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Stojanov IJ, Omari J, Akeel I, Sultan AS, Woo SB. Oral epithelial dysplasia with lymphocytic immune response: clinicopathological characterisation of 44 cases. Histopathology 2024; 85:40-50. [PMID: 38497348 DOI: 10.1111/his.15171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/19/2024]
Abstract
AIMS Oral epithelial dysplasia (OED) often exhibits a lymphocytic/lichenoid immune response (LIR), imparting histological resemblance to lichenoid mucositis and rendering diagnosis challenging. The clinical appearances of OED and lichenoid inflammatory processes are generally divergent, presenting as well-demarcated hyperkeratotic plaques and diffuse white and/or red mucosal change with variably prominent Wickham striae, respectively. To date, clinicopathological characterisation of OED with LIR, including clinical/gross appearance, has not been depicted. METHODS AND RESULTS Cases of solitary OED with LIR for which a clinical photograph was available were identified in the authors' institutional files. Clinical and histological features were documented. In 44 identified cases, dysplasia was mild (19 of 44, 43.2%), moderate (19 of 44, 43.2%) and severe (six of 44, 13.6%). Clinically/grossly, all 44 cases (100.0%), presented as well-demarcated hyperkeratotic plaques lacking diffuse white-and-red mucosal change or Wickham striae. Histologically, OED with LIR exhibited numerous 'lichenoid' features beyond the lymphocytic band in the superficial lamina propria, including: leucocyte transmigration (38 of 44, 86.4%), spongiosis (37 of 44, 84.1%), Civatte/colloid bodies (36 of 44, 81.8%), basal cell degeneration (29 of 45, 65.9%), sawtooth rete ridges (11 of 44, 25.0%) and subepithelial clefting (7 of 44, 15.9%). CONCLUSIONS Virtually any lichenoid histological feature may be seen in OED with LIR, representing a significant diagnostic pitfall. The typical clinical appearance of OED with LIR is of a well-demarcated hyperkeratotic plaque, characteristic of keratinising dysplasia and devoid of lichenoid features. This suggests that pathologist access to clinical photographs during diagnostic interpretation of biopsied white lesions, which represents opportunity to perform gross examination of the disease process, may reduce interobserver variability and improve diagnostic accuracy in this challenging differential diagnosis.
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Affiliation(s)
- Ivan J Stojanov
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joud Omari
- Harvard School of Dental Medicine, Boston, MA, USA
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, School of Dentistry, The University of Jordan, Amman, Jordan
| | - Ibrahim Akeel
- Oral Diagnostic Sciences Department, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Ahmed S Sultan
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, MD, USA
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Sook-Bin Woo
- Harvard School of Dental Medicine, Boston, MA, USA
- Center for Oral Pathology, StrataDx, Lexington, MA, USA
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Tan QX, Shannon NB, Lim WK, Teo JX, Yap DRY, Lek SM, Tan JWS, Tan SJJ, Hendrikson J, Liu Y, Ng G, Chong CYL, Guo W, Koh KKN, Ng CCY, Rajasegaran V, Wong JS, Seo CJ, Ong CK, Lim TKH, Teh BT, Kon OL, Chia CS, Soo KC, Iyer NG, Ong CAJ. Transcriptomic convergence despite genomic divergence drive field cancerization in synchronous squamous tumors. Front Oncol 2024; 14:1272432. [PMID: 38939336 PMCID: PMC11208456 DOI: 10.3389/fonc.2024.1272432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 05/28/2024] [Indexed: 06/29/2024] Open
Abstract
Introduction Field cancerization is suggested to arise from imbalanced differentiation in individual basal progenitor cells leading to clonal expansion of mutant cells that eventually replace the epithelium, although without evidence. Methods We performed deep sequencing analyses to characterize the genomic and transcriptomic landscapes of field change in two patients with synchronous aerodigestive tract tumors. Results Our data support the emergence of numerous genetic alterations in cancer-associated genes but refutes the hypothesis that founder mutation(s) underpin this phenomenon. Mutational signature analysis identified defective homologous recombination as a common underlying mutational process unique to synchronous tumors. Discussion Our analyses suggest a common etiologic factor defined by mutational signatures and/or transcriptomic convergence, which could provide a therapeutic opportunity.
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Affiliation(s)
- Qiu Xuan Tan
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Nicholas B. Shannon
- Department of Head and Neck Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Weng Khong Lim
- SingHealth Duke-NUS Institute of Precision Medicine, National Heart Centre Singapore, Singapore, Singapore
- Cancer and Stem Biology Program, Duke-NUS Medical School, Singapore, Singapore
| | - Jing Xian Teo
- SingHealth Duke-NUS Institute of Precision Medicine, National Heart Centre Singapore, Singapore, Singapore
| | - Daniel R. Y. Yap
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Sze Min Lek
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Joey W. S. Tan
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Shih Jia J. Tan
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Josephine Hendrikson
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Ying Liu
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Gillian Ng
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Clara Y. L. Chong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Wanyu Guo
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Kelvin K. N. Koh
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Cedric C. Y. Ng
- Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Vikneswari Rajasegaran
- Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Jolene S.M. Wong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
| | - Chin Jin Seo
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
| | - Choon Kiat Ong
- Cancer and Stem Biology Program, Duke-NUS Medical School, Singapore, Singapore
- Lymphoma Genomics Translational Laboratory, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Tony K. H. Lim
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
- Pathology Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Bin Tean Teh
- Cancer and Stem Biology Program, Duke-NUS Medical School, Singapore, Singapore
- Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
- Institute of Molecular and Cell Biology, ASTAR Research Entities, Singapore, Singapore
| | - Oi Lian Kon
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Claramae S. Chia
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Khee Chee Soo
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - N. Gopalakrishna Iyer
- Department of Head and Neck Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Cancer and Stem Biology Program, Duke-NUS Medical School, Singapore, Singapore
- Cancer Therapeutics Research Laboratory, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Chin-Ann J. Ong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
- Institute of Molecular and Cell Biology, ASTAR Research Entities, Singapore, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
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Alajaji SA, Khoury ZH, Jessri M, Sciubba JJ, Sultan AS. An Update on the Use of Artificial Intelligence in Digital Pathology for Oral Epithelial Dysplasia Research. Head Neck Pathol 2024; 18:38. [PMID: 38727841 PMCID: PMC11087425 DOI: 10.1007/s12105-024-01643-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/30/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Oral epithelial dysplasia (OED) is a precancerous histopathological finding which is considered the most important prognostic indicator for determining the risk of malignant transformation into oral squamous cell carcinoma (OSCC). The gold standard for diagnosis and grading of OED is through histopathological examination, which is subject to inter- and intra-observer variability, impacting accurate diagnosis and prognosis. The aim of this review article is to examine the current advances in digital pathology for artificial intelligence (AI) applications used for OED diagnosis. MATERIALS AND METHODS We included studies that used AI for diagnosis, grading, or prognosis of OED on histopathology images or intraoral clinical images. Studies utilizing imaging modalities other than routine light microscopy (e.g., scanning electron microscopy), or immunohistochemistry-stained histology slides, or immunofluorescence were excluded from the study. Studies not focusing on oral dysplasia grading and diagnosis, e.g., to discriminate OSCC from normal epithelial tissue were also excluded. RESULTS A total of 24 studies were included in this review. Nineteen studies utilized deep learning (DL) convolutional neural networks for histopathological OED analysis, and 4 used machine learning (ML) models. Studies were summarized by AI method, main study outcomes, predictive value for malignant transformation, strengths, and limitations. CONCLUSION ML/DL studies for OED grading and prediction of malignant transformation are emerging as promising adjunctive tools in the field of digital pathology. These adjunctive objective tools can ultimately aid the pathologist in more accurate diagnosis and prognosis prediction. However, further supportive studies that focus on generalization, explainable decisions, and prognosis prediction are needed.
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Affiliation(s)
- Shahd A Alajaji
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, 650 W. Baltimore Street, 7 Floor, Baltimore, MD, 21201, USA
- Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
- Division of Artificial Intelligence Research, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Zaid H Khoury
- Department of Oral Diagnostic Sciences and Research, Meharry Medical College School of Dentistry, Nashville, TN, USA
| | - Maryam Jessri
- Oral Medicine and Pathology Department, School of Dentistry, University of Queensland, Herston, QLD, Australia
- Oral Medicine Department, Metro North Hospital and Health Services, Queensland Health, Brisbane, QLD, Australia
| | - James J Sciubba
- Department of Otolaryngology, Head & Neck Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Ahmed S Sultan
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, 650 W. Baltimore Street, 7 Floor, Baltimore, MD, 21201, USA.
- Division of Artificial Intelligence Research, University of Maryland School of Dentistry, Baltimore, MD, USA.
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.
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Lechien JR, Vaira LA, Chiesa-Estomba CM. Laryngeal verrucous cell carcinoma. Curr Opin Otolaryngol Head Neck Surg 2024; 32:118-124. [PMID: 37820109 DOI: 10.1097/moo.0000000000000910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW To summarize the recent literature on epidemiology, clinical findings, treatment, and survival of laryngeal verrucous cell carcinoma (LVC). RECENT FINDINGS Epidemiological studies report that LVC accounts for 1-3% of all laryngeal cancers. The incidence is decreasing, while most patients are male individuals and smokers. LVC are commonly detected in early stages because they are more frequently located in the glottic region. Tobacco, alcohol overuse, and, possibly, human papilloma virus are the main contributing factors. Recent studies confirm that surgery is the primary therapeutic approach with better prognosis when compared with other treatment modalities. Surgery alone is associated with 86.8% disease-free and 80.3% overall survival rates, while metastases are anecdotal. SUMMARY LVC presents different clinical, pathological, and survival outcomes when compared with the classic laryngeal squamous cell carcinoma. Biopsies need often to be repeated before getting the most appropriate diagnosis; this supports the need of large-sample biopsy during the tumor diagnosis and staging. The glottic location of most LVC leads to detection of this lesion in its early stages, with ensuing better survival and outcomes after surgery compared with the classic form of squamous cell carcinoma. Future studies are needed to understand the biology of LVC and its related better prognostic outcomes when compared to other laryngeal malignancies.
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Affiliation(s)
- Jerome R Lechien
- Laryngology Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Paris, France
| | - Luigi A Vaira
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacy
- School of Biomedical Sciences, Biomedical Sciences Department, University of Sassari, Sassari, Italy
| | - Carlos M Chiesa-Estomba
- Laryngology Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Department of Otolaryngology-Head and Neck Surgery, San Sebastian University Hospital, San Sebastian, Spain
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Flores-Hidalgo A, Phero J, Steward-Tharp S, Williamson M, Paquette D, Krishnan D, Padilla R. Immunophenotypic and Gene Expression Analyses of the Inflammatory Microenvironment in High-Grade Oral Epithelial Dysplasia and Oral Lichen Planus. Head Neck Pathol 2024; 18:17. [PMID: 38456941 PMCID: PMC10923754 DOI: 10.1007/s12105-024-01624-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/30/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Oral lichen planus (OLP) and oral epithelial dysplasia (OED) present diagnostic challenges due to clinical and histologic overlap. This study explores the immune microenvironment in OED, hypothesizing that immune signatures could aid in diagnostic differentiation and predict malignant transformation. METHODS Tissue samples from OED and OLP cases were analyzed using immunofluorescence/immunohistochemistry (IF/IHC) for CD4, CD8, CD163/STAT1, and PD-1/PDL-1 expression. RNA-sequencing was performed on the samples, and data was subjected to CIBERSORTx analysis for immune cell composition. Gene Ontology analysis on the immune differentially expressed genes was also conducted. RESULTS In OED, CD8 + T-cells infiltrated dysplastic epithelium, correlating with dysplasia severity. CD4 + lymphocytes increased in the basal layer. STAT1/CD163 + macrophages correlated with CD4 + intraepithelial distribution. PD-1/PDL-1 expression varied. IF/IHC analysis revealed differential immune cell composition between OED and OLP. RNA-sequencing identified upregulated genes associated with cytotoxic response and immunosurveillance in OED. Downregulated genes were linked to signaling, immune cell recruitment, and tumor suppression. CONCLUSIONS The immune microenvironment distinguishes OED and OLP, suggesting diagnostic potential. Upregulated genes indicate cytotoxic immune response in OED. Downregulation of TRADD, CX3CL1, and ILI24 implies dysregulation in TNFR1 signaling, immune recruitment, and tumor suppression. This study contributes to the foundation for understanding immune interactions in OED and OLP, offering insights into future objective diagnostic avenues.
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Affiliation(s)
- Andres Flores-Hidalgo
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - James Phero
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Scott Steward-Tharp
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, USA
| | - Megumi Williamson
- Department of Surgical Sciences, East Carolina University School of Dental Medicine, Greenville, USA
| | - David Paquette
- Department of Surgical Sciences, East Carolina University School of Dental Medicine, Greenville, USA
| | - Deepak Krishnan
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ricardo Padilla
- Department of Diagnostic Sciences, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, USA
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Al-Janabi MAH, Mousto R, Abodest R, Tally H, Daoud AK, Ibrahim M. Basaloid squamous cell carcinoma of the larynx: A rare case report. Int J Surg Case Rep 2023; 111:108791. [PMID: 37690277 PMCID: PMC10507190 DOI: 10.1016/j.ijscr.2023.108791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 09/12/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive subtype of squamous cell carcinoma. BSCC in the larynx is an extremely rare occurrence, with only a few cases reported in the medical literature. This case report aims to shed light on the clinical presentation, diagnostic challenges, histopathological features, and therapeutic considerations associated with this rare entity. CASE PRESENTATION This case report describes a 65-year-old male patient who presented with hoarseness and dyspnea. Laryngoscopy revealed a 2.5 cm pedunculated lesion on the left vocal cord. The patient underwent a laryngectomy, and the histopathological examination of the excised specimen confirmed the diagnosis of BSCC. CLINICAL DISCUSSION BSCC of the larynx is a rare malignancy comprising less than 1 % of laryngeal cancers. Clinical features often overlap those of squamous cell carcinoma, such as hoarseness, progressive breathing difficulties, and swallowing issues. Treatment approaches vary, with some opting for neo-adjuvant radiotherapy before surgery, like in this case, while others favor surgical excision as the primary treatment, supplemented by adjuvant chemo- or radiotherapy in certain cases. CONCLUSION Basaloid squamous cell carcinoma is a rare variant of squamous cell carcinoma. Clinicians and pathologists should be aware of the distinctive characteristics of BSCC and its potential clinical aggressiveness. While rare, early recognition and appropriate management are essential for achieving favorable outcomes in patients with this challenging condition.
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Affiliation(s)
| | - Reham Mousto
- Faculty of Medicine, Tishreen University, Lattakia, Syria
| | - Riham Abodest
- Faculty of Medicine, Tishreen University, Lattakia, Syria
| | - Hanan Tally
- Department of ENT, Tishreen University Hospital, Lattakia, Syria
| | - Ali Kamel Daoud
- Department of Pathology, Tishreen University Hospital, Lattakia, Syria
| | - Mostafa Ibrahim
- Department of ENT, Tishreen University Hospital, Lattakia, Syria
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Radaic A, Shamir ER, Jones K, Villa A, Garud NR, Tward AD, Kamarajan P, Kapila YL. Specific Oral Microbial Differences in Proteobacteria and Bacteroidetes Are Associated with Distinct Sites When Moving from Healthy Mucosa to Oral Dysplasia-A Microbiome and Gene Profiling Study and Focused Review. Microorganisms 2023; 11:2250. [PMID: 37764094 PMCID: PMC10534919 DOI: 10.3390/microorganisms11092250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/24/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Oral potentially malignant disorders (OPMDs) are a group of conditions that carry a risk of oral squamous cell carcinoma (OSCC) development. Recent studies indicate that periodontal disease-associated pathogenic bacteria may play a role in the transition from healthy mucosa to dysplasia and to OSCC. Yet, the microbial signatures associated with the transition from healthy mucosa to dysplasia have not been established. To characterize oral microbial signatures at these different sites, we performed a 16S sequencing analysis of both oral swab and formalin-fixed, paraffin-embedded tissue (FFPE) samples. We collected oral swabs from healthy mucosa (from healthy patients), histologically normal mucosa adjacent to dysplasia, and low-grade oral dysplasia. Additionally, FFPE samples from histologically normal mucosa adjacent to OSCC, plus low grade and high-grade oral dysplasia samples were also collected. The collected data demonstrate significant differences in the alpha and beta microbial diversities of different sites in oral mucosa, dysplasia, and OSCC, as well as increased dissimilarities within these sites. We found that the Proteobacteria phyla abundance increased, concurrent with a progressive decrease in the Firmicutes phyla abundance, as well as altered levels of Enterococcus cecorum, Fusobacterium periodonticum, Prevotella melaninogenica, and Fusobacterium canifelinum when moving from healthy to diseased sites. Moreover, the swab sample analysis indicates that the oral microbiome may be altered in areas that are histologically normal, including in mucosa adjacent to dysplasia. Furthermore, trends in specific microbiome changes in oral swab samples preceded those in the tissues, signifying early detection opportunities for clinical diagnosis. In addition, we evaluated the gene expression profile of OSCC cells (HSC-3) infected with either P. gingivalis, T. denticola, F. nucelatum, or S. sanguinis and found that the three periodontopathogens enrich genetic processes related to cancer progression, including skin keratinization/cornification, while the commensal enriched processes related to RNA processing and adhesion. Finally, we reviewed the dysplasia microbiome literature and found a significant decrease in commensal bacteria, such as the Streptococci genus, and a simultaneous increase in pathogenic bacteria, mainly Bacteroidetes phyla and Fusobacterium genus. These findings suggest that features of the oral microbiome can serve as novel biomarkers for dysplasia and OSCC disease progression.
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Affiliation(s)
- Allan Radaic
- School of Dentistry, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (A.R.); (P.K.)
- School of Dentistry, University of California, San Francisco (UCSF), San Francisco, CA 94143, USA; (K.J.); (A.V.)
| | - Eliah R. Shamir
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA 94143, USA; (E.R.S.); (A.D.T.)
- Genentech, Inc., South San Francisco, CA 94080, USA
| | - Kyle Jones
- School of Dentistry, University of California, San Francisco (UCSF), San Francisco, CA 94143, USA; (K.J.); (A.V.)
- Genentech, Inc., South San Francisco, CA 94080, USA
| | - Alessandro Villa
- School of Dentistry, University of California, San Francisco (UCSF), San Francisco, CA 94143, USA; (K.J.); (A.V.)
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA
| | - Nandita R. Garud
- College of Life Sciences, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA;
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - Aaron D. Tward
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA 94143, USA; (E.R.S.); (A.D.T.)
| | - Pachiyappan Kamarajan
- School of Dentistry, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (A.R.); (P.K.)
- School of Dentistry, University of California, San Francisco (UCSF), San Francisco, CA 94143, USA; (K.J.); (A.V.)
| | - Yvonne L. Kapila
- School of Dentistry, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA; (A.R.); (P.K.)
- School of Dentistry, University of California, San Francisco (UCSF), San Francisco, CA 94143, USA; (K.J.); (A.V.)
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Muthupalani S, Annamalai D, Feng Y, Ganesan SM, Ge Z, Whary MT, Nakagawa H, Rustgi AK, Wang TC, Fox JG. IL-1β transgenic mouse model of inflammation driven esophageal and oral squamous cell carcinoma. Sci Rep 2023; 13:12732. [PMID: 37543673 PMCID: PMC10404242 DOI: 10.1038/s41598-023-39907-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/02/2023] [Indexed: 08/07/2023] Open
Abstract
Chronic inflammation is integral to the development of esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC), although the latter has not been associated with reflux esophagitis. The L2-IL-1β transgenic mice, expressing human interleukin (IL)-1β in the oral, esophageal and forestomach squamous epithelia feature chronic inflammation and a stepwise development of Barrett's esophagus-like metaplasia, dysplasia and adenocarcinoma at the squamo-columnar junction. However, the functional consequences of IL-1β-mediated chronic inflammation in the oral and esophageal squamous epithelia remain elusive. We report for the first time that in addition to the previously described Barrett's esophagus-like metaplasia, the L2-IL-1β mice also develop squamous epithelial dysplasia with progression to squamous cell carcinoma (SCC) in the esophagus and the tongue. L2-IL-1β showed age-dependent progression of squamous dysplasia to SCC with approximately 40% (n = 49) and 23.5% (n = 17) incidence rates for esophageal and tongue invasive SCC respectively, by 12-15 months of age. Interestingly, SCC development and progression in L2-IL-1β was similar in both Germ Free (GF) and Specific Pathogen Free (SPF) conditions. Immunohistochemistry revealed a T cell predominant inflammatory profile with enhanced expression of Ki67, Sox2 and the DNA double-strand break marker, γ-H2AX, in the dysplastic squamous epithelia of L2-IL-1β mice. Pro-inflammatory cytokines, immunomodulatory players, chemoattractants for inflammatory cells (T cells, neutrophils, eosinophils, and macrophages) and oxidative damage marker, iNOS, were significantly increased in the esophageal and tongue tissues of L2-IL-1β mice. Our recent findings have expanded the translational utility of the IL-1β mouse model to aid in further characterization of the key pathways of inflammation driven BE and EAC as well as ESCC and Oral SCC.
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Affiliation(s)
- Sureshkumar Muthupalani
- Division of Comparative Medicine, Massachusetts Institute of Technology, 77 Massachusetts Avenue, 16-825C, Cambridge, MA, 02139, USA.
- StageBio, 5930 Main St, Mount Jackson, VA, 22842, USA.
| | - Damodaran Annamalai
- Division of Comparative Medicine, Massachusetts Institute of Technology, 77 Massachusetts Avenue, 16-825C, Cambridge, MA, 02139, USA
| | - Yan Feng
- Division of Comparative Medicine, Massachusetts Institute of Technology, 77 Massachusetts Avenue, 16-825C, Cambridge, MA, 02139, USA
| | - Suresh M Ganesan
- Division of Comparative Medicine, Massachusetts Institute of Technology, 77 Massachusetts Avenue, 16-825C, Cambridge, MA, 02139, USA
| | - Zhongming Ge
- Division of Comparative Medicine, Massachusetts Institute of Technology, 77 Massachusetts Avenue, 16-825C, Cambridge, MA, 02139, USA
| | - Mark T Whary
- Division of Comparative Medicine, Massachusetts Institute of Technology, 77 Massachusetts Avenue, 16-825C, Cambridge, MA, 02139, USA
| | - Hiroshi Nakagawa
- Division of Digestive and Liver Diseases and Herbert Irving Cancer Research Center, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - Anil K Rustgi
- Division of Digestive and Liver Diseases and Herbert Irving Cancer Research Center, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - Timothy C Wang
- Division of Digestive and Liver Diseases and Herbert Irving Cancer Research Center, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - James G Fox
- Division of Comparative Medicine, Massachusetts Institute of Technology, 77 Massachusetts Avenue, 16-825C, Cambridge, MA, 02139, USA.
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.
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9
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Jiang D, Wang H, Deng M, Song Q, Liu Y, Peng R, Xu L, Su J, Xu C, Hou Y. A comparative analysis of clinicopathological factors and survival between esophageal basaloid squamous cell carcinoma and conventional esophageal squamous cell carcinoma. Eur J Surg Oncol 2022; 49:958-963. [PMID: 36588005 DOI: 10.1016/j.ejso.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/17/2022] [Accepted: 12/24/2022] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Recently, the number of diagnosed esophageal basaloid squamous cell carcinoma (EBSCC) has gradually increased. However, available data on EBSCC are limited to date. METHODS A total of 165 EBSCC (Cohort 1) and 515 conventional esophageal squamous cell carcinoma (ESCC) (Cohort 2) were retrospectively analyzed. RESULTS In Cohort 1, 70 cases only had invasive EBSCC component (42.4%, defined as Group 1), 73 cases had concomitant invasive ESCC component (44.2%, Group 2), and 22 had concomitant invasive poor-differentiated component (13.3%, Group 3). Lymph node metastasis rates of Group 3, Group 2 and Group 1 were ranked from high to low (P = 0.044). There were higher patient age (P = 0.047), smaller tumor size (P = 0.009), more nerve invasion (P < 0.001), and lower pTNM stage (P < 0.001) in EBSCC (Cohort 1), compared with ESCC (Cohort 2). In Cohort 1 and Cohort 2, pTNM stage was an independent prognostic factor for both DFS and OS. No significant survival difference was found between EBSCC (Cohort 1) and ESCC (Cohort 2) in pIA-B stage, pIIA-B stage, pIIIA-B stage and pIVA-B stage (P > 0.05). CONCLUSION Our analysis of the largest EBSCC series from a single institution to date with conventional ESCC demonstrated that EBSCC carried a similar prognosis with ESCC in pIA-B stage, pIIA-B stage, pIIIA-B stage and pIVA-B stage. And pure EBSCC, didn't have poorer survival than mixed EBSCC with concomitant ESCC or other components. Our findings may be valuable in the better understanding of EBSCC's biological behaviors, and the related molecular mechanism is needed to be explored in the future.
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Affiliation(s)
- Dongxian Jiang
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China; Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Haixing Wang
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Minying Deng
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Song
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yufeng Liu
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rui Peng
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Xu
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jieakesu Su
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chen Xu
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yingyong Hou
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China; Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China.
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10
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An J, Nagaki Y, Motoyama S, Kuze Y, Hoshizaki M, Kemuriyama K, Yamaguchi T, Ebihara T, Minamiya Y, Suzuki Y, Imai Y, Kuba K. Identification of Galectin-7 as a crucial metastatic enhancer of squamous cell carcinoma associated with immunosuppression. Oncogene 2022; 41:5319-5330. [PMID: 36335283 DOI: 10.1038/s41388-022-02525-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
Metastasis predicts poor prognosis in cancer patients. It has been recognized that specific tumor microenvironment defines cancer cell metastasis, whereas the underlying mechanisms remain elusive. Here we show that Galectin-7 is a crucial mediator of metastasis associated with immunosuppression. In a syngeneic mouse squamous cell carcinoma (SCC) model of NR-S1M cells, we isolated metastasized NR-S1M cells from lymph nodes in tumor-bearing mice and established metastatic NR-S1M cells in in vitro culture. RNA-seq analysis revealed that interferon gene signature was markedly downregulated in metastatic NR-S1M cells compared with parental cells, and in vivo NR-S1M tumors heterogeneously developed focal immunosuppressive areas featured by deficiency of anti-tumor immune cells. Spatial transcriptome analysis (Visium) for the NR-S1M tumors revealed that various pro-metastatic genes were significantly upregulated in immunosuppressive areas when compared to immunocompetent areas. Notably, Galectin-7 was identified as a novel metastasis-driving factor. Galectin-7 expression was induced during tumorigenesis particularly in the microenvironment of immunosuppression, and extracellularly released at later stage of tumor progression. Deletion of Galectin-7 in NR-S1M cells significantly suppressed lymph node and lung metastasis without affecting primary tumor growth. Therefore, Galectin-7 is a crucial mediator of tumor metastasis of SCC, which is educated in the immune-suppressed tumor areas, and may be a potential target of cancer immunotherapy.
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Affiliation(s)
- Jianbo An
- Department of Biochemistry and Metabolic Science, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Yushi Nagaki
- Department of Biochemistry and Metabolic Science, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.,Department of Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Satoru Motoyama
- Department of Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuta Kuze
- Department of Medical Genome Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, 277-8562, Japan
| | - Midori Hoshizaki
- Department of Biochemistry and Metabolic Science, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.,Department of Medical Biology, Akita University Graduate School of Medicine, Akita, Japan
| | - Kohei Kemuriyama
- Department of Biochemistry and Metabolic Science, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.,Department of Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Tomokazu Yamaguchi
- Department of Biochemistry and Metabolic Science, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Takashi Ebihara
- Department of Medical Biology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshihiro Minamiya
- Department of Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yutaka Suzuki
- Department of Medical Genome Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, 277-8562, Japan
| | - Yumiko Imai
- Laboratory of Regulation of Intractable Infectious Diseases, National Institute of Biomedical Innovation, Health and Nutrition, Ibaraki, Osaka, 567-0085, Japan
| | - Keiji Kuba
- Department of Biochemistry and Metabolic Science, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan. .,Department of Pharmacology, Kyushu University Graduate School of Medical Sciences, Fukuoka, 812-8582, Japan.
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11
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Alabdulaaly L, Villa A, Chen T, Kerr A, Ross N, Abreu Alves F, Guollo A, Woo SB. Characterization of initial/early histologic features of proliferative leukoplakia and correlation with malignant transformation: a multicenter study. Mod Pathol 2022; 35:1034-1044. [PMID: 35184151 DOI: 10.1038/s41379-022-01021-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 02/07/2023]
Abstract
The aim of this multicenter retrospective study is to characterize the histopathologic features of initial/early biopsies of proliferative leukoplakia (PL; also known as proliferative verrucous leukoplakia), and to analyze the correlation between histopathologic features and malignant transformation (MT). Patients with a clinical diagnosis of PL who have at least one biopsy and one follow-up visit were included in this study. Initial/early biopsy specimens were reviewed. The biopsies were evaluated for the presence of squamous cell carcinoma (SCCa), oral epithelial dysplasia (OED), and atypical verrucous hyperplasia (AVH). Cases that lacked unequivocal features of dysplasia were termed "hyperkeratosis/parakeratosis not reactive (HkNR)". Pearson chi-square test and Wilcoxon test were used for statistical analysis. There were 86 early/initial biopsies from 59 patients; 74.6% were females. Most of the cases had a smooth/homogenous (34.8%) or fissured appearance (32.6%), and only 13.0% had a verrucous appearance. The most common biopsy site was the gingiva/alveolar mucosa (40.8%) and buccal mucosa (25.0%). The most common histologic diagnosis was OED (53.5%) followed by HkNR (31.4%). Of note, two-thirds of HkNR cases showed only hyperkeratosis and epithelial atrophy. A lymphocytic band was seen in 34.8% of OED cases and 29.6% of HkNR cases, mostly associated with epithelial atrophy. Twenty-eight patients (47.5%) developed carcinoma and 28.9% of early/initial biopsy sites underwent MT. The mortality rate was 11.9%. Our findings show that one-third of cases of PL do not show OED with most exhibiting hyperkeratosis and epithelial atrophy, but MT nevertheless occurred at such sites in 3.7% of cases.
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Affiliation(s)
- Lama Alabdulaaly
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, 02115, USA. .,Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, 02115, USA. .,Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Alessandro Villa
- Department of Orofacial Sciences, University of California San Francisco, San Francisco, CA, 94193, USA
| | - Tiffany Chen
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Alexander Kerr
- Department of Oral & Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry, New York, NY, 10010, USA
| | - Nicholas Ross
- Department of Oral & Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry, New York, NY, 10010, USA
| | - Fabio Abreu Alves
- Stomatology Department, AC Camargo Cancer Center, São Paulo, SP, 01525, Brazil
| | - Andre Guollo
- Stomatology Department, AC Camargo Cancer Center, São Paulo, SP, 01525, Brazil
| | - Sook-Bin Woo
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, 02115, USA.,Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, 02115, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
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12
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Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Hypopharynx, Larynx, Trachea and Parapharyngeal Space. Head Neck Pathol 2022; 16:31-39. [PMID: 35312977 PMCID: PMC9018940 DOI: 10.1007/s12105-021-01405-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/16/2021] [Indexed: 11/17/2022]
Abstract
In this article, we review the chapter on tumors of the larynx, hypopharynx, trachea and parapharyngeal space in the new edition of the WHO book, focusing on the new developments in comparison to the previous edition. Squamous cell carcinoma (SCC) and its variants are by far the most common malignancies at these locations, with very limited new insights. The most important is the introduction of new targeted treatment-checkpoint inhibitors, with a new task for pathologists, who may help to predict the response to treatment by analyzing the expression of targeted proteins in biopsy samples. Precancerous lesions remain a controversial topic and, similarly to other organs, it is acceptable to use the terms "dysplasia" or "squamous intraepithelial lesion" (SIL), but there is a slight difference between low-grade dysplasia and low-grade SIL: in the former, mild atypia must be present, while the latter also includes hyperplastic epithelium without atypia. Two approaches have been proposed: a two-tiered system with low- and high-grade dysplasia/SIL and a three-tiered system with an additional category, carcinoma in situ. We are still searching for reliable diagnostic markers to surpass the subjectivity in biopsy diagnosis, with a few potential candidate markers on the horizon, e.g., stem cell markers. Other tumors are rare at these locations, e.g., hematolymphoid, neuroendocrine and salivary gland neoplasms, and are no longer included in Chapter 3. They must be diagnosed according to criteria described in specific chapters. The same holds true for soft tissue tumors, with the exception of cartilaginous neoplasms, which are still included in Chapter 3.
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13
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SATB2 Immunopositivity in Spindle Cell (Sarcomatoid) Squamous Cell Carcinoma. Appl Immunohistochem Mol Morphol 2021; 30:184-189. [DOI: 10.1097/pai.0000000000000986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/26/2021] [Indexed: 11/26/2022]
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14
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Georgaki M, Theofilou VI, Pettas E, Stoufi E, Younis RH, Kolokotronis A, Sauk JJ, Nikitakis NG. Understanding the complex pathogenesis of oral cancer: A comprehensive review. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:566-579. [PMID: 34518141 DOI: 10.1016/j.oooo.2021.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/27/2021] [Accepted: 04/18/2021] [Indexed: 01/08/2023]
Abstract
The pathogenesis of oral cancer is a complex and multifactorial process that requires a deep understanding of the underlying mechanisms involved in the development and progress of malignancy. The ever-improving comprehension of the diverse molecular characteristics of cancer, the genetic and epigenetic alterations of tumor cells, and the complex signaling pathways that are activated and frequently cross talk open up promising horizons for the discovery and application of diagnostic molecular markers and set the basis for an era of individualized management of the molecular defects underlying and governing oral premalignancy and cancer. The purpose of this article is to review the key molecular concepts that are implicated in oral carcinogenesis, especially focusing on oral squamous cell carcinoma, and to review selected biomarkers that play a substantial role in controlling the so-called "hallmarks of cancer," with special reference to recent advances that shed light on their deregulation during the different steps of oral cancer development and progression.
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Affiliation(s)
- Maria Georgaki
- Department of Oral Medicine and Pathology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Vasileios Ionas Theofilou
- Department of Oral Medicine and Pathology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece; Department of Oncology and Diagnostic Sciences, School of Dentistry, and Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, USA
| | - Efstathios Pettas
- Department of Oral Medicine and Pathology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleana Stoufi
- Department of Oral Medicine and Pathology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Rania H Younis
- Department of Oncology and Diagnostic Sciences, School of Dentistry, and Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, USA
| | - Alexandros Kolokotronis
- Department of Oral Medicine and Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - John J Sauk
- Professor Emeritus and Dean Emeritus, University of Louisville, Louisville, KY, USA
| | - Nikolaos G Nikitakis
- Department of Oral Medicine and Pathology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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15
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Odell E, Kujan O, Warnakulasuriya S, Sloan P. Oral epithelial dysplasia: Recognition, grading and clinical significance. Oral Dis 2021; 27:1947-1976. [PMID: 34418233 DOI: 10.1111/odi.13993] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/14/2021] [Accepted: 07/31/2021] [Indexed: 12/29/2022]
Abstract
Histopathological grading of epithelial dysplasia remains the principal laboratory method for assessing the risk of malignant transformation in oral potentially malignant disorders (OPMDs). Current views on the molecular pathogenesis and histological interpretation of the features of epithelial dysplasia are described, and the use of grading systems for epithelial dysplasia is discussed. Changes to the current 2017 WHO criteria for diagnosis are proposed with emphasis on the architectural features of epithelial dysplasia. The predictive values of three-grade and binary systems are summarised, and categories of epithelial dysplasia are reviewed, including lichenoid and verrucous lesions, keratosis of unknown significance, HPV-associated dysplasia, differentiated and basaloid epithelial dysplasia. The implications of finding epithelial dysplasia in an oral biopsy for clinical management are discussed from the pathologists' viewpoint.
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Affiliation(s)
- Edward Odell
- King's College London and Head and Neck Pathology Guy's Hospital, London, UK
| | - Omar Kujan
- UWA Dental School, The University of Western Australia, Perth, WA, Australia
| | - Saman Warnakulasuriya
- Faculty of Dentistry, Oral and Craniofacial Sciences King's College London and The WHO Collaborating Centre for Oral Cancer, King's College London, London, UK
| | - Philip Sloan
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Chief Histopathologist, AMLo Biosciences, Newcastle upon Tyne, UK
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16
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Xie C, Liao J, Huang C, Wei F, Liu T, Wen W, Sun W. Basaloid squamous cell carcinoma of the hypopharynx: an analysis of 213 cases. Eur Arch Otorhinolaryngol 2021; 279:2099-2107. [PMID: 34319483 DOI: 10.1007/s00405-021-07007-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/14/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Basaloid squamous cell carcinoma (BSCC) is a rare aggressive variant of squamous cell carcinoma (SCC) with a poor prognosis. No large series of exclusively hypopharyngeal BSCC patients have been previously reported. Therefore, this retrospective population-based study aims to explain the patient demographics, clinicopathologic characteristics, incidence, and survival outcomes of hypopharyngeal BSCC and how it relates to conventional-type SCC. METHODS The National Cancer Institute's Surveillance, Epidemiology, and End Results database registry was queried for patients diagnosed with hypopharyngeal BSCC and conventional-type SCC between 2001 and 2016. RESULTS The incidence of hypopharyngeal BSCC from 2001 to 2016 was 0.0161 per 100,000 individuals. The BSCC group comprised 213 patients, and the SCC group 7958 patients. The majority of BSCCs were considered high grade (Grade III/IV, 89.58%). Most BSCC patients were diagnosed at an advanced stage (American Joint Committee on Cancer [AJCC] stage IV, 65.38%). The 1-, 5-, and 10-year disease-specific survival (DSS) rates for hypopharyngeal BSCC were 84.10%, 57.40%, and 46.20%, respectively. Multivariate analysis, after adjustment for sex, age, race, tumor location, grade, and AJCC stage, showed that patients with BSCC had significantly better DSS than those with conventional-type SCC. Surgery with radiation contributed to a favorable DSS for BSCC patients in comparison with other treatments. CONCLUSION This analysis of the largest hypopharyngeal BSCC series indicates a better prognosis for this pathologic type compared with conventional-type hypopharyngeal SCC. Multimodality treatment with surgery and radiation may result in a favorable prognosis for hypopharyngeal BSCC patients.
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Affiliation(s)
- Chubo Xie
- Department of Otorhinolaryngology Head and Neck Surgery, Department of Thyroid Center/Thyroid Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
| | - Jing Liao
- Department of Otorhinolaryngology Head and Neck Surgery, Department of Thyroid Center/Thyroid Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China.,Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chunxia Huang
- Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Fanqin Wei
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China.,Guangzhou Key Laboratory of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Tianrun Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Department of Thyroid Center/Thyroid Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China
| | - Weiping Wen
- Department of Otorhinolaryngology Head and Neck Surgery, Department of Thyroid Center/Thyroid Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China. .,Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China.
| | - Wei Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China. .,Guangzhou Key Laboratory of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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17
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Stojanov IJ, Woo SB. Malignant Transformation Rate of Non-reactive Oral Hyperkeratoses Suggests an Early Dysplastic Phenotype. Head Neck Pathol 2021; 16:366-374. [PMID: 34255278 PMCID: PMC9187802 DOI: 10.1007/s12105-021-01363-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/07/2021] [Indexed: 01/02/2023]
Abstract
The presence of epithelial dysplasia (ED) in oral leukoplakia is the single most important predictor of malignant transformation (MT). The majority of leukoplakias, however, do not show evidence of ED and yet MT of these lesions is well-recognized. These lesions have been referred to as "hyperkeratosis/hyperplasia, no dysplasia," "keratosis of unknown significance" and "hyperkeratosis, not reactive (HkNR)." This study evaluates the MT rate of such leukoplakias. A literature review was performed to identify cohort studies on leukoplakias where (1) there was a recorded histopathologic diagnosis, (2) cases of "hyperkeratosis/hyperplasia, no dysplasia" comprised part of the cohort, and (3) follow-up information was available. There were 9,358 leukoplakias, of which 28.5% exhibited ED while 37.7% consisted of HkNR. Follow-up ranged from 15 to 73 months. The incidence of MT in leukoplakia exhibiting HkNR was 4.9%, compared to 15.3% for ED. Among oral squamous cell carcinomas (SCC) with previously biopsied, site-specific precursor lesions, 55.7% arose from ED/carcinoma in situ and 28.0% arose from HkNR. Leukoplakia exhibiting HkNR has a substantial MT rate, similar to that of mild ED, and must be recognized and managed appropriately to reduce oral SCC incidence.
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Affiliation(s)
- Ivan J. Stojanov
- grid.67105.350000 0001 2164 3847Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, Case Western Reserve University School of Dental Medicine, 10900 Euclid Avenue, Cleveland, OH 44106 USA ,grid.67105.350000 0001 2164 3847Department of Pathology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH USA
| | - Sook-Bin Woo
- grid.38142.3c000000041936754XDepartment of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA USA ,grid.62560.370000 0004 0378 8294Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Boston, MA USA
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18
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ECM Remodeling in Squamous Cell Carcinoma of the Aerodigestive Tract: Pathways for Cancer Dissemination and Emerging Biomarkers. Cancers (Basel) 2021. [DOI: 10.3390/cancers13112759
expr 955442319 + 839973387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Squamous cell carcinomas (SCC) include a number of different types of tumors developing in the skin, in hollow organs, as well as the upper aerodigestive tract (UADT) including the head and neck region and the esophagus which will be dealt with in this review. These tumors are often refractory to current therapeutic approaches with poor patient outcome. The most important prognostic determinant of SCC tumors is the presence of distant metastasis, significantly correlating with low patient survival rates. Rapidly emerging evidence indicate that the extracellular matrix (ECM) composition and remodeling profoundly affect SSC metastatic dissemination. In this review, we will summarize the current knowledge on the role of ECM and its remodeling enzymes in affecting the growth and dissemination of UADT SCC. Taken together, these published evidence suggest that a thorough analysis of the ECM composition in the UADT SCC microenvironment may help disclosing the mechanism of resistance to the treatments and help defining possible targets for clinical intervention.
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ECM Remodeling in Squamous Cell Carcinoma of the Aerodigestive Tract: Pathways for Cancer Dissemination and Emerging Biomarkers. Cancers (Basel) 2021; 13:cancers13112759. [PMID: 34199373 PMCID: PMC8199582 DOI: 10.3390/cancers13112759] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Local and distant metastasis of patients affected by squamous cell carcinoma of the upper aerodigestive tract predicts poor prognosis. In the latest years, the introduction of new therapeutic approaches, including targeted and immune therapies, has improved the overall survival. However, a large number of these patients do not benefit from these treatments. Thus, the identification of suitable prognostic and predictive biomarkers, as well as the discovery of new therapeutic targets have emerged as a crucial clinical need. In this context, the extracellular matrix represents a suitable target for the development of such therapeutic tools. In fact, the extracellular matrix is composed by complex molecules able to interact with a plethora of receptors and growth factors, thus modulating the dynamic crosstalk between cancer cells and the tumor microenvironment. In this review, we summarize the current knowledge of the role of the extracellular matrix in affecting squamous cell carcinoma growth and dissemination. Despite extracellular matrix is known to affect the development of many cancer types, only a restricted number of these molecules have been recognized to impact on squamous cell carcinoma progression. Thus, we consider that a thorough analysis of these molecules may be key to develop new potential therapeutic targets/biomarkers. Abstract Squamous cell carcinomas (SCC) include a number of different types of tumors developing in the skin, in hollow organs, as well as the upper aerodigestive tract (UADT) including the head and neck region and the esophagus which will be dealt with in this review. These tumors are often refractory to current therapeutic approaches with poor patient outcome. The most important prognostic determinant of SCC tumors is the presence of distant metastasis, significantly correlating with low patient survival rates. Rapidly emerging evidence indicate that the extracellular matrix (ECM) composition and remodeling profoundly affect SSC metastatic dissemination. In this review, we will summarize the current knowledge on the role of ECM and its remodeling enzymes in affecting the growth and dissemination of UADT SCC. Taken together, these published evidence suggest that a thorough analysis of the ECM composition in the UADT SCC microenvironment may help disclosing the mechanism of resistance to the treatments and help defining possible targets for clinical intervention.
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Heidarian A, Wenig BM. The Most Common Mistake in Laryngeal Pathology and How to Avoid it. Head Neck Pathol 2021; 15:130-137. [PMID: 33723761 PMCID: PMC8010031 DOI: 10.1007/s12105-020-01273-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 11/30/2022]
Abstract
Upper aerodigestive tract (UADT) spindle cell squamous carcinoma (SCSC), also known as sarcomatoid carcinoma, is a high-grade subtype of conventional squamous cell carcinoma (SCC) that is histologically characterized by a combination of differentiated SCC in the form of intraepithelial dysplasia and/or invasive differentiated SCC, and the presence of an invasive (submucosal) undifferentiated malignant spindle-shaped and pleomorphic (epithelioid) cell component. Typically, SCSC presents as a superficial polypoid mass not infrequently with surface ulceration precluding identification of an intraepithelial dysplasia. Further, in many cases an invasive differentiated SCC is not identified. Adding to the complexity in such cases, is that immunohistochemical staining in a significant minority of cases is negative for epithelial-related markers but often the cells express mesenchymal-related markers. In such cases, differentiating SCSC from a reactive (benign) spindle cell proliferation or a mucosal-based sarcoma can be problematic, with treatment implications. Herein, we detail the clinical and pathologic features of laryngeal SCSC and discuss the rationale for diagnosing a carcinoma and avoiding a diagnosis of sarcoma. In our experience, such cases represent one of the more common mistakes made in laryngeal pathology. Yet, virtually all such lesions are SCSCs. The treatment and prognosis relies on the accuracy of this distinction.
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Affiliation(s)
- Amin Heidarian
- Department of Pathology, Moffitt Cancer Center, Tampa, FL, 33612, USA
| | - Bruce M Wenig
- Department of Pathology, Moffitt Cancer Center, Tampa, FL, 33612, USA.
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Hellquist H, Ferlito A, Mäkitie AA, Thompson LDR, Bishop JA, Agaimy A, Hernandez-Prera JC, Gnepp DR, Willems SM, Slootweg PJ, Rinaldo A. Developing Classifications of Laryngeal Dysplasia: The Historical Basis. Adv Ther 2020; 37:2667-2677. [PMID: 32329013 PMCID: PMC7467449 DOI: 10.1007/s12325-020-01348-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Indexed: 12/12/2022]
Abstract
During the last 60 years numerous significant attempts have been made to achieve a widely acceptable terminology and histological grading for laryngeal squamous intraepithelial lesions. While dysplasia was included in the pathology of the uterine cervix already in 1953, the term dysplasia was accepted in laryngeal pathology first after the Toronto Centennial Conference on Laryngeal Cancer in 1974. In 1963 Kleinsasser proposed a three-tier classification, and in 1971 Kambic and Lenart proposed a four-tier classification. Since then, four editions of the World Health Organisation (WHO) classification have been proposed (1978, 1991, 2005 and 2017). Several terms such as squamous intraepithelial neoplasia (SIN) and laryngeal intraepithelial neoplasia (LIN) are now being abandoned and replaced by squamous intraepithelial lesions (SIL). The essential change between the 2005 and 2017 WHO classifications is the attempt to induce a simplification from a four- to a two-tier system. The current WHO classification (2017) thus recommends the use of a two-tier system with reasonably clear histopathological criteria for the two groups: low-grade and high-grade dysplasia. Problems with interobserver variability apart, subjectivities and uncertainties remain, but to a lesser degree. Ongoing and additional molecular studies may help to clarify underlying events that will increase our understanding and possibly can facilitate our attempts to obtain an even better classification. The classification needs to be easier for the general pathologist to perform and easier for the clinician to interpret. These two objectives are equally important to provide each patient the best personalised treatment available for squamous intraepithelial lesions.
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Affiliation(s)
- Henrik Hellquist
- Epigenetics and Human Disease Laboratory, Faro, Portugal.
- Department of Biomedical Sciences and Medicine, Faro, Portugal.
- Centre of Biomedical Research (CBMR) and Algarve Biomedical Center (ABC), Faro, Portugal.
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
| | - Antti A Mäkitie
- Department of Otorhinolaryngology Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lester D R Thompson
- Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, CA, USA
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Abbas Agaimy
- Institute of Pathology, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Douglas R Gnepp
- Department of Pathology, Alpert Medical School at Brown University, Providence, RI, USA
| | - Stefan M Willems
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter J Slootweg
- Department of Pathology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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Laryngeal Dysplasia: Persisting Dilemmas, Disagreements and Unsolved Problems-A Short Review. Head Neck Pathol 2020; 14:1046-1051. [PMID: 32141027 PMCID: PMC7669915 DOI: 10.1007/s12105-020-01149-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
We present the historical review and current state of the histopathological classifications and terminology of laryngeal precursor lesions. Attention to recent genetic findings is also presented; although in need of additional confirmation, these raise possibility for early detection of patients at risk of dysplasia progression. Although a number of identified genetic alterations with a promising diagnostic and prognostic value are emerging, none of the known genetic alterations can be currently implemented in clinical practice as a completely reliable diagnostic and/or prognostic marker. Regarding the terminology of precursor lesions, dysplasia remains the most frequently used term, but squamous intraepithelial lesion can be used as a synonym as well. Histological findings, in spite of certain degree of subjectivity, remain at present the most reliable method for an accurate diagnosis. The current 2017 WHO classification seems to successfully stratify risk of malignant progression, with a significantly different risk of malignant progression between low-grade dysplasia and high-grade dysplasia. In case of pronounced architectural disorders, severe cellular and nuclear atypias, and an increased number of mitoses, also atypical form, the high-grade dysplasia and carcinoma in situ can be separated. The Slovenian tertiary centers have a policy of surgical removal of high-grade SILs and life-long close follow-up. Radiotherapy is reserved for more pronounced intraepithelial lesions classified as carcinoma in situ and invasive cancer. Such a distinction can facilitate clinical decision to use radiotherapy if complete surgical removal is not possible.
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Basaloid squamous cell carcinoma of the breast. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2020; 53:113-116. [PMID: 32199592 DOI: 10.1016/j.patol.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/10/2019] [Accepted: 10/15/2019] [Indexed: 11/24/2022]
Abstract
Basaloid squamous cell carcinoma (BSCC) is a subtype of squamous cell carcinoma that characteristically occurs in the head and neck, may be related to HPV infection and is usually considered to be aggressive. We present the first description of BSCC of the breast. The tumor exhibited characteristic histologic features of BSCC, including nests of basaloid squamous cells with comedonecrosis, abrupt keratinization, and abundant hyaline basement membrane-like material deposition. The tumor showed immunohistochemical features of triple negativity, diffuse p63 positivity, p16 positivity, and Rb negativity. HPV immunogenotyping was negative. The patient was free of disease after treatment with breast conserving surgery, chemotherapy and radiotherapy. BSCC of the breast should be distinguished from basaloid adenoid cystic carcinoma, triple-negative basal-like breast cancer and nonbasaloid squamous cell carcinoma of the breast based on histology and immunohistochemistry. The prognostic implications of BSCC of the breast should be further studied in larger series.
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Escher P, Bu L, Cayci Z, Yueh B, Li F. Laryngeal Squamous Cell Carcinoma with Osteosarcomatous Differentiation and Involvement of Thyroid Cartilage Mimicking Sarcoma Arising from Thyroid Cartilage. Head Neck Pathol 2019; 14:771-777. [PMID: 31873935 PMCID: PMC7413955 DOI: 10.1007/s12105-019-01119-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/18/2019] [Indexed: 11/29/2022]
Abstract
Basaloid squamous cell carcinoma (BSCC) with a spindle cell component of the head and neck is an uncommon entity. In this case, we present a radiology-pathology correlation of a rare laryngeal BSCC with sarcomatous transformation and osteosarcomatous differentiation involving the laryngeal cartilage, which thus mimicked clinically and radiographically osteosarcoma or chondrosarcoma with calcification. Microscopic examination revealed predominantly BSCC with extensive osseous metaplasia among sheets and nests of basaloid tumor cells. There were also small foci of osteosarcoma, undifferentiated pleomorphic sarcoma, and spindle cell carcinoma. The presence of squamous cell carcinoma (SCC) in-situ, small areas of conventional SCC and diffuse positivity of p40 in conventional and basaloid squamous components confirmed that this tumor was indeed derived from surface squamous epithelium. Awareness of the broad differentiation potentials of SCC can avoid misdiagnosis of SCCs as sarcoma. This case emphasizes the importance of radiologic-pathologic correlation in definitive diagnosis and clinical management of laryngeal malignancies.
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Affiliation(s)
- Paul Escher
- University of Minnesota Medical School, Minneapolis, MN USA
| | - Lihong Bu
- Department of Laboratory Medicine and Pathology, University of Minnesota, MMC 76, C476 Mayo Building, 420 Delaware St. SE, Minneapolis, MN 55455 USA
| | - Zuzan Cayci
- Department of Radiology, University of Minnesota, Minneapolis, MN USA
| | - Bevan Yueh
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN USA
| | - Faqian Li
- Department of Laboratory Medicine and Pathology, University of Minnesota, MMC 76, C476 Mayo Building, 420 Delaware St. SE, Minneapolis, MN 55455 USA
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Liu L, Xue X, Xue L. Liver metastatic basaloid squamous cell carcinoma with negative expression of pancytokeratin: a case report and literature review. Diagn Pathol 2019; 14:102. [PMID: 31488173 PMCID: PMC6729002 DOI: 10.1186/s13000-019-0881-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/29/2019] [Indexed: 12/18/2022] Open
Abstract
Background Basaloid squamous cell carcinoma (BSCC) is a rare subtype of squamous cell carcinoma with a high rate of distant metastasis. BSCC occurs most commonly in the esophagus, lungs, and head and neck. However, BSCC occurring in an atypical site without a known primary tumor and/or with the presence of atypical immunohistochemical features can result in delayed diagnosis or misdiagnosis. Case presentation Here, we report a case of a 67-year-old man with liver metastatic BSCC with negative pancytokeratin (AE1/AE3) expression. He presented with a chief complaint of epigastric discomfort. Imaging examination revealed a subcapsular mass in the right anterior lobe of the liver. Then, the patient underwent an irregular right hepatectomy. Grossly, the mass was gray, with a size of 7 × 7 × 4 cm. Microscopically, the mass comprised epithelioid tumor cells with both solid and pseudoadenoid structures, accompanied by necrosis. Immunohistochemical staining showed that the tumor cells were negative for AE1/AE3, CK18, CK7, CK19, Hepatocyte Paraffin-1, Glypican-3, Arginase-1, CD56, Chromogranin A, Synaptophysin, Vimentin, and Carcinoembryonic antigen. The Ki-67 index was 80%.The mass was diagnosed as a malignant tumor but could not be classified further. One month after surgery, the patient’s reexamination revealed esophageal tumor, and biopsy revealed BSCC. The slides of the liver tumor were reviewed, and the morphology was similar to that of the esophageal tumor. Moreover, supplementary immunohistochemical staining of liver tumor indicated p63 and p40 were strongly positive, that confirmed the liver tumor was metastatic BSCC. Previous studies have reported that 3.7% of esophageal BSCCs did not express AE1/AE3. Conclusion When a malignant tumor comprises epithelioid cells with solid and/or pseudoadenoid structures, but not adenocarcinoma or neuroendocrine carcinoma, even if the tumor cells are negative or weakly positive for AE1/AE3, we should consider BSCC. For a definite diagnosis, immunohistochemical staining for squamous cell carcinoma markers, including p63 and p40, and examination of common primary sites of BSCC should be performed.
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Affiliation(s)
- Linxiu Liu
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xuemin Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Liyan Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Wakely PE. Diagnostic traps awaiting the head/neck pathologist: "Cytoplasm-poor" neoplasms. Ann Diagn Pathol 2019; 42:78-86. [PMID: 31382078 DOI: 10.1016/j.anndiagpath.2019.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT Beyond squamous carcinoma, a variety of diagnostically challenging neoplasms arise within various head and neck sites. This is particularly the situation with neoplasms where little cellular cytoplasm is present to assist the pathologist in categorizing such lesions. OBJECTIVE To highlight diagnostic pitfalls that accompanying neoplasms composed primarily of 'cytoplasmically-poor' cells. These pitfalls include morphologic and immunohistochemical traps that emerge from this class of neoplasms. DATA SOURCES Selection of pathologic specimens from the author's personal files, and literature review. CONCLUSIONS Interpretative pitfalls regarding the histopathology and immunophenotype of small 'cytoplasmically-poor' neoplasms are a diagnostic hazard in head and neck surgical pathology practice, and require knowledge of histomorphologic plasticity and aberrant immunophenotyping.
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Affiliation(s)
- Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, 405 Doan Hall, 410 W. 10th Ave., Columbus, OH 43210, United States of America.
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Flores-Hidalgo A, Murrah V, Fedoriw Y, Padilla RJ. Relationship of infiltrating intraepithelial T lymphocytes in the diagnosis of oral lichen planus versus oral epithelial dysplasia: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 127:e123-e135. [PMID: 30928328 DOI: 10.1016/j.oooo.2019.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 01/17/2019] [Accepted: 02/07/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of this study was to identify the type and distribution of CD4+ and CD8+ T lymphocytes in oral mucosal specimens to potentially distinguish between underlying alterations or patterns in oral epithelial dysplasia and oral lichen planus. STUDY DESIGN This pilot study included 10 archived tissue samples that were received at the University of North Carolina Oral and Maxillofacial Pathology Laboratory and were diagnosed as oral lichen planus and moderate to severe epithelial dysplasia. Dual staining with CD4 and CD8 antibodies was carried out on each case. Slides were scanned in the Aperio ScanScope FL (Leica Biosystems, Wetzlar, Germany) and archived. Histomorphometric analysis was performed to detect inflammatory cells expressing CD4 and CD8 biomarkers in the epithelial and connective tissue regions. RESULTS No differences were found in the amount and ratio of CD4+/CD8+ lymphocytes among the 3 groups analyzed; however, the intraepithelial CD8+ lymphocyte distribution was strikingly different between lichen planus and moderate to severe epithelial dysplasia. CONCLUSIONS The localization of CD8+ cells can be potentially useful as an adjunctive diagnostic procedure to distinguish oral epithelial dysplasia from other inflammatory entities, such as lichen planus.
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Affiliation(s)
- Andres Flores-Hidalgo
- Clinical Assistant Professor, Oral and Maxillofacial Pathology, Department of Surgical Sciences, East Carolina University, School of Dental Medicine, 1851 MacGregor Downs Rd, Greenville, NC 27834-4354, USA.
| | - Valerie Murrah
- Professor and Chair, Oral and Maxillofacial Pathology, Department of Diagnostic Sciences, University of North Carolina at Chapel Hill, School of Dentistry, Chapel Hill, NC, USA
| | - Yuri Fedoriw
- Associate Professor, Director of Hematopathology UNC Hospitals, Department of Pathology and Laboratory Medicine, Hematopathology Laboratory, NC Cancer Hospital C3162, Chapel Hill, NC, USA
| | - Ricardo J Padilla
- Kaneda Family Distinguished Associate Professor, Oral and Maxillofacial Pathology, Department of Diagnostic Sciences, University of North Carolina at Chapel Hill, School of Dentistry, 101 Manning Drive, Chapel Hill, NC, USA
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Jumaily M, Faraji F, Zhang D, Walker RJ, Ward GM. Basaloid Squamous Cell Carcinoma of the Larynx: A National Cancer Database Analysis. Otolaryngol Head Neck Surg 2019; 160:847-854. [PMID: 30717636 DOI: 10.1177/0194599818816299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Basaloid squamous cell histology is a rare variant that accounts for about 2% of all head and neck squamous cell laryngeal carcinomas. The purpose of this study was to examine overall survival rates of patients according to treatment, stage, and laryngeal subsite. STUDY DESIGN Retrospective analysis. SETTING National Cancer Database (NCDB). SUBJECTS AND METHODS The NCDB was queried for patients with basaloid squamous cell carcinoma (BSCC) who were treated from 2004 to 2014. Five-year overall survival rates were determined by the Kaplan-Meier method. Univariate and multivariate analysis was used to identify factors correlated with 5-year overall survival. RESULTS The NCDB identified 440 patients meeting inclusion criteria. Median follow-up time was 31.2 months. On univariate analysis, the treatment modalities assessed (surgery alone, surgery with radiotherapy, surgery with chemoradiotherapy, radiotherapy, chemoradiotherapy) did not differ in their survival benefit. On multivariate analysis, only chemoradiotherapy (hazard ratio, 0.587; 95% CI, 0.37-0.93; P = .022) was associated with improved survival. All treatment modalities performed similarly between stage I and II tumors ( P = .340) and stage III and IV tumors ( P = .154). CONCLUSION This study represents the largest laryngeal BSCC series to date. We found that chemoradiotherapy was associated with improved 5-year overall survival of laryngeal BSCC on multivariate analysis.
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Affiliation(s)
- Mejd Jumaily
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Saint Louis University, Saint Louis, Missouri, USA
| | - Farhoud Faraji
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Saint Louis University, Saint Louis, Missouri, USA
| | - Donald Zhang
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Saint Louis University, Saint Louis, Missouri, USA
| | - Ronald J Walker
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Saint Louis University, Saint Louis, Missouri, USA
| | - Gregory M Ward
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Saint Louis University, Saint Louis, Missouri, USA
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Abstract
Human papillomaviruses (HPVs) are causative of a group of clinically papillary lesions. The HPV-related lesions of the oral cavity include squamous papilloma, condyloma acuminatum, verruca vulgaris, and multifocal epithelial hyperplasia. Benign entities, such as verruciform xanthoma or giant cell fibroma, as well as malignancies, such as papillary squamous cell carcinoma and verrucous carcinoma, may be considered in the clinical and/or histologic differential diagnoses of these lesions. Mechanisms of infection, epidemiology, clinical presentations, histologic features, and differential diagnoses of the HPV-related oral pathologies are discussed. Current concepts of viral transmission, especially as pertaining to lesions in pediatric patients, and the impacts of HPV vaccination are reviewed.
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31
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Thavarajah R, Ranganathan K. Trends in oral squamous cell carcinoma: Diagnosis for effective, evidence-based treatment 2017. J Oral Maxillofac Pathol 2017; 21:189-191. [PMID: 28932025 PMCID: PMC5596666 DOI: 10.4103/jomfp.jomfp_97_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rooban Thavarajah
- Department of Oral Pathology, Ragas Dental College and Hospital, 2/102, East Coast Road, Uthandi, Chennai - 600 119, Tamil Nadu, India. E-mail:
| | - Kannan Ranganathan
- Department of Oral Pathology, Ragas Dental College and Hospital, 2/102, East Coast Road, Uthandi, Chennai - 600 119, Tamil Nadu, India. E-mail:
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Husain N, Neyaz A. Human papillomavirus associated head and neck squamous cell carcinoma: Controversies and new concepts. J Oral Biol Craniofac Res 2017; 7:198-205. [PMID: 29124000 DOI: 10.1016/j.jobcr.2017.08.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 08/29/2017] [Indexed: 12/17/2022] Open
Abstract
High-risk human papillomavirus (HR-HPV) is a causative agent for an increasing subset of oropharyngeal squamous cell carcinoma. HPV 16 accounts for 90% of cases. The chance for malignant transformation due to infection with high-risk HPV is proportional to the expression of the viral oncogene products E6 and E7, which inactivate p53 and retinoblastoma (Rb) tumor suppressor functions. P16 is a surrogate marker of HPV associated HNSCC and 2+/3+ expression in more than 75% cells is diagnostic. Molecular demonstration of integrated virus by in situ hybridization is specific but has low sensitivity. HPV associated oropharyngeal carcinomas classically arise in the tonsillar crypts and commonly have basaloid morphology with a prominent lymphocytic repsonse and minimal despmoplastic reaction. In situ vs invasive carcinomas may be difficult to distinguish in histology. The HPV postitivity overrides traditional prognostic indicators such as tumour grade and histological subtype. Small cell morphology carries a poorer prognosis as does marked tumour anaplasia and multinucleation. Lymph node metastasis is extensive and frequently cystic however extranodal extension, laterality or nodal sizes do not carry prognostic implications as in conventional OSCC and OPSCC. Stage IV is reserved for distant metastasis. HPV-16-positive patients had significantly reduced overall and disease-specific mortality rates and an improved 3-year overall survival (OS) and disease-free survival (DFS) compared to patients with HPV negative tumors. Surgical treatment is the main option for primary and secondary HNSCC. Targeted therapies including drugs targeting EGFR and PIK3CA and have shown some promising results. HPV pathway expressing tumors are less aggressive and may receive adequate curative intent therapy from a reduced radiation or chemotherapy dose revision. OSCC however fails to show a distinct difference between HPV associated and tobaccco associated cancer and prognostic differences do not clearly exist.
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Affiliation(s)
- Nuzhat Husain
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Azfar Neyaz
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
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