Hyalinizing spindle cell tumor with giant rosettes--a soft tissue tumor with mesenchymal and neuroendocrine features. An immunohistochemical, ultrastructural, and cytogenetic analysis.

CONTEXT: Hyalinizing spindle cell tumor with giant rosettes is a recently described biphasic neoplasm of soft tissues that shares mesenchymal and neuroendocrine features. Its morphologic structure is distinctive, with the presence of hyalinized paucicellular foci that are termed rosettes. The cells around the latter display positive immunoreactivity for neuroendocrine markers. The small number of cases described to date indicates that they tend to be localized in the extremities. OBJECTIVE: To describe the clinicopathologic features of 2 unusual cases of hyalinizing spindle cell tumor with giant rosettes. METHODS AND RESULTS: One tumor was located in the prestyloid parapharyngeal space and the second in the left thigh. Both tumors were well circumscribed and surrounded by a thin capsule-like fibrous band without infiltrating projections. The rosettes were embedded in a spindle cell proliferation. Immunohistochemical stains showed positive results for S100 protein, synaptophysin, CD57, protein gene product 9.5, and neuron-specific enolase exclusively in the cells palisading the rosettes. These markers were negative in the spindle cell portions of the tumor. The latter were immunoreactive for factor XIIIa, vimentin, HAM56, collagen IV, and CD68. Vimentin was the only marker shared by the rosette-forming cells and the spindle cells. Ultrastructurally, the rosette-forming cells contained neurosecretory granules. This study describes the first cytogenetic analysis in this type of tumor revealing 2 cell lines, both containing a balanced translocation between chromosomes 7 and 16. Follow-up of the patients at 16 and 8 months did not disclose evidence of recurrence. CONCLUSIONS: These 2 new cases increase the awareness of hyalinizing spindle cell tumor with giant rosettes and demonstrate that it is a spindle cell neoplasm of unique cytogenetic rearrangements composed of dendritic, histiocytic, and fibroblastic cells admixed with cells that have neuroendocrine differentiation.

Basal cell carcinoma of the head and neck: identification of predictors of recurrence.

The goal of this retrospective study was to identify factors that predict the recurrence of basal cell carcinoma of the head and neck. We reviewed the medical records of 165 patients who had undergone a wide surgical excision (negative margins) of one or more basal cell carcinomas of the head and neck. Univariate analysis revealed that recurrence was significantly influenced by the patient's gender (p < 0.01), the presence of preoperative risk factors (p < 0.05), the presence of multiple lesions (p < 0.01), and their histopathologic subtype (p < 0.05). Multivariate analysis revealed that the best predictors of recurrence were the presence of preoperative risk factors and the presence of multiple lesions (p < 0.01); the lesion's histologic subtype approached but did not reach statistical significance in predicting recurrence (p = 0.06).

Otolaryngologic clinical patterns in pediatric infectious mononucleosis.

PURPOSE: Classic infectious mononucleosis (IM) is uncommon in children; therefore, the incidence of severe pharyngotonsillitis complicating the infection is not well established. This study was undertaken to better define the management of complications with special emphasis on the use of parenteral steroids and the role and timing of surgical management. MATERIALS AND METHODS: A retrospective review of all cases of IM encountered between January 1989 through December 1993 was undertaken. RESULTS: There were 109 patients admitted with IM. Sixty patients (55%) were admitted for severe pharyngotonsillitis. Twenty-nine patients in this subgroup were felt to have symptoms of severe upper airway obstruction and were treated with parenteral steroids. Surgical intervention was required in three patients. CONCLUSION: The study shows a higher incidence of admissions for severe pharyngotonsillitis complicating IM than reported in the adult literature. It suggests that routine use of parenteral steroids is indicated in cases of severe upper airway obstruction and may decrease the need for surgical intervention.