Second primary squamous cell carcinoma arising in cutaneous flap reconstructions of two head and neck cancer patients

Early complications of myocutaneous flap transfers following surgical eradication of head and neck tumors have been extensively described. However, knowledge concerning long-term complications of these techniques remains limited. We report the cases of two patients with a prior history of squamous cell carcinoma of the head and neck (HNSCC), who developed a second primary SCC on the cutaneous surface of their flaps, years after reconstruction. Interestingly, it seems that the well-known risk of a second primary SCC in patients with previous head and neck carcinoma also applies to foreign tissues implanted within the area at risk. Given the important expansion of these interventions, this type of complication may become more frequent in the future. Therefore, long-term follow-up of patients previously treated for HNSCC not only requires careful evaluation of the normal mucosa of the upper aero-digestive tract, but also of the cutaneous surface of the flap used for reconstructio

Pancreatic intraductal papillary-mucinous neoplasms: a new and evolving entity

For a long time, intraductal tumors of the pancreas were neglected because they were misdiagnosed as mucinous cystadenocarcinoma, ordinary ductal adenocarcinoma, or chronic pancreatitis. Only in recent years have they been recognized as clinical and pathological entities. Most common are the intraductal papillary-mucinous neoplasms. Although they show an adenoma-carcinoma sequence, they have proved to have a more favorable prognosis than ductal adenocarcinoma, when resected in a preinvasive state. Recently, it has become clear that they constitute a heterogeneous group with at least four subtypes. Their stratification reveals that the various intraductal papillary-mucinous neoplasm subtypes have different biological properties with different prognostic implications

Second primary squamous cell carcinoma arising in cutaneous flap reconstructions of two head and neck cancer patients

Early complications of myocutaneous flap transfers following surgical eradication of head and neck tumors have been extensively described. However, knowledge concerning long-term complications of these techniques remains limited. We report the cases of two patients with a prior history of squamous cell carcinoma of the head and neck (HNSCC), who developed a second primary SCC on the cutaneous surface of their flaps, years after reconstruction. Interestingly, it seems that the well-known risk of a second primary SCC in patients with previous head and neck carcinoma also applies to foreign tissues implanted within the area at risk. Given the important expansion of these interventions, this type of complication may become more frequent in the future. Therefore, long-term follow-up of patients previously treated for HNSCC not only requires careful evaluation of the normal mucosa of the upper aero-digestive tract, but also of the cutaneous surface of the flap used for reconstruction

Tumours of the hepatic hilum

Portant un intérêt particulier pour la pathologie hépatique, et après avoir collecté plus de 50'000 coupes histologiques, Gerald Klatskin décrit en 1965, pour la première fois, une famille particulière de tumeurs malignes des voies biliaires extra hépatiques, situées au niveau de la bifurcation du hile hépatique. Cette entité est connue aujourd'hui dans la littérature sous le nom de « tumeur de Klatskin » et correspond à un adénocarcinome de l'épithélium biliaire. Il s'agit d'une tumeur rare, représentant dans l'année 2000 moins de 0.5 % des nouveaux cas de cancer aux Etats-Unis. Les autres tumeurs malignes intéressant la région péri-hilaire sont le cholangiocarcinome des voies biliaires intra-hépatiques, l'adénocarcinome de la vésicule biliaire, ainsi que les tumeurs malignes primaires d'organes avoisinants, tels que carcinome hépatocellulaire et l'adénocarcinome de la tête du pancréas. On a rapporté également quelques rares cas de sarcome du hile hépatique (Soares et al., 1989), de néoplasies hématopoïétiques (Eliason et Grosso, 2001) et occasionnellement, des métastases à distance d'un site primaire (i.e. cancers coliques, gastriques, pancréatiques, prostatiques, pulmonaires ou mammaires). Les tumeurs bénignes comme le papillome (solitaire ou multiple, Fig. 1) ou le cystadénome, les pseudotumeurs inflammatoires (Sakai et al., 2001), et les kystes ou pseudokystes de la voie biliaire principale (Seguchi et al., 2004) se présentent avec une symptomatologie identique à celle observée dans les tumeurs malignes. Seules, les tumeurs du hile hépatique seront abordées dans cette revue. Les autres pathologies non-tumorales, telles que la cholangite sclérosante, la cholangite pyogénique récidivante, la lithiase biliaire (i.e. Syndrome de Mirizzi) ainsi que la sténose hilaire d'origine inflammatoire, traumatique ou iatrogène ne seront pas discutées ici. Il est toutefois important de savoir que 5 à 15 % des patients opérés avec un diagnostic préopératoire de cancer du hile, présentent en effet une sténose inflammatoire pseudotumorale non-spécifique (Santoro et al., 2004)

Blue-violet excited autofluorescence spectroscopy and imaging of normal and cancerous human bronchial tissue after formalin fixation

Autofluorescence (AF) imaging is a powerful tool for the detection of (pre-)neoplastic lesions in the bronchi. Several endoscopic imaging systems exploit the spectral and intensity contrast of AF between healthy and (pre-)neoplastic bronchial tissues, yet, the mechanisms underlying these contrasts are poorly understood. In this report, the effect of formalin fixation on the human bronchi AF, hence on the contrast, was studied by spectrofluorometric point measurements and DAFE (Diagnostic AutoFluorescence Endoscopy) broad field imaging. Generally, formalin-fixed samples have higher AF intensity than in vivo, whereas the emission spectral shape is similar. Additionally, the spectrofluorometric data showed a moderate decrease of the AF intensity on (pre-)neoplastic lesions relative to the healthy bronchial samples. However, this decrease was lower than that reported from in vivo measurements. Neither spectral measurements nor imaging revealed spectral contrast between healthy bronchial tissue and (pre-)neoplastic lesions in formalin. These results indicate that epithelial thickening and blood supply in the adjacent lamina propria are likely to play a key role in the generation of the AF contrast in bronchial tissues. Our results show that the AF contrast in bronchial tissues was significantly affected by standard, 10% buffered, formalin fixation. Therefore, these samples are not suited to AF contrast studies

Interstitial photodynamic therapy with tetra(m-hydroxyphenyl)chlorin: tumor versus striated muscle damage

Purpose: The present study was initiated to det. the conditions under which a single photodynamic treatment would induce maximal damage to a tumor with no or at least minimal reversible damage to a normal striated muscle. Methods and Materials: The technique of interstitial light delivery was used after prior 0.5 mg/kg tetra(m-hydroxyphenyl)chlorin administration in a hamster model. After having estd. the threshold light doses required for minimal muscle damage, the same light doses were applied to squamous cell carcinomas to evaluate the efficiency of interstitial photodynamic therapy. Sixteen and 96 h after the injection, irradn. at 650 nm was performed on the thigh muscle of the left hind leg. The applied light doses ranged between 0.3-15 J and were delivered at an intensity of 44 mW per cm of diffuser length. Results: The threshold of muscle damage was obtained using light doses of 1.5-3 J at two drug-light intervals of 16 and 96 h, resp. More than 85% of the tumor mass was destroyed when lesions were illuminated using these threshold conditions. In terms of immediate short-term tumor response, this means that for the given irradn. conditions, a relatively low threshold energy of only 1.5 or 3 J, depending on the drug-light interval, is sufficient to induce massive tumor destruction with minimal muscle damage. Conclusion: These results have implications for evaluating interstitial PDT for squamous cell cancers in unfavorable localization in the oral cavity or pharynx, such as at the base of the tongue

In-vivo fluence rate effect in photodynamic therapy of early cancers with tetra(m-hydroxyphenyl)chlorin

Several parameters affect clin. trials in photodynamic therapy and influence the therapeutic outcome. Beside drug dose, light dose, drug-light interval and other variables, the fluence rate is a parameter that can influence the therapeutic results. In this study we have evaluated the fluence rate effect with a second-generation photosensitizer, tetra(m-hydroxyphenyl)chlorin (mTHPC) using a 7,12-dimethylbenz(a)anthracene-induced early squamous cell carcinoma of the Syrian hamster cheek pouch as a tumor model. Following injection of 0.5 mg/kg of mTHPC, irradn. tests were performed at two drug-light intervales, 4 and 8 days. Wavelength and light dose were adapted from those applied routinely in clin. trials. Irradiations at 652 nm were carried out with fluences ranging from 8 to 20 J/cm2 delivered at fluence rates of 15 and 150 mW/cm3. Similar tests were also performed at 514 nm with a fluence of 80 J/cm2 delivered at fluence rates ranging from 25 to 125 mW/cm2. At both wave-lengths and drug-light intervals for a given fluence. the higher fluence rates resulted in less tissue damage in tumor and healthy mucosae. However, the lower fluence rates yielded slightly less therapeutic selectivity. This study confirms that the fluence rate is of major importance in clin. PDT