The clinical histories of 46 cases of chordoma seen and treated at Memorial Hospital from 1930 to 1965 are reviewed, including 30 cases of sacral origin, ten cases of vertebral origin, five sphenoidal and one extranotochordal, with an age range from 2 1/2 years to 71 and a male sex predominance of 32 to 14. Only three patients in this series are alive and free of disease 5, 13 and 16 years after diagnosis and treatment and the absolute 5‐year survival rate with freedom from disease is only 8.7%. Complete surgical excision can result in a cure in a few selected sacrococcygeal or sphenoidal cases but incomplete removal or tumor spillage in the wound are certain to lead to recurrence and probable metastasis and death. When radiation therapy is employed, either alone or preoperatively, symptomatic relief can be expected and some regression in the tumor at least for a time. In those tumors that show some radioresponsiveness repeat x‐ray dosages may prove of extended benefit. The authors conclude that distant metastasis and local recurrence are more common than ordinarily considered and therapeutic doses of supervoltage irradiation pre‐ or postoperatively could be of subtantial benefit in the management of this uncommon disease.
Over a 38-year-period 73 paragangliomas from the head and neck region were seen at Memorial Hospital. These occurred in 69 patients. There were 44 carotid body, 13 vagal body, eight jugulo-tympanic, and three nasal paragangliomas. In addition, one each arose in the orbit, larynx, and area of the aortic arch. Sixty-two patients were surgically treated while three received irradiation only and four were observed but not treated. Follow-up was obtained for 94% of the patients. There were six postoperative deaths, five of which occurred before 1945. Of those treated surgically, 37 had no evidence of recurrent tumor while the paragangliomas recurred locally in 11. All patients in the radiation and untreated groups had persistent tumor. Malignant behavior with death due to tumor was observed in five cases (four carotid body and one vagal body paraganglioma). Using modern techniques carotid body and vagal body paragangliomas can usually be managed by surgery alone. Other paragangliomas of the head and neck due to their anatomic location are sometimes best treated by a combination of surgery and radiation or only by radiation therapy.
Meningioma can be a diagnostic problem for the head and neck surgeon and the surgical pathologist by reason of extracranial manifestation and the varying histological patterns seen in small biopsy specimens submitted from various extracranial sites. During the thirty year period 405 cases of meningioma were seen at the New York Hospital and the Memorial Hospital and the clinical findings have been reviewed together with recent pertinent literature. Thirty-four cases were spinal in origin: 9 cervical, 22 dorsal, and 2 lumbar. An external mass was present in 20% of the intracranial tumors: the orbit was involved in 30 patients, the outer table and scalp in 25, the paranasal sinuses and nasal cavity in 10, and the parotid and parapharyngeal region in 5. Three cases are documented primary extracranial meningiomas arising is soft parts; one free in the orbit and two in the neck masquerading as deep lobe parotid gland tumors. The pathological features of extracranial meningioma were identical with the intracranial variety and a standard classification of the main histological types is outlined. A variety of differential diagnoses were entertained before the true nature of the neoplasm was established. The necessity for sophisticated radiographic studies and neurosurgical attention to the intracranial component of the tumor is emphasized.
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