Do frozen sections help achieve adequate surgical margins in the resection of oral carcinoma?

This retrospective study examined the notes of 82 patients who underwent an attempted curative resection of oro-pharyngeal carcinoma, and who had frozen sections taken, over a four year period. Three hundred and fifty mucosal, 179 deep tissue, and 22 nerve frozen sections had been taken. Concordance between cryostat and paraffin sections was 99.5% although no false positives or negatives for invasive tumour were found. Nine (11%) patients who had frozen sections which were reported as dysplastic or positive for invasive tumour underwent further local resection; excision was then found to be complete in 8 (10%) of these patients with further frozen sections. In 15 patients the margins of the main resection specimen were judged to be close to the tumour (<5mm), 5 patients had squamous epithelial dysplasia and 12 patients had invasive tumour at a resection margin. Ten of the 12 patients with margins containing invasive tumour had negative cryostat sections intraoperatively, which demonstrated problems with sampling which is the major drawback. During follow up, 14 patients developed local recurrence. Only one of the patients who had frozen section guided further local resection, developed local recurrence. Frozen sections help achieve tumour clearance.

Recurrent neck disease in oral cancer.

PURPOSE: The goals were to examine the clinical and pathologic features of patients who developed metastatic squamous cell carcinoma in the cervical lymph nodes after initial treatment and to identify any common patterns. PATIENTS AND METHODS: A retrospective analysis of 35 patients of varying initial tumor stage was performed. There were 18 patients who had an initial neck dissection and 17 patients whose neck was managed by a "watch and wait" policy. RESULTS: Recurrence frequently involved level II nodes, and extracapsular spread was invariably present. The time taken for recurrence to develop was the same in both groups of patients (15 months, P =.35), and the overall median survival time after recurrence was 18 months (12 to 25 months, 95% confidence interval). In 27 of 29 patients (93%) who had the primary tumor resected, the thickness of tumor was greater than 5 mm. CONCLUSION: Neck recurrence may represent residual disease; it has histologically unfavorable features and consequently a poor prognosis. The frequency of recurrence at level II emphasizes the need for meticulous dissection in this region, and tumor thickness needs to be considered in planning treatment of the clinically negative neck.

Lethal invasive mucormycosis: case report and recommendations for treatment.

A case of lethal invasive mucormycosis (IM), a rare fungal infection which predominantly affects immunocompromised patients, is reported in a 73-year-old female patient who presented with a cervical abscess. The patient had asthma treated with steroids and had previously undiagnosed diabetes mellitus. Despite surgical treatment and parenteral antibiotic therapy, there was fatal progression of the condition. The pathogenesis, histological appearances and treatment of mucormycosis are discussed, particularly the importance of urgent histological examination of debrided tissue to distinguish this condition from necrotizing fasciitis (NF) earlier than microbiological culture alone would allow, thus permitting the early introduction of appropriate antifungal therapy.