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Malignant giant cell tumor of bone
ORAL SURGERY Subtotal Parotidectomy for Mixed Zealand J. Surg. 21: 13, 1951.
Salivary
Tumor.
Howard
H. Eddey.
Iiustralian
New
Any operation designed to remove a mixed salivary tumor of the parotid gland must. satisfv two criteria: removal of the tumor must Ire complete and the facial nerve musit no1 be damaged. Subtotal parotidectomg fulfills the first criterion in that an adequate amount of normal tissue surrounding thr tumor, which is almost always situated in the superficial lobe of the gland, is removed. The second criterion can lx satisfied if the operator passesses an.accurate knowledge of the surgical anatomy of thr facial nerve in relation t,o thv parotid gland, and if a technique is follo~vetl mhirh ensures early and constant Visualizatiou of the nerve and its bran(Lher. With use of the surgical technique descril>ed, that author performed nine subtotal parotidectomies for mixed salivary tumors without any resultant permanent facial paral) six No patient developed a salivary fistula and no case of Frey’s syndrome occurred. T. .1-.( I. Malignant Giant 6i. 1951.
Cell Tumor
of Bone.
E. S. J. King.
Australian
Kcw
Zealand
.r. Surg.
21:
While many tumors contain giant cells either of the tumor or of the foreign I&J. type, in this article the term “giant cell tumor ” is reserved for a t.umor in which there are a large number of foreign body giant cells of the osteoclast type. The malignant giant cell tumor differs from the tjenign tumor in the recurrence after treatment to which the benign form responds, by invasion of the surrounding tissue (some and later the development of metastases. Tumors in untimes even before interference), usual sites should be regarded from the oulse1. as probably not being benign in type. Tu. mars exhibiting rapid growth and invasion through the tortes of the l,one at an early stage also suggest gross malignancy. Difficulty arises in the diagnosis only in those instances in which there is a close similarity of the benign and malignant forms of tumor growth,
Bxamination of biopsy material shows thitt the giant cellu (the osteoclastsj give no indication whatever as to the prognosis of the condition. These cells vary in number and in form, they may be scarce or they may predominate in the sections, and the number of nuclei in a cell may be small or large. The iniportxnt distinguishing feature is the stroma. The benign type of tumor has a pleomorphie stroma showing a mixture of various fixed and wandering cells. Malignant tumors shovv the significant feature of neoplasia, namely, a wow uniform strwture of ~10s~~lineage. ‘1’1~ rate 0J proliferation is usually indie:~ictl I)y the discovery of mitotic figures. The difficulties of N histological diagnosis are illcBreased by, and as the result of! hemorrhage and infection. ‘I’. .J. (‘_
Treatment of Mixed Tumor of Tongue with Radioactive Chromic Phosphate Solution. Claude S. Mumma. Arch. Otolaryng. 58: 192, August, I!).%. The author reports with adenocarcinomatous therapy am1 did respond
on a case of a mixed tumor of the tongue of’ salivary gland type features which did not respond to two courses of irradiation to injections of colloidal chromic phosphatr solution.
Case Report “The patient, a white nian 57 years old, was admitted to the hospital on July 5, IN!), for treatment of a vesicular eruption of both hands. On examination, in addition to the skin lesions, a mass of discrete cervical nodes was found beneath and anterior to the angle r)f the right jaw. The patient stated that the swelling was noticed four or five months previously. His attention was called to it by his associates rather than by any localized pain or discomfort. Slight discomfort had been present. but it was thought to IBe due t.o a cervical arthritis which had been present for three or four years. There was a feeling of fullness on swallowing, which the patient said he thought was due to his ‘uvula.’ A right simple mastoidect,omy had heen done in 1928, with uo residual effects. “In the search for the etiological factor of the adenopathy, a moderately large iudurative lesion was found in the tongue. It involved the posterior half of the tongue on 3 by 3 the right side and extended downward into the Ivase. It measured approximately by 0.5 cm. The tonsillar area, the pharyngeal wall, the hypopharynx, and the Iarxux were normal. “A biopsy of this mass prompted a diagnosis of mixed tumor of accessory salivarygland origin. A suprahyoid dissectiorr of the node mass was done. Frozen sections at the Fixed specimens \\-ere later time of the operation were interpreted as adenocarcinoma. interpreted as neoplastic extension to capsules of regional lymph nodes and mixed tumor of the salivary gland with adenocarcinomatous features. ‘On Oct. 12 in canjuuetion with the radiological department, 1.5 radon seeds, i.6 mc. per seed, were distributed throughout the mass. Betu-eeu No\-. 21 and Dec. 3% a total of .i$J23 r (skin), half-value layer 1.56 mm. cu.. was given to the right lateral jaw and sub mentally to the right hypopharynx. “On Feb. 1, 1950: u-hen it was found on examination that. there m-as still tumor tissue present in the tongue, au additional course of x-rays was ordered; 3,162 r (skin), half\-alue layer 1.56 mm. cu., was given to the right jaw area and submentally to the base In addition, 1,402 r (skin) half-value layer 1.13 mm. cu., was given trans. of the tongue. orally to the right base of the tongue, Treatment was completed on March 7. ‘.After therapy there was no material change in the local tougue condition. The There was a moderate-sized area of ulceration over its surface. lesion was still palpable. In the absence of response to both x-ra.y therapy and insertion of radon seeds, in consultation with Dr. Andrew Dowdy, of the x-ray department, it was decided that an interstitial injection of chromic phosphate (CrP,,O,) should he tried. “On April 13, 4.6 CX. of radioactive chromic phosphate in colloidal solution, with a turnor (lose of 41l,OOO REP per gram, was injected into the lesion interstitially. The tongue as was the patient’s discomfort. The lesion regressed! leaving a reaction was minimal,
Salivary
Tumor.
Howard
H. Eddey.
Iiustralian
New
Any operation designed to remove a mixed salivary tumor of the parotid gland must. satisfv two criteria: removal of the tumor must Ire complete and the facial nerve musit no1 be damaged. Subtotal parotidectomg fulfills the first criterion in that an adequate amount of normal tissue surrounding thr tumor, which is almost always situated in the superficial lobe of the gland, is removed. The second criterion can lx satisfied if the operator passesses an.accurate knowledge of the surgical anatomy of thr facial nerve in relation t,o thv parotid gland, and if a technique is follo~vetl mhirh ensures early and constant Visualizatiou of the nerve and its bran(Lher. With use of the surgical technique descril>ed, that author performed nine subtotal parotidectomies for mixed salivary tumors without any resultant permanent facial paral) six No patient developed a salivary fistula and no case of Frey’s syndrome occurred. T. .1-.( I. Malignant Giant 6i. 1951.
Cell Tumor
of Bone.
E. S. J. King.
Australian
Kcw
Zealand
.r. Surg.
21:
While many tumors contain giant cells either of the tumor or of the foreign I&J. type, in this article the term “giant cell tumor ” is reserved for a t.umor in which there are a large number of foreign body giant cells of the osteoclast type. The malignant giant cell tumor differs from the tjenign tumor in the recurrence after treatment to which the benign form responds, by invasion of the surrounding tissue (some and later the development of metastases. Tumors in untimes even before interference), usual sites should be regarded from the oulse1. as probably not being benign in type. Tu. mars exhibiting rapid growth and invasion through the tortes of the l,one at an early stage also suggest gross malignancy. Difficulty arises in the diagnosis only in those instances in which there is a close similarity of the benign and malignant forms of tumor growth,
Bxamination of biopsy material shows thitt the giant cellu (the osteoclastsj give no indication whatever as to the prognosis of the condition. These cells vary in number and in form, they may be scarce or they may predominate in the sections, and the number of nuclei in a cell may be small or large. The iniportxnt distinguishing feature is the stroma. The benign type of tumor has a pleomorphie stroma showing a mixture of various fixed and wandering cells. Malignant tumors shovv the significant feature of neoplasia, namely, a wow uniform strwture of ~10s~~lineage. ‘1’1~ rate 0J proliferation is usually indie:~ictl I)y the discovery of mitotic figures. The difficulties of N histological diagnosis are illcBreased by, and as the result of! hemorrhage and infection. ‘I’. .J. (‘_
Treatment of Mixed Tumor of Tongue with Radioactive Chromic Phosphate Solution. Claude S. Mumma. Arch. Otolaryng. 58: 192, August, I!).%. The author reports with adenocarcinomatous therapy am1 did respond
on a case of a mixed tumor of the tongue of’ salivary gland type features which did not respond to two courses of irradiation to injections of colloidal chromic phosphatr solution.
Case Report “The patient, a white nian 57 years old, was admitted to the hospital on July 5, IN!), for treatment of a vesicular eruption of both hands. On examination, in addition to the skin lesions, a mass of discrete cervical nodes was found beneath and anterior to the angle r)f the right jaw. The patient stated that the swelling was noticed four or five months previously. His attention was called to it by his associates rather than by any localized pain or discomfort. Slight discomfort had been present. but it was thought to IBe due t.o a cervical arthritis which had been present for three or four years. There was a feeling of fullness on swallowing, which the patient said he thought was due to his ‘uvula.’ A right simple mastoidect,omy had heen done in 1928, with uo residual effects. “In the search for the etiological factor of the adenopathy, a moderately large iudurative lesion was found in the tongue. It involved the posterior half of the tongue on 3 by 3 the right side and extended downward into the Ivase. It measured approximately by 0.5 cm. The tonsillar area, the pharyngeal wall, the hypopharynx, and the Iarxux were normal. “A biopsy of this mass prompted a diagnosis of mixed tumor of accessory salivarygland origin. A suprahyoid dissectiorr of the node mass was done. Frozen sections at the Fixed specimens \\-ere later time of the operation were interpreted as adenocarcinoma. interpreted as neoplastic extension to capsules of regional lymph nodes and mixed tumor of the salivary gland with adenocarcinomatous features. ‘On Oct. 12 in canjuuetion with the radiological department, 1.5 radon seeds, i.6 mc. per seed, were distributed throughout the mass. Betu-eeu No\-. 21 and Dec. 3% a total of .i$J23 r (skin), half-value layer 1.56 mm. cu.. was given to the right lateral jaw and sub mentally to the right hypopharynx. “On Feb. 1, 1950: u-hen it was found on examination that. there m-as still tumor tissue present in the tongue, au additional course of x-rays was ordered; 3,162 r (skin), half\-alue layer 1.56 mm. cu., was given to the right jaw area and submentally to the base In addition, 1,402 r (skin) half-value layer 1.13 mm. cu., was given trans. of the tongue. orally to the right base of the tongue, Treatment was completed on March 7. ‘.After therapy there was no material change in the local tougue condition. The There was a moderate-sized area of ulceration over its surface. lesion was still palpable. In the absence of response to both x-ra.y therapy and insertion of radon seeds, in consultation with Dr. Andrew Dowdy, of the x-ray department, it was decided that an interstitial injection of chromic phosphate (CrP,,O,) should he tried. “On April 13, 4.6 CX. of radioactive chromic phosphate in colloidal solution, with a turnor (lose of 41l,OOO REP per gram, was injected into the lesion interstitially. The tongue as was the patient’s discomfort. The lesion regressed! leaving a reaction was minimal,