Eighteen patients (10 women and 8 men), ranging in age from 37 to 80 years, with thyroid carcinoma infiltrating the trachea comprised this series. Eleven had primary and 7 had recurrent cases. Total laryngectomy was performed in 4 patients, and tracheal resection was carried out followed by end-to-end anastomosis in 13 patients. In one patient, reconstruction was done with Naville's artificial trachea after tracheal resection. Eleven patients were alive after 1 year and 8 months to 6 years and 7 months after the operation. This result was significantly better than that of a group of ten patients without resection of the infiltrated trachea (seven patients died within 6 months). Thus, combined resection of the upper airway improved the prognosis of advanced thyroid carcinoma with tracheal infiltration. Histologic examination of surgical specimens demonstrated well-differentiated carcinoma in seven patients, poorly differentiated carcinoma in seven patients, undifferentiated carcinoma in three patients, and squamous cell carcinoma in one patient. The result showed a higher frequency of poorly differentiated carcinoma than in the control group of 70 patients without tracheal infiltration.

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SUMMARYWe have recently reported isolation of a new human papilloma virus (HPVNF) from red plaques of a patient (NF) with epidermodysplasia verruciformis. The HPV DNA was molecularly cloned in Escherichia coli X1776 using plasmid pBR325. We have constructed a detailed physical map of the cloned DNA, which should be useful for examining the relationship of HPV and skin carcinoma.Epidermodysplasia Verruciformis (EV) is a chronic skin disease caused by human papilloma virus (HPV) (Lewandowsky & Lutz, 1922;Orth et al., 1978). EV converts to squamous cell carcinoma in 30 % of the cases (Jablonska et al., 1972;zur Hausen, 1977;Lutzner, 1978;Orth et al., 1979). The HPV DNAs isolated from flat warts or macular lesions of EV patients have been analysed using restriction endonucleases, and several types of HPV, including 3, 5, 8, and 9, have been found in EV lesions (Orth et al., 1978;Pfister et al., 1981;Green et al., 1982;Kremsdorf et al., 1982). HPV-5 DNA has been reported to exist in carcinoma cells as unintegrated, free viral DNA (Orth et al., 1980;Ostrow et al., 1982). Although HPV is strongly suspected of being involved in carcinogenesis, little is known about this virus in comparison with other papovaviruses such as polyoma virus and SV40. This is due in part to the narrow host range of HPV and absence of a system for virus propagation in cultured cells.Recently, we isolated a new HPV from an EV patient (NF), a 24 year-old man (Yutsudo et al., 1982). The cutaneous lesions of NF were red plaques with pityroid scales on the surface. The molecular weight of isolated HPV DNA was 5.0 x 106. The DNA was cleaved at one site with EcoRI or BglI, two sites with HindlII, three sites with BamHI or XbaI, and at more than five sites with HindlI. This cleavage pattern differs from those of other types of HPV reported so far. To elucidate the functions of HPV genes and their role in carcinogenesis, a means of efficiently preparing large amounts of DNA is necessary. Unfortunately, the new virus, like other HPVs, does not replicate in cultured cells. We therefore carried out experiments to clone the DNA of this HPV.HPV DNA used for cloning was extracted from red plaques of patient NF. Form I DNA was purified by caesium chloride-ethidium bromide density gradient centrifugation as described previously (Yutsudo et al., 1982). HPV DNA was cut with EcoRI, producing linear DNA which was then ligated into the EcoRI site of plasmid pBR325 (3.6 x 106 daltons). The single EcoRI site in pBR325 lies within the gene coding for chloramphenicol resistance. After digestion with EcoRI, pBR325 DNA was treated with bacterial alkaline phosphatase. The cleaved HPV and plasmid pBR325 DNAs were mixed at a ratio of 2 : 1 (i.e. 0.2 p.g of HPV DNA and 0.1 lag of pBR325 DNA) in a ligation mixture (20 ~tl) containing 50 mM-Tris-HC1 pH 7.8, 10 mM-MgCI2, 20 mM-dithiothreitol, 1 mM-ATP, 50 ~tg/ml bovine serum albumin, and 3 units ofT4 DNA ligase (New England Biolabs, Beverly, Mass., U.S.A.). After incubation for 15 h at 4 °C, the DNA was precipitated, resuspende...

In order to investigate the possibility of local recurrence in the pectoral muscles of patients who undergo modified radical mastectomies, the cancer cell involvement of the lymphatics associated with the pectoralis major muscle was studied in 39 patients who underwent a standard radical mastectomy for Stage I-III breast cancer. Cancer cell emboli were found in the transpectoral lymphatics of 2 patients (2/39 = 5.1 per cent) and in the pectoral fascial lymphatics of 6 patients (6/39 = 15.4 per cent). Two patients with fascial lymphatic cancer cell emboli were from a group of 14 patients with intramammary lymphatic tumor emboli of a low degree (ly 1). The other 6 patients with cancer cell emboli in either the pectoral fascia or the transpectoral lymphatics were from a group of 11 patients with intramammary lymphatic tumor emboli of a moderate degree (ly 2). There was a significant relationship between the intramammary and the pectoral lymphatic cancer cell emboli (Chi square test: (p less than 0.05). The results of this study therefore indicate that lymphatic cancer cell emboli in the pectoral fascia and muscle are an important risk factor for patients who undergo a modified radical mastectomy.

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