Head and neck mucosal melanoma: clinicopathological analysis of 51 cases treated in a single cancer centre and review of the literature.

Head and neck mucosal melanoma (HNMM) is a rare and aggressive malignancy. The objective of this study was to describe the outcomes of patients with HNMM. Clinical and pathological data from 51 patients with primary HNMM were reviewed. All patients were treated at a single cancer centre between 1954 and 2012. Most tumours involved the nasal cavity (35.3%) and upper gingiva (29.4%). The majority of lesions were ulcerated (54.9%) and pigmented (84.3%). Forty-three patients underwent surgical treatment and 21 (41.2%) underwent adjuvant chemotherapy and/or radiotherapy. Eight patients (15.7%) received palliative treatment. The median follow-up period was 21 months. During this period, 30 (58.8%) patients had tumour recurrences. At the last clinical evaluation, only seven (13.7%) patients were alive with no evidence of disease and three (5.9%) were alive with HNMM. There were significant differences in overall survival probability according to the presence of ulceration (P=0.004), metastatic lymph nodes (P=0.003), and treatment including a radical surgical procedure (P<0.001). On multivariate analysis, ulceration was the only variable associated with an increased risk of death. Despite the poor prognosis, there was significant improvement in overall survival in the most recent years in this sample, mainly due to advances in diagnosis and reconstruction techniques.

Reconstruction after extended orbital exenteration using a fronto-lateral flap.

Orbital exanteration is usually performed for advanced neoplasms of the eyelids and is associated with significant distress for patients. Its reconstruction should aim for functional and aesthetic results and safety for further oncological treatment. The ideal reconstruction should provide adequate cutaneous covering, short healing time, obliteration and closure of communication with facial sinuses and nasal cavity, resistance to radiotherapy, low morbidity and favorable rehabilitation. In 10 patients, a flap based on the frontal branch of the temporal artery was used for immediate reconstruction after orbital exenteration. Flap demarcation began through the frontal midline from the glabella to 0.5 cm above the hairline. Its elevation was performed in a plane above the periosteum and galea, including skin, subcutaneous tissue and frontal muscle. It was rotated tension-free over the defect. In all patients, adequate closure of the defect and obliteration of the orbital cavity was achieved. There was no flap loss or major complications. The lateral frontal flap is easy and fast to execute, with a reliable blood supply and reproducible technique. Its main applicability is for patients with orbital defects and high surgical risks with contraindications for microsurgical reconstruction.

Oral metastasis of telangiectatic osteosarcoma.

Metastases of osteosarcoma in the mouth are rare, and only few cases have been described. We present a case of telangiectatic osteosarcoma of the femur in a 15-year-old girl, who developed metastases in the humerus, lungs and retromolar area 4 years after initial diagnosis and treatment. The girl died 2 months after the diagnosis of metastases despite treatment with chemotherapy. This report emphasizes that telangiectatic osteosarcoma has a very poor prognosis, particularly when multiple metastases develop.

Quantitative leukoviremia and immune complex-dissociated antigenemia as predictors of infection status in children born to mothers infected with human immunodeficiency virus type 1.

Four methods of culturing human immunodeficiency virus type 1 (HIV-1) from peripheral blood mononuclear cells and two serum antigen tests were assessed as predictors of infection status in children born to HIV-1-infected mothers. Of 36 infants whose cocultures were quantitative, all 15 who were deemed to be infected with HIV-1 (nine with symptoms, six without symptoms) by clinical criteria or persistence of Western blot reactive antibody had positive culture results, and all 21 uninfected seroreverters had negative culture results (sensitivity = 100%; specificity = 100%). Quantitative coculture was more sensitive than a technique in which cells were counted and stimulated with phytohemagglutin but not cocultivated with cells from seronegative donors, and more sensitive than two other qualitative techniques evaluated in samples from 80 children, in which cells were not enumerated before culture. The level of leukoviremia in children with symptoms did not differ appreciably from the level of leukoviremia in symptom-free infected children. Among those with positive results on quantitative coculture, only 40% also had free HIV-1 antigen in serum, whereas 86% had antigen in immune complexes. Among the methods evaluated, quantitative HIV-1 coculture was the best indicator of infection status in children.

The role of fine needle aspiration cytology in the diagnosis of lesions of the head and neck excluding the thyroid and salivary glands.

Fine-needle aspiration cytology (FNAC) was performed in 273 cases with suspicious masses of the head and neck, excluding the thyroid and salivary gland, at the A.C. Camargo Hospital from 1983 to 1989. The most frequently punctured site was the lymph nodes (n = 178), and the most common histologic diagnosis of malignancy was squamous cell carcinoma (n = 43). FNAC results were: 105 positive, 6 suspicious, 135 negative, and 27 unsatisfactory cases. There was a correlation between cytology and histology in 217 cases, with 102 true-positive, 76 true-negative, 1 false-positive, and 7 false-negative cases. Suspicious and unsatisfactory cases were not considered for this index. Analysis of the results showed an efficiency of 95.6%, sensitivity of 93.5%, and specificity of 98.7%. Positive and negative predictive values were respectively 99.0% and 91.5%.

Fine needle aspiration cytology in the diagnosis of non-neoplastic diseases of head and neck masses.

In this study, 3 patients with head and neck masses, which were suspicious of neoplastic compromise, were submitted to FNAC investigation. Two cases showed specific infection by Paracoccidioidomycosis and one by Actinomycosis. The cytologic findings were in agreement with histopathologic diagnosis and clinical follow-up; that results showes that FNAC importance in the diagnosis of non-neoplastic masses could be explored in ambulatorial routine.

[Fine needle aspiration cytology in the diagnosis of head and neck tumors]. / Citologia de punção aspirativa por agulha fina no diagnóstico de tumores de cabeça e pescoço.

The authors studied 166 head and neck tumors of patients admitted to the A.C. Camargo Hospital using the method of fine needle aspiration cytology (FNAC) in order to correlate these findings with pathohistological diagnoses. The correlation was possible in 81 cases: 3 cases were false negative and 1 was false positive. FNAC sensibility was 90.6%, specificity was 97.9%, and efficiency was 95%.

Clinical efficacy of computed body tomography.

A method for assessing the effect of computed body tomography on diagnostic understanding and therapeutic decision making is described and the results in the first 184 patients are presented. The patients' referring physicians provided the primary data used for the evaluation. CT improved diagnostic understanding in 41% of patients, reassured the physician about previously planned therapy in 43%, contributed to a change in therapy in 17%, and improved precision of previously planned treatment in an additional 10%. CT contributed to a decision not to perform surgery in 21% of patients in whom an operation had been provisionally planned While CT can play an important role in patient management, its measured value depends on the clinical problems investigated and the level of efficacy on which it is judged.