Incidence of cervical node involvement in metastatic cutaneous malignancy involving the parotid gland.

BACKGROUND: The parotid lymph nodes represent an important group of nodes at risk for metastatic involvement from cutaneous malignancies of the head and neck. When treating patients with metastatic disease in the parotid gland it has been our custom to also remove the lymph nodes of the neck on the basis that these nodes represent other nodal groups at risk for metastatic involvement. The aim of this study is to determine the incidence of cervical node involvement among patients with clinical metastatic SCC or melanoma of the parotid to determine whether treatment of the clinically negative neck is warranted. METHODS: The study group consists of 123 prospectively accessioned patients with clinical metastatic cutaneous squamous cell carcinoma (SCC) (n = 73) or melanoma (n = 50) involving the parotid gland and a minimum of 2 years of follow up, irrespective of the clinical status of the neck. RESULTS: Among 73 patients with metastatic SCC in the parotid, 19 (26%) had clinical neck involvement, and 16 of these were pathologically positive (84%). A total of 37 patients had elective neck dissections, and 13 were pathologically positive, which is an overall rate of 52% neck involvement among patients having neck dissection. Among 50 patients with metastatic melanoma in the parotid, 19 (38%) patients were initially seen with clinical neck disease, and all were pathologically positive. Among 31 patients with clinically negative necks, 26 had neck dissections and seven had positive nodes (27%). Overall, 58% of patients with melanoma who had a neck dissection had positive nodes. CONCLUSION: Patients with metastatic cutaneous SCC and melanoma involving the parotid gland had a high incidence of clinical (26% and 38%, respectively) and occult neck disease (35% and 27%). Treatment of the clinically negative neck in the presence of clinical metastatic parotid cancer should be considered to reduce the likelihood of failure in cervical nodes, to define the extent of disease, and to assist with patient selection for adjuvant therapy.

Prevalence and distribution of ret/ptc 1, 2, and 3 in papillary thyroid carcinoma in New Caledonia and Australia.

The world's highest incidence of thyroid cancer has been reported among females in New Caledonia, a French overseas territory in the Pacific located between Australia and Fiji. To date, no molecular genetic studies in this population are available. Over the past few years, the oncogenic rearrangement of the ret protooncogene (ret/ptc) has been studied in papillary carcinomas in different populations. In this study, we investigated the prevalence and distribution of ret/ptc1, 2, and 3 in papillary thyroid carcinoma from the New Caledonian population and compared the pattern with that of an Australian population. Fresh-frozen and paraffin-embedded papillary carcinomas from 27 New Caledonian and 20 Australian patients were examined for ret rearrangements by means of RT-PCR with primers flanking the chimeric region, followed by hybridization with radioactive probes. ret/ptc was present in 70% of the New Caledonian and in 85% of the Australian samples. Multiple rearrangements were detected and confirmed by sequencing in 19 cases, 4 of which had 3 types of rearrangements in the same tumor. This study demonstrates a high prevalence of ret/ptc in New Caledonian and Australian papillary carcinoma. The findings of multiple ret/ptc in the same tumor suggest that some thyroid neoplasms may indeed be polyclonal.

20th anniversary. Celebrating the past, looking to the future.

This special section marks the 20th anniversary of Crain Communications' ownership of Modern Healthcare. On the following pages, the staff of Modern Healthcare examines the three most important developments of the past two decades (p. 44) and then reviews in detail the news events, trends and people that shaped each year (pages 46-84). A compilation of some of the best work of editorial cartoonist Roger Schillerstrom can be found on p. 86. Finally, with the help of healthcare futurists, we'll take a peek at the next 20 years of healthcare (pages 92-96) as this most changeable of industries undergoes ever more profound transformations.

Use of a specimen-evaluation device for the diagnosis of impalpable breast lesions detected by mammography.

OBJECTIVE: To describe a method for accurate excision and exact histopathological diagnosis of impalpable breast lesions, considered suspicious of carcinoma, and detected on mammographic examination alone. SETTING, PATIENTS AND INTERVENTIONS: Eight-five patients referred with a suspicious but impalpable mammographic lesion underwent preoperative radiological localisation followed by surgical excision biopsy. Specimen radiology with a radiolucent acrylic compression-grid specimen-evaluation device confirmed that the lesion had been excised. By use of the grid coordinates, exact histopathological examination of the radiological area of suspicion was carried out to provide a definitive pathological diagnosis. RESULTS: Twenty-eight patients (33%) were found to have invasive carcinoma or extensive intraduct breast carcinoma requiring further surgical and adjuvant management. Nineteen of these patients (68%) had no axillary node metastases. CONCLUSION: The use of an acrylic compression-grid specimen-evaluation device in the diagnosis of suspicious mammographic breast lesions facilitates confirmation of excision by specimen radiology, and expedites accurate histological examination of suspicious radiological lesions.

Value of urine microscopy in predicting histological changes in the kidney: double blind comparison.

Fresh, first morning specimens of urine from 22 consecutive patients were examined by quantitative microscopy on the morning of renal biopsy; the renal biopsy samples were evaluated "blindly." Five patients showed no abnormality in the biopsy samples but eight had minimal, one mild, six moderate, and two severe histological changes. Comparison of the results of quantitative microscopy of urine with the presence or absence of histological evidence of disease showed that sensitivity was 88%, specificity 83%, accuracy 86%, positive predictive value 93%, and negative predictive value 71%. When combined with microscopy of a second urine specimen these values were 100%, 50%, 87%, 85%, and 100% respectively. There was a significant relation between number of casts and severity of the histological changes (p less than 0.01). Comparison of renal functional abnormalities with histological findings gave values of 64%, 100%, 73%, 100%, and 50% respectively. It is concluded that quantitative microscopy of the first morning specimen of urine is a sensitive test with high predictive value for the presence or absence of renal disease. If no casts are detected in two early morning specimens the likelihood of finding anything more than minimal changes in a biopsy sample is virtually zero.

Aspergillus fumigatus infection of the optic nerve with mycotic arteritis of cerebral vessels.

A 56-year-old Caucasian male, with no obvious immune deficit or systemic disease, presented with unilateral loss of vision due to A. fumigatus infection involving the right optic nerve. There was no proptosis. Despite fungal chemotherapy he developed central nervous system involvement with mycotic arteritis of the branches of the right middle cerebral artery, temporal lobe infarction and rupture of a mycotic aneurysm of the right internal carotid artery, and died. Review of the literature concerning orbital Aspergillus infection showed both this form of presentation and a rapidly fatal course to be unusual.

Systemic lupus erythematosus and thrombotic thrombocytopenic purpura. A case report and review of relationship.

Thrombotic thrombocytopenic purpura (TTP) and systemic lupus erythematosus (SLE) are both multisystem diseases and the latter can manifest hemopoietic abnormalities that may mimic TTP. This has led to diagnostic confusion and reports of the 2 diseases occurring in a single patient. We describe a 15-yr-old girl who presented at age 12 with purpura, fever, headaches, changes in conscious state, thrombocytopenia and microangiopathic hemolytic anemia and who was diagnosed despite the absence of renal disease, as having TTP. ANA and LE cells were negative then, and again 1 yr later. Three yr later she presented with the nephrotic syndrome with a positive ANA (1:100), elevated DNA antibody (79 U/ml, normal less than 25) and a circulating anticoagulant. Renal biopsy confirmed the presence of lupus nephritis. The association is discussed.