[THE MALIGNANT TRANSFORMATION OF MIXED TUMORS OF THE HARD PALATE].
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In order to test the clinical and prognostic significance of flow cytometrically assessed DNA content in minor salivary gland tumours we evaluated 75 neoplasms of the palate, 55 of which were carcinomas. Benign neoplasms were exclusively DNA diploid with low S-phase fractions while 22 per cent of malignant tumours manifested a DNA aneuploidy and 23.5 per cent high S-phase fractions (> 5 per cent). Significant statistical correlations between DNA content and tumour size, histological grade, lymph node metastasis and lethality were observed. Our findings suggest a potentially important role for flow-cytometry in the evaluation of these neoplasms.
To evaluate the role of the Ki-67 proliferation antigen and c-erbB-2/neu oncogene expression in the clinical assessment of salivary gland tumors, we followed up 71 patients with minor salivary tumors of the palate. All benign neoplasms (n = 18) showed low Ki-67 scores (< 12%), whereas 26% (14 of 53) of malignant neoplasms manifested high Ki-67 scores (> 12%). A significant statistical difference between Ki-67 scores for benign and malignant neoplasms was observed (p < 0.001). Ki-67 index also correlated significantly with malignant tumor grade (p = 0.04) and patient survival (p = 0.02). Only 1 of the 18 benign tumors had c-erbB-2/neu oncogene overexpression. A significant difference between c-erbB-2/neu overexpression in benign and malignant tumors was observed (p = 0.01). Overexpression of c-erbB-2/neu oncogene was noted in 38% (16 of 42) of malignant tumors and was significantly associated with aggressive tumor behavior (p < 0.001). Multivariate analysis of significant factors revealed that gender, tumor stage, and c-erbB-2/neu oncogene overexpression were jointly predictive of survival. Our data indicate that although the Ki-67 proliferating antigen and c-erbB-2/neu oncogene expression may reflect certain intrinsic biologic properties of these neoplasms, only c-erbB-2/neu overexpression is significantly associated with their biologic aggression.
Maxillary and midface defects with or without orbital involvement are disfiguring and disabling problems especially in the elderly cancer patient. Often, palatal prostheses are required to enable speech and swallowing. Elderly patients or those with compromised vision often find these appliances cumbersome and difficult to manage. To help obviate these problems a one-stage method of immediate palatal reconstruction was needed to obturate the palate and restore facial contour. Over the past 18 months six patients have undergone immediate reconstruction of complex, composite defects of the maxillary and midface structures after tumor extirpation, three of which extended into the orbit. The latissimus dorsi musculocutaneous flap was utilized because of its bulk, reliable anatomy, ample pedicle length and diameter, and minimal donor site morbidity. No flap loss, suture line dehiscence, or infection occurred. All patients were capable of deglutition and intelligible speech. This technique is a one-stage reconstruction of the palate and accompanying defects of the midface and maxilla that obviates the need for cumbersome palatal appliances.
Rhinocerebral mucormycosis (phycomycetes), a human fungal disease with oral and perioral findings, has an extremely high morbidity and mortality. The disease is most frequently seen in patients with poorly controlled diabetes. The symptoms, findings, and treatment of rhinocerebral mucormycosis are discussed, and two case histories are presented.
The authors present an example of mycosis fungoides which was initially diagnosed from a palatal biopsy. The distinctive nuclear morphology of the tumor cells, with a discussion of their diagnostic importance, is presented. The advantages of plastic-embedded formalin-fixed tissue are delineated.
A technique for resection of a palatal tumour via a Le Fort 1 maxillary access osteotomy is described. Access via the osteotomy allows intra-operative examination of the superior aspect of the palate and resection of the tumour without gross destruction of the nasal mucosa. The nasal mucosa provides a bed for a full-thickness skin graft to effect closure of the palatal defect.