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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.

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.

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.

Between 1962 and 1971, 221 patients (197 men and 24 women) with carcinoma of the supraglottic larynx were treated at our institution. Most of the patients were in the sixth and seventh decades of life. In 89% of the patients, the epiglottis was involved. One hundred ninety patients underwent surgery, 161 for cure initially and 29 for salvage after radiation failure. Definitive surgery included laryngectomy in 117 patients and conservation procedures in 40. Fifty-five patients were treated by radiation for cure. Survival rates after laryngectomy or supraglottic laryngectomy were similar, but radiation therapy carried a poorer prognosis than did definitive surgery. Routine neck dissection was not necessary in all patients with supraglottic carcinoma.

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.

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.

The composite resection operation with sacrifice of a portion of the hemimandible is considered to be the fundamental operation for cancers in the posterior oral cavity. The mandible is resected for cancer control (to ease reconstruction) and perhaps for traditional reasons. Mandibular sacrifice is not always essential for oncologic resection. Access through the mandible is usually required for effective resection of cancers in this region. The lateral mandibular osteotomy approach provides this access in selected patients. The adjacent, remaining portion of the tongue provides 75 to 100 sq cm of thick pliable vascular mucosa that can be used for closing the defects after resection of the cancer in the posterior oral cavity. As much as one half of the tongue can be rotated. If certain precautions are taken, a viable flap can be assured even after radiation treatment or ligation of the ipsilateral lingual artery.

Between 1962 and 1972, 190 patients with squamous cell carcinoma of the hypopharynx were seen; 162 received primary treatment at our clinic. Of the 162 lesions, 117 (72%) originated in the pyriform sinus. The most frequent symptom was pain in the throat (87 patients, 54%). One hundred twenty six patients (78%) had tumors extending beyond the hypopharynx (T3 lesions), and 108 patients (67%) had cervical metastasis (stage III or IV). Treatment modalities included surgical excision in 82 patients, radiation in 39, planned combination of preoperative radiation followed by surgery in 18, radiation plus neck dissection in 15, and surgery plus postoperative radiation in eight. Sixty-nine patients (43%) had recurrent tumor. Recurrences were equally frequent in the primary site and the neck. Comparison of treatment modalities showed no differences in overall recurrence. Surgery alone or in combination with radiation reduced the incidence of local recurrence; however, when recurrences were analyzed in relation to stage of lesion, preoperative or postoperative radiation and surgery offered no advantage over surgery alone in reducing local or neck recurrence or in overall survival rate. Treatment by radiation alone was associated with a poorer survival. For the entire group, three-year survival was 52% and five-year survival was 47%.