Nd:YAG laser therapy of carcinoma lip (stage I squamous cell carcinoma): a retrospective evaluation

OBJECTIVE

To asses the efficacy of Nd:YAG laser for stage I squamous cell carcinoma of the lip. To the authors' knowledge this is the first reported study on this subject.

STUDY DESIGN

Retrospective study design involving treatment of 46 patients of either sex of stage I squamous cell carcinoma of lip over a 10-year period in a single tertiary care university teaching hospital with Nd:YAG laser.

METHODS

Nd:YAG laser ablation of lesions in lip was carried out in all the patients on an OPD basis with prior consent. A regular follow-up was maintained for a period of 5 years. A negative biopsy at the end of one month and one year was considered a treated case. The tabulated data was analysed statistically by "Kaplan Meier" method and "Log Rank" test. Also cosmetic and functional results were assessed by any sign of flow away after filling the oral cavity with water and postoperative integrity of facial nerve in accordance with "House Brackmann" classification.

RESULTS

In this series of 46 patients, 35 patients were disease free at the end of 3 years and this number further declined to 29 at the end of 5 years with 4 deaths and 2 more patients lost to follow-up. The statistical evaluation by Kaplan Meier method gives us an overall 5-year survival rate of 88.14% with a mean survival of 58 months. Further 8 patients required repeat laserization either for residual or recurrence of lesion. Also 2 patients had a lymph node metastasis during the follow-up period. Thus, by applying Kaplan Meier method recurrence-free survival (RFS) and disease-free survival was found to be 85.1% (mean: 55 months) and 73.34% (mean: 57 months respectively. Interestingly on applying Log Rank test it was observed that the site of the lip involvement, i.e. whether upper or lower had no influence on disease-free survival. It was also observed that history of tobacco intake did not influence the disease free survival either (Log Rank Test). Moreover the cosmetic results were excellent and with no significant complication observed.

CONCLUSION

The results reported here support the use of Nd:YAG laser for treatment of Stage I squamous cell carcinoma of lip in accordance with principles of minimal invasive and morbid surgery.

Cyclooxygenase-2 polymorphisms and the risk of esophageal adeno- or squamous cell carcinoma

AIM: To determine whether -1195 A→G and/or -765 G→C polymorphisms in Cyclooxygenase-2 (COX-2) may have a risk modifying effect on the development of esophageal carcinoma in a Dutch Caucasian population.

METHODS: Two study groups were recruited, 252 patients with esophageal carcinoma and 240 healthy controls, matched for race, age, gender and recruiting area. DNA was isolated from whole blood and used for genotyping. PCR products were digested with restriction enzymes and products were analyzed by agarose gel electrophoresis. Odds ratios (OR) and 95% confidence intervals (CI) were estimated.

RESULTS: The distribution of the -1195 A→G polymorphism was significantly different in esophageal cancer patients compared to controls. The -1195 GG genotype resulted in a higher risk of developing esophageal adenocarcinoma (OR = 3.85, 95% CI: 1.45-10.3) compared with the -1195 AA genotype as a reference. The -765 G→C genotype distribution was not different between the two groups. The GG/GG haplotype was present more often in esophageal adenocarcinoma patients than in controls (OR = 3.45, 95% CI: 1.24-9.58; with AG/AG as a reference). The same trends were observed in patients with squamous cell carcinomas, however, the results did not reach statistical significance.

CONCLUSION: Presence of the COX-2 -1195 GG genotype and of the GG/GG haplotype may result in a higher risk of developing esophageal carcinoma.

Human papilloma virus and esophageal carcinoma in a Latin-American region

AIM: To investigate the presence of high-risk human papilloma virus (HPV) in esophageal squamous cell carcinomas (ESCCs) in a non-selected Mexican population.

METHODS: Cases with a pathological diagnosis of squamous cell carcinoma of the esophagus were obtained from Department of Pathology files, at the National Cancer Institute in Mexico City during the period between 2000 and 2008. Slides from each case were reviewed and cases with sufficient neoplastic tissue were selected for molecular analysis. DNA was extracted from paraffin-embedded tissue samples for polymerase chain reaction analysis to detect HPV DNA sequences. Demographic and clinical data of each patient were retrieved from corresponding clinical records.

RESULTS: HPV was detected in 15 (25%) of ESCCs. HPV-16 was the most frequently observed genotype, followed by HPV-18; HPV-59 was also detected in one case. Unfortunately, HPV genotype could not be established in three cases due to lack of material for direct sequencing, although universal primers detected the presence of HPV generic sequences. No low-risk HPV genotypes were found nor was HPV-16/18 co-infection. HPV presence in ESCC was not significantly associated with gender, age, alcohol consumption, smoking, anatomic location, or histologic grade. All patients belonged to low and very low socioeconomic strata, and were diagnosed at advanced disease stage. Male patients were most commonly affected and the male:female ratio in HPV-positive ESCC increased two-fold in comparison with HPV-negative cases (6.5:1 vs 3.1:1).

CONCLUSION: High prevalence of high-risk HPV in ESCC in Mexico does not support the hypothesis that HPV-associated ESCC is more common in areas with higher ESCC incidence rates.

Human Papilloma Virus (HPV) in head and neck region: review of literature

The evidence that human papillomavirus infection is related to head and neck squamous cell carcinoma is supported by molecular and epidemiological data. The definition of a distinct subset of head and neck squamous cell carcinoma, independent of the traditional risk factors and with different clinical presentation and outcome, has led to increasing interest in human papillomavirus infection. This review summarizes current knowledge regarding human papillomavirus biology, oncogenic mechanisms, risk factors for transmission, clinical significance and prophylactic strategies.

Esophageal Carcinoma with Triplicate Differentiation into Squamous Cell Carcinoma, Small Cell Carcinoma and Adenocarcinoma: a Case Report

Esophageal carcinoma with multiple differentiation is very rare. The author herein reports a case of esophageal carcinoma with triplicate differentiation (squamous cell carcinoma, small cell carcinoma, and adenocarcinoma). A 78-year-old man was admitted to our hospital because of dysphagia. An endoscopic examination revealed a polypoid tumor (3 x 4 x 3 cm) in the distal esophagus, and biopsy was obtained. The biopsy showed a tumor composed of moderately differentiated squamous cell carcinoma, small cell carcinoma, and adenocarcinoma. The proportions of them were 40% in squamous cell carcinoma component, 50% in small cell carcinoma component, and 10% in adenocarcinoma. There were gradual merges among them. Immunohistochemically, squamous cell carcinoma component was positive for cytokeratins and p53 protein. The Ki-67 labeling was 43%. The small cell carcinoma component was positive for cytokeratin, p53 protein, CD56, and KIT. The Ki-67 labeling was 95%. The adenocarcinoma component was positive for mucins, cytokeratin, p53 protein and CEA. The KI-67 labeling was 52%. The author speculates that this carcinoma arise from totipotent stem cell of the esophagus. The patient was treated by chemoradiation therapy, but died of systemic metastasis 13 months after the initial manifestation.

Galectin-8 expression in laryngeal squamous cell carcinoma

OBJECTIVES

Despite the ongoing development of treatment protocols for laryngeal squamous cell carcinoma (LSCC), the patients suffering with this malady have shown only a modestly improved outcome. This poor outcome has been attributed to the lack of therapy that's individualized to the tumor's biological properties. Various studies have showed that galectin-8 is widely expressed in tumor tissues as well as in normal tissues, and the level of the galectin-8 expression may correlate with the malignancy of human squamous cell carcinoma. The purpose of this study is to evaluate the expression of galectin-8 and to investigate its correlations with the primary stage, the nodal involvement, the clinical stage and the histologic grade of squamous cell carcinoma of the larynx.

METHODS

The paraffin-embedded tissue specimens from 77 patients who were diagnosed as LSCC between 1993 and 2007 were immunohistochemically stained for galectin-8.

RESULTS

Immunohistochemical analysis showed that a strong positive expression of galectin-8 was correlated with the T-stages, the nodal stages and the clinical stages. However, the histopathologic grades were not correlated with the galectin-8 expression in LSCC.

CONCLUSION

The expression of galectin-8 protein can be used as a prognostic factor for patients with LSCC.

Expression of VEGF-C, VEGFR-3, CD105 and CD68 protein in esophageal squamous cell carcinoma and their significance

AIM: To explore the expression of VEGF-C, VEGFR-3, CD105, CD68 protein and their correlation with lymphatic and vascular metastasis in esophageal squamous cell carcinoma (ESCC).

METHODS: Immunohistochemical SP method was used to detect the expression of VEGF-C, VEGFR-3, CD105 and CD68 protein in 50 cases of esophageal squamous cell carcinoma, 19 cases of adjacent atypical hyperplasia epithelium and 50 cases of normal esophageal epithelium. Relationship between expression of proteins and clinical biology of ESCC was investigated.

RESULTS: The expression rates of VEGF-C, VEGFR-3, CD105 and CD68 protein decreased by turns in carcinoma, adjacent atypical hyperplasia epithelium and normal esophageal epithelium specimens (VEGF-C: 82.0%, 47.4%, 26.0%; VEGFR-3: 72.0%, 36.8%, 18.0%; CD105: 30.53 ± 7.42, 0, 0; CD68: 50.89 ± 10.36, 14.10 ± 3.59, 11.30 ± 3.72). There was a significant statistic difference among the groups (P < 0.05). The expression of VEGF-C, CD105 and CD68 protein was closely correlated with the TNM grade, infiltrative depth and lymphatic metastasis in esophageal squamous cell carcinoma (all P < 0.05). The expression of VEGFR-3 protein was closely correlated with the lymphatic metastasis in esophageal squamous cell carcinoma (all P < 0.05). The expression of VEGF-C protein had positive correlation with the expression of VEGFR-3 (P < 0.01). There were statistically significant differences among positive and negative expression of VEGF-C and VEGFR-3 groups, and TAMs count and positive expression of CD105 blood vessel groups (P < 0.05).

CONCLUSION: VEGF-C, VEGFR-3, CD105 and CD68 protein play important roles in the infiltration, vascular metastasis and carcinogenesis in esophageal carcinoma. Joint detection of VEGF-C, VEGFR-3, CD105 and CD68 protein is expected to be one of molecular index in the early diagnosis, prognostic judgment and vascular metastasis of esophageal squamous cell carcinoma, offering an objective and reliable parameter for the clinic immune therapy and anti-lymphatic metastasis treatment.

Squamous cell carcinoma masquerading as rhinophyma

A rhinophyma lesion can mask the existence of coexisting occult skin cancers, and many types of tumors can mimic a rhinophyma. Although several coexistent malignant tumors have been reported in patients with rhinophyma, few reports have described the coexistence of rhinophyma and cutaneous squamous cell carcinoma (SCC). Herein, we report on a case of SCC in a 45-year-old man who presented with 2-month-history of a painful, erythematous, globular plaque on the tip of his nose and this lesion mimicked a rhinophyma lesion. The histopathologic examination showed a proliferation of atypical squamous cells that extended into the dermis, which was consistent with SCC. He was treated with surgical excision, and there has been no evidence of recurrence during the follow-up period of 1 year.

Dysplasia of the upper aerodigestive tract squamous epithelium

Dysplasia of the oral, laryngeal and oropharyngeal stratified squamous epithelia is a microscopically defined change that may occur in clinically identifiable lesions including erythroplakia, leukoplakia and erythroleukoplakia, lesions that convey a heightened risk for carcinomatous progression. Dysplastic lesions have been classified microscopically according to degree of cytologic atypia and changes in architectural patterns, usually on a three part or four part gradation scale. Vocal cord epithelial lesions are graded according to either the Ljubljana or the World Health Organization (WHO) system whereas oral dysplasias are generally classified according to WHO criteria. Cytologically atypical cells are considered to represent precancerous changes predicting an increase risk for carcinomatous transformation. Inter- and intra-rater reliability studies among pathologists have disclosed low correlation coefficients for four part grading systems, whereas improved agreement is achieved (kappa correlation values) using the Ljubljana systems. Evidence forwarded by some studies supports the prognostic value of progressively severe dysplastic changes for carcinomatous transformation; however, some studies indicate that the presence of a clinically defined lesion without microscopic evidence of dysplasia also connotes increased risk for carcinomatous transformation. Loss of heterozygosity (LOH) at 3p and 9p microsatellite domains, DNA ploidy analysis and nuclear image analyses may have predictive value as molecular and histomorphological biomarkers.

Benign Diseases and Neoplasms of the Penis

This article provides comprehensive review of benign diseases and neoplastic conditions of the penis. It describes and provides representative images of clinical, key pathologic features and ancillary techniques to aid in differential diagnoses. It examines these diseases from the epidemiologic standpoint, looks at environmental and genetic factors, and outlines the new histologic entities for penile neoplasms with distinct outcomes and clinical behavior that have been proposed in recent years.

Primary intracranial squamous cell carcinoma in the brain stem with a cerebellopontine angle epidermoid cyst

Primary intracranial squamous cell carcinoma is extremely rare, with most cases arising from a preexisting benign epidermoid cyst. We report a rare case of primary intracranial squamous cell carcinoma in the brain stem with a cerebellopontine angle (CPA) epidermoid cyst. A 72-year-old female suffered from progressive left hemiparesis, difficulty in swallowing, and right hemifacial numbness. Diffusion-weighted magnetic resonance imaging revealed a high signal intensity (SI) lesion in the CPA region and an intra-axially ring-enhanced cystic mass in the right brain stem with low SI. Whole-body positron emission tomography showed no evidence of metastatic disease. The histological findings revealed a typical epidermoid cyst in the CPA region and a squamous cell carcinoma in the brain stem. We speculate that the squamous cell carcinoma may have been developed due to a chronic inflammatory response by the adjacent epidermoid cyst. The patient underwent a surgical resection and radiotherapy. After 12 months, she had no evidence of recurrence.

Site-specific molecular signatures predict aggressive disease in HNSCC

It is known that head and neck squamous cell carcinomas (HNSCC) originating from different anatomic locations can exhibit varying behavior that is not predictable by histopathology of the primary tumor. Using a microarray containing 27,323 cDNA clones, we generated sets of gene expression profiles for 36 HNSCC primary tumors (12 oral cavity, 12 oropharynx, and 12 larynx/hypopharynx). From these datasets, we ranked genes according to their ability to differentiate between patients whose disease progressed within a 24 month period (aggressive phenotype) and those that did not (non-aggressive phenotype) based on levels of gene expression. A merging of datasets from the three sites revealed that only a fraction of identified genes were shared between any two sites. This contrasted greatly with the significant overlap (approximately 50%) in down-regulated genes identified in tumor/normal comparisons using cases both from oropharynx and larynx/hypopharynx. From these data, we conclude that HNSCC tumors originating from different anatomic sites share consistent changes in gene expression when comparing primary tumors to normal adjacent mucosa; these common changes most likely reflect alterations required for tumor development. In contrast, once a tumor has developed, tumor-host interactions at the different anatomic sites are likely responsible for the site-specific signatures associated with aggressive versus non-aggressive disease. Predictions of outcome based on gene expression profiling are therefore heavily influenced by the anatomic site of the primary tumor.

Ber-EP4, CK1, CK7 and CK14 are useful markers for basaloid squamous carcinoma: a study of 45 cases

Diagnosis of basaloid squamous carcinoma (BSCC) currently relies mainly on histological criteria, with variable immunohistochemical results reported in small series. We explored the use of a battery of immunohistochemical stains to elucidate this diagnosis on 45 cases of BSCC. To further elucidate the immunohistochemical profile of BSCC, to explore potential genetic pathways of malignant transformation using proliferation markers, and to investigate a possible link with Human Papillomavirus (HPV). Forty-five cases of BSCC and 34 site-matched cases of squamous cell carcinoma (SCC) were obtained from the archives of the pathology department at our institution. Extensive literature review was undertaken utilizing Medline. Ber-EP4 is a useful diagnostic marker for BSCC, positive in 82% (37/45) of the cases and in 68% (23/34) of SCC. An alternative is the combination of cytokeratins CK14 and CK7, known to be negative, and CK1, known to be positive, which achieves an accuracy of 73% (33/45) in BSCC and 88% (30/34) in SCC. The two diagnostic approaches were in agreement in 66% of the cases; both methods were equally accurate in the divergent cases. Increased expression of the proliferation markers supports the concept that BSCC is a rapidly growing tumor. Results of p16 stains support an etiological link between BSCC and HPV; interestingly, HPV was present significantly more in BSCC (71% (32/45)), than in SCC (59% (20/34)) in this study (P=0.02).

Laryngeal squamous cell carcinoma in a 13 year-old child associated with human papillomaviruses 16 and 18: a case report and review of the literature

Squamous cell carcinoma (SCC) of the larynx is extremely rare in adolescents and typically has an aggressive nature. The mechanism of laryngeal oncogenesis is complex and little is known about the role that human papillomavirus (HPV) plays in SCC in adolescents. We report a case of invasive laryngeal SCC that co-expressed HPV DNA subtypes 16 and 18 in a 13 year-old boy. Detection of HPV DNA types 6, 11, 16, 18, 31, 33, and 51 was performed by in situ hybridization, with confirmation by polymerase chain reaction. Immunohistochemical staining with p16 and HPV 16/18 revealed diffusely positive staining in the tumor cells. Coinfection by HPV DNA types 16 and 18 has not been previously reported, but our case suggests that HPV is a risk factor in developing laryngeal SCC in children and adolescents. Future studies evaluating HPV in the pathogenesis of these lesions is recommended to determine its prognostic significance.

Squamous Cell Carcinoma: Restaging and Response to Therapy

This article describes the use of 18F-fluorodeoxyglucose PET in patients who have head and neck cancer for assessment of therapy response, detection of locoregional recurrence and distant metastasis, and surveillance.

Squamous Cell Carcinoma: Initial Diagnosis and Staging with PET/CT

Squamous cell carcinoma is the most frequent malignancy of the head and neck region, accounting for 5% of all malignant tumors worldwide. Accurate staging at diagnosis is critical for selection of appropriate treatment strategy. A variety of therapeutic options are used for treatment, including surgery with or without radical dissection, lymph node dissections of various severities, radiotherapy, chemotherapy, and combinations of these. Precise prediction of the extent of primary tumors, detection of unknown primary tumor, cervical lymph node status, and distant metastatic spread is important for treatment planning and prognosis. Accurate evaluation of these factors prior to treatment helps guide surgical extent or radiation porta, minimizing locoregional treatment failure.

Uterine corpus involvement as well as histologic type is an independent predictor of ovarian metastasis in uterine cervical cancer

OBJECTIVE

This study aimed to investigate the independent risk factors for ovarian metastasis in cervical cancer.

METHODS

Among 1,040 consecutive patients who underwent operation for cervical cancer at our institution from January 1998 to July 2007, a total of 625 patients had both ovaries removed during primary operation were retrospectively selected by medical records. In order to determine clinicopathological risk factors for ovarian metastasis, we analyzed patients' demographics, FIGO stage, and other pathologic findings. The Chi-square or Fisher's extract tests were used to compare any association of clinicopathologic variables with ovarian metastasis. For multivariate analysis, the log regression models were used to determine independent predictors for ovarian metastasis.

RESULTS

Overall, ovarian metastasis was detected in fourteen (2.2%) patients: two of 473 patients with squamous cell carcinoma (0.4%) and twelve of 151 patients with non-squamous cell carcinoma (7.9%), respectively (p<0.0001). Univariate analysis represents age (</=45 vs. >45 years: p=0.347), histologic types (squamous vs. non-squamous, p<0.0001), FIGO stages (IA1-IIA </=4 cm vs. IB2-IIB >4 cm, p=0.054), stromal invasion (</=1/2 vs. >1/2, p=0.788), lymph node metastasis (positive vs. negative, p=0.007), parametrium (involved vs. uninvolved, p=0.145), upper vagina (involved vs. uninvolved, p=0.003), uterine corpus (involved vs. uninvolved, p<0.0001), and margin status (involved vs. uninvolved, p=0.017). By multivariate analysis, uterine corpus involvement was the only independent risk factor for ovarian metastasis (p=0.008), in addition to histologic types (p<0.0001).

CONCLUSION

Based on our study, uterine involvement of cervical cancer is an independent predictor for ovarian metastasis, except histologic types. Ovarian preservation in cervical cancer may be safely performed only when no involvement of uterine corpus is present.

Plasma proteomic analysis of patients with squamous cell carcinoma of the uterine cervix

OBJECTIVE

To compare plasma protein expression between patients with squamous cell carcinoma (SCC) of the cervix and normal controls.

METHODS

Plasma samples from patients with benign gynecological disease (normal cervix, n=6) and cervical cancer (SCC, n=6) were subjected to plasma proteomic analysis using two dimensional gel electrophoresis (2-DE) and matrix-assisted laser desorption/ionization mass spectroscopy (MALDI-MS). Western blotting and immunoturbidimetric assay were performed to validate the results of 2-DE.

RESULTS

Eight proteins showed differential expression between controls and SCC patients; six (ceruloplasmin, complement C3, afamin precursor, alpha-1-B-glycoprotein, transferrin, alpha-fibrinogen precursor) were up-regulated, while two (chain A, crystal structure of antithrombin and apolipoprotein A-IV precursor) were down-regulated in the plasma of SCC patients. Western blotting analysis revealed significant elevation of ceruloplasmin, complement C3, afamin, and alpha-1-B-glycoprotein in the plasma of SCC patients in comparison to controls. Immunoturbidimetric assay of a larger group confirmed the results of 2-DE and Western blotting, and showed that ceruloplasmin and complement C3 were significantly elevated in the plasma of SCC patients in comparison with controls and patients with carcinoma in situ (CIS) of the uterine cervix.

CONCLUSION

Plasma protein expression determined using 2-DE and MALDI-MS will give a chance to identify tumor-specific biomarkers for SCC of the cervix.

Factors related to regional recurrence in early stage squamous cell carcinoma of the oral tongue

Objectives

This study analyzed various clinical and histopathologic factors for patients with early stage squamous cell carcinoma (SCC) of the oral tongue to define a high risk group for regional recurrence and finally to find out the indication of elective neck dissection (END).

Methods

Retrospective chart review was performed for 63 patients with T1-T2N0 SCC of the oral tongue who underwent partial glossectomy with/without END. Clinical and histopathologic factors assessed were age, gender, clinical T stage, tumor cell differentiation, depth of invasion, pathologic nodal status, and intrinsic muscle involvement, perineural invasion, lymphovascular emboli and resection margin involvement.

Results

Five year overall survival rate was 97.1% in stage I and 76.2% in stage II, and 5-yr disease free survival rate was 76.7% in stage I and 43.5% in stage II. Rates of occult nodal metastasis in stage I and II were 15.4% and 42.9%, respectively. Overall regional recurrence rate was 15.9%, which consisted of 10.2% in stage I and 35.7% in stage II. The success rate of salvage treatment was 100% in stage I and 40% in stage II. Higher T stage, higher histologic grade, depth of invasion ≥3 mm, presence of intrinsic muscle involvement were significantly related to regional recurrence (P=0.035, P=0.011, P=0.016, P=0.009, respectively). In stage I, the non-END group (n=36) showed 13.9% of regional recurrence rate, while END group (n=13) did not have any regional recurrence (P=0.198). Five year disease free survival rate of END group was significantly higher than non-END group (100% and 68.7%, respectively, P=0.045).

Conclusion

We recommend to perform END in early stage SCC of the oral tongue if the primary tumor has T2 stage, and T1 stage with higher histologic grade, depth of invasion more than 3 mm, or presence of intrinsic muscle involvement.

Microsatellite alterations in phenotypically normal esophageal squamous epithelium and metaplasia-dysplasia-adenocarcinoma sequence

AIM: To investigate the microsatellite alterations in phenotypically normal esophageal squamous epithelium and metaplasia-dysplasia-adenocarcinoma sequence.

METHODS: Forty-one specimens were obtained from esophageal cancer (EC) patients. Histopathological assessment identified 23 squamous cell carcinomas (SCC) and 18 adenocarcinomas (ADC), including only 8 ADC with Barrett esophageal columnar epithelium (metaplasia) and dysplasia adjacent to ADC. Paraffin-embedded normal squamous epithelium, Barrett esophageal columnar epithelium (metaplasia), dysplasia and esophageal tumor tissues were dissected from the surrounding tissues under microscopic guidance. DNA was extracted using proteinase K digestion buffer, and DNA was diluted at 1:100, 1:1000, 1:5000, 1:10 000 and 1:50 000, respectively. Seven microsatellite markers (D2S123, D3S1616, D3S1300, D5S346, D17S787, D18S58 and BATRII loci) were used in this study. Un-dilution and dilution polymerase chain reactions (PCR) were performed, and microsatellite analysis was carried out.

RESULTS: No statistically significant difference was found in microsatellite instability (MSI) and loss of heterozygosity (LOH) of un-diluted DNA between SCC and ADC. The levels of MSI and LOH were high in the metaplasia-dysplasia-adenocarcinoma sequence of diluted DNA. The more the diluted DNA was, the higher the rates of MSI and LOH were at the above 7 loci, especially at D3S1616, D5S346, D2S123, D3S1300 and D18S58 loci.

CONCLUSION: The sequence of metaplasia-dysplasia-adenocarcinoma is associated with microsatellite alterations, including MSI and LOH. The MSI and LOH may be the early genetic events during esophageal carcinogenesis, and genetic alterations at the D3S1616, D5S346 and D3S123 loci may play a role in the progress of microsatellite alterations.

Syndrome of inappropriate antidiuretic hormone (SIADH) secretion caused by squamous cell carcinoma of the nasopharynx: case report

The Paraneoplastic syndromes include the disorders that accompany benign or malignant tumors but are not directly related to mass effects or invasion by the primary tumor or its metastases. Neoplastic cells can produce a variety of peptides that exert biologic actions at local and distant sites and can elicit responses that cause a variety of hormonal, hematologic, dermatologic and neurologic symptoms. Almost every type of malignancy has the potential to produce hormones or cytokines or to induce immunologic responses. Lung cancers, both non-small cell and small cell, are capable of producing a variety of paraneoplastic syndromes. The majority of such syndromes are caused by small cell carcinomas, including many endocrinopathies. Syndrome of inappropriate antidiuretic hormone (SIADH) has been commonly associated with small cell carcinoma and is often seen in these patients. However, SIADH associated with squamous cell carcinoma has rarely been reported on, and the mechanism for this rare association is still unknown. We present here a case of a 77-yr-old man who developed SIADH caused by squamous cell carcinoma of the nasopharynx.

Intraoperative consultation (IOC) in mucosal lesions of the upper aerodigestive tract

Intraoperative consultation (frozen section) plays an important part in the treatment of the head and neck cancer patient. The appropriate use of intraoperative consultations (frozen sections) usually results in a definitive diagnosis with immediate therapeutic impact while the patient is in the operating room. Among the determinations made by frozen section analysis include the evaluation of adequacy of surgical margins of resection; the differentiation between nonneoplastic, benign and malignant proliferations; the evaluation of lymph nodes for the presence of metastatic disease; the determination of specimen identification and specimen adequacy, including the verification of such organs as the parathyroid glands; and the determination of whether a given case requires special diagnostic testing best performed on frozen material, such as for lymphomas. This paper focuses on intraoperative consultation of mucosal lesions of the upper aerodigestive tract, including epithelial dysplasia and squamous cell carcinoma. Other issues that often not diagnosed or at issue at the time of surgery, including the diagnosis of microinvasive carcinoma and differentiating inflammatory lesions from neoplastic lesions are included for completion.

The clinical significance of massive intratumoral lymphocytosis in squamous cell carcinoma of the anus

A recent report indicates that patients with squamous cell carcinoma of the anal canal (SCCAC) and intraepithelial lymphocytes have a poor prognosis. Against that background, histological sections from 277 consecutive SCCACs were reviewed searching for cases with massive tumor-infiltrating lymphocytes (TILs; >/= 50 lymphocytes /100 tumor cells). Of the 277 SCCACs, 8 (3%) had massive TILs. These 8 patients (all females) had both more advanced clinical stage than the remaining 269 control SCCAC patients. Follow-up studies revealed that the 8 patients with SCCACs having massive TILs had a much better 15 years survival rate than control SCCAC patients. It is concluded that despite SCCAC patients with massive TILs had a more advanced clinical stage than SCCAC controls, SCCAC with massive TILs patients had a longer survival rate (with no deaths after 5 years) than control cases. The search via proteomic methodology for the lymphocyte-attracting tumor protein might bring forward a novel co-adjuvant therapy, capable to increase prolonged survival time in patients having SCCAC without massive TILs.

Glucose transporter-1 expression in squamous cell carcinoma of the tongue

PURPOSE

Tumor cells are known to express hypoxia-related proteins such as glucose transporter-1 (Glut-1). These hypoxia-induced changes may allow tumor cells to survive under sustained hypoxic microenvironments, and the surviving tumor cell under hypoxia may develop a more aggressive phenotype and so result in a poor prognosis.

MATERIALS AND METHODS

The Glut-1 expression was analyzed by immunohistochemistry, and its association with the prognosis was assessed in 60 patients with squamous cell carcinoma of the tongue.

RESULTS

The Glut-1 expression was diffuse with a membranous pattern, and the median percentage of Glut-1 positive tumor cells was 60% (range: 0.0 approximately 90.0%). A high Glut-1 expression (the percentage of positive tumor cells >or= the median value, 60%) was associated with the location of primary lesion, lymph node metastasis status and disease stage (p<0.05). The expression of Glut-1 was correlated with the Ki-67 expression (r=0.406, p=0.001). Microvessel density, as represented by CD31 staining, was also correlated with the Glut-1 expression although its significance is weak (r=0.267, p=0.039). On the univariate analysis, the group with a high Glut-1 expression showed poorer overall survival than the group with a low Glut-1 expression (p<0.05). However, the Glut-1 expression failed to show any independent prognostic significance on the multivariate analysis.

CONCLUSION

The expression of Glut-1 may be useful for predicting the prognosis and determining the treatment strategy for the management of squamous cell carcinoma of the tongue.

Circulating Immune complexes (CIC) as marker for disease progress in oral cancer

Oral Cancer is one of the five leading sites of cancer in Indian population. The circulating immune complexes were investigated in 100 serum samples of 60 oral cancer patients having different grades of the disease and 40 patients with precancerous lesions obtained from Nair Hospital Dental collage, Mumbai. The results obtained were compared with those of group of 40 healthy blood donors. Elevated levels of Circulating Immune Complexes were observed in oral cancer patients and patients with oral precancerous lesions. 92% positive samples were observed in well differentiated squamous cell carcinoma whereas 100% positive samples were observed in both moderately and poorly differentiated squamous cell carcinoma. Oral leukoplakia and oral submucous fibrosis showed 15% and 90% positivity respectively. Increased level of Circulating Immune complexes in high grade tumor suggest that Circulating Immune complexes is likely to contribute in evaluating the degree of malignancy, but follow up study is needed to draw any conclusion regarding it's prognostic role.

Squamous cell carcinoma of the descending colon: report of a case and literature review

It is very rare that squamous cell carcinoma (SCC) arises from colorectal epithelium. An 89-year-old man was treated in 2001 with chief complaints of anorexia, abdominal pain, and low grade fever. The histological diagnosis as SCC was determined by biopsy during a colonoscopy. We diagnosed primary SCC of the colon because except in the colon no malignant lesions were found by systemic CT. Surgical complete resection was performed. However, he died three months after surgical resection because of hepatic metastasis and cachexia. The prognosis of this disease seems to be worse than that of adenocarcinoma.

Extraction and identification of mitochondrial DNA and nuclear DNA from human esophageal squamous cell carcinoma tissues

AIM: To extract mitochondrial DNA (mtDNA) and nuclear DNA (nDNA) simultaneously from the same tissues and evaluate its efficiency by comparative analysis.

METHODS: Both mtDNA and nDNA were extracted simultaneously from the same tissues using agent kit. Agarose gel electrophoresis and polymerase chain reaction were used to identify the obtained mtDNA and nDNA.

RESULTS: mtDNA and nDNA were successfully extracted from the mitochondria and nucleus of the same tissue, respectively. The efficiency of this method for extracting mtDNA and nDNA simultaneously from the same tissue was similar to that of the traditional method (extracting mtDNA and nDNA from different tissues), and there was a close relationship between these two methods.

CONCLUSION: It is timesaving and economical to extract mtDNA and nDNA simultaneously from the same tissues, which is a better way for DNA study.

pRB expression in esophageal mucosa of individuals at high risk for squamous cell carcinoma of the esophagus

AIM: To investigate the pRb expression in a large group of patients with history of chronic exposure to the main risk factors for development of squamous cell carcinoma of the esophagus.

METHODS: One hundred and seventy asympto-matic individuals at high risk for esophageal squamous cell carcinoma (consumption of more than 80 g of ethanol and 10 cigarettes/d for at least 10 years) underwent upper gastrointestinal endoscopy with biopsies of the esophageal mucosa. As a control group, specimens of esophageal mucosa obtained from 20 healthy subjects were also studied. Immunohistochemical assessment of the tissues was performed using a monoclonal antibody anti-pRB protein.

RESULTS: Absence of the pRB staining, indicating loss of RB function, was observed in 33 (19.4%) of the individuals at risk for esophageal cancer, but in none of the healthy controls (P < 0.02). Loss of pRb expression increased in a stepwise fashion according to the severity of the histological findings (P < 0.005): normal mucosa (11/97 or 11.3%), chronic esophagitis (17/60 or 28.3%), low-grade dysplasia (3/10 or 30%), high-grade dysplasia 1/2 or 50%) and squamous cell carcinoma (1/1 or 100%).

CONCLUSION: Our findings suggest that abnormal expression of the pRB protein may be implicated in the process of esophageal carcinogenesis. Additional studies are warranted to define the role of the pRB protein as a biomarker for development of esophageal squamous cell carcinoma in individuals at high risk for this malignancy.

Primary squamous cell carcinoma of the liver: A successful surgically treated case

Primary squamous cell carcinoma (SCC) of the liver is rare. Totally nine such cases have been reported in the literature. Primary SCC of the liver has been reported to be associated with hepatic teratoma, hepatic cyst, or hepatolithiasis. Complete remission of poorly differentiated SCC of the liver could be achieved by systemic chemotherapy followed by surgery or remarkably respond to hepatic arterial injection of low dose chemotherapeutic drugs. Here we report the first case of primary SCC of the liver presenting as a solid tumor and receiving successful hepatic resection with 9-mo disease free survival.

Coexistence of esophageal superficial carcinoma and multiple leiomyomas: A case report

Leiomyomas are the most common benign tumors of the esophagus. They usually occur as a single lesion or as two or three nodules. Only two cases of esophageal multiple leiomyomas comprising more than 10 nodules have been reported previously. Moreover, there have been few reports of esophageal squamous cell carcinoma overlying submucosal tumors. We describe a 71-year-old man who was diagnosed as having a superficial esophageal cancer coexisting with two or three leiomyoma nodules. During surgery, 10 or more nodules that had not been evident preoperatively were palpable in the submucosal and muscular layers throughout the esophagus. As intramural metastasis of the esophageal cancer was suspected, we considered additional lymphadenectomy, but had to rule out this option because of the patient’s severe anoxemia. Microscopic examination revealed that all the nodules were leiomyomas (20 lesions, up to 3 cm in diameter), and that invasion of the carcinoma cells was limited to the submucosal layer overlying a relatively large leiomyoma. This is the first report of superficial esophageal cancer coexisting with numerous solitary leiomyomas. Multiple minute leiomyomas are often misdiagnosed as intramural metastasis, and a leiomyoma at the base of a carcinoma lesion can also be misdiagnosed as tumor invasion. The present case shows that accurate diagnosis is required for the management of patients with coexisting superficial esophageal cancer and multiple leiomyomas.

Significance of preoperative C-reactive protein as a parameter of the perioperative course and long-term prognosis in squamous cell carcinoma and adenocarcinoma of the oesophagus

AIM: C-reactive protein (CRP) is an acute-phase reactant and a known indicator of the malignant potential of the tumour. The aim of this study was to investigate the significance of preoperative CRP as a parameter of the perioperative course and long-term prognosis in patients with squamous cell carcinoma and adenocarcinoma of the oesophagus.

METHODS: Serum CRP was determined preoperatively in 291 of 371 patients undergoing oesophagectomy for cancer from December 1989 to March 2004. Median patient age was 59 (28-79) year, 82.5% of patients were males. Squamous cell carcinoma was diagnosed in 151 (51.9%) and adenocarcinoma in 122 patients. Transhiatal oesophagectomy was done in 151 (51.9%) patients and 134 (46.0%) patients underwent the abdominothoracic procedure.

RESULTS: In 127 (43.6%) patients the preoperative serum CRP concentration was within the normal range (< 5 mg/dL), elevated CRP levels were measured in 164 (56.4%) patients. Tumour extension (P < 0.0005) and the number of lymph nodes affected by metastatic spread (P = 0.015) were significantly increased in the group with elevated CRP levels. Among the perioperative parameters both the number of blood transfusions (P = 0.006) and the general complication rate (P = 0.002) were higher in patients with elevated preoperative CRP levels. The long-term survival rate of 13.6 (0-109.8) mo was poorer in the group with elevated CRP levels compared to 18.9 (0-155.4) mo in the group with normal CRP levels (log-rank test: P = 0.107). Multivariate analysis with backward variables selection identified preoperative CRP as an independent prognostic factor of the long-term prognosis in patients with oesophageal carcinoma, with a hazard ratio of 1.182 (95% confidence interval: 1.030-1.356).

CONCLUSION: The preoperative serum CRP-level is an easily determined independent prognostic marker in patients with squamous cell carcinoma and adenocarcinoma of the oesophagus.

Protein expression profile using two-dimensional gel analysis in squamous cervical cancer patients

PURPOSE

Screening in cervical cancer is now progressing to discover candidate genes and proteins that may serve as biological markers and that play a role in tumor progression. We examined the protein expression patterns of the squamous cell carcinoma (SCC) tissues from Korean women with using two- dimensional polyacrylamide gel electrophoresis (2-DE) and matrix assisted laser desorption/ionization-time of flight (MALDI- TOF) mass spectrometer.

MATERIALS AND METHODS

Normal cervix and SCC tissues were solubilized and 2-DE was performed using pH 3 approximately 10 linear IPG strips of 17 cm length. The protein expression was evaluated using PDQuest 2-D software. The differentially expressed protein spots were identified with a MALDI-TOF mass spectrometer, and the peptide mass spectra identifications were performed using the Mascot program and by searching the Swiss-prot or NCBInr databases.

RESULTS

A total of 35 proteins were detected in SCC. 17 proteins were up-regulated and 18 proteins were down-regulated. Among the proteins that were identified, 12 proteins (pigment epithelium derived factor, annexin A2 and A5, keratin 19 and 20, heat shock protein 27, smooth muscle protein 22 alpha, alpha-enolase, squamous cell carcinoma antigen 1 and 2, glutathione S-transferase and apolipoprotein a1) were protein previously known to be involved in tumor, and 21 proteins were newly identified in this study.

CONCLUSION

2-DE offers the total protein expression profiles of SCC tissues; further characterization of these differentially expressed proteins will give a chance to identify the badly needed tumor-specific diagnostic markers for SCC.

Value of Silver Binding Nucleolar Organiser Regions (AgNOR) in Squamous Cell Carcinomas of Upper Aero-digestive Tract

BACKGROUND

Study of Silver-binding nucleolar organizing regions (AgNORs) in 50 cases of squamous cell carcinomas (SCC) of upper Aero-digestive tract was carried out with an aim of correlating AgNOR positivity with histological grade of tumour and evaluating value of AgNOR staining in predicting the progress of disease.

METHODS

Tissue sections of the cases were stained with 50 percent silver nitrate solution for AgNOR evaluation and the data analysed. All the sections were also stained with haematoxylin and eosin stain for tumour typing and grading.

RESULTS

In this study, the mean AgNOR (mAgNOR) score of normal squamous epithelium (50 cases) was 1.56 (range1.00-2.80), that of well differentiated squamous carcinoma (27 cases) was 3.29 (range 2.4-4.6), moderately differentiated squamous carcinoma (21 cases) was 4.29 (range 2.7-5.6) and of poorly differentiated squamous cell carcinoma (2 cases) was 5.21. The mAgNOR scores were statistically significant. Comparison of the percentage AgNOR (pAgNOR) scores between well differentiated and moderately differentiated carcinomas showed that all the pAgNOR values (1-9) were significant. However, pAgNOR 3 and pAgNOR 4 were most significant. Cut off values for pAgNOR score to differentiate between the various grades of squamous cell carcinomas could not be calculated due to lack of data on survival rates.

CONCLUSION

AgNOR technique can definitely be used as a supportive tool to routinely performed Hemotoxylin and Eosin staining and may help in prognosis as well as therapeutic decision-making in squamous cell carcinomas. Studies of larger number of cases in a prospective study are needed to arrive at more substantial conclusions.

An analysis of outcomes for hypopharyngeal squamous cell carcinoma treated with different methods

AIM: To analyze the outcomes of hypop-haryngeal squamous cell carcinoma treated with different methods and to explore a more effective therapy for it.

METHODS: This retrospective study concerns 187 hypopharyngeal squamous cell carcinomas and their characteristics. The survival rate, recurrence rate and influence of laryngeal preservation on the survival were compared among different therapies.

RESULTS: The overall 5-year survival rate was 44.9%. The 5-year survival rates of stageⅠ, Ⅱ, Ⅲ and Ⅳ were 100%, 81.8%, 47.6%, and 30.2%, respectively, and the former two were significantly higher than the latter two (χ² = 22.878, P = 0.000 1). The overall 5-year survival rate for synthetic therapy, surgery and radiotherapy alone was 60.8%, 38.7%, and 22.0%, respectively, and the survival rates of patients at stage Ⅲ and Ⅳ were 75.5% and 45.3% for synthetic therapy, 33.3% and 17.6% in surgery alone, 16.7% and 7.7% in radiotherapy alone. The survival rates of stage Ⅲ and stage Ⅳ in patient received synthetic therapy were markedly higher than those in patient received surgery or radiotherapy (all P < 0.05). The overall recurrence rate was 44.9%. The 5-year recurrence rates of stage Ⅱ, Ⅲ and Ⅳ were 31.8%, 47.6% and 49.0%, respectively, and there was a significant difference between stage Ⅲ, Ⅳ and stage Ⅰ, Ⅱ(48.4% vs 25%, χ² = 5.816, P = 0.016). Significant differences were shown in the recurrence rate of stage Ⅲ, Ⅳ between synthetic therapy (26.7%) and surgery (60.9%) or radiotherapy (80%)(all P < 0.01). The recurrence rates of highly, moderately and lowly differentiated carcinoma were 34.2%, 50% and 56.1%, respectively, and there was significant differences between highly and moderately or lowly differentiated carcinoma (χ²= 4.977, P = 0.026). The 5-year survival rate was not significantly different between patients with laryngeal preservation and without laryngeal preservation at stage Ⅲ or Ⅳ (all P > 0.05).

CONCLUSION: Synthetic therapy is superior to surgery or radiotherapy alone in the treatment of hypopharyngeal squamous cell carcinoma. Laryngeal preservation can be achieved in some of patients at stage Ⅲ or Ⅳ.

Gefitinib trial in a fanconi's anemia patient with multiple squamous cell carcinomas and hepatocellular carcinoma

FA (Fanconi's Anemia) is an autosomal recessive disorder that is characterized by pancytopenia with bone marrow hypoplasia, diverse congenital abnormalities and an increased predisposition towards malignancy. The mainstay of the treatment for these cancers has been surgery, because of the hypersensitive reactions of FA patients to DNA cross- linking agents or radiation. Therefore, there has been no effective therapy for advanced squamous cell carcinoma. We report here on a patient suffering from advanced multiple squamous cell carcinoma and hepatocellular carcinoma along with an FA, and this patient was treated with gefitinib.

Preoperative sorting of circulating T lymphocytes in patients with esophageal squamous cell carcinoma: Its prognostic significance

AIM: To elucidate the immunologic parameters for the outcome of patients with malignant tumors, especially esophageal squamous cell carcinoma (ESCC) associated with high malignant potential.

METHODS: Clinicopathologic features were compared between patients with lower and higher CD4 and CD8 values as well as CD4/CD8 ratio in peripheral blood.

RESULTS: The survival rate of patients with higher CD4 value was significantly better than that in patients with lower CD4 value (P = 0.039). The survival rate of patients with higher CD8 value was significantly worse than that of patients with lower CD8 value (P = 0.026). Similarly, the survival rate of patients with higher CD4/CD8 ratio was significantly better than that of patients with lower CD4/CD8 ratio (P = 0.042). Additionally, multivariate analysis demonstrated that lower CD8 and lower CD4/CD8 ratio were factors independently associated with worse prognosis of patients.

CONCLUSION: All the immunologic parameters can predict the outcome of patients with ESCC.

Squamous cell carcinoma arising from longstanding colocutaneous fistula: A case report

A 60-year-old female patient suffered unhealed wounds over left flank for around 30 years after surgical removal of left renal stones. Fecal material spilled from the two small openings of the scar, bothered her all day long. During the course of the 30 years, she suffered from intermittent fever, diarrhea and wound pain and presented with malnourished condition. After serial examinations, tumor associated with iatrogenic colo-cutaneous fistula was impressed and she received en bloc resection. Pathology revealed squamous cell carcinoma arising from the fistula with colon and spleen invasion. To the best of our knowledge, no such case has been reported, as yet.

Recent advances in the molecular biology of head and neck tumours

Our knowlcwdge about the genetic basis of head and neck tumours is accumulating fast. This article reviews the important advances in this area over the last decade and its implications for the future. Newer aspects of gene therapy, molecular staging and understanding head and neck carcinogenesis on a molecular level are outlined.