The records of 66 patients with osteosarcoma of the jaw were reviewed. The ages of the 42 males and 24 females ranged from 12 to 79 years (mean, 34.2 years). Swelling and pain, the most frequent presenting complaints, were noted an average of three months before the patient was seen by a physician. Fifty-one percent of the lesions involved the maxilla and 49% involved the mandible. The most common sites of involvement were the body of the mandible and the alveolar ridge of the maxilla. Radiologically, most of the lesions in the maxilla were osteoblastic (50%), whereas most of those in the mandible were osteolytic (43%). Chondroblastic osteosarcoma was the most frequent histologic type (48%) and was associated with the best survival rate (47%). Treatment included radical and local surgery with radiotherapy, chemotherapy, or various combinations. The recurrence rate for all treatment modalities was 70%. Patients treated by initial radical surgery had the best survival (80%). Survival decreased to 27% with local surgery. Of the 43 (65%) patients who died, most died with uncontrolled local disease; only four patients had documented distant metastasis, which involved lung, cervical lymph nodes, spinal column, and brain.

From 1950 through 1975, 54 patients with mucoepidermoid carcinoma of the oral cavity were treated at the Mayo Clinic. Metastatic disease occurred in 13 patients; nine patients died of their disease. Mucoepidermoid tumors of the hard palate should be treated by partial maxillectomy. Complete neck dissection is necessary for tumors larger than 2 cm in the base of the tongue. Other intraoral mucoepidermoid carcinomas are treated by wide surgical excision.

From 1949 to 1974, 17 patients with sarcomas of the larynx were treated at the Mayo Clinic. Histologically, the sarcomas were classified as fibrosarcoma (six tumors), chondrosarcoma (seven tumors), rhabdomyosarcoma (three tumors), and osteosarcoma (one tumor). Patients with chondrosarcomas tended to differ from patients with other sarcomas in respect to origin of the sarcoma and length of survival free of disease.

At the Mayo Clinic from 1962 to 1974, 182 patients with early squamous cell cancer of the true vocal cord were treated by laryngofissure and cordectomy. Seven patients (4%) had recurrences: four in the larynx and three in the neck (although the larynx was free of disease). The case histories of these patients are reported. Only three (2%) of the patients died as a consequence of their laryngeal cancer. The data substantiate our belief that the laryngofissure and cordectomy operation, and its minor variations, is an expeditious and highly successful means of eradicating glottic cancers.

After resection of a hypopharyngeal cancer, utilization of the remaining pharyngeal mucosa in restoring pharyngoesophageal continuity is the procedure of choice. This is possible in most patients. However, a few patients have cancers that involve the posterior pharyngeal wall and esophageal introitus. Resection in this group involves complete removal of a segment of the laryngopharynx and reconstruction with the use of tissue from the adjacent side of the neck, chest, or alimentary canal. Between 1965 and 1974, 44 patients required reconstruction of a pharyngeal defect with the use of adjacent skin flaps or visceral interposition. Pharyngeal reconstruction with the use of these techniques involved multiple operative procedures, a greater morbidity, and a large time investment by the patient and surgeon. Survival of these patients was shorter than survival of patients who had repair by primary closure of the pharyngeal mucosa because of the extent of the primary lesions.

Mixed tumors are unusual in that they possess both epithelial and mesenchymal elements. The proportions of the two elements vary greatly; the lesions with a pronounced preponderance of epithelial tissue have been called cellular mixed tumors. This increase in epithelial cellularity often results in misdiagnosis or in concern that the tumor may be more aggressive than the ordinary mixed tumor--possibly even malignant. We have reviewed 1,095 consecutive parotid tumors that were removed at the Mayo Clinic, Rochester, Minn, from 1950 through 1970. Ninety-three of the lesions were diagnosed initially as cellular mixed tumors, and slides were available for review. Of these 93, 43 fulfilled our criteria of having greater than 80% of each tumor composed of the packed epithelial cells. All tumors had a corresponding reduction in the mesenchymal portion. The records of the 43 patients were studied to determine the clinical behavior of these neoplasms, particularly with regard to recurrence, metastasis, and malignant transformation. Our findings confirmed our clinical suspicions that some of these cellular mixed tumors, notably those that showed histopathologic evidence of an increased rate of mitotic activity, can and do act in a more aggressive manner.

We have presented a series of 19 new cases of granular cell tumors of the tongue. This benign condition is often difficult to diagnose if an adequate biopsy specimen has not been obtained. Insufficient biopsy material that includes only the overlying pseudoepitheliomatous hyperplasia may distort the pathologic picture. Review of frozen sections should provide an accurate diagnosis, and local surgical excision should resolve the problem completely.

After extensive evaluation of patients with metastatic neck disease and clinically undetectable primary cancer of the head and neck, the clinician is often faced with the difficult question of subsequent management. In this study, sera from 11 patients with clinically occult carcinoma and metastatic lymphadenopathy were studied for Epstein-Barr virus-associated antigens. These were compared with 35 sera from patients with known nasopharyngeal carcinoma at all stages of disease and treatment and with 212 sera from control patients with other head and neck tumors, patients with lymphoma, and normal controls. There was a significant correlation between high antibody titers to Epstein-Barr virus, especially in the serum IgA fraction, and the presence of nasopharyngeal carcinoma. Thus, identification of occult nasopharyngeal carcinoma by immunologic means may have important application in the selective management of the patient with an unknown head and neck primary malignancy.

There appears to be a total of five cases of chondrosarcoma of the hyoid bone (not all associated with Gardner's syndrome). The case reported herein is one that was first reported in the literature on Gardner's syndrome and the second reported instance of a patient with Gardner's syndrome who had a malignant bone tumor.

Thirteen patients, six men and seven women, were seen at the Mayo Clinic with chondrosarcomas of the nasal cavity, paranasal sinuses, or nasopharynx in a 25-year period. Nasal obstruction, discharge, and bleeding were the major symptoms and a nasal mass was the most common sign. The typical chondrosarcoma is low in grade but malignant and it arises in the nasal cavity as a large, pale, glistening mass. Local excision was employed initially in seven patients and five had local recurrence. Definitive block excision cured four of six patients and the two others had a protracted clinical course and ultimately died of the disease. Long-term follow-up shows that chondrosarcomas are insidious, locally progressive tumors. Radiotherapy, used for palliation after recurrence, failed to produce any cures. Lateral rhinotomy and block excision are advocated as the primary treatment.

Inverting papilloma of the nose and paranasal sinuses has been classified as a true neoplasm by most authors. It is distinct from the ordinary nasal polyps in that it has a different cause, different histologic features, a higher recurrence rate, and is occasionally associated with carcinoma. This study includes 57 patients seen over a 30-year period who had inverting papilloma and for whom the history, clinical and radiologic findings, treatment methods, pathologic sections, and recurrences were analyzed. Features associated with higher recurrence rate were epithelial atypia and extent of lesions. Females showed higher recurrence rates than males. External approaches (lateral rhinotomy) reduced recurrence remarkably compared with transnasal removal (13 percent versus 45 percent). Four patients had associated carcinoma with inverting papilloma, and more extensive operations were perfomred in these cases; one patient died of the tumor. Radical aggressive treatment and careful follow-up are advocated because of the higher recurrence rate after inadequate removal and because of possible malignant transformation.

Treatment for glottic cancer is at best a compromise. Objective must be related to the stage of the disease. Life prevails over voice. The data seem available now for making the decision that will provide the best chance for prolonged disease-free life. When laryngectomy is the most likely way to cure, then laryngectomy should be recommended.

In 18 years, olfactory neuroblastomas were encountered in 19 patients at the Mayo Clinic. Surgery offers the best chance of long-term survival; however, radiation therapy is a valuable therapeutic adjunct.

Plasmacytomas, indistinguishable histologically from plasma cell tumors arising in bone marrow, occur almost anywhere in the body-usually independently of multiple myeloma. Thus, they represent an isolated area of plasmacytic dyscrasia but occasionally can be the first evidence of multiple myeloma. From 1949 to 1974, six patients with solitary extramedullary plasmacytomas of the larynx were seen at the Mayo Clinic; during this period, approximately 3,100 patients with malignant laryngeal neoplasms were examined. For these six patients, the median age was 53 years (range, 32 to 63 years). The first symptom in five patients was hoarseness (mean duration, nine months). Excision, electrocoagulation, irradiation, or some combination of these constituted effective therapy. Follow-up ranged from 3 to 25 years. The choice of therapy depends on the size, shape, and location of the tumor. Extensive surgery is rarely necessary.

Supraglottic cancer differs importantly from glottic cancer; symptoms from it are more obscure and neck metastasis is more frequent and presents a more complex treatment problem. Combined therapy for intrinsic supraglottic cancers seems excessive and not helpful for increasing survivorship.

Verrucous carcinoma, because of its oftentimes unusual clinical appearance, may be misdiagnosed if there is not good communication between the surgeon and the pathologist. We have reviewed our series of 20 cases of verrucous carcinoma from 1964 through 1974 and have analyzed the results of our therapy. We have concluded that verrucous carcinoma is a slow‐growing, locally invasive lesion that does not metastasize to the cervical lymph nodes. Radiation therapy does not seem to be an effective method of treatment; the recurrence rate is high. Conservative laryngeal surgery is the preferred method of treatment in these patients and should prevent loss of life and spare laryngeal function.

Granular cell tumors of the larynx are relatively uncommon, always benign, and most commonly located in the posterior portion of the larynx. They are easily identified and should be differentiated from other lesions. A possible problem in the differential diagnosis is the presence of pseudoepitheliomatous hyperplasia, which overlies the granular cell tumor and which may mimic squamous cell carcinoma. Careful histopathologic differentiation is important because the laryngeal granular cell lesion should be managed conservatively, with transoral local excision usually being adequate. The histogenesis of these lesions remains in doubt, with a neural or epithelial derivation being the most likely possibility.