Perineural Growth Research Articles

Superior orbital fissure syndrome caused by intraorbital spread of a cutaneous squamous cell carcinoma and not detected on computed tomography and magnetic resonance imaging

Intraneural and perineural spread of a squamous cell carcinoma of the frontal region via the orbit to the cranial cavity is a rare cause of a superior orbital fissure syndrome. This mode of tumor spread, for which a previously excised invasive malignant tumor is responsible, is rarely reported. The absence of an intraorbital mass and the fact that computed tomography (CT) and magnetic resonance imaging (MRI) are normal make the diagnosis extremely difficult. We describe a 76-year-old patient in whom both intrane ural and perineural tumor growth deep into the orbit caused acute ocular motility disturbances, visual impairment, and ocular dysfunction with subsequent cerebral and vascular dysfunction. Surgery, radiotherapy, and orbital exenteration did not prevent spread of the tumor toward vital intracranial and intracerebral structures. Even the advanced diagnostic modalities of CT and MRI failed to reveal the cause of the pathologic process in our patient. In such a case, one should look carefully for both intraneural and perineural tumor invasion on previous histologic material and, if positive, treat the patient with radical surgery on purely clinical grounds as early as possible.

Value of Ki-67 Immunolabelling as a Prognostic Factor in Prostate Cancer

The aim of the study was to analyze the results of Ki-67 immunostaining in prostatic adenocarcinoma and to assess its prognostic value. Clinical follow-up data was reviewed in 190 prostatic adenocarcinomas and the results of Ki-67 immunolabelling were correlated to standard prognostic factors and survival data of the patients. All stage and grade categories were included. Ki-67 expression correlated significantly with histological differentiation of tumors, indicators of cell proliferation, perineural growth, density of tumor-infiltrating lymphocytes and TM classification. In survival analysis, Ki-67 expression was able to discriminate patients into different prognostic groups (p = 0.0035). In a separate analysis including T1-2M0 tumors, Ki-67 immunolabelling was a significant predictor of survival (p = 0.0258). In Cox's multivariate analysis Ki-67 was an independent prognostic factor in the entire cohort. The results show that Ki-67 expression is a potentially useful prognostic factor in prostatic adenocarcinoma and it could be used as an additional criterion in defining a correct prognostic category in this malignancy.

Sclerosing sweat duct (syringomatous) carcinoma.

This report describes 20 sclerosing adnexal carcinomas of the skin that recapitulate the sweat duct and share certain microscopic features with benign syringoma. Clinically, the neoplasms were slow-growing, indurated nodules or plaques. Sixteen were located on the face, including five on the upper lip. Three were situated in the axilla, and one involved the buttock. Twelve of the tumors (group 1) were composed primarily of cords and nests of whorled squamous cells with clear cell change and variable keratinization. Lumens consistent with ductal differentiation were few and isolated in some of these lesions, but others had more numerous and complex ducts. The remaining eight neoplasms (group 2) contained large numbers of small, uniform ducts, and exhibited little keratinization. Each neoplasm in the series infiltrated subcutaneous tissue or deeper tissues and was accompanied by sclerotic, fibrous stroma. Sixteen of the lesions (80%) exhibited perineural growth. One tumor involved an underlying lymph node, probably by direct extension. Cytologic atypicality was mild or lacking, and mitotic figures were sparse. Seven of 15 tumors (47%) with follow-up recurred, in some instances many years after primary excision. Tumor-free margins in the initial excision specimen appeared to be a favorable prognostic factor. The most aggressive lesion in the series showed increased cytologic atypicality in recurrences.

Microcystic adnexal carcinoma

We describe a patient with microcystic adnexal carcinoma, a recently recognized cutaneous neoplasm. The patient, a middle-aged woman, had an induration of the left side of her upper lip. At the time of initial resection, the neoplasm also involved the left side of the nose. An extensive recurrence, 27 months later, involved the left turbinates and left orbit. Microscopically the tumor consisted of nests, strands, and cysts composed of mildly to moderately atypical squamous cells that lacked connections with the epidermis. The cysts contained dense, laminated keratin. The tumor was distributed throughout the dermis and infiltrated subcutaneous tissue, skeletal muscle, perichondrium, periosteum, vascular adventitia, and perineural spaces. A few fields contained nests of clear cells, but ductular differentiation, prominent in some microcystic adnexal carcinomas, was not found. There was a distinctive, dense, sclerotic stroma. The foregoing clinical and pathologic findings are characteristic of microcystic adnexal carcinoma. Our observations and available information from the literature suggest the existence of an important family of locally aggressive carcinomas of the face characterized by squamous nests and cysts, variable ductular differentiation, and perineural growth. Such tumors must be clearly differentiated from the more common forms of epidermal and adnexal neoplasia.