1/27. erythroplasia of Queyrat treated by topical aminolaevulinic acid photodynamic therapy. erythroplasia of Queyrat (EQ) is an intraepithelial carcinoma in situ affecting the mucosal surfaces of the penis, with a significant risk of invasion and metastasis. Treatment is often difficult and is associated with significant recurrence rates. Topical 5-aminolaevulinic acid (ALA) photodynamic therapy (PDT) combines a photosensitizer precursor and visible light to produce a photodynamic effect. It has been used successfully to treat benign, premalignant and malignant skin diseases. We present four patients with EQ who have been treated by topical ALA PDT. Of two patients with limited disease one has achieved a long-term complete response (36 months) and the other developed a recurrence at 18 months after a complete response. Two further patients with more extensive disease achieved a significant improvement, allowing easier treatment by laser vaporization. Although topical ALA PDT offers the advantages of tumour specificity, preservation of function and a good cosmetic result, more extensive EQ appears less responsive to this new therapeutic modality using current treatment parameters. ( info) |
2/27. Oral precancerous and malignant lesions associated with graft-versus-host disease: report of 2 cases. The development of secondary malignancies has been recognized as a potential iatrogenic complication in patients who have graft-versus-host disease secondary to bone marrow transplantation. Lymphohematopoietic cancer is most frequent, although solid malignancies have also been reported. We describe 2 patients with graft-versus-host disease who developed oral precancerous and malignant lesions. The first patient, a 24-year-old white man, had erythroplakia of the buccal mucosa that proved to be carcinoma in situ histopathologically. The second patient, a 14-year-old Hispanic boy, developed synchronous cutaneous and lingual squamous cell carcinomas. The current cases and similar sporadic case reports found in the literature highlight the susceptibility of patients with graft-versus-host disease to the development of oral cancer. Therefore, it is recommended that thorough evaluation of the oral mucosa and close follow-up be offered to all patients treated with bone marrow transplantation and particularly to those who develop graft-versus-host disease. ( info) |
3/27. Imiquimod 5% cream in the treatment of human papillomavirus-16-positive erythroplasia of Queyrat. erythroplasia of Queyrat is a human-papillomavirus-associated carcinoma in situ of the penis. Imiquimod, a new topically applied immunomodulatory agent, has been successfully used in the treatment of anogenital warts. We report the complete clearance of HPV-16-positive erythroplasia of Queyrat with 5% imiquimod cream. ( info) |
4/27. Studies on pure red cell aplasia. maintenance therapy with immunosuppressive drugs. Two patients with pure red cell aplasia, whose marrow cells were capable of increasing their rate of haem synthesis when incubated in vitro with erythropoietin concentrate, had a complete remission associated with the administration of cyclophosphamide and prednisone. Both patients relapsed when the drugs were withdrawn. The patients again went into remission when therapy was reinstituted. maintenance of normal erythropoiesis was dependent on the continued administration of these drugs. This study provides additional evidence for a causal relationship between immunosuppressive therapy and the resumption of erythropoiesis in patients with this disease and demonstrates the value of this therapy for the maintenance of a remission. ( info) |
| bowen's disease of the skin may have differing clinical presentations depending on the skin surface on which it presents, but has the same histologic features of squamous cell carcinoma in situ wherever it occurs. The etiologic factors include ultraviolet light and human papillomavirus infection. The choice of therapy requires a consideration for retention of form, function and cosmosis while offering a high cure rate. The immunodualtory agent imiquimod has been shown to be an effective treatment on a variety of skin surfaces. ( info) |
6/27. erythroplasia of Queyrat treated with topical methyl aminolevulinate photodynamic therapy. An 82-year-old man presented with invasive squamous cell carcinoma of the glans penis arising in erythroplasia of Queyrat. He underwent Mohs' micrographic surgery for the invasive carcinoma. Seven weeks later, the residual erythroplasia of Queyrat was treated using photodynamic therapy. Methyl aminolevulinate cream was applied to the glans of the penis under occlusion for 3 hours and then, after local anaesthesia, irradiated with a 630-nm red-light-emitting diode lamp at a dose of 37 J/cm(2) for 8 min. The patient experienced some mild swelling, redness and pain, which subsided over the following 5 days. Eighteen weeks after photodynamic therapy, there had been no recurrence of the lesion, when the patient died from an unrelated cause. ( info) |
7/27. Very early cytological and dna-cytometric diagnosis of in situ carcinoma in an immunosuppressed liver transplant recipient. BACKGROUND: We describe a patient with an in situ carcinoma with the clinical presentation of an erythroplakia of the tongue in an area where dna-aneuploidy was detected by means of exfoliative cytology (EC) and dna-image-cytometry 32 months before. methods: Brush- and scalpel biopsies were obtained from a suspicious lesion of the right border of the tongue prior to scalpel biopsy. After Feulgen restaining of the specimens on glass slides, nuclear dna-contents were measured using a TV image analysis system. RESULTS: A small reddish lesion of the tongue was diagnosed as malignant through EC and dna-image-cytometry, whereas the synchronous histology from the same area showed only mild dysplasia. A subsequent scalpel biopsy 32 months after the first examination showed an in situ carcinoma. CONCLUSIONS: Non-invasive brush biopsies are of great importance for the very early identification of mucosal areas with a high risk for malignant transformation through cytological and dna-cytometric examination. ( info) |
8/27. erythroplasia of Queyrat with urethral involvement: treatment with carbon dioxide laser vaporization. BACKGROUND: erythroplasia of Queyrat is an uncommon carcinoma in situ that usually arises on the mucosa of the glans penis or prepuce as red, shiny, sharply demarcated velvety plaques. The treatment is often difficult and associated with significant recurrence rates, especially in cases with urethral involvement. OBJECTIVE: To evaluate carbon dioxide laser treatment in a case of erythroplasia of Queyrat with urethral involvement. MATERIALS AND methods: We report a patient with erythroplasia of Queyrat involving the urethra who was treated with carbon dioxide laser vaporization. RESULTS: Treatment with carbon dioxide laser vaporization resulted in an excellent cosmetic and functional status outcome for the glans penis and urethral lesions. CONCLUSION: carbon dioxide laser vaporization is probably the initial elective treatment for erythroplasia of Queyrat with urethral involvement in young immunocompetent patients. A follow-up is necessary, and new sessions of treatment should be quickly performed if recurrence occurs. ( info) |
9/27. erythroplasia of Queyrat treated with imiquimod 5% cream. Imiquimod is an immune response-modifying agent with potent antiviral and antitumor activity effective in the treatment of various skin disorders, including in situ carcinoma of the skin (bowen's disease). The case of a 64-year-old man affected by an in situ carcinoma of the glans mucosa, namely erythroplasia of Queyrat, successfully treated with imiquimod 5% cream is described. Because the results of tests for human papillomavirus infection were negative in this case, we suggest that imiquimod may have acted through an antitumor effect mediated by cytokine activation. This compound may represent an alternative treatment in patients with erythroplasia of Queyrat, although the dosing schedule and treatment duration require further evaluation. ( info) |
10/27. Spindle-cell carcinoma: a case report. An unusual case of an exophytic spindle-cell carcinoma of the maxilla arising from an area of erythroplakia is presented. The epithelial nature of the spindle cells was demonstrated by electron microscopy and immunohistochemistry. After initial surgery the tumour recurred and was then extensively infiltrative and rapidly destructive. magnetic resonance imaging (MRI) revealed an invasive tumour of the contra-lateral maxillary antrum suggesting a multicentric origin. ( info) |