Changes in host immunity following excision of a murine melanoma.

Changes in cell mediated and humoral immunity following the excision of a transplantable melanoma growing in the footpad of its syngeneic host, as measured by an in vitro cytotoxicity test, were assessed. Spleen cell cytotoxicity did not change significantly. Cells from the regional lymph nodes stimulated tumour growth before tumour excision. Three days following tumour excision this stimulatory effect was undetectable. Loss of serum factors capable of blocking the cytotoxicity of spleen cells occurred 24 h after tumour excision. Serum cytotoxicity increased after tumour excision to a maximum of the third day. Following tumour excision the rise in serum cytotoxicity and loss of regional lymph node tumour stimulation were concomitant with the loss of blocking activity.     

Malignant melanoma of the nasal cavity-A case report

Mucosal melanoma of the nasal cavity is a rare tumour. Here we have reported a case of 54-year-old male patient presented with the black mass coming out from right nasal cavity and occasional slight bleeding from the mass. The tumour was excised by lateral rhinotomy. The surgery was followed by radiotherapy.     

鼻腔恶性黑色素瘤18例报告

目的报告１８例我科自１９８１－１９９６年间收治的鼻腔恶性黑色素瘤。该病时有误诊,应与鼻腔其它恶性肿瘤、血管瘤和鼻息肉相鉴别。方法广泛的手术切除为本病的首选方法,特别是注意中隔的肿瘤周围时有黑色卫星可见,均应彻底切除。结果切除的粘膜越多,局部复发就越少。术后还要配合化疗,由于黑色素瘤对放疗不敏感,很少放疗。结论早期发现,早期诊断,广泛彻底的手术切除是提高本病生存率的关键。     

Adenomatoid Ameloblastoma in the Mandible and Maxilla: Report of a Case

Juvenile nasopharyngeal angiofibroma (JNA) are locally growing highly vascular tumours treated primarily by surgical excision (open approach as wide as a mid facial degloving or endoscopic approach). All our patients underwent exclusive endoscopic tumour excision after a pre-operative embolisation. The tumours were completely resected with acceptable blood loss and no recurrences or residual masses were seen. Post-operative morbidity was minimal without external scar-marks. To conclude endoscopic excision is a very effective method to resect JNA even for extensive tumours.     

Endoscopic resection of pleomorphic adenoma of the nasal septum

Pleomorphic adenomas originating from the minor salivary glands are rare in the nasal cavity. Total surgical excision is the preferred treatment for pleomorphic adenomas. Lateral rhinotomy, midfacial degloving, transpalatal surgery and endoscopic surgery are among the surgical approaches. Endoscopic tumor removal produces less morbidity, reduces blood loss during surgery, decreases hospital stay, avoids external scars and excessive unnecessary resection, enables the surgeon to better visualize the tumor margins, and has a low recurrence rate. However, only 3 pleomorphic adenomas of the nasal septum have been removed by the endoscopic approach to date. In this paper we report on a case of pleomorphic adenoma of the nasal septum that was removed successfully by the endoscopic approach without any recurrences.     

The influence of tumour burden and therapy on cellular cytotoxicity responses in patients with ocular and skin melanoma.

Using a microassay for cellular immunity, tumour specific cytotoxicity was detected in 2/5 cases of ocular melanoma and 1/3 cases of primary cutaneous melanoma before treatment. Reactivity was measured against allogeneic skin melanoma target cells in short or long term in vitro culture. Lymphoid cells from patients with disseminated cutaneous melanoma were either non-reactive (4/8 cases) or gave a nonspecific cytotoxicity on target cells of diverse histogenic origins. Among tumour-free patients tested after surgery, 0/2 patients with ocular tumour were non-reactive 3-4 months post surgery. After sugical excision of cutaneous melanoma 2/2 patients gave tumour specific reactions during the first month after surgery. After longer time intervals, from 5 months to 3 years, only 1/8 patients were reactive. Preoperative radiotherapy in a total skin dose of 10,000 rad produ-ed a transient tumour specific reaction 24 h after therapy in a single case. Following local tumour excision in patients given preoperative irradiation, 2 cases which had previously demonstrated tumour specific CMI lost reactivity. Among 14 tumour-free individuals tested only after preoperative radiotherapy and surgery, at intervals from 5 day to 13 years, a single case gave tumour specific CMI. Palliative irradiation in doses 4000-4960 rad to the inguinal or axillary lymph nodes was found to induce a generalized lymphopenia within 48 h after treatment. Lymphoid cell preparations from patients with localized melanoma contained significantly increased numbers of immature cells (lymphoblasts and myeloblasts) and myeloid precursor elements. Those prepared from patients with disseminated disease had in addition elevated levels of eosinophils but reduced numbers of recoverable lymphocytes.     

Maligne Melanome am Auge des Erwachsenen

Malignant melanomas are the most frequent pernicious eye tumours in adults. This article reviews some selected characteristics of these tumours. There are three different manifestations of ocular melanoma: melanoma of the eyelid, melanoma of the conjunctiva, and uveal melanoma. Eyelid melanomas behave clinically and biologically like cutaneous melanomas. Conjunctival melanomas are rare and are commonly associated with a primary acquired melanosis of the conjunctiva or with conjunctival naevi. Their treatment comprises excision, brachytherapy and adjuvant local treatment. Melanoma of the uvea is the most common primary malignant intraocular tumour in adults. The diagnosis of choroidal melanoma is based on clinical investigation. Radiotherapy is the standard treatment for this tumour type, although combined treatment modalities including surgical excision are applied in special cases like huge tumours. Conservation of the bulb and maintenance of the best possible visual performance are the secondary goals of the treatment strategy, beside the primary goal to minimize the risk for metastasis.     

鼻内镜下鼻腔鼻窦内翻性乳头状瘤切除术

目的探讨经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术和鼻内镜联合鼻侧切开鼻腔鼻窦内翻性乳头状瘤切除术的疗效。方法26例鼻腔鼻窦内翻性乳头状瘤病例中,22例行经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术,4例行鼻内镜联合鼻侧切开鼻腔鼻窦内翻性乳头状瘤切除术。结果术后随访9~60个月。1例术后30个月复发,其它25例未见复发,全部病例无并发症发生。结论经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术适用于较局限的病变,而对广泛病变则应采用鼻内镜联合鼻侧切开术,术后鼻内镜定期复查可早期发现肿瘤复发并处理。     

Malignant melanoma of nasal fossae: clinical and therapeutic considerations about three cases]

We report in this publication three cases of mucous malignant melanoma of the nasal fossae. The nasal mucous malignant melanoma creates a unilateral obstructive and hemorrhagic tumour, readily septal or situated on the external wall of the nasal fossae (inferior and middle turbinates). The diagnosis established by the clinical examination (pigmented forms) is confirmed by the anatomopathological examination--thanks in particular to its tinctorial affinity for Fontana-Masson colouring. The immunohistochemistry reinforces the diagnosis in the presence of any achromic varieties or those simulating an undifferentiated tumour or neurinoma. Modern imagery (CT Scan, IRM) is impossible to circumvent for a precise loco-regional assessment, an essential preliminary to the therapeutic protocol--mainly of radiosurgical type. Chemotherapy (deticene) remains in force in the metastatic forms. Specific therapies are being evaluated (immunological-hormonal therapy). The forecast of the mucous malignant melanoma remains pejorative with a 10 to 40% survival rate of five years. The improvement of the forecast depends on an early diagnosis, an evolutionary locoregional assessment as complete as possible with an adapted and multidisciplinary choice of therapies (surgery, radiotherapy, immunotherapy, hormonal therapy).     

Malignant melanoma of the nasal mucosa

Malignant melanoma of the nasal mucosa is a rare tumor. We present here a case which involved the nose and the paranasal sinuses. Though surgical excision was achieved, postoperative metastalic spread to the liver resulted in poor prognosis, necessitating chemotherapy. Relevant literature on the subject is reviewed.     

耳鼻颌面部恶性黑色素瘤(附11例分析)

目的：探讨发生于耳鼻颌面部恶性黑色素瘤(恶黑)的诊疗方法。方法：对1986～2001年收治的11例恶黑患的临床资料进行临床病理分析。结果：男性6例、女性5例，年龄6个月～83岁；原发部位：牙龈粘膜2例，外耳道l例，耳廓2例，鼻腔筛蝶窦l例，鼻中隔l例，中耳l例，下睑腮腺l例，上唇2例；手术切除9例，术后化疗2例，术后放疗3例，未治疗2例。0．5～10年随访，死亡6例，生存期6个月～3年；健在5例，生存期1．0—15年。结论：恶黑在皮肤粘膜交界处的色素层或粘膜黑色素斑的基础上发生，肿块多呈黑褐色且常伴溃疡，诊断较易，而对于不含黑色素的恶黑容易误漏诊，须待病理确诊。瘤细胞内含大量黑色素颗粒为其病理特点，免疫组化显示VIM—HMB45和S-100蛋白及Vs38阳性反应均有助于不含色素的恶黑的确诊。本病恶性度极高，可采用手术、放化疗或免疫治疗，但预后差。     

Chondrosarcoma of the nasal septum

Chondrosarcoma of the head and neck region are relatively uncommon, arising rarely in the naval septum. The reported cases of nasal septal chondrosarcomas are extensive lesions with involvement of paranasal sinuses, orbit or skull base at the lime of diagnosis. Those limited to the nasal cavity is extremely rare and to date there has been one case report in English language literature. We present a case of chondrosarcoma of the nasal septum with involvement of the nasal cavity alone and no evidence of bony erosion. Initial multiple biopsies showed mature chondromatous areas with no atypia. The patient had wide excision of the tumour. The final biopsy of the excised specimen revealed foci of well-differentiated chondrosarcoma. Wide surgical excision with adequate margins should be considered as the treatment of choice in lesion of nasal septum even if initial biopsies are negative for malignancy. Hence this case report.     

Prognostic impact of the type of anaesthesia used during the excision of primary cutaneous melanoma

The prognostic value of the type of anaesthesia used for the excision of malignant tumours has been a subject of controversy. Cell-mediated as well as humoral immune responses can be compromised after general anaesthesia, and recurrences may therefore occur more frequently. On the other hand, excision of primary tumours under local anaesthesia might also influence the prognosis unfavourably. The aim of the present study was to determine the prognostic impact of general and local anaesthesia for the primary excision of cutaneous melanoma. Follow-up data of 4329 patients on the Central Melanoma Registry of the German Dermatological Society were analysed. Cox proportional hazards analysis was performed to evaluate the independent significance of the prognostic factors, and survival probabilities were calculated for matched pairs using Kaplan-Meier estimates. Statistical analysis revealed an independent significant effect on survival for tumour thickness, ulceration, level of invasion, anatomical site and gender. General anaesthesia for primary excision of melanoma was associated with a decrease in the survival rate (relative risk 1.46, P<0.0001). This study revealed a slight but significantly increased risk of death for patients treated with general anaesthesia for the primary excision of melanoma. Therefore local anaesthesia should be preferred for the treatment of primary melanoma.     

Nasal Endoscope: An Armamentarium in the Management of Sinonasal Inverted Papilloma

Sinonasal inverted papillomas (SIP) are unique group of locally aggressive benign neoplastic lesions arising from mucosa of sinonasal tract with potential for recurrences and known association with squamous cell carcinoma in 5–15 % of cases. This study was conducted was to assess the efficacy and usefulness of the nasal endoscope in treating SIP. We reviewed 28 biopsy proven cases of SIPs that were treated at our hospital between June 2009 and September 2013. Average patient age was 46 years. Fourteen were treated by transnasal endoscopic excision of tumor with noted recurrence of 21.43 %. Thirteen were treated by endoscopic assisted open surgery which had 23 % recurrence. Three patients had malignant inverted papillomas, of whom two (7 %) were found to have synchronous squamous cell carcinoma and one (3.6 %) had metachronous squamous cell carcinoma. No evidence of recurrence was found in rest during our follow up. The endoscopic approach is the preferred method for the treatment of the majority of inverted papillomas. Powered instrumentation is extremely useful to achieve good results. Although significant number of cases was done by external approach by lateral rhinotomy, the endoscopic assistance is required to ensure complete removal of the tumour to reduce the recurrence rates. Close follow up of the patient for a longer period of time is necessary for the early detection of recurrence and to allow for surgical salvage.     

Anorectal melanoma: surgical management guidelines according to tumour thickness

Management of patients with anorectal melanoma is still controversial. To reach a rationale therapeutic approach, we reviewed our experience obtained over the past decade. In all, 19 consecutive patients with the diagnosis of anorectal melanoma were included in this retrospective survey. Details of the patients' presentation, symptoms, tumour size and histology and tumour state were recorded, and the primary therapeutic procedures were evaluated in detail. The size of the tumours ranged between 0.5 and 7 cm in diameter. The median tumour thickness was 10 mm (range 0.6-40 mm). At diagnosis, six of 19 patients already presented with either regional or distant metastases. The remaining 13 patients were treated with curative intend, either by abdomino-perineal resection (APR) or wide local excision (WLE). The form of operative therapy, however, had no impact on overall survival. Nevertheless, the incidence of local recurrences was lower after APR even for patients with less favourable tumours. In conclusion, WLE alone is not sufficient for local tumour control of thick anorectal melanoma.     

Anti-tumour immunity in malignant melanoma assay by tube leucocyte adherence inhibition.

Tumour antigen-induced inhibition of leucocyte adherence was modified for use in glass test tubes (Tube LAI assay) for the study of cell-mediated anti-tumour immunity to human malignant melanoma. Peripheral blood leucocytes (PBL) of 20 out of 25 patients (80%) with active malignant melanoma responded to an extract of malignant melanoma with LAI, whereas only 4-5% of 475 control subjects showed a response. The malignant melanoma patients reacted to both allogeneic and autologous extracts of malignant melanoma which indicates a common cross-reacting antigen. Malignant melanoma patients did not respond to unrelated tumour extracts. The LAI was mediated by PBL (monocytes) "armed" with cytophilic anti-tumour antibody specific for the sensitizing tumour antigen. The anti-tumour response of the malignant melanoma patients was dependent on the stage of the cancer, and 11 out of 13 Stage I patients had a positive NAI, whereas patients with disseminated cancer had decreased response. The diminished LAI in patients with large tumour burdens appeared to be the result of release of tumour antigen systemically. Also, surgery and chemotherapy depressed LAI. Although LAI was depressed after surgical excision of the cutaneous melanoma, most patients showed LAI 1-3 months later. Tumour-free melanoma patients monitored for one year by the Tube LAI assay showed a decline in their anti-tumour immunity 5-6 months after surgery. The NAI was low or negative after the 8th post-surgical month in tumour-free patients. Patients with residual malignant melanoma showed persistent or recurrent LAI after the 8th post-surgical month. LAI reactivity monitored after "curative" surgery for malignant melanoma may assist in determining whether the patient is tumour-free or has a recurrence.     

Endoscopic surgery with curative intent for malignant tumors of the nose and paranasal sinuses

Aim

To assess the efficacy of endoscopic surgical treatment in patients with nasal and paranasal sinus malignancies.

Patients and methods

During the period 1991–2006, 16 patients with nasal and paranasal sinus malignancies underwent endoscopic surgery with curative intent. The lesions included 11 carcinomas, two malignant melanomas, one olfactory neuroblastoma, one hondrosarcoma and one leiomyosarcoma. Tumors originated from the ethmoids in eight, and from the nasal cavity in another eight patients. Oncologic radicality of resection was verified by intraoperative frozen-section examination of biopsy specimens from the margins of the defect site.

Results

Radical resection was accomplished in 15 out of 16 operated patients. There were no major intra- or postoperative complications. Ten patients were postoperatively irradiated. Follow up of the treated patients ranged from 15 to 178 months (median 67 months). One patient with malignant melanoma died of generalized disease nine months after treatment, another with malignant melanoma recurred locally 30 months and again 49 months after first operation and is at the time of evaluation disease free and one died 21 months after operation without evidence of disease.

Conclusions

It seems that in selected cases, endoscopic surgery with curative intent for removal of malignant tumors of the nasal and paranasal cavities in the hands of highly experienced surgeon is justified.     

神经导航引导内镜下手术切除蝶窦发育不良垂体腺瘤——附19例临床报告

背景与目的：经蝶窦入路切除垂体瘤是当今垂体瘤手术治疗的发展方向。本研究探讨应用神经内镜技术和神经导航技术在单鼻孔手术切除蝶窦发育不良型垂体腺瘤的意义与价值。方法：在神经导航引导内镜下经单鼻孔微创手术治疗垂体瘤19例，其中泌乳素腺瘤13例，生长激素腺瘤1例，无功能腺瘤5例。结果：神经内镜和神经导航下全切肿瘤14例，近全切4例，大部分切除1例，术后13例内分泌化验恢复正常，其中15例术前有视力损害者，术后13例较术前好转，2例无变化；1例出现一过性脑脊液漏。19例随访3-11个月，未发现复发。无鼻中隔穿孔、萎缩性鼻炎等并发症。结论：神经导航引导内镜下经单鼻孔手术切除蝶窦发育不良型垂体腺瘤具有深部照明好．鼻腔结构损伤小、操作简捷、术后恢复快等优点，神经导航技术的应用可以避免蝶窦多房分隔的干扰．快速确定鞍底位置、判定肿瘤切除的程度与范围、减少手术对肿瘤周围神经血管结构的副损伤，二者结合能提高手术全切率，减少复发．是蝶窦发育不良型垂体腺瘤微创外科治疗的理想手段。