Oculodermal melanocytosis (nevus of Ota) and orbital malignant melanoma.
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A 44 year old woman with multiple myeloma and cutaneous involvement is presented. She had a painless tumor over the malar region. Microscopic study showed a cutaneous infiltration of plasma cells. Survival from diagnosis lasted 5 months. Over this period, multiple and progressive cutaneous nodules appeared, having the same structural characteristics.
Report is made of a patient having concurrently an Ota nevus and a blue nevus. The dermal melanocytes showed a marked formation of large intracytoplasmatic vacuoles. Reference to the important role of an "extracellular sheath" is made. The nearly identical ultrastructural characteristics of dermal melanocytes in various dermal melanocyte disorders seems to imply a common pathological origin in their development.
Ninety-nine cases of peripheral facial paralysis in children treated at Ste. Justine's Hospital over a 10 year period were reviewed. Sexes were nearly equally affected with a slightly higher incidence in female. Cases were distributed quite evenly throughout childhood except for a definitely higher incidence in the 0--2 year old group. Trauma, Bell's palsy, and otomastoid inflammation were found to be the most frequent causes of facial palsy in that group of cases. Cases of otomastoid inflammation did generally well on antibiotics and nearly 70 per cent so recovered completely. Twenty per cent only had to undergo simple mastoidectomy and two cases a decompression. Out of 25 cases of Bell's palsy, 18 recovered totally without surgery and four were decompressed with total or partial recovery. Following this study, the need for a more complete evaluation and somewhat more standardized treatment became obvious. This may permit in the future a more adequate knowledge of the problem and likely a better management.
Multiple cutaneous sebaceous neoplasms with or without keratocanthomas are associated with internal low-grade malignant neoplasms, usually of the gastrointestinal (GI) tract (Torre syndrome). We describe a 75-year-old man with multiple sebaceous adenomas, sebaceous epithellomas, and keratoacanthomas in association with multiple colonic polyps. In one polypoid lesion, an adenocarcinoma was noted histologically. Although GI tract carcinoma is clearly established with the Torre syndrome, the occurrence of multiple GI polyps has not been recognized to our knowledge.
Subcutaneous-based triangular skin flaps that have no skin attachments are discussed as a useful method for closing round defects in the medial and lateral canthal regions when adjacent skin is inadequate.
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The techniques for the use of island grafts in the closure of surgical wounds after the excision of cutaneous malignancies are quite simple and yield good cosmetic results. At present, the main configurations of island grafts are described with a diverse and confusing terminology. This article presents a logical classification of the island grafts based upon the shape of the primary defect, the shape of the partial closure, and whether the graft or grafts are distant or contiguous. By use of this classification, it is possible to develop a simplified approach to wound closure for almost all cutaneous surgical defects.
In this work we first analyzed the reliability of materials supplied by the main firms, which must be considered when defining the lesion and planning target volume. The coordinates of specific target landmarks, i.e., bone, calcium deposition or catheters, on baseline CT scans were compared with those measured on control scans. Since the PLATO-SRS system yields 3 coordinates for each target, the final error is calculated by the evaluation of the shift of the different coordinates. The mean error reported for the first material (ORFIT) was 5 mm (13/23 patients). This margin of error is too high and was considered unacceptable; a second material was then tested. The latter, which is not recyclable and softens at higher temperatures, exhibited a mean error of 2.5 mm (10/23 patients), which allows daily repositioning of greater reliability. Treatment was repeated in 4/20 arcs in all, which number depended mainly on fraction size. Correct lesion location and patient positioning were allowed by laser landmarks on the mask made directly on the treatment couch. The laser too was checked before each treatment session, i.e., preferentially at the end of an ordinary working day.
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Malignant fibrous histiocytomas are common sarcomas of later life. They arise most commonly in the lower extremities and, only rarely, in the head and neck. Fibrous histiocytomas, mostly benign, have been reported in the orbit and conjunctiva, but only three benign lesions have been described in the eyelids. I present a case of malignant fibrous histiocytoma of the eyelid which recurred locally, but has shown no evidence of metastases.
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This very unusual case involves a 70-year-old white male who was within 50 miles of atomic bomb testing in the Mohave Desert and had 56 primary malignancies from 1946 to 1992. Major cytogenetic abnormalities sometimes found in patients with apparent genetic susceptibility for developing solid tumors are reviewed.
The pathologic terms hamartoma, choristoma, nevus, and phakoma often are confused. We discuss them in relation to a patient with the linear nevus sebaceous syndrome who had a large limbal mass that grew unusually rapidly and was excised. Histopathologic examination showed that it was a complex choristoma composed of lacrimal gland, adipose tissue, and myxomatous tissue. The latter has not been described previously in this disorder. This neuro-oculocutaneous syndrome has been considered one of the phakomatoses.
There are exceptional cases of malignant epitheliomas in which radiotherapy is at once or eventually becomes a treatment of last resort. We recount the clinical facts, histologic findings, radiotherapeutic techniques, and results of treatment of seven such cases.
The authors report their experience of high dose brachytherapy technique (HDR), relative to the first period of work, especially regarding treatment indications and preliminary clinical results. Twenty eight patients were examined, 12 of them with esophageal carcinoma, 7 biliary tract carcinoma, 6 skin of the face and 3 head and neck carcinoma. HDR brachytherapy was the first treatment in 20 cases; the other 8 cases were recurrences after previous irradiation. The HDR treatment had a curative purpose in 15 patients and was palliative in the other 13. Brachytherapy doses ranged from 20 to 30 Gy for curative treatments, with 4-8 fractions; 1 fraction was used for palliative radiotherapy, with doses from 5 to 10 Gy. The results were satisfactory. Local control was achieved in 5/6 patients affected with cholangiocarcinoma of the biliary tract and in 6/6 patients with skin neoplasia. In esophageal cancer, 9/12 patients treated with palliative, disobstructive purpose, showed dysphagia remission in 89% of the cases; the remission was maintained in 7 patients (78%), with 9 months median follow-up. HDR brachytherapy was then proved, during this first period of clinical application, as a valid and safe therapeutic method. It also allowed to extend the application field of brachytherapy, with new indications, as in esophageal neoplasias and biliary tract carcinomas.