Immunohistochemical expression of CA19-9 and CA125 in mucoepidermoid and adenoid cystic carcinomas of the salivary gland

Biomarkers in Head and Neck Cancer an Update

The study is aimed at establishing the purpose of tumour markers, their application, classification, diagnostic and therapeutic roles in the management of head and neck cancer. A literature review using Medline, Scopus, Google Scholar, the Cochrane Database of Systematic Reviews and the Cochrane central register of controlled trials for articles published between 1993 and 2016 on tumour markers and their role in head and neck cancer was performed. A broader search of prognostic markers in head and neck cancer was also carried out to avoid missing other pertinent markers. Natural history, tumour biology, stage and prognostic factors influence the outcome of management in patients with Head and Neck Squamous cell carcinoma (HNSCC). Evaluation of the cellular lineage and histogenic origin of diverse neoplasms can be done using tumour biomarkers. Identifying predictive tumour markers can lead to improvement in preventive management of HNSCC. There has been remarkable advancement in molecular technology with gene expression and proteomic profiling. Integration of specific tumour markers into routine clinical practice requires substantiation through well designed clinical trials. The investigation of tumour markers is imperative as they influence the prognosis of HNSCC and provide the potential to improve outcomes of treatment through targeted therapy. We have outlined recent tumour biomarkers in this review which have significant role in diagnosis, screening and prognostication in HNSCC. Recent advancement in clinical applications, therapeutic strategies of tumour markers has been highlighted.

Saliva CA125 and TPS Levels in Patients with Oral Squamous Cell Carcinoma

Objectives

To determine the levels of carbohydrate antigen 125 (CA125) and tissue polypeptide-specific antigen (TPS) in saliva of patients with oral squamous cell carcinoma (OSCC) and patients with nonneoplastic disease of the oral cavity, and to investigate their diagnostic value and their relationship with pathological grade and clinical stage.

Methods

A total of 97 hospitalized patients with OSCC, 36 patients with nonneoplastic disease of the oral cavity and 50 healthy individuals were included in this investigation. Mixed saliva was collected from these patients and the healthy controls before treatment. Saliva samples were analyzed by enzyme-linked immunosorbent assay (ELISA).

Results

The saliva CA125 and TPS concentrations were significantly higher in patients with OSCC than in patients with nonneoplastic disease and healthy controls, but not significantly different between patients with nonneoplastic disease and controls. Neither the saliva CA125 nor the TPS level was correlated with pathological grade and clinical stage. The sensitivity, specificity and accuracy of saliva CA125 and TPS for the diagnosis of OSCC were 80.0%, 66.0%, 75.7%, and 82.1%, 74.0%, 79.3%, respectively. When CA125 and TPS were analyzed independently, there was no significant difference in sensitivity, specificity and accuracy between the two markers. When CA125 and TPS were analyzed in combination, there was no significant difference in sensitivity, specificity and accuracy between independent detection and combined detection.

Conclusions

The saliva CA125 and TPS concentrations were elevated in patients with OSCC. CA125 and TPS may prove to be useful tumor markers in OSCC.

Salivary mucoepidermoid carcinoma revisited

Clinicopathological features, prognosis and therapeutic strategies for mucoepidermoid carcinoma originating in salivary and salivary-type glands of the head and neck are reviewed. We emphasise histopathological aspects, appraise the value of histochemistry, electron microscopy, immunohistochemistry and cytophotometry, and discuss histogenesis and characteristic gene translocations. We additionally consider possible diagnostic difficulties, problems related to histological grading and accuracy of existing literature, and areas of controversy or uncertainty which may benefit from further investigations.

Adenoid cystic carcinoma of the buccal mucosa: A case report and review of the literature

Adenoid cystic carcinomas are deceptive malignancies that show slow growth and local invasion with recurrences seen many years after diagnosis. Upto 50% of these tumors occur in the intraoral minor salivary glands usually in the hard palate. Buccal mucosal tumors are relatively rare. We determined the incidence of buccal mucosal adenoid cystic carcinoma by reviewing the number of reported cases in the literature. This is the first article to analyze the occurrence of adenoid cystic carcinomas in the buccal mucosa through a review of 41 articles. Our review revealed 178 buccal mucosal adenoid cystic carcinomas among a total of 2,280 reported cases. We present a case of adenoid cystic carcinoma occurring in the left buccal mucosa of a 45-year-old female.

Cytological features of cystadenocarcinoma in cyst fluid of the parotid gland: Diagnostic pitfalls and literature review

Cystadenocarcinoma is a rare malignant tumor, with an estimated incidence of 2% of malignant salivary gland tumors. Cytological diagnosis of cystadenocarcinoma is important for differential diagnosis between benign lesions and malignant tumors with cystic growth. We report a case of cystadenocarcinoma causing difficulty in cytological diagnosis. A 23-year-old man presented with an asymptomatic mass in the left parotid gland that had been present for 2 years. The mass was elastic hard, measuring 30 x 35 mm in diameter. Preoperative fine-needle aspiration cytology (FNAC) showed a small number of tumor cell clusters in the cystic fluid. The cluster was arranged in a ball-like structure and was cohesive with overlapping. Tumor cells had a small vacuolated, soap-bubble appearance in the cytoplasm. The papillary-cystic variant of acinic cell carcinoma (ACC-PCV) was suggested from these findings on FNAC. Histologically, the tumor was not encapsulated, but formed large cystic spaces against a background of fibrous connective tissue. The tumor cells in the cystic dilated duct showed papillary structures, which were continuous with the lining cuboidal cells. There was neither a definite double-layered arrangement in cystic ducts and solid islands nor histological findings characteristic of the papillary-cystic or follicular pattern of ACC-PCV. As tumor cells with a small vacuolated, soap-bubble appearance of the cytoplasm are common findings of both cystadenocarcinoma and ACC-PCV, they are of little use for differentiation; however, they are so characteristic that the majority of benign salivary gland lesions with cystic structures can be excluded, if enough attention is paid.

Mumps and ovarian cancer: modern interpretation of an historic association

BACKGROUND

Epidemiologic studies found childhood mumps might protect against ovarian cancer. To explain this association, we investigated whether mumps might engender immunity to ovarian cancer through antibodies against the cancer-associated antigen MUC1 abnormally expressed in the inflamed parotid gland.

METHODS

Through various health agencies, we obtained sera from 161 cases with mumps parotitis. Sera were obtained from 194 healthy controls. We used an ELISA to measure anti-MUC1 antibodies and electro-chemiluminescence assays to measure MUC1 and CA 125. Log-transformed measurements were analyzed by t-tests, generalized linear models, and Pearson or Spearman correlations. We also conducted a meta-analysis of all published studies regarding mumps and ovarian cancer.

RESULTS

Adjusting for assay batch, age, and sex, the level of anti-MUC1 antibodies was significantly higher in mumps cases compared to controls (p = 0.002). Free circulating levels of CA 125, but not MUC1, were also higher in cases (p = 0.02). From the meta-analysis, the pooled odds ratio estimate (and 95% CI) for the mumps and ovarian cancer association was 0.81 (0.68-0.96) (p = 0.01).

CONCLUSION

Mumps parotitis may lead to expression and immune recognition of a tumor-associated form of MUC1 and create effective immune surveillance of ovarian cancer cells that express this form of MUC1.

Mucoepidermoid carcinoma of the salivary glands––clinical review of 42 cases

In this retrospective study we analyzed our experience with mucoepidermoid carcinoma (MEC) of the salivary glands and compared our results with those reported in the literature. A total of 42 patients were treated between January 1983 and December 2002 at the Department of Oral and Maxillofacial Surgery, Hanover Medical School. Thirty-three tumors were classified as low grade carcinomas, 9 tumors as high grade carcinomas. Tumor sites were the parotid gland in 11 cases, sublingual and submandibular gland in 6 cases, oral cavity and oropharynx in 22 cases and nasal cavity and maxillary sinus in 3 cases. There were 23 T1-, 6 T2-, 5 T3- and 8 T4-tumors with 35 N0-, 5 N1- and 2 N2-necks, all M0 at presentation. Resection remained incomplete for 9 patients. Six patients received postoperative radiation. Overall survival rates, overall local control rates and overall regional control rates at 5 and 10 years were 79.1% and 65.5%, 89.1% and 80.8%, 92.3% and 87.7%. None of our patients developed distant failure. Grade, stage and margin status significantly influenced prognosis. MEC is a rare tumor entity and should be treated in specialist centres within randomised prospective multicentric trials.

Immunohistochemical panel of antibodies in the diagnosis of brain metastases of the unknown primary

The primary tumor of brain metastases (BM) is unknown in up to one-half of BM at the time of neurosurgery. Fifty-four consecutive unselected BM were investigated immunohistochemically using antibodies against different intermediate filaments and tumor markers. By correlating the immunohistochemical results with the location of the primary tumor, a staining pattern characteristic of the most frequent BM could be established. Subsequently, 40 cases with known primary tumor were blinded and re-evaluated based on their immunohistochemical staining pattern. Lung (20.4%), colorectum (11.1%), melanoma (7.4%), and breast (7.4%) were the most common primaries. In 14 (25.9%) cases, the primary was unknown. The characteristic immunohistochemical profiles of BM were found to be positivity of cytokeratin 7 and thyroid transcription factor-1 (TTF-1) pointing to the lung, positivity of cytokeratin 20 and negativity of cytokeratin 7 pointing to the colorectum, positivity of vimentin and protein S100 and negativity of cytokeratins (CK) pointing to a melanoma, and positivity of cytokeratin 7 and CA 15-3 with negativity of TTF-1, CA 125 and CA 19-9 pointing to the breast. These primaries comprise the majority in our series. Using the established panel of immunohistochemical markers, we were able to identify the primary in 29 out of 40 (72.5%) BM correctly. To predict the primaries of BM, a combination of antibodies against different CK, vimentin, protein S100, TTF-1, and CA 15-3 is able to point to the primary site in BM of the unknown primary.

Chemiluminescent immunosensor for CA19-9 based on antigen immobilization on a cross-linked chitosan membrane

A novel chemiluminescent immunosensor for carbohydrate antigen 19-9 (CA19-9) based on the immobilization of CA19-9 on the cross-linked chitosan membrane was developed. The different membranes were characterized by atomic force microscopy (AFM) and infrared spectrum, respectively. Based on a noncompetitive immunoassay format, this proposed chemiluminescent immunosensor enabled a low-cost, flexible and rapid determination for CA19-9 in combination with flow injection analysis (FIA). After an off-line incubation of the analyte CA19-9 with horseradish peroxidase (HRP)-labeled anti-CA19-9, the mixture was injected into the immunosensor, which led to the trapping of free HRP-labeled anti-CA19-9 by the immobilized antigen in the immunosensor. The trapped HRP-labeled antibody was detected by chemiluminescence due to its catalytic activity following the reaction of luminol and H2O2. Under optimal conditions, the decreased chemiluminescent signal of the immunosensor was proportional to the CA19-9 concentration in the range of 2.0-25 U/ml with a detection limit of 1.0 U/ml. The immunosensor showed an acceptable accuracy and good reproducibility. The results of 20 human serum samples detected by this method were in acceptable agreement with those obtained by immunoradiometric assay. The proposed immunosensor provided a new promising tool for practical clinical detection of the serum CA19-9 level.

Immunological assay for carbohydrate antigen 19-9 using an electrochemical immunosensor and antigen immobilization in titania sol–gel matrix

We describe a novel electrochemical immunosensor for carbohydrate antigen 19-9 (CA19-9) based on the immobilization of CA19-9 with titania sol-gel on a graphite electrode (GE) by vapor deposition. The CA19-9 membrane was characterized using scanning electron microscopy and proved to be chemically clean, porous and homogeneous. The incubation of the immunosensor in a solution containing horseradish peroxidase (HRP)-labeled CA19-9 antibody led to the binding of HRP-labeled antibody with the immobilized antigen. The immobilized HRP catalyzed the oxidation of catechol by H(2)O(2) and this provided a competitive method for the measurement of serum CA19-9. The response current decreased with increasing CA19-9 concentration in the incubation solution. The effects of pH, amount of HRP-labeled antibody, incubation time and temperature were explored to provide optimum analytical performance. Under optimal conditions, the current decrease of the immunosensor was proportional to CA19-9 concentrations in the range of 3-20 U/ml with a detection limit of 2.68 U/ml at a current decrease of 10%. The detection of CA19-9 in two serum samples obtained from clinically diagnosed patients with pancreatic carcinoma showed acceptable accuracy. The proposed immunosensor provides a new promising tool for the clinical immunoassay of CA19-9.