive lymphocytes

Regular screening mammographies and increasing knowledge of high-risk groups have resulted in an improvement in the rate of detection of smaller malignant lesions. However, uncertain minimal mammographic features frequently require further costly and often uncomfortable investigation, including repeat radiological controls or surgical procedures, before cancerous lesions can be identified. Placental isoferritin (p43), a protein with immunosuppressive effects, has been detected on the surface of lymphocytes taken from peripheral blood in patients with breast cancer. In this study we evaluated the sensitivity and specificity of the expression of p43-positive lymphocytes as a marker in early stage breast cancer and also investigated its expression on T-cell subpopulations. The presence of p43-positive lymphocytes was investigated using the monoclonal antibody CM-H-9 and flow cytometry in 76 women with controversial, non-palpable mammographic findings who were undergoing surgical biopsy. Patients with early breast cancer (n = 48) had significantly higher p43-positive cell values (median 3.83%, range 0.98-19.4) than patients with benign lumps (n = 28, median 1.43%, range 0.17-3.7) or controls (n = 22, median 1.3%, range 0.4-1.87) (P \u3c 0.0001). At a cut-off level of 2% p43-positive cells a sensitivity of 91.7% and a specificity of 89.3% for detection of breast cancer could be reached. While the median ratio of total CD4+/CD8+ cells was 2.6, a ratio of 1.3 was found for the p43-positive subpopulation (P \u3c 0.001), thus indicating a significant link between p43 and CD8+ cells. The determination of p43-positive lymphocytes in peripheral blood could serve as an additional diagnostic tool in patients with controversial mammographic findings and could also reduce the need for cost-intensive and often uncomfortable management of these patients

Aggressive fibromatosis of the head and neck: a new classification based on a literature review over 40 years (1968-2008)

BACKGROUND: Fibromatosis is an aggressive fibrous tumor of unknown etiology that is, in some cases, lethal. Until now, there has been no particular classification for the head and neck. Therefore, the aim of the present study was to review the current literature in order to propose a new classification for future studies. METHODS: An evidence-based literature review was conducted from the last 40 years regarding aggressive fibromatosis in the head and neck. Studies that summarized patients' data without including individual data were excluded. RESULTS: Between 1968 and 2008, 179 cases with aggressive fibromatosis of the head and neck were published. The male to female ratio was 91 to 82 with a mean age of 16.87 years, and 57.32% of the described cases that involved the head and neck were found in patients under 11 years. The most common localization was the mandible, followed by the neck. All together, 143 patients were followed up, and in 43 (30.07%), a recurrence was seen. CONCLUSION: No clear prognostic factors for recurrence (age, sex, or localization) were observed. A new classification with regard to hormone receptors and bone involvement could improve the understanding of risk factors and thereby assist in future studies

Factors influencing survival of free-flap in reconstruction for cancer of the head and neck: a literature review

Microvascular free tissue transfer is a reliable technique for head and neck reconstruction with success rates of 90-99%. Currently, there is no consensus concerning antithrombotic agents, antibiotics, or monitoring techniques. Therefore, the aim of this study was to review current literature dealing with microvascular free-tissue transfer and factors influencing the outcome. In addition to excellent microsurgical techniques, coupling devices are a promising new technique, but are not useful in all arteries. Antibiotics should be given in three doses, as a more lengthy dosage time seems to have no advantage. The risk for elderly patients can be best assessed by the American Society of Anesthesiologists (ASA) score, but early mobilization, including intense chest physiotherapy, is important. Anticoagulation can be considered in cases of small vessels, significant size mismatch, vein graft, or vessels of poor quality. Monitoring should be done hourly during the first 24 hours and then every 4 hours for the next 2 postoperative days

Free flap monitoring protocol

In microsurgery, the successful salvage of free tissue transfer is dependent on the rapid decision to return to the operating room. Therefore, a free flap monitoring protocol is presented, including checking color, temperature, capillary return, and signal from a handheld Doppler ultrasonograph in an intraoperatively marked skin area directly over the pedicle