Weiland, Louis H.

Primary “colonic type” tumors of the nasal cavity and paranasal sinuses are adenocarcinomas with histologic features similar to those of colonic cancers. Their behavior is one of local invasion and recurrence. Unlike tumors of the colon, they rarely metastasize. Surgical resection by means of lateral rhinotomy with or without radiation is the treatment of choice. Prognosis is poor. This type of tumor should be recognized by pathologists and its implications should be known to head and neck surgeons.

Otolaryngologists‐head and neck surgeons and surgical pathologists should be aware of the potential for acinic cell carcinomas to dedifferentiate so that adequate histologic tumor sampling can be performed. Dedifferentiated acinic cell carcinoma is a highly malignant, newly recognized parotid malignancy. Clinical clues that may help identify this more ominous lesion must be recognized.

From 1978 to 1981, 151 patients with nasopharyngeal carcinoma (NPC) were enrolled in a prospective, collaborative study of North American patients, most of them white. Thirty‐seven had World Health Organization (WHO) type 1 tumors, and 114 had WHO types 2 and 3 tumors. The anti‐Epstein‐Barr virus (EBV) profile of elevated antibody titers directed against viral capsid antigen and early antigen was seen in 85% of the patients with WHO types 2 and 3 tumors but in only 16% of the patients with WHO type 1 tumors. Geometric mean titers tended to be higher in higher stages of the disease in several staging systems. Low antibody‐dependent cellular cytotoxicity at diagnosis appears to reflect a poorer prognosis, and the determination of antibody titers by this assay may prove to be useful for identifying persons in whom recurrent disease is likely to develop after conventional therapy. Anti‐EBV titers can aid in diagnosis and treatment planning in patients with NPC, particularly those with occult primary NPC.

Adenomas and adenocarcinomas originating from the middle ear are few in number and have met with significant controversy in the literature. Our experience with 11 previously described patients is updated and five new cases are added. These tumors were seen in persons whose ages ranged from 7 to 77 years. The most common initial symptom was decreased hearing (11 cases), followed by otorrhea (4 cases), and otalgia (4 cases). At the time of diagnosis, facial nerve weakness was present in several patients (seven), and this was a poor prognostic sign. These glandular tumors engender controversy regarding histologic origin and the pathologic demarcation between adenoma and adenocarcinoma. In this review, we show that otorrhea, bone erosion, facial nerve involvement, and aggressive clinical behavior can be the result of lesions that appear microscopically benign. Furthermore, we present evidence of the similarity of these glandular lesions to paragangliomas and carcinoid tumors. Finally, pathologic data are presented to develop the previously unreported theory that the origin for this group of tumors is paraganglionic tissue.

AbstractFrom 1951 through December, 1985, a total of 89 patients underwent total pancreatectomy for ductal adenocarcinoma. Of the 89 patients, 54 were male and 35 were female; their average age was 60.0 years. Histologic grading (Broders') demonstrated that 56% of the patients had a grade 2 tumor and 38%, a grade 3 tumor. None of the patients had grade 4 tumors. Peripancreatic lymph nodes were positive in 47% of the patients at the time of resection. Multicentricity was noted in 32.5% of patients. The operative mortality was 10.1%; however, for the patients who had surgery after January, 1980, the operative mortality was 6.2%. At the completion of the study, 78 patients had died and 11 were alive. The principal cause of death was recurrent malignancy. The median duration of survival, including the duration of survival in patients who had operative deaths, was 1.03 years. The influence of sex, tumor grade and size, multicentricity, and nodal status was evaluated multivariately with Cox's proportional hazard model.