GILZ regulates type I interferon release and sequesters STAT1

Glucocorticoids remain a mainstay of modern medicine due to their ability to broadly suppress immune activation. However, they cause severe adverse effects that warrant urgent development of a safer alternative. The glucocorticoid-induced leucine zipper (GILZ) gene, TSC22D3, is one of the most highly upregulated genes in response to glucocorticoid treatment, and reduced GILZ mRNA and protein levels are associated with increased severity of inflammation in systemic lupus erythematosus (SLE), Ulcerative Colitis, Psoriasis, and other autoimmune/autoinflammatory diseases. Here, we demonstrate that low GILZ permits expression of a type I interferon (IFN) signature, which is exacerbated in response to TLR7 and TLR9 stimulation. Conversely, overexpression of GILZ prevents IFN-stimulated gene (ISG) up-regulation in response to IFNα. Moreover, GILZ directly binds STAT1 and prevents its nuclear translocation, thereby negatively regulating IFN-induced gene expression and the auto-amplification loop of the IFN response. Thus, GILZ powerfully regulates both the expression and action of type I IFN, suggesting restoration of GILZ as an attractive therapeutic strategy for reducing reliance on glucocorticoids.

Evolving multidisciplinary treatment of squamous cell carcinoma of the head and neck in India✰

In this article, we highlight the evolution of a multimodal approach in the overall management of squamous cell carcinoma of the head and neck (SCCHN) in India; present advances in technology (newer surgical techniques), novel medical and radiotherapy (RT) approaches; review their roles for an integrated approach for treating SCCHN and discuss the current role of immunotherapy in SCCHN. For locally advanced (LA) SCCHN, the multidisciplinary approach includes surgery followed by RT, with or without chemotherapy (CT) or concurrent chemoradiotherapy. Improved surgical techniques of reconstruction and voice-preservation are being implemented. Advanced forms of high-precision conformal techniques like intensity-modulated radiotherapy are used to deliver highly conformal doses to tumors, sparing the surrounding normal tissue. Compared with RT alone, novel CT regimens and targeted therapeutic agents have the potential to improve locoregional control and survival and reduce treatment-induced toxicities. Several clinical trials have demonstrated efficacy, safety, and quality of life benefits of adding cetuximab to RT regimens in LASCCHN. Studies have also suggested a cetuximab-related laryngeal preservation benefit. At progression, platinum-based CT combined with cetuximab (a monoclonal anti-epidermal growth factor receptor antibody) is the only validated option available as the first-line therapy. Thus, an integrated multidisciplinary approach plays a key role in maximizing patient outcomes, reduction in treatment related morbidities that consequently impact quality of life of survivors.

Effectiveness of the 'Oral Rub And Rinse Technique' As a Tool for Oral Cancer Screening in South Indian Population

Background: Oral cancer is a public health problem and causing huge economic and a social burden. Early detection of oral potentially malignant disorders and oral cancers is very important in reducing the morbidity and mortality rates. Aim: To assess the effectiveness of the 'Oral Rub and Rinse Technique' as a tool for oral cancer screening among South Indian population. Methods: A population based, high risk targeted oral cancer screening was conducted in 2 districts of Karnataka, South India. About 523 subjects participated in the study. Data were collected regarding the sociodemographic details, history of tobacco use and knowledge regarding oral cancer. The participants were then screened for presence of oral premalignant/malignant lesions or conditions. Exfoliative cytology was done using traditional method and the 'Oral Rub and Rinse Technique' if red/white lesions were present. Smears were stained with Papanicolaou (PAP) stain and were evaluated by 2 cytopathologists independently. The data were tabulated and subjected to statistical analysis. Results: Of the 523 subjects, 112 had red/white lesions. Of these, 23% were Class I smears, 24% Class II smears, 31% Class III and 16% Class IV smears and 6% were unsatisfactory using the conventional technique whereas the Oral Rub and Rinse Technique showed 19% Class I smears, 28% Class II smears, 32% Class III smears, 17% Class IV smears and 4% unsatisfactory. The cellular quantity and quality in terms of clarity and dispersion was better with the smears prepared by the Oral Rub and Rinse Technique than the conventional technique. Conclusion: Oral Rub and Rinse Technique can be a reliable tool for population screening of oral cancer.

A nomogram for predicting the risk of neck node metastasis in pathologically node-negative oral cavity carcinoma

OBJECTIVE

To generate a nomogram for predicting the risk of neck node metastasis in pathologically node-negative patients using a combination of variables comprising of protein expression, ultrastructural alterations and clinicopathological parameters.

MATERIALS AND METHODS

Surgically removed oral tumours (n = 103) were analysed for the expression of desmosomal and hemidesmosomal assembly proteins by immunohistochemistry and ultrastructural alterations by transmission electron microscopy (TEM). Protein expression, ultrastructural alterations and clinicopathological variables were used to construct nomogram from the training set in 75 patients. Clinical utility of the nomogram was validated in a discrete set of 28 patients.

RESULTS

Univariate and multivariate analyses were performed on the training set, and obtained significant variables comprising of integrin β4 expression (p = .027), number of hemidesmosomes (p = .027)/desmosomes (p = .046), tumour differentiation grade (p = .033) and tumour thickness (p = .024) were used for construction of the nomogram. The area under the curve was calculated for both training 0.821 (95% CI 0.725-0.918) and validation sets 0.880 (95% CI 0.743-1.000). The nomogram demonstrated a predictive accuracy of 73.3% and 78.6% with the sensitivity of 81.4% and 83.3% in the training and validation sets, respectively.

CONCLUSIONS

The nomogram constructed on postsurgical tumour samples will be a value addition to histopathology for the detection of neck node metastasis in pathologically node-negative patients.

Predictivity of human papillomavirus positivity in advanced oral cancer

BACKGROUND AND OBJECTIVE

Human papillomavirus (HPV) is a known prognostic factor world over in patients of carcinoma oropharynx. The role of HPV in oral cancers has not been investigated adequately. We tried to identify standard clinicopathological features in oral cancer, which would predict HPV-positivity.

METHODS

This was a retrospective analysis of 124 cases of T4 oral cancer patients at our center. HPV-positive was defined in accordance with positive p16 immunohistochemistry done on pretreatment local tumor site biopsy. Age, sex, habits (smoking history and oral tobacco), Eastern Cooperative Oncology Group performance status (ECOG PS), T stage, N stage, grade, and site were selected, for testing of prediction for HPV-positivity. The analysis was performed by R studio version 3.1.1. Two-sample test for equality of proportions with continuity correction was used to identify factors predicting for HPV-positivity. P = 0.05 was considered as significant.

RESULTS

Of 124 patients, 16 patients (12.9%) were HPV-positive. The median age of the whole cohort was 43 years (interquartile range 37-52 years) with 15 females (12.1%). All had squamous cell carcinoma (100%). The grade of the tumor was well differentiated in 9 patients (7.2%), moderately differentiated in 98 patients (79.1%), and poorly differentiated in 17 patients (13.7%). The ECOG PS 0 in 19 patients (15.3%), 1 in 104 patients (83.9%), and 2 in 1 patient (0.8%). The subsite of the tumor was buccal mucosa in 74 patients (59.7%), anterior two-third of tongue in 33 patients (26.6%), and others in 17 patients (13.7%). None of the tested factors except the use of oral tobacco were statistically significantly associated with HPV-positivity. History of tobacco usage had a statistical trend toward ability to predict HPV-positivity. The proportion of patients with HPV-positive oral cancer in patients without history usage of oral tobacco was 31.3% while it was 10.2% in patients with previous history of tobacco use (P = 0.03).

CONCLUSION

Standard clinicopathological variables could not predict for HPV-positivity. Negative history of tobacco (smokeless) usage showed statistical trends toward ability to predict HPV-positivity in oral cancer patients.

Decreased functional response to Toll like receptor ligands in patients with oral cancer

Patients with oral cancer (OC) show dysregulation of variety of anti tumor immune responses. To assess the role of Toll like receptor (TLR) signaling in peripheral blood lymphocytes (PBL) from OC patients, we analyzed the expression of TLR2, TLR3, TLR4 and TLR9 on various lymphocyte subsets. Results revealed an increased expression of TLRs on unconventional T cells (like γδ T cells, NKT cells and CD4(+)CD8(+) T cells) as compared to conventional αβ T cells. Functional studies using TLR ligands (CpG, Poly I:C, LPS and Pam3CSK4) showed defects in the TLR mediated signaling in PBLs of OC patients. Proliferation of OC PBLs in response to stimulation with TLR ligands was significantly decreased. TLR ligand induced IFN-γ production by PBLs from OC patients were low as compared to HI. Stimulation with TLR ligands upregulated the levels of activation markers (CD25 and CD69) on PBLs from HI but not from OC patients. TLR ligands CpG, Poly I:C, LPS and Pam3CSK4 significantly augmented the tumor directed cytotoxic response of PBLs from HI but not from OC patients. Our data suggests that impairment of TLR function on PBLs may be another strategy adopted by tumor cells to dampen tumor directed immune responses.

Primary angiosarcoma of the larynx: a rare entity

Angiosarcomas are extremely rare malignant tumours of the larynx. We present a case of laryngeal angiosarcoma in a 58-year-old man who presented with hoarseness of voice, dysphagia and neck swelling. The patient underwent a total laryngectomy with a pre-operative and frozen section diagnosis of a poorly differentiated carcinoma of the larynx. Histopathological and immunohistochemical evaluation revealed features of a laryngeal angiosarcoma. The case is presented for its rarity and diagnostic difficulty.

Metastatic tumors to the jaw bones: retrospective analysis from an Indian tertiary referral center

AIM

Being a tertiary referral center, we encounter the highest number of oral cancer patients in India, and there is direct involvement of the jaw bone in approximately 40% of these cases. There are no large case series from the Indian subcontinent on metastatic tumors to the jaw bones. With this retrospective analysis, we intend to estimate the incidence of this rare manifestation in the jaw bones in our patients and compare it with the available literature.

MATERIALS AND METHODS

All patients with biopsy proven metastatic disease involving jaw bones having complete clinical data were included.

RESULTS

Nineteen out of 10,411 oral cancer patients who reported between the years 2000 and 2005 were included. Breast and thyroid malignancies (5/19 each) were commonest in the females to metastasize to the mandible, whereas in the males, there was no predominant site that resulted in jaw bone metastasis, although mandible was commonly affected. Neuroblastoma of adrenal gland metastasized to maxilla in the age group ranging from 4 months to 16 years. maxilla was the commonest jaw bone affected in this age group. in five cases, jaw bone was found to be the first site of metastasis.

CONCLUSIONS

There is variation in the primary site that causes metastasis to the jaw bones depending on age, sex and geographic distribution. Jaw bone metastases are rare and can be the first site of metastasis. We get approximately four cases in a year with metastatic disease manifesting in the jaw bones. Metastasis to jaw bone is associated with poor prognosis.

Cancer of the buccal mucosa: a tale of two continents

Squamous cell carcinoma (SCC) of the buccal mucosa in North America is thought to be different from that in the Indian subcontinent. This study compared the treatment outcomes and prognostic factors in 64 patients with SCC of the buccal mucosa treated at Cancer Care Manitoba (CCMB), Canada, and 64 similar patients treated at the Tata Memorial Hospital (TMH), India. Overall, cause-specific and disease-free survival for the two geographical groups were calculated and the impact of individual prognostic factors on survival was assessed. CCMB patients were significantly older (p<0.001), had less differentiated tumour (p=0.053) and had higher chances of positive or close surgical margins (p=0.012). At 5 years, they had lower 5-year overall survival (57.4% versus 80.1%; p<0.001), cancer-specific survival (76.4% versus 85.0%; p=0.043) and disease-free survival (42.9% versus 66.4%; p=0.004). Age had an independent influence on overall survival and cause-specific survival. After adjusting for age there was no difference in cause-specific survival between the two groups (HR=1.20; 95% CI=0.46,3.17; p=0.710). The apparent survival difference between the CCMB and TMH patients was due to the difference in the age of presentation and not because of different biological behaviour.

Demonstration of cytokeratin-5 non-expression in tobacco related oral carcinogenesis—use of reverse transcriptase polymerase chain reaction as a sensitive assay

Cytokeratins (CK) are the epithelia specific intermediate filament proteins. We have shown consistent non-expression of CK-5 protein in human oral pre-cancer and cancer, in earlier studies. To investigate whether non-expression of CK-5 protein is the result of transcriptional or translational block and to evaluate the possibility if CK-5 non-expression can be used as a marker for early diagnosis of tobacco related oral cancer, RT-PCR using CK-5 specific primers was conducted. Out of 36 precancerous lesions and 29 squamous cell carcinomas (SCC) of buccal mucosa (BM) samples studied, 11 and 13 samples respectively of precancer and SCC did not show CK-5 product in RT-PCR. Down regulation of CK-5 mRNA expression was also observed in some samples. Thus, in conclusion, our results have shown that CK-5 non-expression is the result of transcriptional block. We proposed CK-5 non-expression as a potential marker for the early diagnosis of tobacco related oral cancer.

Thoracoscopy in the diagnosis of pleural effusion of ambiguous etiology

Between 1985 and 1989, 27 patients underwent thoracoscopy for an undiagnosed pleural effusion. Prior thoracocentesis (in all patients) and a needle pleural biopsy (in 15 patients) had been nondiagnostic. The rigid thoracoscope was used in 21 patients, the cystoscope in 4 patients, and the flexible bronchoscope in 2 patients. We had one mortality, and there was no operative morbidity. Thoracoscopy was diagnostic in 24 of the 27 patients (4 benign, 20 malignant). The average duration of stay in the hospital was 48 hr. We conclude that thoracoscopy is an important diagnostic aid in the management of a pleural effusion of ambiguous origin and that it is a relatively safe procedure that can be performed with an acceptable morbidity and mortality.