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Fibrous histiocytoma of the parotid gland.

Fibrous histiocytomas are not uncommonly found in the head and neck region. These tumors, arising from the tissue histiocyte, generally behave in a benign fashion. An unusual case of a fibrous histiocytoma arising in the parotid gland is presented. The histopathology of these lesions as well as parotid neoplasms in children is reviewed. Wide local excision without sacrifice of important structures is the treatment of choice.

Histiocytoma, Benign Fibrous

Malignant mixed tumors arising in salivary glands. I. Carcinomas arising in benign mixed tumors: a clinicopathologic study.

Forty-seven cases of malignant mixed tumor (MMT) arising in major and minor salivary glands are presented. By definition, all these lesions contained both a benign mixed tumor (BMT) as well as a malignant neoplasm, usually a poorly differentiated carcinoma. In some cases, the carcinoma developed in a previously untreated salivary gland mass which was known to have been present for many years, others evolved in a recurrent previously resected BMT and still others originated in a previously undetected BMT. Adverse prognostic factors included: carcinomatous involvement of the resection lines, perineural invasion, metastases in lymph nodes, and origin in a major salivary gland. Lesions arising in the palate had a better prognosis as compared to major salivary gland tumors. Some patients died of locally uncontrollable tumor and others because of metastatic disease. Local recurrences of MMT were seen frequently; 18 patients (38%) had a total of 32 local recurrences. Of patients followed five years or more, seven (35%) had died of tumor, 11 (55%) had no evidence of disease, and two (10%) had died of other causes. Prolonged follow-up is required because recurrences and death from tumor may be seen many years following the diagnosis of MMT. Recommendations for therapy are made. Criteria for differentiating MMT from recurrent BMT and from cylindromatous carcinoma are discussed.

Adenocarcinoma

Cerebral necrosis following radiotherapy of extracranial neoplasms.

We have examined 6 patients with delayed cerebral necrosis following irradiation of extracranial neoplasms. Four of the 6 patients received 1,760 rets (or less) tumor dose. The initial symptoms attributable to radiation necrosis appeared 4 to 31 months after irradiation and were those of a focal supratentorial mass. Cerebral angiography delineated an avascular frontal or temporal lesion in all 6 patients; in 1 case a magnification study revealed narrowing, irregularity, and occlusion of small cortical vessels. Four of our 6 patients underwent craniotomy with partial or complete surgical extirpation of necrotic brain tissue. Two operated patients are alive and without disabling neurological symptoms 30 and 25 months, respectively, after the operation. The characteristic neuropathological features of delayed radiation necrosis of brain suggest that vascular injury rather than neuronal or glial damage is of primary pathogenetic significance.

Adult

[Computerized tomography of the facial skeleton (part II). Pathological changes (author's transl)].

The value and main task of computerized tomography in the diagnosis of benign and malignant processes in the middle and upper facial skeleton lies in its accurate demonstration of the extent of the disease; this is important in relation to the planning of treatment, prognosis and to other complementary procedures. CT is a new and potent method for the TNM classification of tumours of the nose, paransal sinuses and nasal pharynx. The ability of the CT to demonstrate deeply situated structures in the face, without disturbing overlying shadows, makes precise staging of deep tumours possible, eg. stages T2-T4. The consequences in terms of pre-treatment TNM classification are discussed. In cases of fronto-basal fractures, the CT will show particularly trauma to the orbital contents, intracranial displacement of bone fragments and cerebral trauma with or without bleeding. Suspicion of orbital involvement by benign or malignant disease is a definite indication for a CT examination. As regards the middle and upper facial skeleton, computer tomography provides information of a morphological and quantitative nature and aids in the localisation of lesions. It should be properly integrated into the conventional clinical, endoscopic and tomographic methods employed in the diagnosis of lesions of the facial skeleton.

Facial Bones

Therapeutic embolisation of the external carotid arterial tree.

Intra-arterial embolisation is a valuable adjunct to the treatment of many vascular lesions, including neoplasms such as glomus tumours or juvenile angiofibromas, and arteriovenous malformations. Its place in the management of the individual patient should be established before any surgical procedure is carried out, as this may prejudice the eventual result. The indications for the procedure, the technique, and possible complications are discussed in this paper, and it is emphasised that the latter are best avoided by the use of a scrupulous technique and adequate technical facilities.

Adult

[Basal cell adenomas of the salivary glands].

The author presents data on morphology and clinical features of basal-cell adenomas of the salivary gland (10 cases). Singling out this neoplasm into independent onconosological group seems reasonable since basal-cell adenoma not infrequently is erroneously diagnosed as cylindroma or mixed tumour of the salivary gland, which may lead to a wrong clinical prognosis and inadequate therapeutic measures. The clinical course of this tumour is benign. The main morphological feature of the tumour is a monomorphic character of cell elements, their palisade-like distribution over the periphery of individual tumour structures and a clear-cut delimination of the parenchyma from the stroma.

Adenoma

Chemotherapy of malignant major salivary gland neoplasms: a 25-year review of M. D. Anderson Hospital experience.

From 1950 through 1975, 671 patients with malignant major salivary gland neoplasms were referred to M. D. Anderson Hospital and Tumor Institute. Thirty-six patients with advanced local or metastatic disease subsequently underwent 62 evaluable trials with a variety of chemotherapeutic agents, either alone or in combination. Six patients achieved a partial response, with a median duration of 3 months. Ten additional patients had stable disease for 2 or more months. Anthracyclines appeared to be the most effective agents in this study, with three partial responses of six evaluable trials. The longest partial response (10 months) occurred in a patient receiving combination chemotherapy plus BCG immunotherapy. Pulmonary metastases were most commonly responsive to chemotherapy. The median intervals from diagnosis to death or to last follow-up and from initiation of chemotherapy to death or to last follow-up were 30 months and 6 months, respectively. Further therapeutic trials are necessary before response rates to single chemotherapeutic agents or combinations can be accurately assessed. In view of the poor prognosis of patients with recurrent disease, postoperative adjuvant studies with chemoimmunotherapy in patients with a high risk of recurrence are planned.

Adenocarcinoma

Growth analysis of pulmonary metastases from salivary gland tumors.

Three cases of primary salivary gland tumors with lung metastasis are presented with extremely long survival (six, ten, and twelve years). The tumor doubling time was calculated and the growth rate of the pulmonary metastasis was found to be slow and erratic. A simplified table was devised, which permits rapid calculation of the tumor doubling time without the use of graphs. The presence of lung metastasis from some primary malignant salivary tumor is not necessarily an ominous sign: a long survival without symtoms is possible.

Adult