Use of intraoperative cytologic assessment of mandibular marrow scrapings to predict resection margin status in patients with squamous cell carcinoma.

PURPOSE: This study assessed the feasibility of intraoperative microscopic assessment of mandibular bone resection margins in patients undergoing segmental resection of mandible for treatment of squamous cell carcinoma. PATIENTS AND METHODS: This prospective pilot study involved 7 consecutive patients undergoing segmental resection of mandible as part of surgical treatment of oral squamous cell carcinoma. Cytologic examination of smear/touch preparations of 35 bone marrow scrapings, including simulated positive margins, was performed. RESULTS: "Malignant" excision margins produced a high cell yield, and it was easy to assign samples to malignant or benign categories on microscopic examination. All the simulated positive margins were easily identified. No false positive results were found. CONCLUSION: Cytologic examination of bone excision margin scrapings is a rapid, inexpensive, and accurate technique. This study confirms its feasibility and accuracy in cases of mandibular resection for squamous cell carcinoma.

Cystic hygroma in an adult: a case report.

Cystic hygromas are benign lesions arising due to an abnormality in lymphatic development and only rarely present in adults. Adequate radiological imaging prior to surgery is important as incomplete excision often leads to recurrence. Several adjunctive therapies have been shown to be beneficial in recurrent or inaccessible lesions but these are not in common use. We describe the case of a cystic lymphangioma appearing in adulthood that presented a diagnostic and therapeutic challenge.

Primary malignant melanoma of the esophagus.

Primary malignant melanoma of the esophagus, first recognized as a primary tumor by de la Pava et al. in 1963, is rare. It usually presents as an aggressive polypoidal darkly colored or non-pigmented tumor in the mid to lower esophagus which may be diagnosed preoperatively by the use of immunohistochemical stains such as HMB-45 (melanoma specific antigen). The treatment of choice is surgical resection however the overall prognosis is poor with only 4 per cent of patients surviving 5 years.

Granular cell tumour of the larynx.

A granular cell tumour may present as clinically innocuous lesions on the vocal cords and the diagnosis is usually made by histopathology. However, the granular cells characteristic of this tumour may not be obvious and accompanying epithelial hyperplasia may be interpreted by the pathologist as invasive squamous cell carcinoma. Good communication between pathologist and surgeon is required to ensure that clinically benign lesions on the vocal cords are not misdiagnosed. The diagnosis of granular cell tumour can be confirmed by immunocytochemical staining for S100 antigen.

Plasma cell granuloma of the larynx (case report and review of the literature).

A case is reported of Plasma Cell Granuloma of the larynx treated successfully with steroids and antibiotics.

Limited value of type III intestinal metaplasia in predicting risk of gastric carcinoma.

Endoscopic gastric biopsy specimens taken in 1976 from 174 patients were reviewed. Biopsy specimens from 44 patients showed intestinal metaplasia, and subtyping by mucin histochemistry showed that 16 were of type I, 14 of type II, and 14 of type III. Only two of these 174 patients developed gastric adenocarcinoma over the next 10 to 11 years: one with type II and one with type III intestinal metaplasia. Case notes of a separate group of 68 patients with gastric adenocarcinoma diagnosed in 1985 were reviewed for evidence of intestinal metaplasia in a previous gastric biopsy. Only two patients had previously been biopsied; one of these biopsy specimens showed type II intestinal metaplasia and the other showed no intestinal metaplasia. These findings suggest that subtyping of intestinal metaplasia in endoscopic gastric biopsy specimens is of only limited value in identifying patients at risk of gastric adenocarcinoma who require long term follow up.

The effect of strenuous physical exercise on circulating blood lymphocytes and serum cortisol levels.

Venous blood was removed from healthy subjects immediately before and at intervals after exercise on a bicycle ergometer. Immediately after exercise, the subjects developed a lymphocytosis in which (a) the E-rosette percentage fell by 10% but their absolute number in the circulating blood rose by more than 70%, (b) the percentage of PHA-stimulated cells fell, but their absolute numbers increased considerably and (c) the absolute numbers of Con A- and PWM-responding cells increased. The numbers of lymphocytes in the various subpopulations had returned virtually to the pre-exercise levels 15 minutes after stopping exercise. During the response to exercise, the characteristics of the cells in the various subpopulations did not show any major changes, despite considerable and rapid fluctuations in numbers: it is suggested that exercise discharges intravascularly sequestered cells and that cortisol may be involved in re-sequestration of stress-released cells. It is recommended that, in clinical studies on circulating lymphocyte numbers and populations, the patient should be rested for at least 15 minutes before venesection.