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Speakman GC, McNamara KK, Kalmar JR, Argyris PP. SATB2 expression in oral sarcomatoid (spindle cell) squamous cell carcinoma: clinicopathologic and immunophenotypic characterization of 10 cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2024:S2212-4403(24)00446-2. [PMID: 39317604 DOI: 10.1016/j.oooo.2024.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 08/14/2024] [Accepted: 08/15/2024] [Indexed: 09/26/2024]
Abstract
OBJECTIVE Sarcomatoid squamous cell carcinoma (sSCC) represents an uncommon histopathologic variant of squamous cell carcinoma (SCC). We examined the clinicopathologic and immunophenotypic characteristics, including SATB2 expression, of 10 cases of oral sSCCs. STUDY DESIGN Archived sSCC cases diagnosed during the period 2000 to 2023 were retrieved. Lesions lacking proper histomorphological features or adequate immunohistochemical confirmation were excluded. Patient age, sex, and lesion location were recorded. All cases were immunostained against SATB2 (Clone EP281; Cell Marque). RESULTS Ten oral sSCCs were identified (M:F ratio = 1.5:1; age range = 47-82 years, median = 74.5 years). The tongue was the most common anatomic site. Lesions presented as fungating or ulcerated, polypoid, and indurated masses. Microscopically, most tumors demonstrated an infiltrative population of atypical spindle cells organized in slender cords or fascicles. Rhabdoid/plasmacytoid morphology was observed in 3 cases. Immunohistochemically, all cases exhibited strong, focal-to-diffuse positivity for pancytokeratin, p63, and/or p40. Patchy, moderate-to-strong SATB2 staining was seen in 4 oral sSCCs, whereas 4 additional cases showed rare, weak-to-moderate expression. CONCLUSIONS Oral sSCC is uncommon and primarily exhibits spindled histomorphology, although rhabdoid/plasmacytoid features may be observed. A battery of epithelial and non-epithelial markers is required for proper diagnosis. Positive SATB2 immunostaining in oral sSCCs may pose a potential diagnostic pitfall, particularly in small biopsy specimens. (Oral Surg Oral Med Oral Pathol Oral Radiol YEAR;VOL:page range).
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Affiliation(s)
- Gabriella C Speakman
- Division of Oral and Maxillofacial Pathology, The Ohio State University College of Dentistry, Columbus, OH, USA.
| | - Kristin K McNamara
- Division of Oral and Maxillofacial Pathology, The Ohio State University College of Dentistry, Columbus, OH, USA
| | - John R Kalmar
- Division of Oral and Maxillofacial Pathology, The Ohio State University College of Dentistry, Columbus, OH, USA
| | - Prokopios P Argyris
- Division of Oral and Maxillofacial Pathology, The Ohio State University College of Dentistry, Columbus, OH, USA
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2
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Surolia P, Kambala R, Bhola N, Agarwal A. Sarcomatoid Squamous Cell Carcinoma in a 15-Year-Old Girl: A Report of a Rare Case. Cureus 2024; 16:e65767. [PMID: 39211661 PMCID: PMC11361403 DOI: 10.7759/cureus.65767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Sarcomatoid is a rare variant of squamous cell carcinoma. We present here the case of a 15-year-old female patient; she presented with an extra-oral fungation on the right side of her face and restricted tongue movements, diagnosed as sarcomatoid squamous cell carcinoma of the tongue on incisional biopsy. A positron emission tomography scan was advised on the first visit to rule out distant metastasis. Due to the previous history of no improvement after medical oncology management and the extent of the lesion, which made the disease inoperable, the patient was planned for the best supportive care.
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Affiliation(s)
- Prachi Surolia
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rajanikanth Kambala
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nitin Bhola
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anchal Agarwal
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Lin MC, Hsu CL, Lai SF, Huang YL, Hsieh MS, Chen TC, Chen CN, Wang CP, Yang TL, Ko JY, Tsai MH, Lou PJ. Spindle Cell Carcinoma of the Head and Neck: Clinical Characteristics and Molecular Signatures. Laryngoscope 2023; 133:2183-2191. [PMID: 36300609 DOI: 10.1002/lary.30467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE/HYPOTHESIS Spindle cell carcinoma of the head and neck (HNSpCC) is a rare variant of head and neck squamous cell carcinoma (HNSCC). This study evaluated the clinical characteristics and molecular signatures of such tumors. STUDY DESIGN Retrospective analysis. METHODS Medical records of patients diagnosed with HNSpCC from 1996 to 2018 were reviewed. The clinicopathologic features, treatment modalities, and survival status were carefully recorded. Whole exome sequencing (WES) was performed to evaluate the genetic signatures of HNSpCC. RESULTS We found that among all 71 patients included in this study, the majority of them were male, with tumors developing predominantly in the oral cavity. The 1-, 3-, and 5-year disease-specific survival (DSS) rates were 64.6%, 49.5%, and 43.9%, respectively. A high local recurrence (LR) and distant metastasis (DM) rate (47.9%-25.3%, respectively) were observed. A significant proportion (28.2%) of patients with the worst prognosis had history of previous head and neck cancer (HNC) and had been treated with radiotherapy (RT). WES revealed that those post-RT SpCC shared common mutations with their previous HNC (pre-RT SCC), but gained additional genetic traits, such as hypoxia and cell-ECM interaction that were favorable for survival in an irradiated microenvironment. Distinct genetic landscapes in primary and post-RT SpCC were also found. CONCLUSIONS This study demonstrates that HNSpCC is a unique entity with more aggressive behavior than conventional HNSCC. HNSpCC arising from a previously irradiated field is a predictor of dismal survival. Both genetic and microenvironmental factors contribute to this highly invasive tumor. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2183-2191, 2023.
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Affiliation(s)
- Mei-Chun Lin
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Lang Hsu
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Fan Lai
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Lin Huang
- Department of Pathology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Min-Shu Hsieh
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tseng-Cheng Chen
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Nan Chen
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Ping Wang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Mong-Hsun Tsai
- Bioinformatics and Biostatistics Core, Center of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
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4
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Sang L, Dai Y, Hu J, Zhu Y, Xu L, Zhang W, Cheng J. Comprehensive analyses of intraoral spindle cell carcinoma: A rare disease entity revisited. Oral Dis 2023; 29:686-695. [PMID: 34592043 DOI: 10.1111/odi.14037] [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: 06/04/2021] [Revised: 09/13/2021] [Accepted: 09/21/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The present study was aimed to comprehensively characterize the epidemiological, clinicopathological characteristics, treatments, and prognosis of intraoral spindle cell carcinoma (SpCC). MATERIALS AND METHODS Patients diagnosed with intraoral SpCC at our institution in the past 15 years (2005-2019) were screened from inpatient disease registry. All relevant data concerning patients with intraoral SpCC were retrieved. Previous reports about intraoral SpCC with adequate clinicopathological data in both English literature and Chinese literature were collected. Eligible cases were further reviewed and pooled for statistical analyses. RESULTS Six patients (5 females and 1 male; average age: 59 years) with intraoral SpCC were histopathologically diagnosed and surgically treated at our institution. The literature review identified another 63 published cases from 34 articles. Most cases were presented in the fifth to seventh decade of life with a male preponderance. Gingiva (23/69, 33.3%) was the most common site followed by the tongue (19/69, 27.5%) and buccal mucosa (8/69, 11.6%). Complete surgical ablation remains the primary treatment option. Tumor size, pathological grades, cervical node metastasis, and distant metastasis were significantly associated with reduced survival. CONCLUSIONS Intraoral SpCC is an uncommon and aggressive malignancy with dismal prognosis. Much attention and effort are needed to characterize this rare entity and improve its clinical outcomes.
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Affiliation(s)
- Lei Sang
- Department of Oral and Maxillofacial Surgery, Suzhou Huaxia Stomatological Hospital, Jiangsu, China
| | - Yibin Dai
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China
| | - Jiaan Hu
- Department of Stomatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang, China
| | - Yaqing Zhu
- Department of Oral and Maxillofacial Surgery, Suzhou Huaxia Stomatological Hospital, Jiangsu, China
| | - Linhong Xu
- Department of Oral and Maxillofacial Surgery, Suzhou Huaxia Stomatological Hospital, Jiangsu, China
| | - Wei Zhang
- Department of Oral Pathology, Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China
| | - Jie Cheng
- Department of Oral and Maxillofacial Surgery, Suzhou Huaxia Stomatological Hospital, Jiangsu, China.,Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China
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5
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Patel AM, Choudhry HS, Desai AD, Shah VP, Patel P, Eloy JA, Roden DF, Fang CH. Prognostic significance of head and neck spindle cell carcinoma. Head Neck 2023; 45:685-696. [PMID: 36584171 DOI: 10.1002/hed.27285] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/13/2022] [Accepted: 12/09/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Our study investigates the prognostic significance of spindle cell histology on overall survival (OS) of conventional head and neck squamous cell carcinoma (HNSCC). METHODS The 2004 to 2017 National Cancer Database was queried for patients with head and neck spindle cell carcinoma (HNSpCC) (n = 1572) or HNSCC (n = 242 697) of the oral cavity, major salivary glands, sinonasal tract, oropharynx, hypopharynx, and larynx treated with curative intent. RESULTS Patients with HNSpCC presented more frequently with higher-grade tumors and cN0 disease than those with HNSCC (p < 0.001). In the oral cavity, the HR for death for SpCC compared with SCC was 1.33 (p < 0.001). In the oropharynx, the HR for death for SpCC compared with SCC was 1.47 (p = 0.028). CONCLUSIONS After adjusting for patient, tumor, and treatment characteristics, SpCC histology had an independent adverse prognostic effect on OS in the oral cavity and oropharynx. SpCC histology does not necessarily portend poorer survival in all HNSCC. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Aman M Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Hannaan S Choudhry
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Amar D Desai
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Vraj P Shah
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Prayag Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center-Robert Wood Johnson Barnabas Health, Livingston, New Jersey, USA
| | - Dylan F Roden
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Christina H Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein School of Medicine/Montefiore Medical Center, Bronx, New York, USA
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6
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Zhang X, Liang J, Du Z, Xie Q, Li T, Tang F. Comparison of nomogram with random survival forest for prediction of survival in patients with spindle cell carcinoma. J Cancer Res Ther 2022; 18:2006-2012. [PMID: 36647963 DOI: 10.4103/jcrt.jcrt_2375_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Purpose Spindle cell carcinoma (SpCC) is a relatively rare tumor with an unfavorable prognosis. This study aimed to develop and validate a prediction model for the individual survival of patients with SpCC using Cox regression and the random survival forest (RSF) model. Methods Patients diagnosed with SpCC between 2004 and 2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) database, and randomly divided into training and validating cohorts. Cox regression and RSF were used to identify prognostic predictors and build prediction models. A nomogram based on Cox regression was constructed to predict the 1-, 3-, and 5-year survival of patients with SpCC. Internal validation was conducted using the bootstrapping method. We evaluated the discrimination accuracy and calibration of the model using Harrell's C-index and calibration plot, respectively. Results Two hundred and fifty patients diagnosed with SpCC with required information were enrolled in this study. Multivariate Cox regression and RSF identified age, primary site, grade, SEER stage, tumor size, and treatment as significant prognostic predictors of SpCC. The bootstrapped and validated C-indices were 0.812 and 0.783 for nomogram, and 0.790 and 0.768 for RSF, respectively. Calibration plot of the nomogram showed an agreement between the prediction and actual observation. Conclusions The nomogram developed in this study is a promising tool with a simplified presentation that can easily be used and interpreted by clinicians for evaluating the survival of each patient with SpCC; its performance was comparable to that of RSF. Application of such models are needed to help oncologists identify the high-risk patients and improve clinical decision making of SpCC treatment.
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Affiliation(s)
- Xiaoshuai Zhang
- Department of Data Science, School of Statistics, Shandong University of Finance and Economics, Jinan, China
| | - Jing Liang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Zhaohui Du
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Qi Xie
- Medical Research Center, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Ting Li
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Fang Tang
- Center for Data Science in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University; Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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7
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Kshithi K, Kini J, Dosemane D, Banerjee S. Spindle cell carcinoma masquerading as a benign polyp of the soft palate. J Cancer Res Ther 2022; 18:804-806. [DOI: 10.4103/jcrt.jcrt_617_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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8
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Yamazaki M, Maruyama S, Abé T, Sumita Y, Katsumi Y, Nikkuni Y, Hayashi T, Tanuma JI. Spindle cell squamous cell carcinoma exhibiting prominent neutrophil phagocytosis: a case report. J Med Case Rep 2021; 15:438. [PMID: 34452644 PMCID: PMC8401061 DOI: 10.1186/s13256-021-03066-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/16/2021] [Indexed: 12/02/2022] Open
Abstract
Background Spindle cell squamous cell carcinoma is an uncommon variant of squamous cell carcinoma; its diagnosis is sometimes challenging because it histopathologically resembles neoplastic or reactive spindle cell lesions of mesenchymal origins. Here, we report a rare case of spindle cell squamous cell carcinoma exhibiting prominent neutrophil phagocytosis. Case presentation A 69-year-old Japanese man presented with pain and a polypoid mass on the lower left gingiva. He had received chemoradiotherapy for squamous cell carcinoma of the buccal mucosa 15 years prior to this consultation. In addition, he was treated for mandibular osteonecrosis 6 years after chemoradiotherapy without evidence of cancer recurrence. A biopsy revealed atypical spindle or pleomorphic cells scattered in the edematous and fibrin-rich stroma; however, no malignant squamous components were apparent. These atypical cells frequently contained neutrophils within their cytoplasm that formed cell-in-cell figures. Immunohistochemically, the atypical cells were negative for cytokeratins, epithelial membrane antigen, and E-cadherin, but positive for p63, vimentin, and p53. Although these findings suggested spindle cell squamous cell carcinoma, it was difficult to reach a definitive diagnosis. Based on a clinical diagnosis of a malignant tumor, the patient underwent a hemimandibulectomy. The surgically resected specimen had a typical spindle cell squamous cell carcinoma histology consisting of biphasic spindle cells and conventional squamous cell carcinoma components. Moreover, the surgical specimen also exhibited spindle tumor cells that frequently included neutrophils, around which intense staining for lysosomal-associated membrane protein 1 and cathepsin B was observed. This suggested that the cell-in-cell figures represent active neutrophil phagocytosis by tumor cells, and not emperipolesis. Conclusion The presence of neutrophil phagocytosis may be a potent indicator of malignancy.
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Affiliation(s)
- Manabu Yamazaki
- Division of Oral Pathology, Faculty of Dentistry and Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan.
| | - Satoshi Maruyama
- Oral Pathology Section, Department of Surgical Pathology, Niigata University Hospital, Niigata, Japan
| | - Tatsuya Abé
- Division of Oral Pathology, Faculty of Dentistry and Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Yoshimasa Sumita
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry and Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuji Katsumi
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry and Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yutaka Nikkuni
- Division of Oral Radiology, Faculty of Dentistry and Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takafumi Hayashi
- Division of Oral Radiology, Faculty of Dentistry and Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Jun-Ichi Tanuma
- Division of Oral Pathology, Faculty of Dentistry and Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan.,Oral Pathology Section, Department of Surgical Pathology, Niigata University Hospital, Niigata, Japan
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9
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Mingo KM, Derakhshan A, Abdullah N, Chute DJ, Koyfman SA, Lamarre ED, Burkey BB. Characteristics and Outcomes in Head and Neck Sarcomatoid Squamous Cell Carcinoma: The Cleveland Clinic Experience. Ann Otol Rhinol Laryngol 2020; 130:818-824. [PMID: 33269613 DOI: 10.1177/0003489420977778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To analyze characteristics, treatment outcomes, and prognostic factors of sarcomatoid squamous cell carcinoma of the head and neck. STUDY DESIGN Retrospective chart review. SETTING Tertiary care center. SUBJECTS AND METHODS Fifty-five patients were treated for sarcomatoid squamous cell carcinoma of the head and neck between 1996 and 2018. Data collection included clinical history, tumor characteristics, pathology, treatment modality, and outcomes. Mean follow up was 17.1 months. Cox univariate analysis was used to evaluate for associations with locoregional recurrence, distant metastasis, and overall survival. RESULTS Most patients were white males with a smoking history and median age 66 years (range 41-92) at diagnosis. Twenty-two percent had prior head and neck radiation. Tumor site was most frequently oral cavity (41.8%), followed by larynx (29.1%), and oropharynx (16.4%). Half presented with early T stage disease (15.5% T0, 12.7% T1, 30.9% T2) and the remainder with late stage disease (16.4% T3, 34.5% T4). Locoregional recurrence rate was 60.0%, metastatic recurrence was rate 21.8%, with median time to recurrence of 4 months and mean overall survival of 20 months. Presence of lymphovascular space invasion was statistically associated with locoregional recurrence (P = .018, HR 3.55 [95% CI 1.24, 10.14]) and poorer overall survival (P = .015, HR 2.92 [95% CI 1.23, 4.80]). Treatment with multimodality therapy was associated with decreased locoregional recurrence (P = .039, HR 0.39 [95% CI 0.16, 0.95]) but did not impact overall survival. CONCLUSION Sarcomatoid squamous cell carcinoma remains a rare and aggressive disease variant with high recurrence rates and high mortality. High risk features such as lymphovascular space may indicate the need for more aggressive therapy.
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Affiliation(s)
| | | | - Neelab Abdullah
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
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10
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Gates JC, Tuluc M, Gargano SM. Patient with uncontrolled diabetes with a nonpainful, exophytic, purulent mandibular mass. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 132:130-136. [PMID: 33277189 DOI: 10.1016/j.oooo.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/07/2020] [Accepted: 11/02/2020] [Indexed: 11/24/2022]
Affiliation(s)
- James C Gates
- Instructor, Thomas Jefferson University, Department of Oral and Maxillofacial Surgery, Philadelphia, PA, USA.
| | - Madalina Tuluc
- Associate Professor, Thomas Jefferson University, Department of Pathology, Philadelphia, PA, USA
| | - Stacey M Gargano
- Associate Professor, Thomas Jefferson University, Department of Pathology, Philadelphia, PA, USA
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11
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Chen L, Chen Q, Li C, Zhou L, Wang S, Zhang M. Clinical Analysis of Laryngeal Spindle Cell Carcinoma. ORL J Otorhinolaryngol Relat Spec 2020; 82:310-317. [PMID: 32877904 DOI: 10.1159/000508134] [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: 10/06/2019] [Accepted: 04/21/2020] [Indexed: 11/19/2022]
Abstract
AIMS To investigate the clinical features, treatment, and outcomes of laryngeal spindle cell carcinoma (SpCC). METHODS Between 2005 and 2014, patients from our hospital with SpCC of the larynx were retrospectively analyzed alongside patient data from the SEER database of America. RESULTS A total of 11 patients with SpCC of the larynx were diagnosed and underwent surgery in our hospital. All patients were male and all tumors were located in the glottis. The 3- and 5-year OS rates were both 54.5%. In the SEER database, 148 patients were diagnosed with SpCC of the larynx. The 3- and 5-year OS rates were 72.8 and 63.2%, respectively. According to the comparison of propensity score-matched analysis, the OS was longer in squamous cell carcinoma (SCC) of the larynx (p < 0.0001). CONCLUSION SpCC of the larynx is rare and typically originates in the glottis. Its prognosis is worse than that of laryngeal SCC, and surgery is a reasonable treatment strategy.
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Affiliation(s)
- Le Chen
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Qi Chen
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China.,Department of Otolaryngology, Jing'an District Centre Hospital of Shanghai, Shanghai, China
| | - Cai Li
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Liang Zhou
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Shuyi Wang
- Department of Pathology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Ming Zhang
- Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China,
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12
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Tamaki A, Miles BA, Lango M, Kowalski L, Zender CA. AHNS Series: Do you know your guidelines? Review of current knowledge on laryngeal cancer. Head Neck 2017; 40:170-181. [PMID: 29076227 DOI: 10.1002/hed.24862] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/22/2017] [Indexed: 11/07/2022] Open
Abstract
The following article is part of a series in an initiative by the American Head and Neck Society's Education Committee and will review clinical practice guidelines for head and neck oncology. The primary goal is to increase awareness of current best practices pertaining to head and neck surgery and oncology. This manuscript is a review of current knowledge in laryngeal cancer with a focus on anatomy, epidemiology, diagnosis, evaluation, and treatment.
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Affiliation(s)
- Akina Tamaki
- Ear, Nose, and Throat Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Brett A Miles
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
| | - Miriam Lango
- Department of Surgical Oncology, Division of Head and Neck Surgery, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Luiz Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, Sao Paulo, Brazil
| | - Chad A Zender
- Ear, Nose, and Throat Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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13
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Gamez ME, Jeans E, Hinni ML, Moore E, Young G, Ma D, McGee L, Buras MR, Patel SH. Outcomes and patterns of failure of sarcomatoid carcinoma of the larynx: The Mayo Clinic experience. Laryngoscope 2017; 128:373-377. [PMID: 28681992 DOI: 10.1002/lary.26725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/24/2017] [Accepted: 05/05/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Sarcomatoid carcinoma is a rare variant of squamous cell carcinoma of the head and neck. No consensus exists on its management. Our aim was to present our outcomes. STUDY DESIGN Retrospective study. Median follow-up 45 months. METHODS There were 38 patients with pathologically confirmed sarcomatoid carcinoma of the larynx treated at the Mayo Clinic from 1990 to 2014. Statistical analysis of overall survival (OS), progression-free survival (PFS), and local control (LC) were conducted using the Kaplan-Meier method. RESULTS The majority of patients were elderly males (92%) with a smoking history (74%) presenting with early-stage disease (71%). Surgery alone was the primary treatment in 27 patients (71%). Nine patients (25%) were treated with adjuvant radiation due to initial stage or high-risk pathologic features. Median radiation dose to the primary/surgical bed was 65 Gy (range, 60.3-75.0 Gy). A total of 15 patients (39%) had tumor recurrence, majority being local (n = 12). Sixty percent (n = 9) had multiple local recurrences. Five-year OS, PFS, and LC were 63%, 46%, and 72%, respectively. Subgroup analysis by stage I versus higher stages (II-IV) showed an OS of 80% versus 43% (P = .030), PFS of 65% versus 18% (P = .003), and LC of 84% versus 57% (P = .039). CONCLUSIONS Sarcomatoid carcinoma of the larynx is rare, and frequently presents at an early stage in older men with history of smoking. Based on our outcomes and patterns of failure, it appears early-stage tumors are treated appropriately with single-modality therapy, whereas more advanced tumors require multimodality therapy. Validation in a larger cohort is warranted. LEVEL OF EVIDENCE 4. Laryngoscope, 128:373-377, 2018.
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Affiliation(s)
- Mauricio E Gamez
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, U.S.A
| | | | - Michael L Hinni
- Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Eric Moore
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Geoffrey Young
- Department of Otolaryngology, Mayo Clinic, Jacksonville, Florida, U.S.A
| | - Daniel Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Lisa McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Matthew R Buras
- Division of Health Sciences Research, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, U.S.A
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14
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Rosko AJ, Birkeland AC, Wilson KF, Muenz DG, Bellile E, Bradford CR, McHugh JB, Spector ME. Tumor Biomarkers in Spindle Cell Variant Squamous Cell Carcinoma of the Head and Neck. Otolaryngol Head Neck Surg 2016; 155:106-12. [PMID: 26980915 DOI: 10.1177/0194599816636612] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 02/10/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine biomarkers of recurrence and survival in patients with spindle cell variant squamous cell carcinoma (SpSCC) of the head and neck. STUDY DESIGN Retrospective case control study. SETTING Tertiary academic center. SUBJECTS AND METHODS Thirty-two SpSCC patients (mean age, 68.8) between 1987 and 2009 were identified and reviewed. A tissue microarray (TMA) was constructed from tumor specimens. Tumor biomarkers under study included p16, epidermal growth factor receptor (EGFR), p53, EZH2, cyclin D1, CD104, HGFa, p21, and cMET. An additional TMA was constructed from patients with non-SpSCC oral cavity squamous cell carcinoma for comparative purposes. The main outcomes were overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS). RESULTS In the SpSCC cohort, tumors positive for cMet had worse OS (P < .001). Patients positive for cMet (P = .007), cyclin D1 (P = .019), and p16 (P = .004) had worse DSS. Recurrence-free survival was also worse in patients with tumors positive for cMet (P = .037), cyclin D1 (P = .012), and p16 (P < .001). Compared with the oral cavity cohort, there was a significantly larger proportion of patients in the SpSCC group with tumors staining positive for cMet and a lower proportion of tumors positive for cyclin D1. CONCLUSION cMet, cyclin D1, and p16 are predictive tumor biomarkers for risk of recurrence and worse DSS in patients with SpSCC.
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Affiliation(s)
- Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin F Wilson
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Daniel G Muenz
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily Bellile
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
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15
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Bice TC, Tran V, Merkley MA, Newlands SD, van der Sloot PG, Wu S, Miller MC. Disease-Specific Survival with Spindle Cell Carcinoma of the Head and Neck. Otolaryngol Head Neck Surg 2015. [DOI: 10.1177/0194599815594360] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives (1) Determine factors influencing survival in patients diagnosed with spindle cell carcinoma (SpCC), a rare variant of head and neck squamous cell carcinoma (SCC). (2) Compare survival of patients with SpCC to those with conventional SCC. Study Design Retrospective cohort study. Setting Surveillance, Epidemiology, and End Results 18 database (years 2004-2009). Subjects and Methods Among patients receiving treatment for a single primary in the oral cavity, oropharynx, hypopharynx, or larynx, 118 subjects with SpCC and 18,298 subjects with SCC were identified with complete data for the variables of age, sex, grade, tumor size, stage group, and TNM stage. Disease-specific survival curves were compared. Univariate and multivariate analyses were used to examine the effects of each factor on survival over all sites and within each of 3 sites. Results Univariate analysis of the combination of the 3 anatomic subsites showed survival with SpCC was worse than with conventional SCC ( P < .001). Three-year disease-specific survival with SpCC was 49.5%, and 5-year disease-specific survival was 40.2%. Compared with conventional SCC, survival was worse for SpCC of the oral cavity ( P < .001) and oropharynx ( P < .001) but no different for the larynx and hypopharynx site ( P = .15). Multivariate analysis identified age ( P = .02), tumor size ( P = .006), and M stage ( P < .001) as the only variables significantly affecting survival with SpCC. All variables significantly affected survival with conventional SCC. Conclusions Spindle cell carcinoma carries a worse prognosis than SCC. Larger tumor size, older age, and metastatic disease portend worse survival with SpCC of the head and neck.
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Affiliation(s)
- Tristan C. Bice
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Van Tran
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA
| | - Mark A. Merkley
- Department of Otolaryngology Head and Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Shawn D. Newlands
- Department of Otolaryngology Head and Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Paul G. van der Sloot
- Department of Otolaryngology Head and Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Shuang Wu
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA
| | - Matthew C. Miller
- Department of Otolaryngology Head and Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
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16
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Dubal PM, Marchiano E, Kam D, Dutta R, Kalyoussef E, Baredes S, Eloy JA. Laryngeal spindle cell carcinoma: A population-based analysis of incidence and survival. Laryngoscope 2015; 125:2709-14. [DOI: 10.1002/lary.25383] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - David Kam
- Department of Otolaryngology-Head and Neck Surgery
| | - Rahul Dutta
- Department of Otolaryngology-Head and Neck Surgery
| | | | - Soly Baredes
- Center for Skull Base and Pituitary Surgery; Neurological Institute of New Jersey
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery
- Center for Skull Base and Pituitary Surgery; Neurological Institute of New Jersey
- Department of Neurological Surgery; Rutgers New Jersey Medical School; Newark New Jersey U.S.A
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17
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Vazquez A, Khan MN, Blake DM, Patel TD, Baredes S, Eloy JA. Sinonasal squamous cell carcinoma and the prognostic implications of its histologic variants: a population-based study. Int Forum Allergy Rhinol 2014; 5:85-91. [DOI: 10.1002/alr.21418] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 07/29/2014] [Accepted: 08/20/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Alejandro Vazquez
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Mohemmed N. Khan
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai School of Medicine; New York NY
| | - Danielle M. Blake
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Tapan D. Patel
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey; Rutgers New Jersey Medical School; Newark NJ
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey; Rutgers New Jersey Medical School; Newark NJ
- Department of Neurological Surgery; Rutgers New Jersey Medical School; Newark NJ
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18
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Gerry D, Fritsch VA, Lentsch EJ. Spindle Cell Carcinoma of the Upper Aerodigestive Tract. Ann Otol Rhinol Laryngol 2014; 123:576-83. [DOI: 10.1177/0003489414525337] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: We sought to better characterize spindle cell carcinoma (SpCC) of the upper aerodigestive tract, a rare and aggressive variant, through comparison of a large cohort of head and neck SpCCs against a cohort of conventional head and neck squamous cell carcinoma (SCC) patients. Methods: We compared epidemiologic and clinicopathologic characteristics of 341 SpCCs with 67 882 SCCs of the head and neck, drawing data from the SEER national database. We also compared disease-specific survivals (DSS) for SpCC and SCC based on tumor site and mode of treatment. Results: SpCCs were predominantly laryngeal (46.4%, P < .001) and were more likely to be high grade ( P > .001). SpCCs were also more likely than SCCs to present at an early stage ( P < .001 to P < .05). Rates of distant metastasis were similar between the tumor types. DSS was similar between SpCCs and SCCs, although site-specific survival rates were higher for SpCCs of the larynx ( P = .017) and lower for those of the oral cavity ( P = .008). Conclusion: SpCC of the head and neck is more likely than SCC to present at an early stage, with fewer nodal metastases. Survival rates appear to depend on anatomic site as well.
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Affiliation(s)
- Daniel Gerry
- Georgia Regents University, Augusta, Georgia, USA
| | | | - Eric J. Lentsch
- Medical University of South Carolina, Charleston, South Carolina, USA
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19
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Lanzer M, Gander T, Kruse A, Luebbers HT, Reinisch S. Influence of histopathologic factors on pattern of metastasis in squamous cell carcinoma of the head and neck. Laryngoscope 2013; 124:E160-6. [PMID: 24254388 DOI: 10.1002/lary.24458] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 09/13/2013] [Accepted: 10/01/2013] [Indexed: 01/29/2023]
Abstract
OBJECTIVES/HYPOTHESIS Knowledge of histopathological factors, such as perineural invasion (PNI), extracapsular spread (ECS), angiolymphatic vessel invasion, and conglomerate lymph nodes, in patients with head and neck squamous cell carcinoma is important for appropriate treatment decisions. Given the availability of aggressive therapeutic options with known side effects and burdens for the patient, choosing the correct treatment option is vital. STUDY DESIGN Retrospective patient database. METHODS Using a retrospective database of patients treated over a 10-year period, independent prognostic factors for disease-free survival and overall survival were assessed. Univariate analysis was used to identify significant variables, and multivariate Cox regression analysis was used to determine independent prognostic factors. RESULTS Between January 1, 1999 and December 31, 2009, 291 patients with head and neck squamous cell carcinoma were analyzed to identify influence of histopathological factors on pattern of metastasis. PNI tends to set metastasis locoregional, both in ipsilateral and contralateral lymph nodes. Lymphangiosis eases the way toward ipsilateral lymph node metastasis. ECS spread and hemangiosis demonstrated a significantly higher risk of distant metastasis. With the occurrence of conglomerate lymph nodes, patient data demonstrated a highly significant accumulation of distant metastasis. CONCLUSIONS Patients with PNI and lymph vessel invasion tend toward locoregional lymph node metastasis on the ipsilateral side of the neck. In cases of PNI, the patient is at risk for a contralateral neck recurrence of the tumor. In patients with ECS, blood vessel invasion, or conglomerate disease, disseminated spread of the disease to distant locations is more likely and has a high negative impact on survival of the patient.
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Affiliation(s)
- Martin Lanzer
- Department of General Otorhinolaryngology-Head and Neck Surgery, University Hospital of Graz, Graz, Austria; Clinic for Cranio-Maxillofacial Surgery, University Hospital of Zürich, Zürich, Switzerland
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20
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RhoB promotes cancer initiation by protecting keratinocytes from UVB-induced apoptosis but limits tumor aggressiveness. J Invest Dermatol 2013; 134:203-212. [PMID: 23792460 DOI: 10.1038/jid.2013.278] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 04/30/2013] [Accepted: 05/20/2013] [Indexed: 11/09/2022]
Abstract
The role of UVB-induced apoptosis in the formation of squamous cell carcinoma (SCC) is recognized. We previously identified the small RhoB (Ras homolog gene family, member B) GTPase, an early response gene to cellular stress, as a critical protein controlling apoptosis of human keratinocytes after UVB exposure. Here we generated SKH1 (hairless immunocompetent mouse) mice invalidated for RhoB to evaluate its role in UVB-induced skin carcinogenesis in vivo. We show that rhob-/- mice have a lower risk of developing UVB-induced keratotic tumors and actinic keratosis that is associated with a higher sensitivity of UVB-exposed keratinocytes to apoptosis. We extend this observation to primary cultures of normal human keratinocytes in which RhoB was downregulated with small interfering RNA (siRNA) and further show that the hypersensitivity to apoptosis depends on B-cell lymphoma 2 (Bcl-2) downregulation. In rhob-/- mice, the UVB-induced tumors were preferentially undifferentiated and highly proliferative. Finally, we show in humans an almost constant loss of RhoB expression in undifferentiated SCCs. These undifferentiated and RhoB-deficient tumors have elevated phosphorylated histone H2AX (γH2AX) and 53BP1, two markers of DNA double-strand breaks. Together, our results indicate that UVB-induced RhoB expression participates in in vivo SCC initiation by increasing keratinocyte survival. Conversely, RhoB may limit tumor aggressiveness as loss of RhoB expression in tumor cells is associated with tumor progression.
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