Mucoepidermoid tumour of the parotid gland: a very difficult prognostic evaluation.

The correct management of mucoepidermoid tumours is still debatable because of their unpredictable biological course. The issue discussed is that of identifying biological characteristics of these tumours which may have predictive value. Sixteen patients with a mucoepidermoid tumour of the parotid gland, treated at the ENT Clinic of Bologna University over a 15-year period, were reviewed. The follow-up of each patient has been related to the surgical management, in order to evaluate whether superficial parotidectomy provides adequate treatment. No prognostic differences were noted between total and superficial parotidectomy when the latter was clinically appropriate. The histopathological specimens from these patients were reviewed in an attempt to correlate the histological grade of tumour with the course of the disease. Our data suggest that histological evaluation of malignancy alone is insufficient for accurate prognosis. We think that the clinical presentation (facial nerve palsy, pain, etc.) predicts the prognosis with greater accuracy.

An unusual manifestation of renal osteodystrophy.

Besides the more frequent aspects, an unusual manifestation of renal osteodystrophy occurred in a 19-year-old man on regular hemodialysis treatment. About 6 years after the start of hemodialysis, the patient, who had severe osteodystrophy, presented a brown tumor, localized to the jaw, which caused a serious deformity of the face. Pharmacological treatment for hyperparathyroidism did not reduce the volume of the mass. Only total surgical removal gave long-lasting success. Brown tumor is an unusual but serious complication of renal bone disease which can be treated successfully by surgical removal of the tumoral mass and by pharmacological treatment for hyperparathyroidism.

Metastatic malignant melanoma in the parotid gland.

3 cases of metastatic malignant melanoma to the parotid gland are reported. Diagnosis before surgery was not possible because of the particular characteristics of the primary lesions. Neither physical examination nor sialography or ultrasonography provided any differential diagnostic assistance. A thorough case history allowed us to trace a pigmented lesion in 2 cases: in the first case it had been removed about 1 year prior to our examination, whereas in the second case it had regressed spontaneously leaving no trace. In the 3rd case the presence of multiple surgical scars, due to reconstructive plastic surgery for multiple burns of the scalp contracted 30 years earlier, might have concealed a primary malignant melanoma. The path of diffusion (either direct or retrograde) towards the parotid gland as well as treatment procedures are discussed on the basis of recently published data. Moreover, the authors underline the value of thorough case histories aimed at identifying suspect cutaneous lesions of the head and neck, in all cases of parotid swellings, where the possibility of metastases is considered.

A two-stage immunocytochemical method for oestrogen receptor analysis: correlation with morphological parameters of breast carcinomas.

An immunocytochemical method for oestrogen receptor (ER) analysis of breast carcinomas is described and compared with the dextran-coated charcoal (DCC) assay and a cytochemical method. The method described is superior to the purely cytochemical, especially in terms of sensitivity, demonstration of nuclear receptors and correlation with the DCC assay. The DCC assay is reliable except in the case of poorly cellular tumours: in these the immunocytochemical method is far superior, being independent of tumor cellularity. With this new method, lobular carcinomas are shown to be ER-rich compared with their ductal counterparts, a conclusion currently disputed, largely because methods employed mostly fail to take account of tumour cellularity. A combination of the DCC assay and the immunocytochemical method here described gives the maximum information about the ER-status of a particular carcinoma.