Heterogeneous distribution of tumor blood supply affects the response to chemotherapy in patients with head and neck cancer.

OBJECTIVE: To evaluate if the heterogeneous distribution of tumor blood supply affects the response to chemotherapy in patients with head and neck cancer. METHODS: We treated 25 stage III/IV patients with an intraarterial cisplatinum-bleomycin regimen. Prior to treatment, a blue dye was injected directly to tumors through the catheter. Well-stained areas were considered as profusely perfused areas whereas poorly stained areas were considered as poorly perfused areas. Biopsies of both areas of each tumor were taken prior to and after the treatment and the histopathological response was evaluated with the following grading: I, tumor disappearance; II, destruction of some tumor nests; III, no changes. RESULTS: Grade I responses were attained in 13/25 (52%) of profusely perfused areas against 1/25 (4%) of poorly perfused areas (p < 0.001). Moreover, there were significant differences (p < 0.001) in the overall responses: 21/25 (84%) in the profusely perfused areas versus 7/25 (28%) in the poorly perfused areas; and in grade III responses (4/25, 16% vs. 18/25, 72%). To determine a possible correlation between the histopathological responses obtained in profusely perfused and in poorly perfused areas of each tumor, we then calculated the Kendall's tau-b statistics, obtaining a tau value of 0.279 (p = 0.145). This data indicated that histopathological responses to chemotherapy of profusely perfused and poorly perfused areas were independent in each tumor. CONCLUSIONS: Heterogeneity in the distribution of tumor blood supply affects the response to chemotherapy by influencing the intratumoral delivery of therapeutic agents. After the administration of effective doses of anticancer drugs to a tumor, cells in profusely perfused areas receive enough to destroy them while cells in the poorly perfused areas are exposed to lower drug concentrations and, therefore, survive. This phenomenon could explain in part the difficulty in the treatment of human solid tumors.

Angina bullosa hemorrhagica.

BACKGROUND: In 1967, Badham used the term angina bullosa hemorrhagica (ABH) to describe an entity we already knew as traumatic oral hemophlyctenosis (TOH) (1933) and later renamed recurrent oral hemophlyctenosis (ROH) (1971). OBJECTIVES: The objective of this study was to review and discuss the literature, and to report 54 new cases seen between 1989 and 1996. MATERIALS AND METHODS: Fifty-four patients were thoroughly assessed to determine the clinical features, histology, etiology, pathogenesis, differential diagnosis, and therapy. RESULTS: In 35 patients (64.8%), the lesions predominated on the palate and in nine (16.6%) on the oral mucosa. The incidence was similar in both sexes (women, 52%; men, 48%) and the condition affected mostly the 51-70-year age group. ABH was never documented in children under 10 years of age. In 24 cases (44.4%), diabetes mellitus, hyperglycemia, and/or a family history of diabetes was found. CONCLUSIONS: ABH is a disorder more common than the literature would suggest. Although the causes may be multiple (mucosal trauma, inhaled corticosteroids), the available data indicate that, in these patients, the presence of an alteration in glucose metabolism should be considered.

Van der Woude syndrome. A case report.

We describe several members of a family with Van der Woude syndrome, a genetic and congenital malformation syndrome with autosomal dominant inheritance and 70% to 80% penetrance with variable expressivity. It is characterized by clinical signs localized to the face, such as bilateral or unilateral pits on conical elevations in babies or extensive depressions in adults, both in the vermilion border of the lower lip, with cleft lip, with or without cleft palate and uvula. Small accessory or heterotopic salivary glands empty into sinuses or fistulas in the lips. This eight member family had various clinical signs of the condition. All had cleft lip and palate. We studied the major characteristics of the eight patients and describe histopathologic and immunohistochemical features.

Melanoma on dysplastic nevus spilus.

BACKGROUND: Nevus spilus is found with relative frequency. It is observed as as tan to brown macule serving as base to a speckle of smaller and darker maculo-papular elements. On rare occasions it turns into a malignant melanoma. PURPOSES: To describe one case with some characteristics different from routine observations and to revise the cases published reporting nevus spilus that turned into malignant melanoma, in order to point out the most frequent aspects. RESULTS: The 17 patients with nevus spilus and melanomas, including ours, were white, with ages between 35 and 56 years. Most of the cases were localized in the dorsal region. Five patients were men. Almost all nevus were congenital and their size ranged between 2 and 10 cm in diameter. Histologically, the speckled spots were junctional nevus, and few of them had dysplastic characteristics. Melanomas corresponded to the extensive superficial type MES; one of them was nodular. Some had systemic ganglial metastases and three of the patients are known to have died. Our patient had an intradermal cellular nevus on the man spot, and terminal hairs could be observed on it. The speckled elements were junctional nevus with dysplastic cells. CONCLUSIONS: Nevus spilus must be closely monitored, because it may turn into a malignant melanoma.

Response of leiomyosarcoma to cryosurgery: clinicopathological and ultrastructural study.

Two elderly patients with primary leiomyosarcoma (LMS) of the scalp were treated cryosurgically. Complete involution of both tumours with full epithelialization of the affected sites was achieved. Pretreatment biopsies and sequential biopsies obtained after treatment allowed observation of microscopical changes taking place during tumour involution. Gradual shrinkage of both LMS, closely monitored under the operating microscope, started immediately after the initial freezing. Light and electron microscopic observation of the shrinking LMS revealed a rapid disappearance of the tumoral architecture. Early accumulation of eosinophils and erythrocytes was followed by migration of lymphocytes and plasma cells. Capillary neoformation, fibroblasts and newly formed connective tissue fibres became apparent during the later stages of healing. Two years after treatment, both patients showed no signs of recurrence. These results suggest cryosurgery--performed in an extended protracted fashion--can be a valuable therapeutic choice in the management of LMS, particularly when surgical excision is not feasible.

[Eosinophilic migratory nodular panniculitis (human gnathostomiasis)]. / Paniculitis nodular migratoria eosinofílica (gnathostomiasis humana).

The case of a patient with thoracic abdominal and left arm, migratory erythema-edematous plates over a space of three years is described. The histopathologic features reveal a eosinophilic panniculitis due to probable larva migrans (gnathostomiasis). This appears to be the first report on the subject because we have not found any reference to the subject in Argentina bibliographic search.

[Arnozán-Dubreuilh depilating folliculitis]. / Foliculitis depilante de Arnozán y Dubreuilh.

Male patient, aged twenty-six years. Having an eight-and-a-half-year- old dermatosis of localized evolution on scalp, under arms, thighs, pubis and legs, characterized by inflammatory papules and follicular and extra-adnexial pustules, tiny scars and lack of hair in the affected areas. The authors present a representative case of "depilating folliculitis" of (Arnozán and Dubreuilh) stressing the following: Uncommon frequency in our country but frequent in warmer climates where it is observed mainly among peasants and sugar-cane workers. Wide-depilated areas principally in folds. Seasonal outbreak. Good response to treatment. A revision of the theme is made emphasizing the histopathologic pathogenesis.

[Cellulitis. Study of microangiopathy in 254 cases]. / Celulitis. Estudio de la microangiopatía de 254 casos.

In a previous work, Segers and adl., the histological and histochemical study of the features of cellulitis is performed, expliciting the importance in this lipodystrophy of microangiopathy PAS positive. As a complement of that work, we study a group of 254 patients, all females, which came to us to be treated for their cellulitis, general clinical and local laser therapy. All of these patients presenting microangiopathy of their dermohipodermic capillary vessel confirmed by biopsy. These cases were divided in four groups according to the existence or not family antecedents of diabetes mellitus, and positivity or negativity to the test of glucose overcharge, sensibilized with corticoid (Fajans-Conn). The results are extensively described and discussed, and considerations are made referring to the aetiopathogenesis of both entities, diabetes and micro-pathological angiopathy, that could be generically and/or immunologically related.

[Cellulite]. / Celulitis.

In a group of 130 patients carriers of cellulite, that were subjected to a general clinic treatment and local treatment of laser-therapy, the authors, previous to the therapeutics, made an anatomopathologic study of the skin and the adipose tissue. The biopsies were done on patients of the feminine sex, confirming that all these cases presented the histopathologic and histochemical features of cellulite in their dermo-hypodermic tissue. A full study of intolerance to carbohydrates; lipidic, proteic and hormonal metabolism was also performed in all patients. Comparing the different parameters, the authors emphasize the multiple pathogenic varieties of the illness, and the possibility of future risk of macroangiopathy and coronariopathy.

[Cellulitis. Histopathologic and histochemical study of 100 cases]. / Celulitis. Estudio histopatológico e histoquímico de 100 casos.

An analysis of the bibliographical background is made. A study of 100 cases of cellulitis from the histopathologic and histochemical features is performed. The biopsies were done on patients of the feminine sex as a start of a whole treatment. It is inferred that in cellulitis pathologic, metabolic, hormonal and may be immunological factors, are linked to the malfunction of the vascular changes (micro-pathological angiopathy) in the form of thickening of the walls of capillaries and arterioles, that would generate a muco-edema in the dermo-hypodermic tissues. The cellulitis owing to its typical histological characteristics might be considered as a dystrophic capillary connective mucoidotic edema predominant in the skin of the root of the lower limbs.

[Vegetative dystrophic epidermolysis bullosa. Urogenital manifestations and treatment with hydantoin]. / Epidermólisis ampollar distrófica vegetante. Manifestaciones urogenitales y tratamiento con hidantoína.

Dystrophic epidermolysis bullosa has a rare recessive polydysplastic vegetant variant, which was described by Nicolas et al. Two siblings are reported. The male was affected by urethral lesions, an exceptional finding in this disease. Many members in family died of renal insufficiency . A variety of therapeutics was indicated along ten years. Only hydantoins caused a marked involution of the lesions. An interesting feature was that high drug levels in the blood produced not only common side effects, such as macrulia , but also exacerbation of the dermatosis and growth of new lesions, which took on a botriomicoid aspect.