Gaffey, Thomas A.

Cervical lymphangioma is rare among adults. Thirty‐two patients with cervical lymphangioma were treated at the Mayo Clinic between 1950 and 1982. The records of these patients were reviewed to investigate the clinical and pathologic behavior of this lesion in persons more than 16 years of age. The lesions were seen in all decades of adult life and equally in men and women. Most lesions presented as a rapidly enlarging, asymptomatic mass. The anterior triangle of the neck was involved nearly as often as the posterior triangle, and right‐sided locations predominated (72%). Histopathologic differentiation of the lesions into simplex, cavernous, and cystic lymphangiomas was not helpful in predicting clinical behavior. Surgical excision is the treatment of choice. The lesions may intimately involve the carotid sheath or adjacent nerves. Recurrence in 21% of the 28 patients on whom follow‐up data were available mostly represented incomplete excision. Lymphangioma should be included in the differential diagnosis of a large asymptomatic neck mass of recent origin in the adult.

Lymphoepithelioma is common in the nasopharynx, but its presence elsewhere in Waldeyer's ring is rare. Thirteen patients with lymphoepithelioma in the tonsil and base of the tongue have been treated at our institution. At Initial examination, all 13 patients had advanced clinical disease. Five years after their initial treatment, seven patients were alive and free of disease. Radiation therapy controlled local and regional disease in 10 (77%) patients, yet three of these died of distant metastasis. Patients with lymphoepithelioma have a significantly better prognosis (p < 0.05) than do patients with either nonkerafinizing or keratinizing high‐grade oropharyngeal carcinoma. Early recognition and combined therapy may further improve the prognosis. Differentiation of lymphoepithelioma from other high‐grade squamous cell carcinomas of the oropharynx is important to guide treatment and to provide prognostic information.

High‐grade carcinoma of the oral cavity is considered to be an aggressive malignancy associated with a poor prognosis. The tumors are often considered to be relatively radiosensitive. Because previous reviews of oral cavity cancer have contained few patients with grade 4 lesions, little is known about the true behavior of these tumors. Information was collected on 80 patients with high‐grade carcinoma of the oral cavity to determine the clinical findings and optimal treatment of this tumor. Primary tumor location, presence of neck metastasis, and clinical stage did not affect survival. Tumor size was a significant risk factor. The 5‐year survival rate for patients with high‐grade carcinoma treated by combination surgery and radiation (52%) was significantly greater (p ≤ 0.05) than that for patients treated by radiation alone (28%) or surgery alone (24%). This study is the first to describe the clinical course of a large number of patients exclusively with high‐grade carcinoma of the oral cavity.

Abstract The use of high energy devices has been suggested for intra‐articular surgery. Experimental studies have been performed using the laser and electrocautery. However, clinical application has primarily been with the use of the electrocautery. Electrosurgery is currently being used for lateral retinacular release as well as meniscal surgery. Inadvertent damage to articular cartilage may occur, especially during meniscal resection. The objective of the current study is to assess the effect of the Concept electrocautery with the meniscal cutting electrode on fresh human articular cartilage. Twenty fresh tibial plateaus removed at the time of total knee arthroplasty were subjected to electrocautery currents ranging from 25 to 82.5 W. The articular cartilage was stained with hematoxylin and eosin. The extent of cartilage necrosis was quantitated as a percentage of the thickness of the articular cartilage. A dose response curve was developed. The extent of articular cartilage necrosis with the electrocautery setting of 20 (24.4 W) commonly used for meniscal resection resulted in only an 11.4%‐injury to the articular cartilage. At the manufacturer's recommended setting of 24 (27 W), a 16% depth of laceration of the articular cartilage may be anticipated. We conclude that the lowest current setting possible should be utilized for meniscal surgery and the risk of articular cartilage damage from inadvertent injury is not excessive.