Squamous cell carcinoma of the lower lip: FAS/FASL expression, lymphocyte subtypes and outcome

Squamous cell carcinoma (SCC) of the lip is a relatively common malignancy of the head and neck region. Tumour thickness, grading and perineural invasion are significant prognostic indicators. However, there is still the need of new reliable biological markers able to predict the prognosis of the single cases with an unfavourable biological behaviour unpredictable by the classic clinical-pathological parameters. 32 cases of (SCC) of the lower lip were analysed for their clincopathologic features, and immunohistochemical expression of Fas/FasL in neoplastic cells and in inflammatory infiltrate. Moreover the density and phenotype of tumour-infiltrating lymphocytes (TIL) were analysed. The results were related with the follow-up of the patients ranging from 2 to 6 years. The cases with over-expression of Fas/FasL in neoplastic cells and Fas+ in T cells preferentially showed a more aggressive clinical behaviour (P<0.01). Moreover we found an alteration of the normal expression of CD4 and CD8 lymphocyte types in ten cases. This data suggest that the Fas/FasL pathway is involved in the close relation between neoplastic cells and T cells and so in the biological behaviour of these tumours.

[The role of aldosterone in the development of postinfarction fibrosis]

Aldosterone was discovered in 1953, and until the beginning of the 1960s, when spironolactone was developed, it was the focus of considerable interest among the scientific community. The following 30 years represented a sort of Dark Age, interrupted by the Weber's classic studies. He first demonstrated the pivotal role of aldosterone in the promotion of cardiac hypertrophy and fibrosis and such an observation represented a solid background for the implementation of large survival trials, the RALES and the EPHESUS. These landmark studies showed that aldosterone receptor blockade prolongs survival in advanced and postinfarction heart failure, respectively. After a myocardial infarction, there is a significant upregulation of the local steroidogenic system in the area remote from the scar, that leads to a remarkable fibroblast activation, collagen deposition, and reactive fibrosis. Fibrosis in turn further impairs systolic and diastolic function, and induces electrical heterogeneity with attendant ominous arrhythmias. The following review will dwell upon the importance of fibrosis in postinfarction heart failure, the role of aldosterone, and the novel therapeutic approach based on mineralocorticoid receptor blockade.

Cyclooxygenase-2 expression in oral squamous cell carcinoma

Cyclooxygenase (COX), the key enzyme in prostaglandin cascade, is expressed in two isoforms: the constitutive COX-1 and the inducible COX-2. Hyper-expression of COX-2 has been implicated in the pathogenesis of colon-rectal cancer in humans but it appears to play a significant role as a tumour progression factor also in other forms of human cancer, including oral cancer. The aim of this study was to analyze the expression of COX-2, at the protein level, in 45 cases of oral squamous cell carcinoma. Standard immunohistochemical streptavidin-biotin peroxidase analysis was carried out with highly specific antibody against human COX-2 and cell specific markers, in 45 oral squamous cell carcinomas. Our study revealed a moderate to high COX-2 expression in 35 out of the 45 oral squamous cell carcinoma specimens (77.8%). COX-2 expression appeared particularly abundant in the superficial ulcerated layers of relatively well differentiated carcinomas. However, we were unable to assess any statistically significant association between COX-2 hyper-expression and tumor site, tumor grading, tumor size, presence of lymph node metastases, tumor stage and age at onset, respectively. Interestingly, COX-2 expression was detected not only in areas of epithelial dysplasia adjacent to the primary layers (86% of the cases) but also in normal-appearing epithelium at the boundaries of squamous cell carcinoma (77%), indicating a possible involvement in tumour progression by the apparently normal tissue surrounding the lesion. Moreover, intense COX-2 staining was observed in endothelial cells of intra-tumour vessels and extra-tumour vessels adjacent to the tumour nests, in a high proportion of cases (82%). COX-2 positivity was associated with CD34 and VEGF positivity, indicating that these vessels were probably neo-formed ones. From this study as well as from other works, it appears that indeed COX-2 is over-expressed in this important human malignancy. However, further studies are necessary to understand the exact magnitude of this over-expression and, mostly, the possible role of COX-2 in the pathogenesis and progression of oral cancer.

Proliferative verrucous vs conventional leukoplakia: no significantly increased risk of HPV infection

Proliferative verrucous leukoplakia (PVL) is a very aggressive form of oral leukoplakia (OL) with high morbidity and mortality rates, hypothesised to be linked to HPV infection. This study aimed to determine the presence of HPV DNA in PVL in comparison with OL, and in relation to social-demographical variables (age, gender, smoking and drinking habits) in an Italian multi-centric hospital-based study. The study group consisted of 58 cases of PVL and 90 cases of OL as controls (47 homogeneous (H) and 43 non-homogeneous (non-H) form), both recruited from four Italian cohorts. HPV DNA was identified in exfoliated mucosal cells by nested PCR (nPCR) with MY09/MY11 and GP5+/GP6+ primer pairs and the HPV genotype determined by direct DNA sequencing. HPV DNA was found in 24.1% (14/58)of PVL and in 25.5% (23/90) of OL; there was thus no significant difference found between PVL and OL (both forms) for risk of HPV infection (OR=0.93; 95% IC:0.432-1.985). Similarly, in both groups of PVL and OL lesions, no statistic association was found between any demographical variable considered and HPV infection. HPV-18 was the most frequently detected genotype in all tissues, being found in 78.5% and 60.8% of HPV+ve PVL and OL, respectively. Other more rarely detected genotypes were HPV-16 (28.6% in PVL and 13% in OL), HPV-6 (17.4% in OL) and HPV-53 (8.8% in OL). PVL does not appear more likely to be associated to HPV infection than conventional OL lesions.

Oral squamous cell carcinoma during long-term treatment with hydroxyurea

Hydroxyurea (HU) is commonly used for the treatment of chronic myelogenous leukaemia, polycythemia vera and essential thrombocythaemia. Patients receiving HU present a number of side-effects including skin/mucosa changes and tumours. Mucocutaneous abnormalities include xerosis, ichthyosiform lesions, dark brown pigmentation of skin folds and nails, malleolar ulcers, oral mucositis and oral ulcers. Cutaneous squamous/basal cell carcinomas have also often been reported following long-term administration of HU. HU-induced carcinogenesis is due to both the mutagenic potential of this agent and to an impairment of DNA repair mechanisms after damage by external factors such as ultraviolet radiation. Oral cancer following long-term treatment with HU has been reported only once, in a patient with concomitant multiple skin tumours. We present the unique case of a patient with polycythemia vera who developed oral cancer after 15 years of HU therapy.

Immune response in patients with oral lichen planus and HCV infection

In recent years an association between oral lichen planus (OLP) and HCV infection has been reported, but the frequency of this association seems to differ in the various geographic areas. It is clear, instead, that some abnormalities occur in the immune-regulation mechanisms of patients with OLP and it is thought to be due to the chronic antigenic stimulus of HCV that causes functional disorders of the immune system in infected patients. Possible immunologic difference between 17 patients with OLP and HCV+ and 17 patients with OLP and HCV- were investigated using standard immunofluorescence and flow cytometry techniques. The distribution of T and B cells was normal in all patients examined, while NK CD56+ cells were increased, above all in HCV- patients. About 65% of T CD4+ lymphocytes coexpressed the CD45RO isoform (p=0.002), while approximately 32% expressed CD45RA, without significant differences in comparison to HCV+ subjects (p>0.05). Moreover, almost all the CD4+CD45RO+ subpopulation coexpressed CD29 in all patients examined. No significant differences between the two groups of patients were detected as to the increase of cytotoxic T CD8+CD57+ lymphocytes. The B cells CD19+CD5+ responsible for the production of "natural" antibodies were detectable in both the examined groups, even if not in all HCV+ subjects (30% +/- 10.1 in HCV- and 27% +/- 19.4 in HCV+ patients; p=0.47). These findings suggest the existence of differences in lymphocyte subpopulations between OLP-HCV+ subjects and OLP-HCV- patients.

HSP 27 as possible prognostic factor in patients with oral squamous cell carcinoma

HSP27 belongs to the Heat shock protein (HSP) family, which plays essential functions in cells under physiological conditions and prevents stress-induced cellular damage. The aim of this study was to investigate the biological role of HSP27 in oral tumorigenesis.

MATERIALS AND METHODS

Seventy-nine cases of oral squamous cell carcinoma and 10 cases of normal mucosa were analysed for HSP27 expression by immunohistochemistry. Moreover, the western blot analysis was performed on two cases of normal mucosa and five cases of OSCC.

RESULTS

Normal oral mucosa showed a suprabasal expression of HSP27. Twenty-four cases of SCC (30.7%) showed a diffuse staining for HSP27, and 48 cases (60.3%) showed instead a decrease in staining, which was diffuse, homogeneous, or with alternation of positive and negative areas in a single tumor ("mosaic" pattern). Only 7 cases of OSCC (7.5%) were completely negative for HSP27. Frequency of lymph node metastases was higher in HSP27-negative tumours (3/7, 42.8%) than in HSP-reduced (16/48, 33.3%) or positive ones (5/26, 19.2%). Regard staging, stages I and II had a higher score than stages III and IV (stage I > stage II > stage III > stage IV). There was also a statistically significant correlation between HSP27 expression and grade: HSP27 expression was reduced in poorly differentiated tumours (P < 0.05). When analysed for prognostic significance, patients with negative/reduced HSP27 expression had poorer survival rates than the group with positive HSP27 expression (P < 0.05). The statistical analysis of these findings showed no significant correlation between HSP27 expression, sex, and tumour size.

CONCLUSION

Cases with reduced expression were more aggressive and poorly differentiated. These data suggest that HSP27 expression may be useful in order to identify cases of oral squamous cell carcinoma with more aggressive and invasive phenotype providing novel diagnostic and prognostic information on individual patient survival with oral cancers.

Oro-dental manifestations in Hallopeau-Siemens-type recessive dystrophic epidermolysis bullosa

Recessive dystrophic epidermolysis bullosa of Hallopeau-Siemens (RDEB-HS) is a rare genetic disorder characterized by trauma-induced blisters, milia, acral pseudosyndactyly, and scarring. RDEB-HS patients present with a distinct pattern of oral involvement consisting of microstomia, ankyloglossia, vestibule obliteration and dental caries. In this review, we describe the orodental manifestations of RDEB-HS and present our experience in a cohort of six new cases of RDEB-HS in children aged 6-10 years, documenting the presence of microstomia, ankyloglossia and vestibule obliteration in childhood. We also show that compared with unaffected control children, RDEB-HS subjects have a greater risk of developing high caries indices with early onset, both for permanent or deciduous teeth, and a worse oral hygiene index (scored as OHI). Tooth malpositions and the cross-bite relationship between maxilla and mandible could play a major role in promoting these events. We propose that dental management of RDEB-HS subjects should commence as soon as tooth eruption begins.

Scatter factor receptor (c-Met) as possible prognostic factor in patients with oral squamous cell carcinoma

This report was performed to study the biological role of c-Met in oral tumorigenesis by analyzing its expression in relation to clinicopathological features. Seventy-three cases of oral squamous cell carcinoma and 10 of normal mucosa were analysed for c-Met expression by immunohistochemistry. Normal oral squamous epithelium showed absent or low membranous positivity in the intermediate (malpighian-spinous) layer. Fifty-seven cases (78%) of carcinoma showed immunopositivity, with a prevalently membranous positivity and scattered areas also showing a cytoplasmic localization. Sixteen cases of carcinoma (22%) showed no positivity for c-Met. Among positive tumours, well-differentiated areas showed low or absent cytoplasmic positivity, while low-differentiated areas showed both membranous and cytoplasmic positivity. There was no statistically significant correlation between c-Met expression and sex, recurrence, staging or grading. The frequency of lymph node metastases was higher in c-Met-positive tumours (17/57, 29%) than in c-Met-negative ones (4/16, 25%). When analysed for prognostic significance, patients with negative/reduced c-Met expression had better survival rates than patients with high expression. The difference between survival rates was statistically significant (p<0.05). These data suggest that c-Met expression may be useful to identify cases of oral squamous cell carcinoma with a more aggressive and invasive phenotype.

Expression and subcellular distribution of Bcl-2 and BAX proteins in serum-starved human keratinocytes and mouth carcinoma epidermoid cultures

Squamous cell carcinoma (SSC) is the most frequent malignant tumor of the oral cavity. Aberration of programmed cell death is thought to participate in cancer. Using specific antibodies a study of the expression and subcellular distribution of Bcl-2, BAX, caspase-3 and cytochrome c in normal human keratinocytes and mouth carcinoma slowly (HN) and rapidly growing (KB) cells has been carried out. In carcinoma cells depressed expression of BAX, presence in the cytosol of procaspase-3 and absence in this fraction of cytochrome c have been found. PGE2 treatment prevented cell growth depression induced by pro-apoptotic serum starvation both in control and carcinoma cell cultures. It is also shown that PGE2 promoted both in keratinocytes and KB cells expression of Bcl-2, which was accompanied in the first case by increase in its mitochondrial level. These results indicate that in carcinoma cells there is an apparent down regulation of the apoptotic cascade as compared to normal keratinocytes. Thus the possibility that down regulation of apoptosis is associated with promotion of tumor development in the oral mucosa cells seems to be supported by these observations.

Growth hormone prolongs survival in experimental postinfarction heart failure

OBJECTIVES

We evaluated the effects of growth hormone (GH) on survival in experimental heart failure (HF).

BACKGROUND

Growth hormone has been beneficial in various models of experimental HF. Whether GH also affects HF progression and survival is not known.

METHODS

A total of 119 rats with moderate myocardial infarction were randomized to receive either GH (3.5 mg/kg every other day) or placebo for 28 days. Treatment was initiated one month after coronary ligation; the follow-up lasted 13 months. In the surviving animals, Doppler echocardiography and closed-chest Millar left ventricular (LV) catheterization were performed. Apoptosis, collagen volume fraction, and capillary density in the LV zone remote from infarction were measured. The early effects of GH on apoptosis were also assessed in a subgroup of eight infarcted rats, treated as specified earlier and euthanized at one month.

RESULTS

Survival rate was 68% in GH-treated rats and 48% in the placebo group (p = 0.0377). Growth hormone had no effect on myocardial architecture, systolic function, and sarcoplasmatic reticulum calcium ATPase-2 messenger ribonucleic acid. Growth hormone improved LV relaxation; this was associated with a 50% reduction in collagen volume fraction and a 27% increase in capillary density. Growth hormone reduced the apoptotic index by 50% at one month and by 33% at 13 months.

CONCLUSIONS

Growth hormone prolonged survival of rats with postinfarction HF. This effect was associated with marked attenuation of cardiomyocyte apoptosis and pathologic interstitial remodeling in the surviving myocardium and enhanced LV relaxation.

Aldosterone receptor blockade improves left ventricular remodeling and increases ventricular fibrillation threshold in experimental heart failure

OBJECTIVES

To investigate the effects of aldosterone receptor blockade in postinfarction heart failure.

METHODS

Eighty-seven rats with moderate myocardial infarction were randomized to receive either no drug or canrenone, the active metabolite of spironolactone, 20 mg/kg/day, or ramipril, 1 mg/kg/day, or a combination of the two drugs. Treatment was initiated 1 month after coronary ligation and lasted 4 weeks. Echocardiography was performed at baseline and after 4 weeks. LV catheterization, isolated heart studies, morphometric histology, myocardial norepinephrine and SERCA-2 mRNA were assessed at the end of the treatment period.

RESULTS

Infarct sizes were 33+/-3, 32+/-3, 34+/-3, and 34+/-4% in the placebo, canrenone, ramipril, and combination groups, respectively. Canrenone attenuated LV remodeling, improved LV systolic and diastolic function, and markedly reduced interstitial and perivascular fibrosis. These effects were increased by concomitant ramipril therapy. Moreover, myocardial norepinephrine content was decreased while ventricular fibrillation threshold significantly augmented by canrenone. SERCA-2 levels remained unchanged.

CONCLUSIONS

Canrenone attenuated LV dilation and interstitial remodeling, and improved LV filling dynamics and systolic function in the rat model of postinfarction heart failure. Addition of ramipril conferred further cardioprotection. Canrenone also reduced myocardial norepinephrine content and increased ventricular fibrillation threshold. The data provide a potential explanation for the decreased sudden death observed in the RALES study. The mechanisms of action of aldosterone inhibition are still poorly understood, despite its proven efficacy in heart failure. Rats with postinfarction heart failure were randomized to receive for 1 month either no drug or canrenone, or ramipril, or a combination of canrenone and ramipril. Canrenone treatment was associated with a significant attenuation of LV dilation, better LV diastolic and systolic dynamics, and a marked reduction of reactive fibrosis. These effects were enhanced by concomitant ramipril therapy. Moreover, canrenone increased ventricular fibrillation threshold and reduced myocardial norepinephrine content. The data may explain the reduced mortality demonstrated by the RALES.

Prospective evaluation of hypertensive patients with carotid kinking and coiling: an ultrasonographic 7-year study

The aim of this study was to determine the incidence of vascular events during a 7-year follow-up evaluation in a group of 34 hypertensive patients with kinking of the internal carotid artery and 36 well-matched hypertensive control subjects. The carotid intima-media thickness (IMT) was measured at three points of the carotid bifurcation and at three points of carotid kinking on the ultrasonographic posterior wall. The mean IMT measured in the segment of the angular bending was lower than the mean values detected at the bifurcation in normal subjects and in hypertensives without carotid elongation (p < 0.01). At the carotid bifurcation of the same side of the kinking, there was an arterial IMT that was significantly lower as compared to the contralateral axis and to the measurements obtained in other hypertensive subjects. During a 7-year follow-up study, 10 vascular events occurred in the hypertensives with carotid kinking and 14 in the controls, without significant differences between the 2 groups. In hypertensives with carotid kinking, the mean IMT measured on the angular bending and at the ipsilateral carotid bifurcation was significantly lower than the values obtained at the contralateral bifurcation and in the other hypertensive subjects. In the 7-year follow-up study, moreover, the presence of carotid kinking does not impact the incidence of vascular events in the hypertensive population. Thus, the presence of carotid kinking in hypertensive subjects may not be considered a further risk factor for ischemic events.

Expression of bcl-2 in oral squamous cell carcinoma: an immunohistochemical study of 90 cases with clinico-pathological correlations

Apoptosis is a genetically determined process playing an active role in tissue size regulation, morphogenesis and removing damaged cells that could be potentially dangerous for their host. Several agents involved in apoptosis regulation, such as the bcl-2 family components, act as oncogenes and are involved in oral carcinogenesis. Aim of this study is to explore bcl-2 immunoreactivity in oral cancers and to assess its potential clinico-pathological implications. Ninety oral squamous cell carcinoma and 10 normal mucosal formalin-fixed, paraffin-embedded samples were analysed for bcl-2 expression by immunohistochemistry. Normal oral mucosa showed a cytoplasmic pattern of bcl-2 immunoreactivity in the basal cell layers. Seventy-four cases of carcinoma (83%) showed no immunoreactivity, at variance with 16 cases (17%) manifesting consistent cytoplasmic positivity. Overall, the peripheral cells of differentiating epithelial tumour islands were intensely stained, with decreasing immunoreactivity toward the centre of the neoplastic nests. Fully keratinised tumour cells showed inconspicuous or absent bcl-2 immunoreactivity. No statistically significant correlations could be demonstrated between bcl-2 immunoreactivity and the sex of the patients, tumour size and with the occurrence of lymph node metastases. Though a direct correlation was found between bcl-2 immunoreactivity and increasing tumour stage, this did not reach statistical significance. Furthermore, G1 and G3 tumours displayed higher percentages of bcl-2-positive cells in comparison with G2 neoplasms and the different distribution of bcl-2 immunoreactivity in G2 and G3 was statistically significant (p<0.05). Finally, patients with absent or low (scores 0 and 1) bcl-2 immunoreactive tumours manifested poorer overall survival rates in comparison with patients with moderate or high (scores 2 and 3) bcl-2 immunoreactive tumours but the difference was not statistically significant. In normal oral mucosa bcl-2 protein is selectively present in the basal cell layers and possibly participates in the control of the terminal keratinocytes differentiation. The study of bcl-2 immunoreactivity possibly may be useful for better characterising and predicting the prognosis of oral SCC but cooperative studies are needed to assess its applications in the clinical practice.

Oral lichen planus: a preliminary clinical study on treatment with tazarotene

OBJECTIVE

The rationale for using tazarotene in oral lichen planus (OLP) is its regulatory action on the growth and differentiation of keratinocytes and on inflammation. This randomized, placebo-controlled study addresses evaluation of the effects of topic tazarotene in the treatment of OLP.

DESIGN

The degree of lesions before and after treatment scored by a 6-score scale in six cases treated with tazarotene was statistically compared with those of six controls treated with placebo.

SUBJECTS

Twelve patients with hyperkeratosic OLP were randomly allocated to treatment with tazarotene gel 0.1% b.i.d. or with placebo for eight consecutive weeks.

METHODS

The statistical comparison was executed by means of Wilcoxon analysis for paired data.

RESULTS

Patients treated with tazarotene presented a significant reduction of their lesions as compared with the control group. Among transitory side-effects, burning sensation and taste abnormalities were observed.

CONCLUSION

Topical tazarotene may be a valuable therapeutic tool in the treatment of hyperkeratotic OLP.

Effects of canrenone on myocardial reactive fibrosis in a rat model of postinfarction heart failure

BACKGROUND

Spironolactone reduces overall mortality by 30% in advanced congestive heart failure. Nevertheless, few data are available with regard to the effects of mineral corticoid inhibition in postinfarction heart failure.

MATERIALS AND METHODS

Experimental myocardial infarction was induced by left coronary ligation in 70 male rats with body weights ranging from 180 to 200 gr. The day after surgery, animals were randomized to either placebo or canrenone-gamma-cyclodestrin 8 mg/kg/die or canrenone-gamma-cyclodestrin 18 mg/kg/die. Twelve animals served as the control group. After two weeks, the rats underwent closed chest left ventricular catheterization. The heart was the rapidly excised for subsequent histological analysis.

RESULTS

Compared with controls, infarcted rats had reduced left ventricular systolic pressures (-6%) and higher left ventricular end-diastolic pressures (+600%), associated with a marked increase of mean collagen fraction (+446%) and perivascular fibrosis (+72%). Compared with placebo-infarcted rats, in the group treated with high canrenone dose there was a significant reduction of left ventricular systolic and end-diastolic pressures (-6.5% and -23%, respectively) and an attenuation of interstitial and perivascular fibrosis (-47% and -34%, respectively). The low-dose canrenone group did not show differences compared with the placebo infarcted rats, except for a slight reduction of mean collagen fraction (-21%).

CONCLUSIONS

Canrenone attenuates LV interstitial remodeling and reduces filling pressures in rats with postinfarction heart failure.

p120(cat) Delocalization in cell lines of oral cancer

p120(cat) is a novel component of the catenin family, a cytoplasmic molecule closely associated with the cell-cell adhesion molecule E (epithelial)-cadherin, by forming complexes between the cytoplasmic domain of E-cadherin and the cytoskeleton. Recent studies suppose a role for this molecule in human cancers and to date none report its expression in oral squamous cell carcinomas (SCCs). The goal of this study was to evaluate the role of this protein in the oral carcinogenetic process. A linked streptavidin-biotin-alkaline phosphatase technique was used to examine the immunoreactivity and cellular localisation of p120(cat) in five oral epithelial cell lines (NCTC 2544, normal and immortalized keratinocytes; KB, a poorly differentiated SCC cell line; OSC 20, a well differentiated oral SCC cell line; CAL 33 and CAL 27, moderately differentiated oral SCC cell lines) and 10 normal oral epithelium biopsies.

RESULTS

As already reported for E-cadherin, beta- and gamma-catenin, p120 expression showed a homogeneous membranous localization in normal oral specimens. The intensity of staining for p120 progressively increased from basal and parabasal layers toward the intermediate spinous layer. No staining for p120 was observed in the upper layer. NCTC showed a membranous positivity. OSC 20, CAL 33 and CAL 27 showed a membranous positivity, even if polarized to cell-cell adhesion sites, in 40-50% of cells. OSC 20, CAL 33 and CAL 27 cells showed also a cytoplasmic delocalization. All positive KB cells showed a prevalent cytoplasmic staining and 10% of these cells showed a nuclear delocalization. In cancer cells, p120 showed an inverse relationship with the degree of differentiation for a progressive displacement of the signal toward the cytoplasm or nucleus in dedifferentiated cells. In conclusions, this nuclear delocalization for p120 could suppose its potential involvement in signalling and cancer transformation.

Altered expression of integrins and basement membrane proteins in malignant and pre-malignant lesions of oral mucosa

Integrins are transmembrane receptors that regulate cell-cell and cell-extracellular matrix (ECM) contact. In epithelial tissues, they interact with ECM components of the basement membrane (BM) to maintain the homeostasis and the architecture of the tissue. This interaction controls several cell functions such as adhesion, migration, proliferation, differentiation, and therefore has a key role in cancer development and metastasis. We studied the expression of integrins and ECM components of the BM by immunohistochemistry in frozen specimens of malignant squamous cell carcinoma (SCC), pre-malignant lesions of the oral mucosa (leucoplakia) and oral lichen planus. In invasive SCC, we observed altered polarity and distribution of alpha2beta1, alpha6beta4 and alpha3beta1 integrins, whereas in the in situ carcinoma alpha6beta4 and alpha3beta1 patterns only were altered. Immunostaining for ECM components such as Laminin-1 (Ln-1), Ln-5, and Collagen IV (Coll IV) was discontinuous and interrupted in invasive SCC, whereas it was normal in the in situ carcinoma. In both pre-malignant lesions and lichen planus specimens, integrins were expressed in a polarized manner in the presence of a normal BM, whereas were abnormally distributed in those tissues with altered staining patterns of the ECM components. In conclusion, we suggest that abnormal re-distribution of alpha3beta1 and alpha6beta4 integrins and expression of ECM components such as Ln-5 could play an important role in SCC invasion and metastasis.

P53 and hMSH2 expression in basal cell carcinomas and malignant melanomas from photoexposed areas of head and neck region

Ultraviolet (UV) radiation plays a pivotal role in skin damage and photocarcinogenesis. The basic mechanism of phototoxicity lies in DNA damage, and involves mutation of tumor suppressor genes, oncogenes and genes directly involved in the control of the stability of genome, such as the mismatch repair (MR) genes. The goal of this study was to evaluate the role of p53 and hMSH2 in the UV-related carcinogenetic process. An immunohistochemical study for p53 and hMSH2 was performed in a series of 43 basal cell carcinomas (BCC) and 60 melanomas (MM) from photoexposed areas of head and neck region, comparing the findings with follow-up. A deregulated p53 expression characterized less differentiated, more aggressive BCC (BCC2) but not the well-differentiated ones (BCC1). The hMSH2 protein was present, though expressed at varying levels, in 18 out of 21 BCC1 cases and in 4 out of 22 BCC2. In the remaining 3 cases of BCC1 and 18 cases of BCC2, a complete absence of hMSH2 expression was found, correlating directly with the presence of recurrence and/or death of the disease in case of melanoma (p<0.05). Overall, the expression of hMSH2 correlated inversely with the p53 overexpression (p<0.01). In MM, p53 was found overexpressed in 81.6% of the cases, and this correlated positively with the level of infiltration and with the presence of relapses (p<0.01) or metastasis (p<0.01) and inversely with the disease-free interval (p<0.05). These results are in agreement with the reported association between p53 deregulation and a more aggressive cancer phenotype. The evaluation of the expression of p53 and hMSH2 could improve the management of patients with BCC and MM, and could have a role also in the evaluation of the early cutaneous photo-inducted damage, contributing to the identification of presymptomatic patients predisposed to the development of UV-related new skin tumors, who could become candidates for chemoprevention trials.

The human multidrug resistance gene (MDR-1): immunocytochemical detection of its expression in oral SCC

A large number of oral cancer patients show poor or partial response to chemotherapy and the mechanisms are poorly understood. At present, an MDR-1 product, the P-170 glycoprotein, is the best known of the P-170 family and is involved in resistance to natural product-based chemotherapeutics, including taxanes, anthracyclines, vinca alkaloids, podophyllotoxins and camptothecins. Although several reports suggest that P-170 is clinically relevant in haematological malignancies, its role in solid tumours is not well understood. Its overexpression has been found to be correlated with the poor outcome observed in patients treated with chemotherapy and presenting drug resistance. The aim of this study was to detect the protein expression patterns of MDR-1 product by immunohistochemistry in formalin-fixed-paraffin-embedded tissues. For these reasons, 30 oral SCC and 6 healthy oral mucosa specimens were tested with anti-P-170 antibodies using standard streptavidin-biotin-peroxide technique. Immunohistochemistry demonstrated that 4 cases (66.6%) of normal oral mucosa and 24 cases (80%) of oral SCC showed positivity. Four cases (13.4%) showed strong positivity in tumour areas and complete negativity in normal epithelial cells adjacent to the tumour. No staining was observed in stromal structures, with the exception of the lymphocytic compartment that showed a strong staining as reported in literature for CD56+ and CD8+ cells. Four G1 tumours (33%) and 2 G3 tumour (33%) showed strong positivity in areas with a higher degree of differentiation. P-170 positivity in normal epithelial cells of smoker patients, in differentiated area of neoplasia and negativity or zonal positivity in undifferentiated area of tumour suggested that activation of the MDR-1 gene or selection of intrinsically multidrug resistance neoplastic cells may occur at early stages of tumorigenesis of oral cancers, before the real evidence of cellular transformation. Thus the contact with possible chemical carcinogens, such as those of tobacco smoke, may induce activation of MDR-1 gene. This study was conducted only on untreated carcinomas so for this reason it cannot indicate the real incidence of acquired multidrug resistance. The data of MDR-1 product expression by immunohistochemistry in oral SCC might suggest that an overexpression of this protein could constitute a hallmark of potential more aggressive phenotype for this type of neoplasia and a rapid method for pre-screening tumours for a constitutive multidrug resistance in order to orientate the cancer treatment.

The NM23 gene and its expression in oral squamous cell carcinoma

The murine nm23, a putative metastasis suppressor, has three human homologues, NM23-H1, -H2, and -H3b. Several reports have suggested a low metastatic potential for neoplasms with a high expression of NM23-H1 gene, while other studies have not shown this relationship. These apparent differences in the role of NM23 in metastasis suppression might be explained by unability to discriminate between the expression of the two genes NM23-H1 and NM23-H2. The NM23-H2 product is not related to tumor progression and metastasis suppression. Two studies on human oral squamous cell carcinoma (OSCC) have been reported, both showing the NM23 product to be a metastasis suppressor factor. However, none of these two studies distinguished NM23-H1 from NM23-H2. The aim of this study was to detect the protein expression pattern of NM23-H1 product in 24 OSCCs by immunohistochemistry in paraffin-embedded tissues using a monoclonal antibody non-cross-reactive with NM23-H2. The NM23-H1 positive group showed lower frequency of lymph node metastasis, and a better grading than the NM23-H1 negative group supporting the role of NM23-H1 as metastasis suppressor factor which may be useful for predicting tumor metastasis in OSCC.

[Dental enamel hypoplasia in a group of celiac disease patients. Clinico-epidemiologic correlations]

BACKGROUND

The aim of present study was to carry out a personal clinical-epidemiological research concerning a possible correlation between coeliac disease and enamel hypoplasia.

MATERIALS AND METHODS

Forty-five patients of Cam-pania, aged between 2 and 26 years old, with a diagnosis of coeliac disease (diagnosis in accordance with recent protocol ESPGAN), were subjected to a careful dental examination: at the same time a control-group formed by 105 healthy subjects, of the same province, age- and sex-matched with coeliac patients was examined.

RESULTS

The finding of enamel hypoplasias was more significant in coeliac patients (11 cases with a percentage of 2.4%) than in controls (5 cases with a percentage of 4.7%).

CONCLUSIONS

The percent rate, if on the one hand is lower than in Finnic studies, on the other hand fundamentally reflects the results of studies on the same topic carried out by other Italian groups. Furthermore also in this research the involvement of milk-teeth is observed as reported by other authors. This appears to confirm a clear association between coeliac disease and dental hard tissues alterations.

[A statistical epidemiological study of a possible correlation between serum transaminase levels and viral hepatic pathology markers and lichen planus orale]

The aim of the present study is to carry out a clinical-statistical research into a large number of patients suffering from oral lichen planus (LPO) and from different odontostomatologic pathologies. In both groups of patients serum transaminase values and eventual presence of hepatopathy viral markers were investigated in order to identify a possible correlation between the aforesaid parameters and LPO, considered in its various clinical forms (papular and erosive essentially). Results had showed a close association between hepatopathy and LPO, according to results of studies performed by other Italian and Spanish groups and differently from Anglo-Saxon authors: above all an increased incidence of C hepatitis in patients with lichen was observed. Furthermore our investigation is agreed in underlining the great importance to attach to erosive form of oral lichen, that seems to join to active chronic hepatitis most frequently than papular one.

[The quantitative assessment of DNA in potentially cancerous cases of oral lichen]

The increased prevalence of all variants of oral lichen, both as a result of increasing frequency and improved knowledge of the pathologist, coupled with its greater trend to malignant transformation has focused the attention of researchers on the development of new technology that could help in the early detection of the precancerous lesion. DNA cytometric detection can be useful to detect the precancerous lesion when clinical and histological findings of the transformation are still absent. The early diagnosis of such lesions entitles to use a more aggressive treatment, both medical and surgical.