Background: To the best of our knowledge, only 52 cases of squamous cell carcinoma (SCC) complicating hidradenitis suppurativa (HS) have been reported since 1958. We describe 13 new cases. Methods: We propose a clinical and histological analysis of our cases. We include these results in a review of previously reported cases to analyze a total of 65 patients. In our series of 13 cases, we also investigate the presence of human papillomavirus (HPV) in tumor samples, by polymerase chain reaction (PCR) on paraffin-embedded material. Results: Malignant transformation affects mainly men with a long-term history of genitoanal HS. Although our cases were 7 well-differentiated carcinomas and 6 verrucous carcinomas, lymphatic and visceral metastasis occurred in 2 and 3 cases, respectively. With PCR, we demonstrated presence of HPV in genitoanal tumoral lesions, principally HPV-16. Conclusion: SCC complicating HS evolves poorly, despite a good histological prognosis. Our results sustain the implication of HPV in the malignant transformation of HS.
ABSTRACT.Purpose: In order to further assess the survival value of orbital exenteration in malignant orbital and periorbital tumors. Methods: The charts of 44 patients exenterated for a neoplasm of the orbit or periorbit were reviewed in a retrospective study.
Results:The overall 4-year survival was 45%. 26 patients had free margins on histological examination and 24 patients had developed local recurrence or metastasis. Local recurrence or metastasis were significantly more common in the group with transected margins than in the group with free-margins (pΩ 0.01). Survival between the group of patients with local recurrence or metastasis and the group without local recurrence or metastasis showed statistically significant difference (pΩ0.0025). In contrast, survival between the group of patients with free margins and the group with transected margins did not show statistically significant difference (pΩ0.13). Conclusion: Surgical free margins section is a key element in successful cancer surgery but seems not the only prognosis variable.
The free jejunal graft is a very useful procedure for hypopharyngeal reconstruction after total pharyngolaryngectomy. Between 1985 and 1994 56 patients with squamous cell carcinoma of the hypopharynx were treated by this method. The median age was 54 (range 35-76). There were 54 men and 2 women. The mortality rate was 4% (2/56). The graft failure was 4% (2/56). Good swallowing function was achieved in 91% (49/54 assessable patients). Nine patients developed local recurrences, four patients had local and neck recurrences. Distant metastases occurred in six patients and five developed metachronous cancers. Follow-up analysis showed a 5-yr survival rate of 33%. After 10 yr, the free jejunal graft has become, for us, the method of choice for hypopharyngeal reconstruction after total pharyngolaryngectomy.
The authors reported an original 1.9 im diode laser assisted microvascular anastomosis (LAMA) in human. This technique has been applied in 12 patients during reconstructive surgery for digital replantations (n=2), for digital revascularisations (n=3) and for free flap transfers (n=7). Fourteen end-to-end anastomoses (10 arteries, 4 veins) were performed. LAMA were always performed on vessel which did not impede the chance of success of the surgical procedure in case of thrombosis. LAMA was performed with a 1.9tm diode laser after placement of 2 equidistant stitches. The diode spot was obtained by mean of an optic fiber transmitted to the vessel wall via a pencil size hand piece. The used parameters were as followed: spot size = 400jim, power = 70 to 220 mW, time -0.7 to 2 seconds, mean fluence = 1 15 J/cm2. The mechanism involved is a thermal effect on the collagen of the adventitia and media leading to a phenomena which the authors have termed "heliofusion". This preliminary trial has permitted to define the modalities of its use in human. The technique is simple, rapid and easily learned.The equipment is not cumbersome, sterilisable and very ergonomic. LAMA does not replace sutures but is complementary, thanks to a reduction in the number of stitches used and to an access to surgical areas which are not easily accessible. This study must be completed by a larger scale study to confirm this technique and its reliability. Others uses could be performed on different tissues such as biliary and urinary track, specially under laparoscopic conditions.
Levamisole (an increasingly frequent contaminant of cocaine) can cause antineutrophil cytoplasmic antibody-associated vasculitis. Dermatologists should consider a diagnosis of cocaine/levamisole-associated cutaneous vasculopathy syndrome in cases of purpura of the ears and/or extensive retiform purpura in drug users. We report a case of particularly severe levamisole-induced necrotic purpura and immunological abnormalities in a 40-year-old woman.
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