Low-grade mucoepidermoid carcinoma of the palate-a previously unreported case of metastasis to the liver.

Intraoral low-grade mucoepidermoid carcinoma (MEC) is not known to metastasize to the liver. This type of malignant salivary gland tumor is comparatively rare and has a well-defined set of parameters guiding histolopathologic grading into low to high grade. Although distant and regional lymph node metastases have been reported in about 15% of all MEC cases, tumors diagnosed as low grade have only very rarely been implicated. We present a case, as yet unreported, in which cervical lymph node and hepatic metastatic spread occurred from a primary low-grade MEC of the hard palate. A 33-year-old man presented with a 4-week history of painful, right-sided palatal ulceration crossing the midline. Imaging revealed cervical lymph node involvement and metastatic liver deposits. Tissue diagnosis supported a low-grade palatal MEC with histologic identical hepatic metastases. We examined the clinical features of this rare case, reviewed the published data, and discuss the histologic features and treatment of such patients.

The role of narrow band imaging in early detection of head and neck cancer.

Narrow band imaging (NBI) is a novel method of imaging that increases the diagnostic potential of conventional endoscopy. It highlights abnormalities in the superficial vasculature of mucosal lesions so that precancerous or cancerous lesions can be identified more easily. Initially developed for the gastrointestinal tract, and widely used in other branches of medicine, it is now being used for the assessment of patients with malignancy in the head and neck. We review current published papers relating to NBI and discuss its benefits for early detection of cancer of the head and neck.

Treatment of breast adenocarcinoma metastasis to the neck: dedifferentiation of the tumor as suggested by hormone markers.

BACKGROUND: Breast carcinoma rarely metastasizes to the neck, and its management in this area is controversial. There is little published data about whether hormone receptor status changes between primary breast tumors and neck metastasis and whether this influences management. METHODS: We evaluated the demographics and treatment of 13 patients presenting with neck metastasis. We used immunochemistry to assess estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 in the primary and metastatic neck nodes. RESULTS: Hormone receptor status changed in some patients (23% for estrogen receptor, and 31% for progesterone receptor). Three patients had complete excision of their neck disease and subsequent good local control. None of our patients survived despite treatment. CONCLUSION: The change in hormone status could suggest tumor dedifferentiation. Surgical resection, where possible, achieves good local control for these patients, but, because survival is poor, it is only recommended when it results in little significant morbidity.

A survey of the career-defining determinants of prospective UK oral and maxillofacial surgical trainees.

Increasing numbers of medics are applying to dental school to pursue a career in oral and maxillofacial surgery (OMFS), particularly in the aftermath of Modernising Medical Careers (MMC), but their perspectives, experience, and training up to this point differ widely. We aimed to characterise these differences in the light of MMC and beyond by doing a survey of 20 dentists and 24 medics who were applying for their second degree. They were questioned about factors that influenced their choice of career and university, the motivation to pursue specialty training, and were asked for their opinions on suggested measures for workforce planning. The medics were subdivided into those who had trained before MMC (n=18), and those who had not (n=6). Dentists had considerably more OMFS experience than medics (mean 22 months compared with 4.2 months), and 46% (11/24) of medics had no substantive OMFS experience. Of those who had trained before MMC 3/18 considered OMFS as their first choice of career, compared with 4/6 who have trained since, and 15/20 of dentists. Eighty-three percent (20/24) of medics admitted that MMC had influenced their choice of career, and 54% (13/24) had applied for training in a specialty other than OMFS, notably otolaryngology. The most favoured method of workforce planning among all respondents (25/44) was "roughly matching" places on a second degree to projected OMFS training posts.