Diagnostik und Therapie lymphoider Tumoren der Orbita

Zusammenfassung Hintergrund: Die Abkl?rung raumfordernder orbitaler Prozesse erfordert neben einer modernen bildgebenden Diagnostik ein interdisziplin?res Konzept, in das der HNO-Arzt wegen der rhinochirurgischen Zugangsm?glichkeit zur Orbita unmittelbar eingebunden ist. Patienten: Innerhalb von 14 Jahren wurde bei 6 Patienten ein prim?res malignes Lymphom der Orbita sowie bei 9 Patienten ein Pseudotumor orbitae bzw. Pseudolymphom diagnostiziert. Leitsymptome waren in den meisten F?llen eine Protrusio bulbi, schmerzhafte Lidschwellung mit Diplopie und in 3 F?llen eine Visusminderung. In der bildgebenden Diagnostik lie?en sich homogene, von den Orbitastrukturen unscharf abgrenzbare Gewebevermehrung erkennen, die über eine mediale Orbitotomie biopsiert wurden. Ergebnisse: Therapeutisch wurde bei den isolierten Lymphomen eine Bestrahlung durchgeführt, w?hrend bei den Patienten mit einem „Pseudotumor orbitae” zun?chst eine Steroidgabe versucht wurde. In 2 F?llen wurde zus?tzlich eine Bestrahlung veranla?t. W?hrend es bei keinem Fall eines „Pseudotumors orbitae” zu einer malignen Transformation gekommen ist, verstarben 2 Patienten an einem sp?ter disseminierten Non-Hodgkin-Lymphom. Schlu?folgerung: Die Abgrenzung orbitaler lymphatischer Raumforderungen ist mit indirekten Verfahren nicht zuverl?ssig m?glich, weswegen in jedem unklaren Fall eine histologische Abkl?rung erforderlich ist. Je nach Lokalisation des Prozesses bietet sich hierbei ein komplikationsarmer rhinochirurgischer Zugang zur Durchführung der Biopsie und gegebenenfalls Exstirpation des Tumors an. Eingegangen am 28. Januar 1997Angenommen am 25. M?rz 1997     

Klinik und Therapie der Tumoren des Gesichtsschädels

Ohne Zusammenfassung     

Therapie maligner Tumoren im Bereich der Nasennebenhöhlen

Malignome im Bereich der Nasennebenh?hlen treten selten auf, werden aber durch ein vielf?ltiges Erscheinungsbild erst sp?t entdeckt und haben dadurch eine schlechte Prognose. Da ein gesicherter Therapiestandard nicht festgelegt werden kann, muss der Schwerpunkt auf der chirurgische Sanierung des Lokalbefundes liegen. Ziel dieses Beitrages ist es, die wichtigsten Aspekte in der Tumortherapie der Nasennebenh?hlenmalignome mit einer Literaturübersicht der letzten 10 Jahre zusammenzufassen.     

Aszendierende Pankreatitis mit mediastinaler und parapharyngealer Beteiligung

A male patient who had suffered from alcohol dependence for several years was transferred to the Magdeburg University Hospital with signs of sepsis. The main cause for this was a previously unsuccessfully treated acute episode of chronic pancreatitis. Diagnostic imaging showed a distended ascending abscess extending above the larynx. During interdisciplinary emergency surgery, the neck, mediastinum and abdomen were drained and the pancreatic abscess removed. Under drainage, antibiotic therapy and parenteral nutrition the patient made a full recovery.     

Untersuchungen zum Generations-cyclus maligner Tumoren im HNO-Bereich und ihre Bedeutung für die cytostatische Therapie

Summary More than 40 patients with malignant tumors of head and neck were investigated on cytostatic therapy. In these patients advances tumor stage was manifested. Therefore a major curative effect of therapy was not expected. In the beginning of cytostatis surgical and radiological possibilities were exhausted.Theoretical basis of the performed therapy were animal experiments of H. O. Klein in which evidence of cell cinetics for cytostatic therapy was demonstrated. The tumorcell cycle was determined autoradiographically with the double labeling method (H₃- and C₁₄-Thymidine) in vitro in most of the patients.A slow proliferation rate of tumor cells regularly was found. So a high dose oytostatic treatment (high dose monodrug therapy) appeared not to be optimal. Therefore we prefered in our cases a combination therapy with Cyclophosphamide (2–3 mg/kg body weight/day) and Methotrexate^® (2.5–5 mg/day). Methotrexate^® was given on only 3 days of the week to avoid severe haematological complications. In other cases without these complications the substance was administered dayly. In drug incompatibility other oytostatic substances were used.In most of the patients tumor development could be retarded, stopped, or a regression could be induced. Only in some cases no effect was observed. Details of cytostatic therapy, evaluation of toxic side effects and complications, also time and success of therapy are demonstrated in diapositives.     

Radiogene Tumoren im HNO-Bereich

Ohne Zusammenfassung     

Die malignen Tumoren des Mesopharynx

Ohne Zusammenfassung     

Synchrones Auftreten dreier seltener Tumoren

A 70-year-old woman presented with nasal obstruction and pain projecting onto the left cheek. The face seemed asymmetric including exophthalmus on the right side. Nasal endoscopic inspection revealed a sarcomatous tumor located on the middle turbinate. The CT showed that the tumor filled the left maxillary sinus completely and had eroded the maxillary bone. In addition, a round, sharply defined intraorbital neoplasm on the right side was identified in the contrast-enhanced MRI. Histological examination of the extirpated intraorbital tumour showed a neurilemmoma. A tissue biopsy of the intranasal tumour falsely suggested an intestinal adenocarcinoma. Multiple neoplasms suspicious of disseminated lung metastases were detected in the CT of the thorax. One round lesion removed by thoracoscopy revealed a carcinoid. The intranasal tumour was excised completely and the histology proved beyond doubt an inverted papilloma.     

Gutartige Tumoren der Glandula parotidea

Background

Fine needle aspiration cytology (FNAC) is a widely used diagnostic tool to evaluate neoplastic or inflammatory tumorous lesions of the salivary glands. This method influences the selection of the modality of surgical treatment. In cases of benign tumors of the parotid gland, a (partial) superficial parotidectomy is usually recommended. However, for tumors other than pleomorphic adenomas (such as cystadenolymphomas, other adenomas, or benign tumor-like lesions) this operation is considered an overtreatment because extracapsular satellites are rare and recurrences in case of a capsular lesion are not likely. In such cases, a less extended surgery (enucleation) with lower morbidity is sufficient and can be carried out provided that pleomorphic adenomas and non-pleomorphic benign lesions are reliably differentiated prior to surgery. The aim of this study was to evaluate the reliability of the FNAC in differentiating benign tumors of the parotid gland.

Methods

A retrospective evaluation of 160 cases of benign parotid gland tumors was performed and the cytological diagnoses compared with the histomorphological results. A collection of 26 cases with false-negative and false-positive results was reevaluated.

Results

FNAC showed a sensitivity of 74.2% and a specificity of 89.8% for differentiation between pleomorphic adenomas and non-pleomorphic benign lesions. The predictive value for pleomorphic adenomas was 82.1%, and for non-pleomorphic benign lesions 84.6%. Reevaluation showed higher sensitivity (96.2%), specificity (98.9%), and negative/positive predictive values (97.9% and 98.1%, respectively).

Discussion/conclusion

Poor quality and hypocellularity of the cytological smears seem to negatively effect the outcome of the cytological diagnosis. It is concluded that only an accurate diagnosis of non-pleomorphic adenoma or a benign tumor-like lesion, based on an adequate FNAC specimen and assessed by an experienced cytopathologist, can justify tumor enucleation because the risk of pleomorphic adenoma is only 2% under these circumstances.     

Die Radiokobaltbehandlung der oto-rhino-pharyngealen Tumoren

Ohne Zusammenfassunga.G.     

Primäre Tumoren der Unterkieferpharynxregion

Summary Eighteen cases of parapharyngeal tumors have been reported. Their most predominant and usually solitary sign was a medial displacement of the oropharyngeal wall or a palpable mass beneath the ramus of the mandible. The safest approach of these tumors is external with dissection and preservation of the facial nerve.     

Tumoren des Gesichts bei organtransplantierten Patienten

Hintergrund: Anhand von 3 eigenen typischen Fallbeobachtungen und den Daten des Schrifttums wird auf das hochgradig gesteigerte Risiko, Pr?kanzerosen, Basalzell- und Plattenepithelkarzinome der Haut nach Organtransplantation zu entwickeln, hingewiesen. Diskussion: Als Ursache der gesteigerten Tumorinzidenz und des Auftretens multipler syn- und metachroner Tumoren nach Organtransplantation kann in erster Linie die Immunsuppression angenommen werden. UV-Belastung und onkogene Virusinfektionen müssen als weitere tumor-disponierende Faktoren in Betracht gezogen werden. ?Mit einem aggressiveren Verlauf der Tumorerkrankung muss gerechnet werden. Ein gezieltes Dispensair und eine frühzeitige konsequente Therapie der Hauttumoren organtransplantierte Patienten sind zwingend erforderlich.      

Aktivierung des Sonic-hedgehog-Signalwegs in keratozystischen odontogenen Tumoren

Background

Keratocystic odontogenic tumors are benign neoplasms of the viscerocranium that occur sporadically as well as in association with Gorlin–Goltz syndrome. Multiple basal cell carcinomas of the skin are another typical feature of Gorlin–Goltz syndrome. Aberrant activation of sonic hedgehog signaling has been reported for sporadic and hereditary basal cell carcinoma caused by specific genetic mutations, but for keratocystic odontogenic tumors, the role of aberrant sonic hedgehog signaling has not yet been evaluated in detail.

Materials and methods

In the present study, 131 keratocystic odontogenic tumors were analyzed by immunohistochemistry for the expression of sonic hedgehog signaling proteins SHH, PTCH1, SMO, GLI1, and NMYC on tissue microarray sections.

Results

High expression of the analyzed proteins—between 67.3% (PTCH1) and 92.9% (SHH)—was found in the epithelial compartment of the keratocystic odontogenic tumors analyzed. In the stromal compartment of the tumors, high expression of the target proteins was found significantly less frequently (all p-values <0.001).

Conclusion

Aberrant sonic hedgehog signaling is critically involved in the molecular pathogenesis of keratocystic odontogenic tumors. This finding underlines the neoplastic character of this intraosseous lesion. Because of high recurrence rates after local excision, more radical surgical approaches are recommended for treating keratocystic odontogenic tumors.