Warthin's tumor-associated neoplasms: report of two cases and review of the literature.

The association of Warthin's tumor with another neoplasm of a different histological type in the same salivary gland is extremely rare. The literature includes 42 such cases to date. A case of malignant lymphoma developing within Warthin's tumor and another case of oncocytoma synchronous with Warthin's tumor in the same parotid gland are reported. The relation of Warthin's tumor to other neoplasms is discussed.

Hemangioma of the nasal septum: A clinicopathological profile.

Septal hemangioma is a rare cause of epistaxis and nasal obstruction. Ten cases were seen in our center over 25 years and constitute 31% of all cases of nasal hemangioma. The male to female ration was 2.4:1; patient age ranged between 14 and 63 years (average, 39 years). The main presenting symptom was epistaxis with progressive nasal obstruction. There was a positive history of trauma in 7 cases. Symptoms varied between 1.5 months to 4 years (average, 13 months). All tumors but one were located anteriorly in the septum and measured between 0.5 and 2 cm in diameter. Histologically they were well-defined benign neoplasms covered with stratified squamous epithelium and showed varying degrees of ulceration. In eight cases the core was composed of proliferating capillary-type vessels, and two were cavernous. Operative intervention is the treatment of choice, with recurrences likely in the event of incomplete excision (two of the ten cases recurred).

Mycobacterial cervical lymphadenitis.

Mycobacterial cervical lymphadenitis remains a diagnostic challenge for many clinicians despite current advances in diagnostic laboratory techniques. Although much has been done to prevent tuberculosis, cases of mycobacterial disease in endemic form still occur. Six hundred and forty-five patients with tuberculosis were diagnosed and treated at the American University of Beirut Medical Center during the period from 1970 to 1985. Twenty-nine (4.5%) of these patients had proven mycobacterial cervical lymphadenitis. We stress histopathologic examination as the single most important means for diagnosing mycobacterial cervical lymphadenitis. Operation in combination with antituberculous chemotherapy remain the treatments of choice.

Tumors of the major salivary glands in children.

During the 30-year period 1955-1985, 21 children with neoplasms of the major salivary glands were treated at the Johns Hopkins Hospital. A thorough review of the English literature revealed an additional 472 cases. The cases were studied as to age, sex, site, histopathologic characteristics, mode of treatment, and results. The majority of the patients were between 8 and 20 years of age. There was a female preponderance of 1.42:1. The parotid gland was the site of origin in 85.1%, the submandibular in 11.7%, and the sublingual in 3.2%. An equal incidence of benign (50.1%) and malignant (49.9%) lesions is noted. Pleomorphic adenoma was the most common benign neoplasm and mucoepidermoid carcinoma the most common malignant neoplasm. The final prognosis seems to be similar with superficial or total parotidectomy, provided the tumor has been completely removed at the initial surgery. Re-excision is recommended for tumor recurrence, and the use of radiation therapy should be individually determined in cases of aggressive malignancies.

Unilateral pulmonary edema as a complication of contralateral bronchial obstruction.

A unique case of acute unilateral bronchial obstruction complicated by contralateral pulmonary edema is reported. Postulated pathogenetic mechanisms are hypoxia and hyperfusion of one lung with resultant pulmonary capillary endothelial damage and lymphatic insufficiency.

The physiology and immunology of the pharyngeal lymphoid tissue.

The immunologic structure and function of the parapharyngeal lymphoid tissue are presented. The antigen-processing activities of the tonsils are compared to those of the adenoids and other mucosal-associated lymphoid tissues. Both immunoglobin synthesis and secretion as well as T-lymphocyte activities are described.

Multiple primary malignancies in head and neck cancer.

Multiple primary (MP) malignancies were found in 9.7% of 1961 patients with primary head and neck cancer diagnosed at The Johns Hopkins Hospital, Baltimore, during the years 1975 to 1985. The index tumors were divided into six main groups. Out of the 190 MP malignancies, 46.9% were synchronous and 53.1% were metachronous. Seventy-four percent of MP lesions were noted during the first year after diagnosis of the index primary tumor. Patients with an index tumor in the upper aerodigestive tract had a significantly increased risk of developing a second cancer in the head and neck area. This risk was 5.94 for the oral cavity, 6.98 for the pharynx, 3.57 for the larynx, and 7.02 for the esophagus. Patients with an index tumor in the salivary gland or the thyroid gland had, respectively, a 3.59 and a 7.38 higher risk than the general population of developing a second tumor. Efforts aimed at improving the survival of patients with head and neck cancer must incorporate strategies for the prevention, early detection, and treatment of MP neoplasms.

Head and neck war injuries: 10-year experience at the American University of Beirut Medical Center.

Lebanon has witnessed over the past 10 years fierce outbreaks of violence resulting in heavy casualties. Head and neck injuries secondary to bullets, shrapnel, and/or glass were quite frequent: 1,357 injuries in 1,021 patients were taken care of by members of the Department of Otolaryngology between 1975 and 1984. They were distributed as follows: (Formula: see text). Fractures of the mandible were treated by closed reduction in 54% of cases and by open reduction in 46%; 74% healed well and 26% required secondary surgery. Primary repair of oral cavity injuries resulted in healing in 68% of cases; 32% had dehiscences or fistulae. In around one-third of the orbital injuries, the orbital contents herniated into the maxillary sinus, so orbital floor repairs had to be done with good results in 82% of cases. The nasal fractures were treated by closed reduction in 75% of cases and open reduction when the wound was open in the rest. The overall infection rate was 12%. The most common offending organisms were, in order of frequency, S. aureus, P. aeruginosa, and E. coli.

Multiple primary neoplasms in patients with salivary gland or thyroid gland tumors.

The exact risk of multiple primary neoplasms in patients with salivary gland or thyroid gland malignancies is difficult to ascertain from the data available in the literature. This study examines, retrospectively, 198 patients with a first malignancy of the salivary gland and 186 patients with a first malignancy of the thyroid gland, treated over a 10-year period. Fourteen cases of second tumors were found in the first group and 29 cases in the latter. Patients whose second neoplasm was a skin cancer or who had a previous neoplasm at a site other than those selected for study were excluded. The risk of a second tumor compared to the expected number of second cancers from the Combined National Cancer Institute Registry Data, and the results indicated an increased risk in males with a first malignancy of the salivary gland and in both men and women with a first thyroid malignancy. The salivary glands, larynx, and colon were the most common sites of second tumors after a first salivary cancer. The adrenals, brain, lymphatic system, and breast were the most common site after a first thyroid cancer. The previously reported association of cancers of the thyroid and the breast in females is confirmed here in men and women. The excess of brain tumors and lymphomas has not been reported previously.

Infantile subglottic hemangiomas. An update.

Between 1913 and 1985, 323 cases of infantile subglottic hemangiomas have been reported in the English language literature. The purpose of this study is to review these cases, to report The Johns Hopkins Hospital experience with ten additional cases, and to compare the various methods of treatment in an attempt to identify the regimens associated with the best outcome. The majority of the patients presented before the age of 6 months with respiratory distress, most commonly inspiratory stridor. There was a 2:1 female to male preponderance. The diagnosis was established by endoscopy in the majority and confirmed by biopsy in one third, without serious bleeding complications. A plethora of treatment methods have been described, including the following: corticosteroids, tracheotomy, radiation therapy, radioactive implant therapy, surgical excision, cryotherapy, and carbon dioxide laser. These methods were reviewed and their results compared to our own. We conclude that several methods are effective, each having its advantages and disadvantages. We believe that immediate tracheotomy should be performed in cases with severe airway obstruction. Smaller lesions may be vaporized with the carbon dioxide laser without tracheotomy if postoperative care is provided in a pediatric intensive care unit. Corticosteroids may be used alone or in combination with other modalities. External radiation therapy and injection of sclerosing agents are not advised.

Surgical treatment of giant hemangiomas of the head and neck.

This article is a review of 22 cases of giant hemangiomas of the head and neck treated at the American University of Beirut Medical Center over a 20-year period 1964 to 1984. All these cases were treated by surgical excision. Two maneuvers designed to reduce blood loss during the operation are described: the placement of strangulating silk sutures around the periphery of the hemangioma, and temporary occlusion of the ipsilateral external carotid artery. These cases were studied as to age, sex, site, size of hemangioma, histopathologic characteristics, mode of treatment, and results. A review of the literature and current modes of treatment of hemangiomas of the head and neck is also presented and our results are compared with those in other published reports. The surgical approach as a primary and definitive treatment for these giant hemangiomas is emphasized.

The use of dexamethasone in pediatric bronchoscopy.

The beneficial effect of intravenous corticosteroids in preventing traumatic laryngeal edema is controversial. Between 1968 and 1971, a controlled clinical study was conducted, at the American University of Beirut Medical Center, of 70 children who underwent bronchoscopy for removal of foreign bodies from the tracheobronchial tree. The patients were divided into two randomized groups; one group was given intravenous dexamethasone while the second was kept as a control. The length of hospitalization and the development of complications attributable to tracheobronchial edema were compared. Intravenous corticosteroids do not seem to reduce the incidence of post-bronchoscopy laryngeal edema.

Rhinocerebral mucormycosis with internal carotid occlusion: report of two cases and review of the literature.

Two fatal cases of rhinocerebral mucormycosis with fungal invasion and occlusion of the internal carotid artery are described. Review of the literature reveals 35 similar cases of whom only 6 survived. Emphasis is placed on the need for early diagnosis and prompt therapy which consists of correction of the underlying disease, aggressive surgical debridement, and amphotericin B.