Prognostic indicators in carcinoma of the nasal vestibule.

OBJECTIVES: Squamous cell carcinoma of the nasal vestibule is rare variant of skin cancer. The TNM classification for skin cancer has been used, whereas, Wang has devised an independent staging system, which he stated was more accurate. The purpose of this study was to analyse the prognostic indicators for survival in a patients with nasal vestibule cancer from the Princess Margaret Hospital, Toronto. DESIGN: A retrospective review of case notes from the Princess Margaret Hospital archives was performed. SETTING: The Princess Margaret Hospital/Ontario Cancer Institute is the tertiary regional Head and Neck Oncology Centre for ON, Canada. PARTICIPANTS: All patients with nasal vestibule cancer (ICD10 C300) were included. MAIN OUTCOME MEASURES: Univariate and multivariate analyses were performed and Kaplan-Meier survival curves constructed. RESULTS: Eighty-four patients were identified. The mean age was 67, there was a male preponderance of 2 : 1. Primary radical radiation was used in 77% of patients. Age (P = 0.02), N stage (P = 0.0001) and Wang classification (P = 0.0001) were associated with prediction of overall survival using multivariate analysis. Grade, depth of invasion and N stage were associated with disease-free survival outcome. A 5-year overall survival rate of 58% and disease-free survival of 52% was seen. CONCLUSION: Nasal vestibule cancer behaves in a more aggressive manner than any other skin cancers affecting the head and neck. The Wangs' classification appears to be a better prognostic indicator for overall survival then the TNM classification for skin cancer.

Retrospective study of management of uterine sarcomas at Oxford 1990-1998: role of adjuvant treatment.

We report a retrospective study of 47 consecutive patients with uterine sarcoma treated at the Churchill Hospital in Oxford between 1990-1998. The mainstay of treatment was surgery with adjuvant chemotherapy and radiotherapy reserved for selected patients with early stage disease. Overall 1 and 2 year survival was 49% and 30% respectively compared with 73% and 55% in the group who received adjuvant chemotherapy/radiotherapy. Median survival was 11 months for the group as a whole compared to 32.9 months in the adjuvant therapy group. This is a retrospective review with small numbers and considerable selection bias, however, given the poor survival of patients with this disease, adjuvant treatment should be considered in future trials of patients with uterine sarcoma.

Granulomatous reaction to Bowman's layer in herpetic keratitis and band keratopathy.

OBJECTIVE: To characterize granulomatous reactions around Bowman's layer. DESIGN: Case series. SETTING: Registry of Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington. PATIENTS: All patients with a code for granulomatous reactions to Bowman's (membrane) layer or Descemet's membrane. In addition, all corneas identified as having elastotic or calcific degeneration of Bowman's layer were reexamined to identify a possible granulomatous reaction to Bowman's layer. RESULTS: Review of 210 corneal buttons and enucleated eyes yielded eight cases in which evidence of a granulomatous reaction to Bowman's layer was present: five patients with chronic keratitis, including three with herpetic keratitis (disciform in two and ulcerative in one), and three patients whose corneas had old degenerative pannus with calcification of Bowman's layer. In the patients with chronic keratitis the reaction tended to be focal and accompanied by inflammation; in those with degenerative pannus the reaction was diffuse and accompanied by minimal inflammation. CONCLUSIONS: Granulomatous reactions to Bowman's layer are observed much less frequently than granulomatous reactions to Descemet's membrane. Although the pathogenesis of granulomatous reaction to Bowman's layer is unclear, a change in the antigenic properties of Bowman's layer may be implicated.

Ligneous conjunctivitis. A clinicopathologic study of 17 cases.

Seventeen cases of ligneous conjunctivitis were studied. Most of the patients were children; however, two elderly individuals were involved (range, birth to 85 years). The most common site was the tarsal conjunctiva, where firm sessile or pedunculated membranous lesions were seen. However, corneal involvement, as well as similar and recurrent lesions, were also present in the larynx, vocal cords, trachea, nose, vagina, cervix, and gingiva. Many recurrences (up to 10 times) rapidly followed simple surgical excision in all patients. Histopathologically, the lesions were characterized by subepithelial, eosinophilic, amorphous material admixed with acute and chronic inflammatory cells. The finding of amorphous material containing fibrin, immunoglobulins, and albumin suggested leakage from hyperpermeable blood vessels. Electron microscopic studies of the lesions disclosed few abnormal blood vessels with wide gaps between endothelial cells that were surrounded by a thick multilaminar basement membrane. The duration of the disease ranged from 4 months to 44 years. After several recurrences, spontaneous resolution occurred in six patients.

Primary carcinoid tumor of the orbit. A clinicopathologic study with histochemical and electron microscopic observations.

A patient with a primary carcinoid tumor of the orbit is described. No other tumor had been found during the 15-year interval since the onset of unilateral proptosis. Symptoms of the carcinoid syndrome were absent, and the urinary levels of 5-hydroxyindoleacetic acid were normal. Histologically, the bulky, noninfiltrating tumor compressed but did not invade the optic nerve. The argyrophilic cells were arranged in solid lobules and formed abundant, rosettelike structures. Pleomorphic neurosecretory granules were demonstrated by transmission electron microscopy.

Carcinoid tumors of the eye and orbit: a clinicopathologic study of 15 cases, with histochemical and electron microscopic observations.

This clinicopathologic study includes 15 cases of carcinoid tumors of the eye and orbit. The patients ranged in age from 14 to 86 years (median, 53). No prediction for either gender was found. Seven tumors involved the orbit, seven the choroid, and one the iris. The primary site of origin of the carcinoid tumor was known in 12 cases: seven in the bronchus, one in the trachea, and four in the ileum. In three cases an orbital tumor was present but no other known primary neoplasm was clinically apparent. The postoperative follow-up period ranged from 0 to 4 years. The urinary levels of 5-hydroxyindoleacetic acid (5-HIAA) were elevated in four of ten patients tested, each of whom had a known primary tumor and two of whom had clinical evidence of the carcinoid syndrome. Four main histologic patterns were recognized: pattern A (solid lobules or masses), pattern B (trabecular or cord-like), pattern C (tubular or rosette-like) and pattern D (mixed). The apparently primary carcinoid tumors and the orbital or ocular metastases were closely related by their histologic patterns, histochemical staining characteristics, and ultrastructural features.

Silica granuloma of eyelid and ocular adnexa.

Seven cases of subcutaneous epithelioid granulomas caused by silica and involving the eyelids and periorbital region are described. Histologically, all cases disclosed epithelioid tubercles and varying numbers of foreign-body-type giant cells, areas of scarring, and birefringent crystals. Light microscopy with polarized readily facilitated visualization of the crystals. Scanning electron microscopy and energy dispersive x-ray analysis clearly established that the crystals were composed of silica in both its pure and combined forms. This study emphasizes the need for examination of all epithelioid granulomas with polarized light. If crystalline foreign bodies are identified, further special techniques should be used for chemical characterization of the crystals.

Hereditary benign intraepithelial dyskeratosis. A report of two cases from Texas.

Hereditary benign intraepithelial dyskeratosis (HBID) is a rare disorder characterized by autosomal dominant inheritance, onset in childhood, bilateral limbal conjunctival plaques, chronic relapsing course of ocular irritation and photophobia, and oral lesions resistant to medical and surgical therapy. The lesions are characterized histologically by dyskeratosis, acanthosis, parakeratosis, and a variable amount of subepithelial inflammation. The patients in all previously reported cases have been descendants of Halowar Indians from North Carolina. This report illustrates the typical clinical and histologic findings of HBID in two siblings who, along with their parents and grandparents, were born in Texas.

Association of foveomacular retinitis, ankylosing spondylitis, iritis, and acquired iris atrophy.

A case of foveomacular retinitis, ankylosing spondylitis, iritis, and iris dissociation is described. Only ankylosing spondylitis was present in other family members. The differential diagnosis is discussed. The iritis of ankylosing spondylitis must be considered in cases of developmental full-thickness iris holes.