Clinical Experience of Mucosal Amelanotic Melanoma in the Nasal Cavity and Maxillary Sinus

Malignant melanoma comprises 1.2% of all malignant tumors and more than 90% of malignant melanoma arises in the skin. About 1% of all malignant melanomas occur in the nasal cavity and paranasal sinuses. Mucosal melanoma of head and neck are rare and show poor prognosis. Although melanoma in the oral cavity sometimes tends to be neglected more than similar lesions on the skin and other locations, pigmented melanoma is usually easy to diagnose clinically because of its red to black or brown color and its irregular outline. However, amelanotic melanoma with lack of pigmentation, often defies correct clinical diagnosis initially before confirmation by biopsy. The authors have recently experienced a case showing good clinical result to the present, after total maxillectomy and split thickness skin graft and postoperative radiotherapy in the mucosal amelanotic melanoma involving the nasal cavity and right maxillary sinus, so report this case with a review of literature

Sensory Recovery after Reconstruction of Oral Cavity and Oropharynx using Non-sensate Flap

The ablation surgery of the oral cavity and oropharyngeal carcinoma induced some disturbance in multiple aspects of normal anatomy and physiologic function. Sensation is one of the most important factor for restoration of many disturbed oral function like articulation, swallowing and mastication. Thirteen oral cavity and oropharyngeal carcinoma patients with reconstruction using non- sensate flap including free flap or musculocutaneous pedicled flap were subjects of this study. The sensory recovery was evaluated among the following 5 subjective senses: light touch, deep touch(pressure), pain, warm and cold sense and the two point discriminations were also recorded after postoperative 6 months. For histologic examination, after the flap tissues including the normal mucosa were obtained, H&E and immunohistochemical stains with anti-S-100 protein were performed at the same time. The subjective sensation, especially deep touch(pressure) and pain were almost restored(92%) in the flap and histologic changes, such as loss of keratin, granular layer and hyperkeratosis were observed. But, only 15% of the flap revealed positive reaction in staining with S-100 protein. Our results demonstrates some recovery of sensation in the non-sensate flap and the changes in epidermis of the flap such as mucosalization. However, histologic evidence were lack on the sensory nerve regeneration. Therefore, detailed study should be included electromicroscopic examination and comparison between the sensate and non-sensate flap.

Diagnosis and Management of Adult Intussusception

BACKGROUND: In contrast to childhood intussusception, the clinical features in adults are not typical, and the incidence of adult intussusception is low. This study was to evaluate the clinical features, diagnosis, and management of adult intussusception. METHODS: Thirty-seven cases of adult intussusception occurring between 1981 and 1996 in individuals older than 16 were investigated retrospectively. RESULTS: The most common age was in the 3rd decade (24.3%). Abdominal pain, nausea and vomiting, abdominal tenderness and palpable abdominal mass were common symptoms and physical findings in order of frequency. The duration of symptoms was less than 7 days in 54% of the cases. Correct preoperative diagnosis was made in 13.3% from 1981 to 1990 versus 72.7% from 1991 to 1996. This difference was caused by common use of abdominal ultrasound (US) and computed tomography (CT) during recent years. On exploration there were 27 cases of enteric (73%) and 10 cases of colonic (27%) intussusceptions and there were underlying lesions in 30 cases (81%). Two manual reductions only, 7 manual reductions and resections, including one reoperation after manual reduction only, 28 resections without manual reduction, and 1 ileocolostomy were performed. While only 2 cases (7.4%) of malignancy were identified among the enteric intussusceptions, there were 7 cases (70%) of malignancy among the colonic intussusceptions. CONCLUSIONS: With the advance of abdominal US and CT, preoperative diagnosis of adult intussusception was not so difficult. Because of high prevalence of underlying lesions in adult intussusception, operative management is mandatory. Resection without reduction is the most common method of operation and is recommended in edematous and ischemic enteric intussusceptions and in all colonic intussusceptions which have high malignant rate.

Splenic Metastasis of Lung Cancer

Splenic metastasis from solid cancer is a rare clinical event. Especially splenic metastasis from the lung is very rare. Most spleen metastases are found at autopsy and are part of a widely spread disease. Solitary splenic metastasis in the abscence of other metastases is extremely rare. The authors report the case of a 54-year-old man in whom the only discover distant metastasis from lung cancer was a splenic mass. The splenic lesion was detected after the resection of the primary lung lesion. The time from diagnosis to the development of splenic metastasis was 25 months. The rarity of a solitary spleen metastasis from lung cancer and the treatment modalities are discussed. When solitary spleen metastasis is suspected in a clinical setting, aggressive treatment is indicated, a splenectomy followed by combined modality treatment to prevent the spread and aggravation of the disease.

ABO Blood Type Incompatible Liver Transplantation in a Child

ABO incompatible organ transplantation has been contraindicated because of acute rejection or hyperactive rejection by its antigen-antibody reaction. To overcome these problems, plasma pheresis, antibody adsorption and other diverse methods have been tried by many investigators. The authors experienced a case of orthotopic liver transplantation across the ABO incompatibility by using plasma pheresis. The recipient was a 3-year-old male with blood type B, and the donor was his father with blood type AB. Perioperative plasma pheresis was performed a total of four times. The initial anti-A titer was 1:64; after the plasma pheresis, the titer was weakened to 1:4. Orthotopic liver allografting was successfully accomplished without hyperacute rejection. The usual mild acute rejection symptom was noted, but no serious problem developed. As in this experience, an ABO incompatible liver transplant is not an absolute, but a relative, contraindication. Selecting the proper candidate and using plasma pheresis should be a good optional approach for ABO incompatible transplantation patients.

Surgical Treatment of Retroperitoneal Tumors

Retroperitoneal tumors are rare. Surgery is generally considered the first treatment of choice. There is still controversy about the treatment modalities. From January 1986 to December 1994, 41 patients underwent operations at the Department of Surgery, College of Medicine, Korea University for retroperitoneal tumors. In a retrospective study, the prognostic effect of complete resection, hiopathologic grade and stage were evaluated. There were 26 cases of benign tumors, and 15 cases of malignant tumors. Complete resection was achieved in 31 patients, 23 of which had benign tumors, and 8 malignant tumors. These patients had a 5-year survival rate of 88% compared to 41% for those undergoing partial resection(p=0.0025). Grade 1 tumors were associated with 100% 5-year survival rate compared to 20% for grade 3 tumors(p=0.0001). The stage was found to have a same pattern as the grade(p=0.0034). Tumor grade and stage were significant predictors of outcome. Adjuvant chemotherapy and radiation therapy could not be shown to have a great impact on survival. In conclusion, complete resection, low-grade and low-stage were found to have a significant favorable effect on the survival rate.

A Case of Villous Adenoma of the Ampulla of Vater with Malignant Change / 대한소화기내시경학회지

Ampullary adenoma is a benign neoplasm with malignant potential that arises from the glandular epithelium of the ampulla of Vater. When the tumor is confined to the ampulla, abdominal sonogram and CT scan can show dilatation of the common bile duct or pancreatic duct, but the mass itself may not be seen. And even biopsies are done, the confirmation of malignant change is frequently missed, and it may be impossible to assess the presence of carcinoma in situ or invasive carcinoma without complete exicision of the lesion. So complete surgical resection is recommended because of extensive growth of the ampullary adenoma and its malignant potential. Recently, we experienced a case of about 0.8 x 1.0 cm sized tumor of the ampulla of Vater that was diagnosed as villous adenoma on endoscopic biopsy, and malignant change was found on resected surgical specimen.