Histopathologic parameters in the evaluation of T1 squamous cell carcinomas of the oral cavity.

BACKGROUND: Prognostic indicators that could assist in a more precise selection of patients with small oral carcinomas for differentiated therapy would be valuable. A significant fraction of patients with stage I disease have a relatively poor prognosis despite the small size of the tumor, but in general stage I tumors of the oral cavity have a favorable prognosis. METHODS: Seventy-eight patients with stage I (T1N0M0) oral squamous cell carcinoma from two different ENT departments were included in the study. The pretreatment biopsy specimens were graded according to the modified classification of Jakobsson et al. Eight individual parameters were recorded, four parameters describing the tumor cell population and four parameters describing the tumor/host interaction. RESULTS: The only significant prognostic parameter for disease-specific survival was "mode of invasion." The histologic mean score was not significantly correlated to disease-specific or crude survival. CONCLUSIONS: Mode of invasion is the most important histologic parameter when evaluating the prognosis. Histologic evaluation of small squamous cell carcinomas of the oral cavity may assist the design of a differentiated treatment strategy (eg, monotherapy vs combined treatment).

[Surgical treatment of preauricular fistula. A follow-up study]. / Kirurgisk behandling af praeaurikulaere fistler. En efterundersøgelse.

INTRODUCTION: Our aim was to evaluate the results of surgery on preauricular fistulas over a ten-year period and to determine the postoperative recurrence rate and the factors responsible. MATERIALS AND METHODS: Forty-three patients with 51 preauricular fistulas, who had been operated on in the period, 1 August 1990 to 1 August 2000, at the Department of Otolaryngology, Aarhus University Hospital, were asked to participate in a follow-up examination. Thirty-three patients turned up for examination, four patients were interviewed over the telephone, and for the rest the data available from the medical records were used. RESULTS: Surgical extirpation was performed on 51 fistulas. Eight fistulas had previously been operated on. The recurrence rate of the fistula primarily operated on at our department was 5%. The recurrence rate of secondary surgery was 63%. Five fistulas were infected at the time of surgery, three recurred. Seven patients developed a postoperative abscess, six of whom had a recurrence. All the fistulas were blind-ended. In 94% of the histology tests, the fistula was lined with multilayered squamous epithelium. Sixteen patients had a family history of the condition. CONCLUSION: Preauricular fistula is a benign disease that often stays asymptomatic, but can become troublesome if infected. The treatment is surgical extirpation. The recurrence rate rises if the fistulas are infected at the time at surgery or if there has been an earlier attempt of extirpation. This emphasises the importance of an extended knowledge of the disease, so that patients can be referred to an ENT specialist should symptoms occur.