Über 8o% der gutartigen Larynxtumoren sind Papillome, eine Übersicht der übrigen Tumoren and ihrer Häufigkeit zeigt Tabelle l. Von den gutartigen Tumoren sind sog. Pseudotumoren, wie Polypen, abzugrenzen, bei denen es sich im wesentlichen um entzündliche, degenerative oder stoffwechselbedingte Veränderungen handelt and nicht um eine autonome Zellvermehrung. Häufig haben die Tumoren eine bestimmte Prddilektionsstelle.

Proliferating cell nuclear antigen (PCNA) expression was investigated immunhistochemically in 53 squamous cell carcinomas of the head and neck. PCNA is a 36-kDa nuclear protein associated with the cell cycle. Results were compared with Ki67 counts, with this latter marker used to demonstrate proliferative compartments. Overall, the PCNA and Ki67 labelling index showed a similar distribution pattern in normal and tumor tissue. A strong correlation was found to histological differentiation. There was no significant difference between PCNA and Ki67 counts (r = 0.8), and PCNA immunostaining allowed assessment of proliferative activity in the head and neck cancers studied. The application of formalin-fixed, paraffin-embedded tumor material demonstrated the advantage of this method and showed that it is an excellent alternative to Ki67 counts.

Klare Definition der regionalen Gliederung

Bei der Behandlung der Polyposis nasi et sinuum bietet die endoskopisch kontrollierte Lasertherapie insbesondere bei der Rezidivpolyposis und Solitärpolypen eine ambulant durchführbare und nahezu unblutige Methode zur Wiederherstellung von Ventilation und Drainage der anhängenden Nasennebenhöhlensysteme. Von Vorteil ist hier der kontinuierliche Einblick in das Operationsgebiet und die Möglichkeit, in engen anatomischen Arealen wie z.B. Siebbein- oder voroperierten Kieferhöhlenostien dosiert und gezielt Gewebe abzutragen.

Die Klassifikation maligner Tumoren dient dem Ziel, Daten über Diagnostik und Therapie allgemein vergleichbar zu machen. Um diesen Anforderungen zu genügen, müssen die Klassifikationsregeln bestimmte Mindestbedingungen erfüllen, klare Definition der regionalen Gliederung, klare Definition der einzelnen Klassen, gute klinische Erfaßbarkeit und prognostische Relevanz. Seit 1987 gelten besonders für die T1- und T2-Klassen der Supraglottis veränderte Regeln, auf die hier noch einmal kurz hingewiesen sei. Anders ist vor allem, daß alle Tumoren, die zwei und mehr Unterbezirke befallen, zu T2 gezählt werden, also auch die nach den Regeln von 1979 unter T1b klassifizierten Karzinome.

Transferrin ist the transport protein of iron known to be an essential element of life. Iron transport crossing the cell membrane is mediated by the specific transferrin receptor (TR). However, the receptor was observed especially in proliferating tissues. We examined immunohistochemically the distribution pattern of this receptor in 60 squamous cell carcinomas of the head and neck. The results were correlated with their proflierative activities determined by the monoclonal antibody Ki67. All investigated tumors expressed the TR mostly distributed homogeneously with slight intra- and intertumorous differences. Generally with increasing expression of TR we could observe a decrease of the histopathological grading of the tumors investigated in our series. However, this relation could not be verified in all our cases. Therefore, only a semiquantitative analysis seemed to be reasonable. Our results indicate that the expression of TRs is not strongly associated to proliferative activity and cannot be used for measurements of growth fractions in squamous cell carcinomas.

The expression of epidermal growth factor receptors (EGFR) has been studied immunohistochemically in 66 squamous cell carcinomas of the head and neck. All investigated tumours overexpressed EGFR showing a homogenous distribution pattern. Pretreatment of tumours (eg. chemotherapy or radiation) did not influence this result. Our findings indicate that EGFR expression is not strongly correlated to proliferative activity, and is not suited to be used as a prognostic marker. It is possible that the observed overexpression of EGFR in squamous cell carcinomas of head and neck can be used as a target for ligand-complexed drugs.

Transferrin ist the transport protein of iron known to be an essential element of life. Iron transport crossing the cell membrane is mediated by the specific transferrin receptor (TR). However, the receptor was observed especially in proliferating tissues. We examined immunohistochemically the distribution pattern of this receptor in 60 squamous cell carcinomas of the head and neck. The results were correlated with their proliferative activities determined by the monoclonal antibody Ki67. All investigated tumors expressed the TR mostly distributed homogeneously with slight intra- and intertumorous differences. Generally with increasing expression of TR we could observe a decrease of the histopathological grading of the tumors investigated in our series. However, this relation could not be verified in all our cases. Therefore, only a semiquantitative analysis seemed to be reasonable. Our results indicate that the expression of TRs is not strongly associated to proliferative activity and cannot be used for measurements of growth fractions in squamous cell carcinomas.

Forty-six patients with advanced head and neck squamous cell carcinomas received two courses of chemotherapy with cisplatinum and bleomycin before undergoing cancer surgery. After surgery, histological serial sections of the resection specimens were examined. Biopsies from each resected specimen were shock-frozen for immunohistochemical examinations using the monoclonal antibodies Ki-67 and RPN-511, which are associated with cell proliferation. In no case did the morphologic analysis demonstrate complete tumor regression after chemotherapy. Thirty-seven patients showed partial tumor regressions histologically, as seen by tumor shrinkage of more than 50%. Nine of the specimens showed only minor regressions, with shrinkage less than 50%. The immunostaining of the frozen sections revealed in all cases the expressions of the Ki-67 nuclear antigen and the presence of specific transferrin (RPN-511) receptors in the proliferative compartments of the carcinomas.

The expression of epidermal growth factor receptors (EGFR) has been studied immunhistochemically in 66 squamous cell carcinomas of the head and neck. All investigated tumours overexpressed EGFR showing a homogenous distribution pattern. Pretreatment of tumours (eg. chemotherapy or radiation) did not influence this result. Our findings indicate that EGFR expression is not strongly correlated to proliferative activity, and is not suited to be used as a prognostic marker. It is possible that the observed overexpression of EGFR in squamous cell carcinomas of head and neck can be used as a target for ligand-complexed drugs.

Since 1972, the principles of the T classification of glottic carcinomas have remained unchanged. Nevertheless, discrepancies between T-classification and post-therapeutic pT classification are reported repeatedly and doubts have been expressed about the reliability of this system. Our T classification is based on pathohistological investigations performed 20 years ago. Therefore, the origin of the above-mentioned discrepancies must be sought in the definition and the clinical diagnostics. First, problems of the T classification of glottic cancer are analyzed and discussed on the basis of conditions which must be fulfilled by each classification: (1) clearly defined boundaries of the anatomical regions; (2) clearly defined rules for classification; (3) practicability for the clinician as well for the pathologist and comparability for both, and (4) prognostic relevance. Second, a new definition of the glottic region is proposed. It should be confined to the extension of the vocal ligaments, their anterior commissure and the medial surface of the arytenoid cartilages, including Reinke's space and the epithelial layer covering all the described areas. This is because the glottic region is confined to anatomical areas with reduced lymphatic drainage and a connective tissue barrier. The proposal is based on an anatomical and morphometric investigation of 154 larynx specimens. Third, 403 glottic carcinomas, treated between 1970 and 1984 were classified by the current T classification and histologically by pT classification (UICC 1987). By comparing these two classifications it was established that the early carcinomas had been overestimated and the advanced carcinomas underestimated.(ABSTRACT TRUNCATED AT 250 WORDS)

An 25 „Neckblöcken“, die im Rahmen von Primärtumoroperationen der Mundhöhle (4/pT1, 4), des Oropharnyx (14/pT1−4) und des Larynx (7/pT1−4) gewonnen wurden, wurde die Trefferquote von Lymphknotenmetastasen sowie die p-N-Klassifikation in Abhängigkeit von der Anzahl untersuchter Lymphknoten/Neckblock und der angewandten histologischen Methodik untersucht.

Three different proliferation-associated monoclonal antibodies have been studied immunohistochemically to evaluate their prognostic value in patients with squamous cell carcinomas of head and neck. The monoclonal antibody Ki 67 shows a heterogeneous distribution pattern, whereas epidermal growth factor receptor and transferrin receptor expression show a homogeneous one. Concluding from our results the chances to use the described monoclonal antibodies as prognostic markers are limited.

43 Patienten mit Plattenepithelkarzinomen der Mundhöhle und des Oropharynx der Stadien III und IV wurden einer zytostatischen Induktionstherapie mit Cisplatin und Bleomycin zugeführt. - Zwei Wochen nach Abschluß der Chemotherapie wurde eine Tumorresektion in den vorgegebenen Grenzen mit Ausräumung der regionären Lymphknoten vorgenommen. Anschließend wurden die Tumorpräparate und Neck-dissection-Blöcke serienmäßig aufgearbeitet und lichtmikroskopisch beurteilt. In allen 43 Fällen fanden sich noch Karzinomzellverbände unterschiedlichen Ausmaßes. 35 Präparate zeigten eine gute Tumorverlustrate von über 50% nach der zytostatischen Therapie mit von Keratin und Nekrosen ausgefüllten pseudomakro- und mikrozystischen Tumorarealen, umgeben und durchflochten von bindegewebigen Zügen. Bei 10 Patienten wurde eine komplette klinische Remission festgestellt, mikroskopisch konnten unter regelrechtem Epithel Tumorzonen nachgewiesen werden. Acht der 43 Resektate zeigten eine Tumorverlustrate von deutlich unter 50% mit nur kleinherdigen Nekrosebezirken. Exophyten sprachen besser an als Endophyten, bei denen mehrfach in der Tumorperipherie isolierte Karzinomzellverbände nachgewiesen werden konnten.

Three treatment groups (hydroxyethyl starch-pentoxifylline (HAES-steril/Trental), hydroxyethyl starch-pentoxifylline-naftidrofuryl (HAES-steril/Trental/Dusodril) and dextran-pentoxifylline (Rheomacrodex/Trental] and a placebo therapy control group (normal saline) were compared in a prospective randomised study (102 patients) and a retrospective study (292 patients). The trial therapy results were the same in all groups. However all treatments on patients with a haemoglobin greater than 14 g/l result in a significant hearing improvement compared with the placebo. The patient group with systolic blood pressure greater than 130 mm Hg treated with hydroxyethyl starch-pentoxifylline had a significant hearing improvement compared with the placebo, hydroxyethyl starch-pentoxifylline-naftidrofuryl and dextran-pentoxifylline. With increasing systolic blood pressure, patients in the placebo, hydroxyethyl starch-pentoxifylline-naftidrofuryl and dextran-pentoxifylline groups had a statistically significant worse result.

These tumours showed a correlation between Ki 67 labelling index and histological differentiation: poor differentiation resulted in a Ki 67 labelling index from 30 to 50%, high differentiation below 20%. Labelling index of moderately differentiated carcinomas ranged between these values. Pretreatment of tumours, i.e. chemotherapy and radiotherapy, resulted in a labelling index of less than 6%. The observed heterogeneity must be considered as a limitation for using the monoclonal antibody Ki 67 in these cases as a prognostic marker.

At the University ENT Clinic Frankfurt 105 patients with zygomatic fractures were treated from 1980 until 1986: 45 were treated with a maxillary sinus stent, part of them in combination with wire osteosynthesis, miniplate osteosynthesis was performed in 30 patients, some fractures seemed stable after reposition without fixation. The zygomatic fractures are classified into 3 types requiring different surgical treatments. Comparing the long term results of these methods with the pre- and postoperative radiological and functional data, patients with type 2 and 3 fractures do better with miniplate osteosynthesis than with the other treatments. In combination with an orbital floor fracture, the degree of enophthalmus is more severe in those patients where fractures were only repositioned without fixation.