Verrucous carcinoma is a low grade, well differentiated, unusual variant of squamous cell carcinoma. It has been described to represent an intermediate lesion between condyloma acuminata and squamous cell carcinoma. Since malignant transformation of verrucous carcinoma has been reported to occur in 30-50% of cases, the first line treatment for verrucous carcinoma is surgery, preferably Mohs surgery. Herein, we describe a case of recurrent verrucous carcinoma on the right buttock of a man with a history of radical excision and radiotherapy of a previous perianal verrucous carcinoma. The patient was successfully treated with 5% imiquimod cream, an immune response modifier with potential antiviral and antitumor effects. Imiquimod may be an effective treatment for verrucous carcinoma and presents an alternative therapy to surgical excision.
Buttocks ; Carcinoma, Squamous Cell ; Carcinoma, Verrucous* ; Humans ; Mohs Surgery ; Radiotherapy

Adenocarcinoma, Follicular/surgery* ; Carcinoma, Squamous Cell ; Humans ; Thyroid Neoplasms/surgery*

OBJECTIVES: 1) To determine if there is an association between physical examination by cervical palpation, pre-operative contrast-enhanced multi-detector computed tomography (MDCT), and intraoperative lymph node assessment, with final histopathology in the evaluation of cervical lymph node metastasis in Filipino patients with squamous cell carcinoma of the head and neck. 2) To determine the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and likelihood ratios of cervical palpation, contrast enhanced MDCT, and intra-operative lymph node assessment compared with final histopathology in the evaluation of cervical lymph node metastasis in Filipino patients with squamous cell carcinoma of the head and neck.

METHODS: Study Design. Retrospective; Cross-sectional. Setting. Tertiary Government Hospital Charity Section, Department of Otorhinolaryngology, Department of Radiology, Department of Pathology. Participants, Patients or Population. Retrospective chart review of all biopsy proven head and neck squamous cell carcinoma patients admitted at the charity ward of a Otorhinolaryngology Department from 2008-2010 who had documented admission physical examination, a pre-operative contrast enhanced multi-detector computed tomography (MDCT) scan of the neck done in the same institution within 20 days or less from date of surgery, and underwent neck dissection with appropriate cervical lymph node level specimen labeling with subsequent post-operative histopathologic evaluation of submitted specimens for neck node metastasis by the Pathology Department of the same institution. After set of exclusion criteria was applied, the analyzed sample included 82 lymph node level samples from 9 patients with head and neck Squamous Cell Carcinoma (SCCA).

RESULTS: Pre-operative contrast enhanced MDCT, and intraoperative nodal assessment, were both significantly correlated with the final histopathologic evaluation of neck node metastasis as evaluated with Fisher's Exact test (p = 0.00). Cervical palpation however was not able to show a significant association (p=0.099).Cervical palpation had a sensitivity of 25.00% (8.33-52.59%), specificity of 90.91% (80.61-96.25%), NPV of 83.33 (72.30-90.73%), PPV of 40.00 (13.69-72.63%), accuracy of 78.05%, and a likelihood ratio of 3.33. Pre-operative contrast enhanced MDCT had a sensitivity of 43.75% (20.75-69.45%), specificity of 93.94% (84.44-98.04%), NPV of 87.32 (76.80-93.69%), , PPV of 63.64 (31.61-87.63%), accuracy of 84.15%, and a likelihood ratio of 12.06. Intraoperative surgical evaluation had a sensitivity of 68.75% (41.48-87.87%), specificity of 93.94% (84.44-98.04%), NPV of 92.54 (82.74-97.22%), PPV of 73.33 (44.83-91.09%), accuracy of 89.02%, and a likelihood ratio of 34.10. Further analysis with McNemar's Test comparing MDCT and Intraoperative assessment showed no significant difference (p = 0.387).

DISCUSSION AND CONCLUSIONS: In the evaluation of cervical lymph node metastasis for head and neck squamous cell carcinoma in the local setting, the extent of neck dissection, clinical staging and prognosis, as well as adjuvant therapy can be guided by pre-operative contrast enhanced MDCT and intra-operative nodal assessment. Contrast-enhanced MDCT can aid treatment planning in preoperative or non-operative cases; but intraoperative evaluation can be used to guide final extent of surgery. Evaluation solely by physical examination by cervical palpation unfortunately in this study was not able to show a significant association with final histopathology.

The oligometastatic and oligoprogressive state has been a hot issue in cancer research. Its indolent tumor behavior, representing a novel therapeutic opportunity, has been identified as a clinical subtype in several malignancies. However, the clinical implications of the oligometastatic and oligoprogressive state in esophageal squamous cell carcinoma (ESCC) have not been thoroughly elucidated. There are still controversies regarding the existence of the oligometastatic state in ESCC, if the solitary regional lymph node metastasis should be viewed as oligoprogressive disease after esophagectomy, and the role of surgery and radiotherapy in ESCC oligometastatic disease. Despite many exciting contributions to the literature on these, further exploration is warranted. Thus, fostering the advance of research and scientific knowledge on the biological and prognostic characteristics scrupulously would facilitate personalizing treatment strategy for better outcomes.
Carcinoma, Squamous Cell/surgery* ; Esophageal Neoplasms/surgery* ; Esophageal Squamous Cell Carcinoma ; Esophagectomy ; Humans ; Neoplasm Staging ; Prognosis ; Retrospective Studies

Carcinoma, Squamous Cell ; surgery ; Humans ; Hypopharyngeal Neoplasms ; surgery ; Laryngeal Neoplasms ; surgery ; Larynx ; physiology ; surgery

Carcinoma, Squamous Cell ; surgery ; Head and Neck Neoplasms ; surgery ; Humans ; Hypopharyngeal Neoplasms ; surgery ; Larynx ; surgery

We present an elderly patient with a squamous cell carcinoma over the subcutaneous aspect of the leg involving the tibia. En bloc resection of the tumour together with a 10 centimetre segment of the tibia was done. The resected bone was autoclaved, replaced in its original position and stabilized with bone cement and a locked nail. This allowed early ambulation with minimal cost.
Bone Neoplasms/*surgery ; Carcinoma, Squamous Cell/*surgery ; *Replantation ; Soft Tissue Neoplasms/*surgery ; *Sterilization ; Tibia/*surgery

Female ; Humans ; Teratoma/pathology* ; Ovarian Neoplasms/pathology* ; Carcinoma, Small Cell/surgery* ; Carcinoma, Squamous Cell/pathology* ; Carcinoma, Neuroendocrine/surgery*

Recent advances in multimodality treatment offer excellent opportunities to rethink the paradigm of perioperative management for locally advanced esophageal squamous cell carcinoma. One treatment clearly doesn't fit all in terms of a broad disease spectrum. Individualized treatment of local control of bulky primary tumor burden (advanced T stage) or systemic control of nodal metastatic tumor burden (advanced N stage) is essential. Given that clinically applicable predictive biomarkers are still awaited, therapy selection guided by diverse phenotypes of tumor burden (T vs. N) is promising. Potential challenges regarding the use of immunotherapy may also boost this novel strategy in the future.
Humans ; Esophageal Squamous Cell Carcinoma/surgery* ; Carcinoma, Squamous Cell/pathology* ; Esophageal Neoplasms/pathology* ; Combined Modality Therapy ; Immunotherapy

Carcinoma, Squamous Cell ; surgery ; Head and Neck Neoplasms ; surgery ; Humans ; Neoplasm Recurrence, Local ; prevention & control ; surgery ; Prognosis