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Sirviö M, Aro K, Naukkarinen M, Mäkitie A, Tarkkanen J, Kelppe J, Atula T. Clinical decision making when cytology indicates a Warthin tumor. Sci Rep 2024; 14:8832. [PMID: 38632256 PMCID: PMC11023945 DOI: 10.1038/s41598-024-58892-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
Warthin tumor (WT) is a benign tumor usually affecting the parotid gland. The main diagnostic tool remains ultrasound combined with fine-needle aspiration cytology (FNAC). This study aims to examine how reliably FNAC indicates WT for clinical decision making regarding surgical versus conservative management. We included all patients who underwent FNAC from a parotid gland lesion between 2016 and 2018 at our institution, and whose FNAC revealed WT suspicion. The FNACs were divided into three groups based on the cytology report: certain, likely, and possible WT. The patients were divided into two groups based on having had either surgery or follow-up. We sent a questionnaire to patients who had not undergone surgery in order to obtain follow-up for a minimum of four years. Altogether, 135 FNAC samples, from 133 tumors and 125 patients, showed signs of WT. Of the 125 patients, 44 (35%) underwent surgery, and 81 (65%) were managed conservatively. Preoperative misdiagnosis in FNAC occurred in three (7%) surgically treated tumors. Their FNACs were reported as possible WTs, but histopathology revealed another benign lesion. In the conservatively treated group, two patients underwent surgery later during the follow-up. Cytological statements of WT were seldom false, and none were malignant. The majority of the patients were only followed-up and rarely required further treatment. A certain or likely diagnosis of WT in the FNAC report by an experienced head and neck pathologist is highly reliable in selecting patients for conservative surveillance.
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Affiliation(s)
- Minna Sirviö
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland.
| | - Katri Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland
| | - Mira Naukkarinen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jussi Tarkkanen
- Pathology, Helsinki University Hospital Diagnostic Center, Helsinki, Finland
| | - Jetta Kelppe
- Pathology, Helsinki University Hospital Diagnostic Center, Helsinki, Finland
| | - Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Sjöblom A, Jouhi L, Laakkonen P, Randén-Brady R, Tarkkanen J, Haglund C, Mattila P, Carpén T, Hagström J, Mäkitie A. IGSF3 tissue expression in squamous cell carcinoma of the oropharynx: a novel tool for prognosis assessment in HPV-related and HPV-unrelated disease. APMIS 2024. [PMID: 38623593 DOI: 10.1111/apm.13417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
Biomarkers are not broadly used in the management of head and neck cancers (HNCs). Biomarkers have been beneficial in the management of other cancers, however, not in HNCs. Therefore, we observed the immunopositivity of a novel biomarker called immunoglobulin superfamily member 3 (IGSF3) in tumor tissues in HPV-related and HPV-unrelated OPSCC. Two patient cohorts (C1 and C2) from separate time periods were available for this study (total N = 282). Both consisted of OPSCC patients treated at the Helsinki University Hospital (HUS, Helsinki, Finland) during 2000-2016. For HPV determination, HPV mRNA in situ hybridization was used. Immunohistochemistry was used to assess IGSF3 immunopositivity in cancer tissues. Overall survival (OS) was used as endpoint in the statistical analysis. In C1, stronger immunopositivity of IGSF3 in tumor-infiltrating lymphocytes (TILs) correlated with favorable OS (p = 0.005). Stronger IGSF3 immunopositivity in tumor cells (TCs) was associated with HPV negativity (p = 0.017). Stronger IGSF3 immunopositivity in TILs correlated with HPV positivity (p < 0.001). Elevated IGSF3 immunopositivity in TILs associates with HPV-related tumors and may signify favorable prognosis. The immunopositivity of IGSF3 differs between HPV-related and HPV-unrelated OPSCC.
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Affiliation(s)
- Anni Sjöblom
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Lauri Jouhi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pirjo Laakkonen
- Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Reija Randén-Brady
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jussi Tarkkanen
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Caj Haglund
- Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Petri Mattila
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Timo Carpén
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jaana Hagström
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Oral Pathology and Oral Radiology, University of Turku, Turku, Finland
| | - Antti Mäkitie
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
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Sjöblom A, Pehkonen H, Jouhi L, Monni O, Randén-Brady R, Karhemo PR, Tarkkanen J, Haglund C, Mattila P, Mäkitie A, Hagström J, Carpén T. Liprin-α1 Expression in Tumor-Infiltrating Lymphocytes Associates with Improved Survival in Patients with HPV-Positive Oropharyngeal Squamous Cell Carcinoma. Head Neck Pathol 2023; 17:647-657. [PMID: 37335526 PMCID: PMC10513983 DOI: 10.1007/s12105-023-01565-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/03/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Liprin-α1 is a scaffold protein involved in cell adhesion, motility, and invasion in malignancies. Liprin-α1 inhibits the expression of metastatic suppressor CD82 in cancers such as oral carcinoma, and the expression of these proteins has been known to correlate negatively. The role of these proteins has not been previously studied in human papillomavirus (HPV)-related head and neck cancers. Our aim was to assess the clinical and prognostic role of liprin-α1 and CD82 in HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) in comparison to HPV-negative OPSCC. METHODS The data included 139 OPSCC patients treated at the Helsinki University Hospital (HUS) during 2012-2016. Immunohistochemistry was utilized in HPV determination and in biomarker assays. Overall survival (OS) was used in the survival analysis. RESULTS Stronger expression of liprin-α1 in tumor-infiltrating lymphocytes (TILs) was linked to lower cancer stage (p < 0.001) and HPV positivity (p < 0.001). Additionally, we found an association between elevated expression of liprin-α1 and weak expression of CD82 in tumor cells (p = 0.029). In survival analysis, we found significant correlation between favorable OS and stronger expression of liprin-α1 in TILs among the whole patient cohort (p < 0.001) and among HPV-positive patients (p = 0.042). CONCLUSIONS Increased liprin-α1 expression in the TILs is associated with favorable prognosis in OPSCC, especially among HPV-positive patients.
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Affiliation(s)
- Anni Sjöblom
- Department of Pathology, University of Helsinki and Helsinki University Hospital, PO Box 21, 00014 Helsinki, Finland
| | - Henna Pehkonen
- Applied Tumor Genomics Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Lauri Jouhi
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Outi Monni
- Applied Tumor Genomics Research Program and Department of Oncology, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Reija Randén-Brady
- Department of Pathology, University of Helsinki and Helsinki University Hospital, PO Box 21, 00014 Helsinki, Finland
| | - Piia-Riitta Karhemo
- Applied Tumor Genomics Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jussi Tarkkanen
- Department of Pathology, University of Helsinki and Helsinki University Hospital, PO Box 21, 00014 Helsinki, Finland
| | - Caj Haglund
- Research Programs Unit, Translational Cancer Medicine and Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Petri Mattila
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
- Departments of Pathology and of Otorhinolaryngology, Head and Neck Surgery and Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jaana Hagström
- Department of Pathology and Research Programs Unit, Translational Cancer Medicine, University of Helsinki, Helsinki, Finland
- Department of Oral Pathology and Oral Radiology, University of Turku, Turku, Finland
| | - Timo Carpén
- Departments of Pathology and of Otorhinolaryngology, Head and Neck Surgery and Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Wahbi W, Korelin K, Sieviläinen M, Karihtala P, Wilkman T, Tarkkanen J, Salo T, Al-Samadi A. Evaluation of in vitro and in vivo personalized cancer treatment assays for oral squamous cell carcinoma. Transl Oncol 2023; 33:101677. [PMID: 37099957 PMCID: PMC10182324 DOI: 10.1016/j.tranon.2023.101677] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/28/2023] [Accepted: 04/14/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Oral squamous cell carcinoma (OSCC) is a common cancer with a high heterogeneity and few approved treatments. OSCC is one of the least explored areas for precision oncology. In this study, we aimed to test the reliability of our three established rapid cancer systemic treatment-testing assays: human tumour-derived matrix (Myogel)-coated well-plates, zebrafish xenografts, and 3D microfluidic chips. METHODS Chemo-, radio- and targeted-therapy testing in Myogel-coated wells and zebrafish xenografts was conducted nine times using five samples; two primary and three metastatic lymph node samples from three OSCC patients. Peripheral blood mononuclear cells (PBMNCs) were isolated from the patients' blood. The response of the tumour cells to radio-, chemo-, and targeted therapy was tested using Myogel-coated wells and zebrafish larvae xenografts. The tumour cells' response to immunotherapy was tested using 3D microfluidic chips. The cells' sensitivity to the treatments was compared with the patients' clinical response. Primary and metastatic lymph node tissue-derived DNA samples from two patients underwent whole exome sequencing to compare the mutational profiles of the samples. RESULTS Test results were in line with patients' responses in 7/9 (77%) zebrafish xenograft assays and 5/9 (55%) Myogel-coated wells assays. Immunotherapy testing was done using one metastatic patient sample which matched the patients' response. Differences in responses to treatments between primary and metastatic samples of the same patient were detected in 50% of the zebrafish larvae assays. CONCLUSIONS Our results show the potential of using personalized cancer treatment testing assays - specifically zebrafish xenografts that revealed promising results - in OSCC patient samples.
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Affiliation(s)
- Wafa Wahbi
- Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Biomedicum Helsinki 1, C223b, Haartmaninkatu 8, P.O. Box 63, Helsinki 00014, Finland; Translational Immunology Research Program (TRIMM), Faculty of Medicine, University of Helsinki, Biomedicum Helsinki 1, Haartmaninkatu 8, P.O. Box 63, Helsinki 00014, Finland
| | - Katja Korelin
- Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Biomedicum Helsinki 1, C223b, Haartmaninkatu 8, P.O. Box 63, Helsinki 00014, Finland; Translational Immunology Research Program (TRIMM), Faculty of Medicine, University of Helsinki, Biomedicum Helsinki 1, Haartmaninkatu 8, P.O. Box 63, Helsinki 00014, Finland
| | - Meri Sieviläinen
- Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Biomedicum Helsinki 1, C223b, Haartmaninkatu 8, P.O. Box 63, Helsinki 00014, Finland; Translational Immunology Research Program (TRIMM), Faculty of Medicine, University of Helsinki, Biomedicum Helsinki 1, Haartmaninkatu 8, P.O. Box 63, Helsinki 00014, Finland
| | - Peeter Karihtala
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and University of Helsinki, P.O. Box 180, Helsinki 00029, Finland
| | - Tommy Wilkman
- Department of Oral and Maxillofacial Surgery, HUS Helsinki University Hospital, P.O. Box 281, Helsinki 00029, Finland
| | - Jussi Tarkkanen
- Department of Pathology, HUSLAB, University of Helsinki and Helsinki University Hospital, P.O. Box 21, Helsinki, 00014, Finland
| | - Tuula Salo
- Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Biomedicum Helsinki 1, C223b, Haartmaninkatu 8, P.O. Box 63, Helsinki 00014, Finland; Translational Immunology Research Program (TRIMM), Faculty of Medicine, University of Helsinki, Biomedicum Helsinki 1, Haartmaninkatu 8, P.O. Box 63, Helsinki 00014, Finland; Department of Pathology, HUSLAB, University of Helsinki and Helsinki University Hospital, P.O. Box 21, Helsinki, 00014, Finland; Cancer and Translational Medicine Research Unit, Faculty of Medicine, University of Oulu, P.O. Box 5281, Oulu 90014, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5281, Oulu 90014, Finland
| | - Ahmed Al-Samadi
- Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Biomedicum Helsinki 1, C223b, Haartmaninkatu 8, P.O. Box 63, Helsinki 00014, Finland; Translational Immunology Research Program (TRIMM), Faculty of Medicine, University of Helsinki, Biomedicum Helsinki 1, Haartmaninkatu 8, P.O. Box 63, Helsinki 00014, Finland.
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Auvinen E, Nieminen P, Pellinen J, Dillner J, Tarkkanen J, Virtanen A. Human papillomavirus self-sampling with mRNA testing benefits routine screening. Int J Cancer 2022; 151:1989-1996. [PMID: 35716139 PMCID: PMC9796070 DOI: 10.1002/ijc.34170] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/04/2022] [Accepted: 05/30/2022] [Indexed: 12/30/2022]
Abstract
High risk human papillomavirus (hrHPV) based screening provides the possibility of vaginal self-sampling as a tool to increase screening attendance. In order to evaluate the impact and feasibility of opt-in self-sampling in the Finnish setting, we invited a randomized population of 5350 women not attending screening after age group invitation or after reminder, to attend HPV self-sampling-based screening in the autumn of 2018 in Helsinki. Out of those, 1282 (24.0%) expressed their interest and ordered the sampling package. Eventually 787 women (14.7% of the total invited population) took part in screening, 770 women by providing a vaginal sample within 2 months from invitation and 17 by providing a pap smear in the laboratory. Self-taken samples were collected in Aptima Multitest vials and tested using the Aptima HPV mRNA assay. A high proportion, 158/770 (20.5%) of the samples were positive in the Aptima HPV assay. One hundred and forty-one samples were further submitted to Aptima HPV Genotyping and extended genotyping by a Luminex based assay. Of those, 23 samples (16.3%) were HPV 16 positive and 7 (5.0%) were positive for HPV 18/45; extended genotyping revealed multiple high-risk and low-risk HPV genotypes. At follow-up seven cases of high-grade squamous intraepithelial lesion (HSIL) were diagnosed, which represents 4.4% of HPV positive women and 0.9% of screened women, whereas the rate was 0.5% in routine screening. Our findings suggest that self-sampling with HPV mRNA testing is a feasible approach to improve screening efficacy in a high-risk population among original nonattendees.
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Affiliation(s)
- Eeva Auvinen
- Department of VirologyHelsinki University Hospital Diagnostic Center and University of Helsinki and HUSHelsinkiFinland
| | - Pekka Nieminen
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | | | - Joakim Dillner
- Center for Cervical Cancer Prevention, Department of PathologyKarolinska University Laboratory and Karolinska InstitutetStockholmSweden
| | - Jussi Tarkkanen
- Department of PathologyHelsinki University Hospital Diagnostic Center and University of HelsinkiHelsinkiFinland
| | - Anni Virtanen
- Department of PathologyHelsinki University Hospital Diagnostic Center and University of HelsinkiHelsinkiFinland
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Nicoli TK, Atula T, Sinkkonen ST, Korpi J, Vnencak M, Tarkkanen J, Mäkitie AA, Jero J. Ear canal and middle-ear tumors: a single-institution series of 87 patients. Acta Otolaryngol 2022; 142:132-139. [PMID: 35148225 DOI: 10.1080/00016489.2022.2032824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Ear canal and middle ear tumors are rare and exhibit variability in histology and clinical manifestation. Surgical resection remains the treatment of choice, but individualized approach is needed to preserve function when possible. AIMS/OBJECTIVES To review the management and outcome of ear canal and middle ear tumors at an academic referral center. MATERIALS AND METHODS Helsinki University Hospital (HUS) patient files were searched for clinically and histologically confirmed ear canal and middle ear tumors over a 14-year period. The minimum follow-up time was 2 years. RESULTS Eighty-seven patients with 88 tumors were identified. There were 20 (23%) benign external auditory canal (EAC), 36 (41%) benign middle ear space (MES), 29 (33%) malignant EAC, and 3 (3%) malignant MES tumors. Most (92%) tumors were managed with primary resection. Thirty-five percent of the operatively managed patients had a residual or a recurrent tumor. CONCLUSIONS AND SIGNIFICANCE EAC and MES tumors show great diagnostic and histologic heterogeneity with need for individualized investigative and treatment approaches. In benign tumors, we advocate aggressive local surgical control without sacrificing vital structures. In malignant tumors, we recommend local surgical control with or without adjunct RT.
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Affiliation(s)
- Taija K. Nicoli
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Timo Atula
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Saku T. Sinkkonen
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Jarkko Korpi
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Matej Vnencak
- Department of Otorhinolaryngology – Head and Neck Surgery, Turku University Hospital, Turku, Finland
| | - Jussi Tarkkanen
- Department of Pathology, HUSLAB, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jussi Jero
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
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Peuraharju E, Hagström J, Tarkkanen J, Haglund C, Atula T. IgG4-positive plasma cells in nonspecific sialadenitis and sialolithiasis. Mod Pathol 2022; 35:1423-1430. [PMID: 35606412 PMCID: PMC9514989 DOI: 10.1038/s41379-022-01089-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/14/2022] [Accepted: 04/20/2022] [Indexed: 11/09/2022]
Abstract
Chronic sclerosing sialadenitis is commonly regarded as a manifestation of IgG4-related disease. We previously found that a high IgG4 expression or IgG4-related disease could accompany nonspecific sialadenitis, whereas chronic sclerosing sialadenitis was not directly associated with IgG4-related disease. Our previous findings lead us to hypothesize that these inflammatory conditions of the submandibular gland signify a continuous progression of disease rather than different disease entities. We, therefore, aimed to determine the presence of IgG4-positivity and genuine IgG4-related disease in a cohort of 165 submandibular gland specimens from patients who underwent surgery due to chronic nonspecific sialadenitis or sialolithiasis. To do so, we re-evaluated histopathological features and divided samples into three groups: (A) nonspecific sialadenitis without known sialolithiasis, (B) sialadenitis with sialolithiasis, and (C) sialolithiasis without sialadenitis. We performed immunohistochemical staining for IgG4, IgG, and CD31, and assessed the Boston consensus statement criteria for IgG4-related disease in IgG4-positive samples. We also reviewed patient records and supplemented follow-up data with a questionnaire among patients with IgG4-positive samples. IgG4-positive plasma cells (range 1-344) were found in 131 samples. Among these, 19 samples were classified as IgG4-positive (≥70 IgG4-positive plasma cells/high-power field). Two IgG4-positive samples were histologically highly suggestive of IgG4-related disease, but only one had a clinically confirmed diagnosis of IgG4-related disease. Our results indicate that patients with sialadenitis and sialolithiasis often present with IgG4-positive lymphoplasmacytic infiltrates, but exceedingly rarely present with genuine IgG4-related disease. In sialolithiasis without sialadenitis, IgG4-positive plasma cells are often absent or appear in small numbers. These results support our hypothesis of a continuum of disease, and indicate that progressive inflammation of the submandibular gland leads to the development of more specific pathological features over time.
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Affiliation(s)
- Elin Peuraharju
- Department of Oral and Maxillofacial Diseases, University of Helsinki, P.O. Box 41, FI-00014, Helsinki, Finland.
| | - Jaana Hagström
- grid.7737.40000 0004 0410 2071Department of Pathology, University of Helsinki, HUSLAB, Helsinki University Hospital, P.O. Box 21, FI-00014 Helsinki, Finland ,grid.1374.10000 0001 2097 1371Department of Oral Pathology and Radiology, University of Turku, Turku, Finland
| | - Jussi Tarkkanen
- grid.7737.40000 0004 0410 2071Department of Pathology, University of Helsinki, HUSLAB, Helsinki University Hospital, P.O. Box 21, FI-00014 Helsinki, Finland
| | - Caj Haglund
- grid.7737.40000 0004 0410 2071Research Programs Unit, Translational Cancer Medicine, University of Helsinki, P.O. Box 22, FI-00014 Helsinki, Finland ,grid.7737.40000 0004 0410 2071Department of Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 20, FI-00014 Helsinki, Finland
| | - Timo Atula
- grid.7737.40000 0004 0410 2071Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, FI-00029 HUS Helsinki, Finland
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Roos JH, Mäkitie AA, Tarkkanen J, Ilmarinen TT. Correction to: Pretreatment tumor sampling and prognostic factors in patients with soft-tissue sarcoma of the head and neck. Eur Arch Otorhinolaryngol 2021; 279:3157. [PMID: 34862926 PMCID: PMC9072445 DOI: 10.1007/s00405-021-07205-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Johan H Roos
- Department of Otolaryngology, Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland.
| | - Antti A Mäkitie
- Department of Otolaryngology, Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jussi Tarkkanen
- Department of Pathology, HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Taru T Ilmarinen
- Department of Otolaryngology, Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
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Nicoli TK, Saat R, Tarkkanen J, Kinnunen I, Mäkitie AA, Jero J. Challenging Management of Plexiform Schwannoma and Plexiform Neurofibroma. J Craniofac Surg 2021; 33:803-808. [PMID: 34855632 DOI: 10.1097/scs.0000000000008381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Plexiform variants of neurofibromas and schwannomas are rare and typically arise in superficial soft tissues in the head and neck region. The treatment of these tumors is challenging and no generally accepted guidelines exist for their optimal management. The purpose of this study was to review the management and long-term prognosis of head and neck plexiform neurofibromas and schwannomas at 2 tertiary care academic hospitals in Finland over a 31-year period. The pathology files were searched for plexiform neurofibromas and schwannomas between the years 1990 and 2020. The case notes were reviewed for full management details. Two plexiform schwannomas and 6 plexiform neurofibromas were identified. Five of the 6 plexiform neurofibromas were managed operatively. All patients with a surgically managed plexiform neurofibroma underwent multiple operations. Sclerotherapy abolished 1 patient's cutaneous plexiform neurofibromas. The management of plexiform neurofibromas and plexiform schwannomas remains challenging. Sclerotherapy may offer a promising management option for cutaneous plexiform neurofibromas.
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Affiliation(s)
- Taija K Nicoli
- Departments of Otorhinolaryngology - Head and Neck Surgery Radiology Pathology, HUSLAB, University of Helsinki and HUS Helsinki University Hospital, Helsinki Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital, Turku, Finland Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden Department of Radiology, East Tallinn Central Hospital, Tallinn, Estonia
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Roos JH, Mäkitie AA, Tarkkanen J, Ilmarinen TT. Pretreatment tumor sampling and prognostic factors in patients with soft-tissue sarcoma of the head and neck. Eur Arch Otorhinolaryngol 2021; 279:3147-3155. [PMID: 34773167 PMCID: PMC9072459 DOI: 10.1007/s00405-021-07162-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/26/2021] [Indexed: 10/28/2022]
Abstract
BACKGROUND Insufficient preoperative work-up and consequent intralesional or marginal resection of soft-tissue sarcomas of the head and neck (STSHNs) is common. METHODS This retrospective cohort study comprised 63 patients with STSHN treated at the Helsinki University Hospital between 2005 and 2017. We assessed the effect of pretreatment tumor sampling on surgical margin status and need for supplemental surgery, as well as prognostic factors and survival. RESULTS The lack of representative pretreatment biopsy specimen was associated with unfavorable margin status. Primary surgery at a non-academic center was associated with need for supplemental surgery. The 3-year overall survival (OS) was 68%, disease-specific survival (DSS) 71%, and recurrence-free survival (RFS) 61%. Higher tumor grade and primary tumor size over 5 cm were associated with reduced DSS. CONCLUSIONS Diagnosis and management of STSHNs should be centralized to experienced academic centers. Decision-making between needle biopsy, open biopsy, or upfront radical surgery depends on tumor location and size.
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Affiliation(s)
- Johan H Roos
- Department of Otolaryngology, Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland.
| | - Antti A Mäkitie
- Department of Otolaryngology, Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jussi Tarkkanen
- Department of Pathology, HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Taru T Ilmarinen
- Department of Otolaryngology, Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
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11
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Aro K, Korpi J, Tarkkanen J, Mäkitie A, Atula T. Preoperative evaluation and treatment consideration of parotid gland tumors. Laryngoscope Investig Otolaryngol 2020; 5:694-702. [PMID: 32864441 PMCID: PMC7444776 DOI: 10.1002/lio2.433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/28/2020] [Accepted: 07/02/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The nature of parotid tumors often remains unknown preoperatively and final histopathology may reveal unexpected malignancy. Still, the use of fine-needle aspiration cytology (FNAC) and imaging varies in the management of these tumors. METHODS We evaluated the preoperative examinations and management of all 195 parotid gland tumors diagnosed within our catchment area of 1.6 million people during 2015. RESULTS Altogether 171 (88%) tumors were classified as true salivary gland neoplasms. FNAC showed no false malignant findings, but it was false benign in 5 (2.6%) cases. Preoperative MRI was utilized in 48 patients (25%). Twenty (10%) malignancies included 16 salivary gland carcinomas. Pleomorphic adenomas accounted for 52% of all adenomas. For 24 (40%) Warthin tumors, surgery was omitted. CONCLUSION The proportion of malignancies was lower than generally presented. Our proposed guidelines include ultrasound-guided FNAC with certain limitations. MRI is warranted in selected cases, but seems unnecessary routinely.
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Affiliation(s)
- Katri Aro
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Jarkko Korpi
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Jussi Tarkkanen
- Department of PathologyHUSLAB, University of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Antti Mäkitie
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
- Research Program in Systems Oncology, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and TechnologyKarolinska Institutet and Karolinska HospitalStockholmSweden
| | - Timo Atula
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
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12
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Peuraharju E, Saarinen R, Aro K, Mäkinen LK, Tarkkanen J, Mäkitie A, Haglund C, Hagström J, Atula T. Sclerosing sialadenitis of the submandibular gland is rarely an immunoglobulin G4-related disease in the Finnish population. Mod Pathol 2020; 33:551-559. [PMID: 31680120 DOI: 10.1038/s41379-019-0395-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 12/24/2022]
Abstract
Chronic sclerosing sialadenitis may represent one of many manifestations of an immunoglobulin G4-related disease. However, existing studies typically consist of small patient cohorts rarely conducted in Western populations. The clinical behavior of chronic sclerosing sialadenitis, including follow-up data, warrants further study. Thus, we aimed to determine whether chronic sclerosing sialadenitis always presents as IgG4-related disease or associates with autoimmune diseases and to determine which additional examinations patients may require. Between 2000 and 2017, 51 patients undergoing submandibular gland resection within the Helsinki University Hospital area were diagnosed with chronic sclerosing sialadenitis. We re-evaluated all specimens and performed immunostaining for IgG4. IgG and CD31 stainings were performed for IgG4-positive specimens. IgG4-related disease diagnosis was defined by the Boston consensus statement criteria. We revised clinical data, distributing a follow-up questionnaire to patients to register symptoms of IgG4-related disease or autoimmune disease during follow-up. The chronic sclerosing sialadenitis criteria were fulfilled in 34 patients, whereby 17 were diagnosed as non-sclerosing chronic sialadenitis. In 19 cases, a sialolith associated with a salivary gland lesion. In total, 12 of 51 cases were recognized as IgG4-positive, while two met the criteria for IgG4-related disease. These two cases belonged to the non-sclerosing chronic sialadenitis group, and both involved other organs. The histopathological features between chronic sclerosing sialadenitis and non-sclerosing chronic sialadenitis overlapped regarding the degree of fibrosis and inflammatory infiltrates. In the Finnish population, chronic sclerosing sialadenitis of the submandibular gland does not appear to present as IgG4-related disease. Non-sclerosing chronic sialadenitis can associate with IgG4-related disease. A histopathological distinction between chronic sclerosing sialadenitis and non-sclerosing chronic sialadenitis is not always unequivocal and the presence of a sialolith does not exclude IgG4-positivity. Therefore, immunostaining for IgG4 should be performed when dense plasma cell infiltration is present in either non-sclerosing chronic sialadenitis or chronic sclerosing sialadenitis.
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Affiliation(s)
- Elin Peuraharju
- Department of Oral and Maxillofacial Diseases, University of Helsinki, PO Box 41, FI-00014, Helsinki, Finland.
| | - Riitta Saarinen
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029, Helsinki, Finland
| | - Katri Aro
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029, Helsinki, Finland
| | - Laura K Mäkinen
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029, Helsinki, Finland
| | - Jussi Tarkkanen
- Department of Pathology, University of Helsinki, HUSLAB and Helsinki University Hospital, PO Box 21, FI-00014, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Caj Haglund
- Research Programs Unit, Translational Cancer Medicine, University of Helsinki, PO Box 22, FI-00014, Helsinki, Finland.,Department of Surgery, University of Helsinki and Helsinki University Hospital, PO Box 20, FI-00014, Helsinki, Finland
| | - Jaana Hagström
- Department of Pathology, University of Helsinki, HUSLAB and Helsinki University Hospital, PO Box 21, FI-00014, Helsinki, Finland.,Research Programs Unit, Translational Cancer Medicine, University of Helsinki, PO Box 22, FI-00014, Helsinki, Finland
| | - Timo Atula
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, PO Box 263, FI-00029, Helsinki, Finland
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13
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Aro K, Valle J, Tarkkanen J, Mäkitie A, Atula T. Repeatedly recurring pleomorphic adenoma: a therapeutic challenge. ACTA ACUST UNITED AC 2019; 39:156-161. [PMID: 31131834 PMCID: PMC6536033 DOI: 10.14639/0392-100x-2307] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/29/2018] [Indexed: 12/29/2022]
Abstract
Pleomorphic adenoma (PA) is the most common tumour of the salivary glands, and can recur even after proper surgery. The extent and timing of surgery for recurrent tumours remains controversial, and multiple recurrences pose a special challenge. We evaluated all recurrent PAs (RPAs) treated at the Helsinki University Hospital through 2004-2013 focusing on patients with multiple recurrences. Follow-up data were obtained until January 2018. Of the 47 patients, 70% were women and the median age was 33.5 years. Most of the RPAs were located in the parotid gland (87%), and six (13%) in the submandibular gland. One-third (17/47) of tumours had been primarily excised. This patient population experienced 75 recurrent events in total with two or more recurrences in 14 patients (30%). The time interval between recurrences shortened after each recurrent event and the tumour was more likely to be multifocal. At the end of the follow-up period, 15% had recurrent disease and malignant transformation had occurred in 6%. Treatment for PA and RPA is challenging and requires centralised management. Patients with RPA are often young and recurrences may cause lifelong morbidity, especially when the tumour recurs repeatedly. The utilisation and timing of postoperative radiotherapy needs to be discussed as well as the potential risk for malignant transformation in this patient population.
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Affiliation(s)
- K Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Finland
| | - J Valle
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Finland
| | - J Tarkkanen
- Department of Pathology, HUSLAB, University of Helsinki and Helsinki University Hospital, Finland
| | - A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - T Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Finland
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14
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Carpén T, Sorsa T, Jouhi L, Tervahartiala T, Haglund C, Syrjänen S, Tarkkanen J, Mohamed H, Mäkitie A, Hagström J, Mattila PS. High levels of tissue inhibitor of metalloproteinase-1 (TIMP-1) in the serum are associated with poor prognosis in HPV-negative squamous cell oropharyngeal cancer. Cancer Immunol Immunother 2019; 68:1263-1272. [PMID: 31240326 PMCID: PMC6682571 DOI: 10.1007/s00262-019-02362-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 06/17/2019] [Indexed: 01/19/2023]
Abstract
Background An emerging subset of oropharyngeal squamous cell carcinomas (OPSCC) is caused by HPV. HPV-positive OPSCC has a better prognosis than HPV-negative OPSCC, but other prognostic markers for these two different diseases are scarce. Our aim was to evaluate serum levels and tumor expression of matrix metalloproteinase-8 (MMP-8) and tissue inhibitor of metalloproteinase-1 (TIMP-1) and to assess their prognostic role in HPV-positive and HPV-negative OPSCC. Materials and methods A total of 90 consecutive OPSCC patients diagnosed and treated with curative intent at the Helsinki University Hospital between 2012 and 2016 were included. Serum samples were prospectively collected. An immunofluorometric assay and an enzyme-linked immunosorbent assay were used to determine MMP-8 and TIMP-1 serum concentrations, respectively. HPV status of the tumors was determined using a combination of HPV-DNA genotyping and p16-INK4a immunohistochemistry. The endpoints were overall survival (OS) and disease-free survival (DFS). Results High TIMP-1 serum levels were strongly and independently associated with poorer OS (adjusted HR 14.7, 95% CI 1.8–117.4, p = 0.011) and DFS (adjusted HR 8.7, 95% CI 1.3–57.1, p = 0.024) among HPV-negative patients; this association was not observed in HPV-positive OPSCC. Although TIMP-1 was immunoexpressed in the majority of the tumor tissue samples, the level of immunoexpression was not associated with prognosis, nor did MMP-8 serum levels. Conclusion Our results indicate that serum TIMP-1 levels may serve as an independent prognostic marker for HPV-negative OPSCC patients.
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Affiliation(s)
- Timo Carpén
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 263, 00029 HUS, Helsinki, Finland. .,Department of Pathology, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 21, 00014 HUS, Helsinki, Finland.
| | - Timo Sorsa
- Department of Oral and Maxillofacial Diseases, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 41, 00014 HUS, Helsinki, Finland.,Department of Oral Diseases, Karolinska Institutet, Huddinge, Sweden
| | - Lauri Jouhi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 263, 00029 HUS, Helsinki, Finland
| | - Taina Tervahartiala
- Department of Oral and Maxillofacial Diseases, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 41, 00014 HUS, Helsinki, Finland
| | - Caj Haglund
- Department of Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 440, 00029 HUS, Helsinki, Finland.,Research Programs Unit, Translational Cancer Biology, University of Helsinki, P.O.Box 63, 00014, Helsinki, Finland
| | - Stina Syrjänen
- Department of Oral Pathology and Oral Radiology, University of Turku, Lemminkäisenkatu 2, 20520, Turku, Finland.,Department of Pathology, Turku University Hospital, Kiinamyllynkatu 10, 20520, Turku, Finland
| | - Jussi Tarkkanen
- Department of Pathology, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 21, 00014 HUS, Helsinki, Finland
| | - Hesham Mohamed
- Department of Pathology, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 21, 00014 HUS, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 263, 00029 HUS, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, 171 76, Stockholm, Sweden.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jaana Hagström
- Department of Pathology, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 21, 00014 HUS, Helsinki, Finland.,Research Programs Unit, Translational Cancer Biology, University of Helsinki, P.O.Box 63, 00014, Helsinki, Finland
| | - Petri S Mattila
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 263, 00029 HUS, Helsinki, Finland
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15
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Randén-Brady R, Carpén T, Jouhi L, Syrjänen S, Haglund C, Tarkkanen J, Remes S, Mäkitie A, Mattila PS, Silén S, Hagström J. In situ hybridization for high-risk HPV E6/E7 mRNA is a superior method for detecting transcriptionally active HPV in oropharyngeal cancer. Hum Pathol 2019; 90:97-105. [PMID: 31121191 DOI: 10.1016/j.humpath.2019.05.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 12/23/2022]
Abstract
Current human papillomavirus (HPV) detection methods in oropharyngeal squamous cell carcinoma (OPSCC) have varying sensitivity and specificity. We aimed to compare different HPV-detection methods against the test used in clinical practice, ie, p16 immunohistochemistry (IHC) and to evaluate whether another HPV-detection test additional to p16 IHC would be worthwhile in OPSCC specimens. The study cohort comprised 357 consecutive OPSCC patients during two time periods: 2000-2009 and 2012-2016. From tumor tissue slides, HPV mRNA via in situ hybridization (ISH), HPV DNA via ISH and HPV DNA via polymerase chain reaction (PCR) were detected. The results of these methods were compared with p16 IHC results. Additionally, clinicopathological factors were compared with the methods studied. The sensitivity of HPV mRNA ISH, HPV DNA ISH and HPV DNA PCR were 93.4%, 86.3%, and 83.5%, respectively. The corresponding specificity was 92.4%, 95.3%, and 89.1%, respectively. The negative predictive value for p16 IHC was highest (89.0%) when using mRNA ISH, and followed by DNA ISH (83.5%). ISH for high-risk HPV E6/E7 mRNA was found to be a highly specific and sensitive method for detecting HPV in OPSCC. As p16 protein may be overexpressed due to HPV-independent mechanisms, all p16 IHC-positive OPSCCs should be considered for retesting using mRNA ISH in order to verify transcriptionally active HPV. This is especially critical when considering de-escalated treatment approaches for patients with HPV-positive tumors and still maintaining favorable outcomes for this subgroup of patients.
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Affiliation(s)
- Reija Randén-Brady
- Department of Pathology, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 21, FI-00014 HUS, Helsinki, Finland.
| | - Timo Carpén
- Department of Pathology, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 21, FI-00014 HUS, Helsinki, Finland; Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 263, FI-00029 HUS, Helsinki, Finland
| | - Lauri Jouhi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 263, FI-00029 HUS, Helsinki, Finland
| | - Stina Syrjänen
- Department of Oral Pathology and Oral Radiology, University of Turku and Department of Pathology, Turku University Hospital, Lemminkäisenkatu 2, F, IN-20520, Turku, Finland
| | - Caj Haglund
- Department of Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 440, FI-00029 HUS, Helsinki, Finland; Research Programs Unit, Translational Cancer Biology, University of Helsinki, P.O.Box 63, FI-00014, Helsinki, Finland
| | - Jussi Tarkkanen
- Department of Pathology, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 21, FI-00014 HUS, Helsinki, Finland
| | - Satu Remes
- Department of Pathology, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 21, FI-00014 HUS, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 263, FI-00029 HUS, Helsinki, Finland; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, SE-171 76, Stockholm, Sweden; Research Programme in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Petri S Mattila
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 263, FI-00029 HUS, Helsinki, Finland
| | - Suvi Silén
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 263, FI-00029 HUS, Helsinki, Finland; Department of Biosciences and Nutrition, Karolinska Institutet, SE-171 76, Stockholm, Sweden
| | - Jaana Hagström
- Department of Pathology, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 21, FI-00014 HUS, Helsinki, Finland; Research Programs Unit, Translational Cancer Biology, University of Helsinki, P.O.Box 63, FI-00014, Helsinki, Finland
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16
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Carpén T, Saarilahti K, Haglund C, Markkola A, Tarkkanen J, Hagström J, Mattila P, Mäkitie A. Tumor volume as a prognostic marker in p16-positive and p16-negative oropharyngeal cancer patients treated with definitive intensity-modulated radiotherapy. Strahlenther Onkol 2018; 194:759-770. [PMID: 29774396 DOI: 10.1007/s00066-018-1309-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/23/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE To investigate the impact of primary gross tumor volume (pGTV) and nodal gross tumor volume (nGTV) in oropharyngeal squamous cell carcinoma (OPSCC) and the difference in their role between human papillomavirus (HPV)-positive and HPV-negative patients. METHODS The patient cohort consists of 91 OPSCC patients treated with definitive radiochemotherapy or radiotherapy using intensity-modulated radiotherapy (IMRT). All patients had a minimum follow-up of 31 months. Volume measurements were made from computer tomography (CT) scans and HPV status was assessed by p16 immunohistochemistry. The end points were as follows: overall survival (OS), disease-free survival (DFS) and locoregional control (LRC). RESULTS pGTV was a significant independent prognostic factor for overall survival (OS; p = 0.020) in p16-negative patients. nGTV of p16-negative tumors had significant prognostic value in all end points in multivariate analyses. High-stage (III-IVc) p16-negative tumors were only associated with significantly poorer OS (p = 0.046) but not with poorer LRC or DFS when compared with the low-stage (I-II) tumors. nGTV of p16-positive tumors was an independent prognostic factor for DFS (p = 0.005) and LRC (p = 0.007) in multivariate analyses. CONCLUSION pGTV may serve as an independent prognostic factor in p16-negative patients and nGTV may serve as an independent prognostic factor both in p16-positive and p16-negative patients treated with radiochemotherapy or radiotherapy using IMRT. Tumor volume may have an impact on selecting patients for de-escalation protocols in the future, both in p16-positive and p16-negative patients.
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Affiliation(s)
- Timo Carpén
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Kasarmikatu 11-13, 00029 HUS, Helsinki, Finland.
| | - Kauko Saarilahti
- Department of Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Caj Haglund
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland
| | - Antti Markkola
- Department of Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jussi Tarkkanen
- Department of Pathology, Haartman Institute and HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Hagström
- Research Program Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland.,Department of Pathology, Haartman Institute and HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Petri Mattila
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Kasarmikatu 11-13, 00029 HUS, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Kasarmikatu 11-13, 00029 HUS, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
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17
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Carpén T, Sjöblom A, Lundberg M, Haglund C, Markkola A, Syrjänen S, Tarkkanen J, Mäkitie A, Hagström J, Mattila P. Presenting symptoms and clinical findings in HPV-positive and HPV-negative oropharyngeal cancer patients. Acta Otolaryngol 2018; 138:513-518. [PMID: 29161981 DOI: 10.1080/00016489.2017.1405279] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Oropharyngeal squamous cell carcinoma (OPSCC) is divided in two different disease entities depending on HPV involvement. We investigated differences in presenting symptoms and clinical findings in patients with HPV-positive and -negative OPSCC tumors. METHODS Altogether 118 consecutive patients diagnosed with primary OPSCC between 2012 and 2014 at the Helsinki University Hospital were included. HPV-status of the tumors was assessed by PCR detection of HPV DNA and immunostaining with p16-INK4a antibody. RESULTS Fifty-one (47.7%) of the patients had HPV-positive and 56 (52.3%) HPV-negative tumors. Forty-nine (49/51, 96.1%) of the HPV+ tumors were also p16+ showing high concordance. The most common presenting symptom among HPV+/p16+ patients was a neck mass (53.1%), whereas any sort of pain in the head and neck area was more frequently related to the HPV-/p16- (60.0%) group. HPV+/p16+ tumors had a tendency to locate in the tonsillar complex and more likely had already spread into regional lymph nodes compared with HPV-/p16- tumors. Smoking and heavy alcohol consumption were significantly more common among HPV−/p16− patients but also rather common among HPV+/p16+ patients [corrected]. CONCLUSIONS This analysis of symptoms and signs confirm that OPSCC can be dichotomized in two distinct disease entities as defined by HPV status.
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Affiliation(s)
- Timo Carpén
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anni Sjöblom
- Department of Pathology, Haartman Institute and HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marie Lundberg
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Caj Haglund
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Markkola
- Department of Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Stina Syrjänen
- Department of Oral Pathology and Oral Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Jussi Tarkkanen
- Department of Pathology, Haartman Institute and HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | - Jaana Hagström
- Department of Pathology, Haartman Institute and HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Petri Mattila
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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18
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Aro K, Tarkkanen J, Saat R, Saarilahti K, Mäkitie A, Atula T. Submandibular gland cancer: Specific features and treatment considerations. Head Neck 2017; 40:154-162. [PMID: 29083518 DOI: 10.1002/hed.24981] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/15/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In the absence of unified treatment protocol, we evaluated the management and outcomes of submandibular gland cancers in an unselected patient series. METHODS We included all patients with resected submandibular gland cancer treated at the Helsinki University Hospital from 2000 to 2010 with a 5-year minimum follow-up. RESULTS Twenty-five patients with cancer represented 30% of submandibular gland neoplasms, and most were adenoid cystic carcinomas (ACCs; 56%). At presentation, 3 patients showed clinical signs of probable malignancy. Of 22 neck dissection specimens, 5 patients (20%) had metastases with an occult metastasis rate of 4%. Cancer recurred in 11 patients (44%), of which 7 (28%) were only at a distant site. The 5-year disease-specific survival (DSS) and overall survival (OS) rates were 76%, and disease-free survival (DFS) was 68%. CONCLUSION Most tumors were ACCs differing from the histological pattern of parotid gland cancers. Occult metastases were rare. The rarity of submandibular gland cancer, its variable histological pattern, and varying biological behavior warrant centralized management.
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Affiliation(s)
- Katri Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,School of Dentistry, University of California, Los Angeles, Los Angeles, California
| | - Jussi Tarkkanen
- Department of Pathology, HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riste Saat
- Department of Radiology, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kauko Saarilahti
- Department of Radiation Oncology, HUS Cancer Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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19
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Tiefenböck-Hansson K, Haapaniemi A, Farnebo L, Palmgren B, Tarkkanen J, Farnebo M, Munck-Wikland E, Mäkitie A, Garvin S, Roberg K. WRAP53β, survivin and p16INK4a expression as potential predictors of radiotherapy/chemoradiotherapy response in T2N0-T3N0 glottic laryngeal cancer. Oncol Rep 2017; 38:2062-2068. [PMID: 28849066 PMCID: PMC5652956 DOI: 10.3892/or.2017.5898] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/16/2017] [Indexed: 02/06/2023] Open
Abstract
The current treatment recommendation for T2-3N0M0 glottic squamous cell carcinoma (SCC) in the Nordic countries comprises of radiotherapy (RT) and chemoradiotherapy (CRT). Tumor radiosensitivity varies and another option is primary surgical treatment, which underlines the need for predictive markers in this patient population. The aim of the present study was to investigate the relation of the proteins WRAP53β, survivin and p16INK4a to RT/CRT response and ultimate outcome of patients with T2-T3N0 glottic SCC. Protein expression was determined using immunohistochemistry on tumors from 149 patients consecutively treated with RT or CRT at Helsinki University Hospital, Karolinska University Hospital, and Linköping University Hospital during 1999–2010. Our results demonstrate a significantly better 5-year relapse-free survival, disease-free survival (DFS), disease-specific survival and overall survival of patients with T3N0 tumors treated with CRT compared with RT alone. Patients with tumors showing a cytoplasmic staining of WRAP53β revealed significantly worse DFS compared with those with nuclear staining. For survivin, we observed a trend towards better 5-year DFS in patients with strong nuclear survivin expression compared with those with weak nuclear survivin expression (P=0.091). Eleven (7%) tumors showed p16 positivity, with predilection to younger patients, and this age group of patients with p16-positive SCC had a significantly better DFS compared with patients with p16-negative SCC. Taken together, our results highlight WRAP53β as a potential biomarker for predicting RT/CRT response in T2-T3N0 glottic SCC. p16 may identify a small but distinct group of glottic SCC with favorable outcome. Furthermore, for T3N0 patients better outcome was observed following CRT compared to RT alone.
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Affiliation(s)
- Katharina Tiefenböck-Hansson
- Division of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Aaro Haapaniemi
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Lovisa Farnebo
- Division of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Björn Palmgren
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jussi Tarkkanen
- Department of Pathology, HUSLAB, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marianne Farnebo
- Department of Oncology-Pathology, Cancer Centrum Karolinska (CCK), Karolinska Institutet, Stockholm, Sweden
| | - Eva Munck-Wikland
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Stina Garvin
- Department of Clinical Pathology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Karin Roberg
- Division of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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20
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Atula T, Panigrahi J, Tarkkanen J, Mäkitie A, Aro K. Preoperative evaluation and surgical planning of submandibular gland tumors. Head Neck 2017; 39:1071-1077. [PMID: 28370782 DOI: 10.1002/hed.24691] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 08/29/2016] [Accepted: 11/29/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Roughly half of submandibular gland neoplasms are malignant. Because preoperative information on the nature of these tumors remains limited, both preoperative evaluation and assessment of the extent of primary surgery warrant guidelines that are more accurate. METHODS We evaluated the preoperative examinations and management of all submandibular gland neoplasms treated surgically at the Helsinki University Hospital between 2000 and 2010. RESULTS Of the 83 tumors, 58 (70%) were benign and 25 (30%) were malignant. Of the benign tumors, 54 (93%) were pleomorphic adenomas. The cytology in 8 patients (10%) was class IV or V, and in 12 patients was class III; the tumors in 9 of these 12 patients turned out to be malignant. Of all malignancies, 10 (40%) required additional more extensive surgery. CONCLUSION Ultrasound-guided fine-needle aspiration cytology (FNAC) proved useful, with limitations, in preoperative examination. Surgeons should always obtain wide margins whenever possible, even when clinical means or cytology indicates no malignancy. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1071-1077, 2017.
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Affiliation(s)
- Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha Panigrahi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jussi Tarkkanen
- Department of Pathology, HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Katri Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,School of Dentistry, University of California, Los Angeles, California
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21
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Nicoli TK, Saat R, Kontio R, Piippo A, Tarkkanen M, Tarkkanen J, Jero J. Multidisciplinary Approach to Management of Temporal Bone Giant Cell Tumor. J Neurol Surg Rep 2017; 77:e144-e149. [PMID: 28078198 PMCID: PMC5045306 DOI: 10.1055/s-0036-1592082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Giant cell tumors (GCTs) are rare osseous tumors that rarely appear in
the skull. Methods We review the clinical course of a 28-year-old previously healthy woman
with a complicated GCT. Results The reviewed patient presented with a middle cranial fossa tumor acutely
complicated by reactive mastoiditis. Left tympanomastoidectomy was performed for
drainage of the mastoiditis and for biopsies of the tumor. Due to the challenging tumor
location, the patient was treated with denosumab, a fully humanized monoclonal antibody
against receptor activator of nuclear factor kappa-B ligand, for 7 months, which
resulted in significant preoperative tumor shrinkage. Extensive temporal craniotomy and
resection of the tumor followed utilizing a temporomandibular joint total endoprosthesis
for reconstruction. A recurrence of the tumor was detected on computed tomography at 19
months after surgery and treated with transtemporal tumor resection, parotidectomy, and
mandible re-reconstruction. Conclusion A multidisciplinary approach resulted in a good functional result and,
finally, an eradication of the challengingly located middle cranial fossa tumor.
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Affiliation(s)
- Taija K Nicoli
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riste Saat
- Department of Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Risto Kontio
- Department of Maxillofacial Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna Piippo
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki Finland
| | - Maija Tarkkanen
- Cancer Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jussi Tarkkanen
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jussi Jero
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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22
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Helkamaa T, Rossi S, Mesimäki K, Suomalainen A, Tarkkanen J, Leivo I, Skalova A, Hagström J. Mammary analog secretory carcinoma of minor palatal salivary glands: A case report and review of the literature. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology 2015. [DOI: 10.1016/j.ajoms.2015.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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23
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Atula T, Tarkkanen J, Aro K. [Neck lump--fine-needle aspiration biopsy specimen in diagnostics and planning of therapy]. Duodecim 2014; 130:2405-2412. [PMID: 25558601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In elucidating the cause of a non-tender neck lump, the age of the patient, location and finding on palpation of lumps, and clinical examination of ear, nose and throat disorders and possible other findings are crucial. Fine-needle aspiration biopsy specimen, most commonly obtained in connection with ultrasonic imaging, is a key method in diagnosing lumps of the neck and salivary gland region that are obviously noninflammatory. Ultrasonic imaging combined with a cytological specimen is primary in the case of otherwise normal clinical examination.
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Affiliation(s)
- Timo Atula
- HYKS, korva-, nenä- ja kurkkutautien klinikka
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24
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Qian K, Pietilä T, Rönty M, Michon F, Frilander MJ, Ritari J, Tarkkanen J, Paulín L, Auvinen P, Auvinen E. Identification and validation of human papillomavirus encoded microRNAs. PLoS One 2013; 8:e70202. [PMID: 23936163 PMCID: PMC3728184 DOI: 10.1371/journal.pone.0070202] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 06/17/2013] [Indexed: 01/28/2023] Open
Abstract
We report here identification and validation of the first papillomavirus encoded microRNAs expressed in human cervical lesions and cell lines. We established small RNA libraries from ten human papillomavirus associated cervical lesions including cancer and two human papillomavirus harboring cell lines. These libraries were sequenced using SOLiD 4 technology. We used the sequencing data to predict putative viral microRNAs and discovered nine putative papillomavirus encoded microRNAs. Validation was performed for five candidates, four of which were successfully validated by qPCR from cervical tissue samples and cell lines: two were encoded by HPV 16, one by HPV 38 and one by HPV 68. The expression of HPV 16 microRNAs was further confirmed by in situ hybridization, and colocalization with p16INK4A was established. Prediction of cellular target genes of HPV 16 encoded microRNAs suggests that they may play a role in cell cycle, immune functions, cell adhesion and migration, development, and cancer. Two putative viral target sites for the two validated HPV 16 miRNAs were mapped to the E5 gene, one in the E1 gene, two in the L1 gene and one in the LCR region. This is the first report to show that papillomaviruses encode their own microRNA species. Importantly, microRNAs were found in libraries established from human cervical disease and carcinoma cell lines, and their expression was confirmed in additional tissue samples. To our knowledge, this is also the first paper to use in situ hybridization to show the expression of a viral microRNA in human tissue.
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Affiliation(s)
- Kui Qian
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
- * E-mail:
| | - Tuuli Pietilä
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
- Haartman Institute, Department of Virology, University of Helsinki, Helsinki, Finland
- Department of Virology and Immunology, Helsinki University Hospital Laboratory, Helsinki, Finland
| | - Mikko Rönty
- Department of Pathology, Helsinki University Hospital Laboratory, Helsinki, Finland
| | - Frederic Michon
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | | | - Jarmo Ritari
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - Jussi Tarkkanen
- Department of Pathology, Helsinki University Hospital Laboratory, Helsinki, Finland
| | - Lars Paulín
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - Petri Auvinen
- Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - Eeva Auvinen
- Haartman Institute, Department of Virology, University of Helsinki, Helsinki, Finland
- Department of Virology and Immunology, Helsinki University Hospital Laboratory, Helsinki, Finland
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25
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Auvinen E, Carpen O, Korpela T, Ronty M, Vaheri A, Tarkkanen J. Altered expression of ezrin, E-Cadherin and β-Catenin in cervical neoplasia. Neoplasma 2013; 60:56-61. [PMID: 23067217 DOI: 10.4149/neo_2013_008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
High-grade cervical squamous intraepithelial lesions (CIN) as well as squamous cell carcinoma and adenocarcinoma of the cervix are associated with persistent high-risk human papillomavirus (HPV) infection. A number of cellular events play a role in HPV pathogenesis and in the development of cervical lesions, including alterations in cell adhesion and motility. The crucial plasma membrane - cytoskeleton linker protein ezrin of the Ezrin-Radixin-Moesin (ERM) protein family is involved in the regulation of cell morphology, cell adhesion and invasion. Based on our previous work on ERM proteins we sought out to study the expression of ezrin in cervical premalignant lesions. We also studied the expression of E-cadherin and β-catenin, which play an important role in epithelial cell adhesion. We observed intensifying expression of ezrin along with progressing grade of neoplasia. Ezrin staining was found to colocalize with p16 staining in high-risk HPV associated lesions. Expression of E-cadherin and β-catenin was found to be altered along with the severity of the lesion, similar to ezrin. Enhanced expression of ezrin in cervical HPV associated lesions suggests a role in the development of cervical neoplasia and cancer. Further clinical evaluation should reveal the feasibility of ezrin as a biomarker for the progression of cervical lesions.
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Affiliation(s)
- E Auvinen
- Department of Virology, University of Helsinki, Helsinki, Finland.
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26
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Jakobsson M, Tarkkanen J, Auvinen E, Häkkinen R, Laurila P, Tapper AM. Colposcopy referral rate can be reduced by high-risk human papillomavirus triage in the management of recurrent atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion cytology in Finland. Int J STD AIDS 2013; 23:485-9. [PMID: 22844002 DOI: 10.1258/ijsa.2011.011336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to establish whether a combination of high-risk human papillomavirus (hrHPV) testing and cervical cytology could reduce colposcopy referral among women with atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion cytology. We randomized 598 women in the Helsinki area, Finland into three study groups. Different strategies of hrHPV testing, cytology and colposcopy with biopsy were used; subsequent hrHPV test results and cytological findings were compared with histology. The rates of hrHPV positivity and CIN2+ were compared. In total, 62.5% of all samples were hrHPV-positive. Altogether 45 (12.7%) CIN2 or worse (CIN2+) lesions were found in study groups A and B. Among hrHPV-positive women the rate of CIN2+ was 19.0% (n = 43), in contrast with 1.6% (n = 2) among hrHPV-negative women (relative risk = 12.2, 95% confidence interval [CI] 3.6-81.1, P < 0.001). Among all hrHPV-negative women whose cytological findings were normal or ASCUS, dysplastic lesions were uncommon (n = 4/119, 3.4%), and all were CIN1. If these women had not been referred to colposcopy, the number of colposcopies would have been reduced by 33.6%. We conclude that hrHPV testing combined with repeat cervical cytology had a high negative predictive value in patients with recurrent low-grade cervical cytology. This could reduce the referral rate to colposcopy without jeopardizing patient safety.
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Affiliation(s)
- M Jakobsson
- Department of Obstetrics and Gynaecology, University Hospital, Finland.
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27
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Leinonen MK, Nieminen P, Lönnberg S, Malila N, Hakama M, Pokhrel A, Laurila P, Tarkkanen J, Anttila A. Detection rates of precancerous and cancerous cervical lesions within one screening round of primary human papillomavirus DNA testing: prospective randomised trial in Finland. BMJ 2012; 345:e7789. [PMID: 23197596 PMCID: PMC3509927 DOI: 10.1136/bmj.e7789] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2012] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare the detection rates of precancerous and cancerous cervical lesions by human papillomavirus (HPV) DNA testing and by conventional cytology screening. DESIGN Prospective randomised trial. Two cohorts were followed over one screening round of five years, screened initially by primary HPV DNA testing or by primary Pap test. SETTING Population based programme for cervical cancer screening in Finland. PARTICIPANTS Women aged 25-65 years invited for screening in 2003-07 (101,678 in HPV arm; 101,747 in conventional cytology arm). INTERVENTION Women were randomly allocated (1:1) to primary HPV DNA screening followed by cytology triage if they had positive results, or to primary cytology screening. Screening method was disclosed at the screening visit. Trial personnel involved were aware of all test results. MAIN OUTCOME MEASURES Cumulative detection rates of cervical intraepithelial neoplasia (CIN), adenocarcinoma in situ (AIS), and invasive cervical cancer before the second screening (after five years) or before 31 December 2008. Lesions detected at screening and during the five year interval were included. RESULTS 1010 and 701 precancerous or cancerous lesions were detected during an average follow-up of 3.6 years in the HPV and cytology arms, respectively. Among invited women, the hazard ratio was 1.53 (95% confidence interval l.28 to 1.84) for CIN grade 1, 1.54 (1.33 to 1.78) for CIN 2, 1.32 (1.09 to 1.59) for CIN 3 or AIS, and 0.81 (0.48 to 1.37) for cervical cancer. In 25-34 year old participants, the cumulative hazard (or cumulative detection rate) was 0.0057 (0.0045 to 0.0072) for HPV screening versus 0.0046 (0.0035 to 0.0059) for conventional screening; corresponding data for women aged 35 years and older were 0.0022 (0.0019 to 0.0026) and 0.0017 (0.0014 to 0.0021), respectively. CONCLUSIONS Primary HPV DNA screening detects more cervical lesions than primary cytology within one screening round of five years. Even if the detection rate of CIN 3 or AIS increased in the HPV arm in both age groups, the absolute difference in cumulative rates in women aged 35 years or older was small. By carefully selecting age groups and screening intervals, HPV screening could increase the overall detection rate of cervical precancerous lesions only slightly. However, these findings should be interpreted in the context of the high level of opportunistic screening that occurs in Finland. TRIAL REGISTRATION International Standard Randomised Controlled Trial ISRCTN23885553.
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Affiliation(s)
- Maarit K Leinonen
- Mass Screening Registry, Finnish Cancer Registry, FI-00130 Helsinki, Finland.
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28
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Mattila PS, Hammarén-Malmi S, Saxen H, Kaijalainen T, Käyhty H, Tarkkanen J. Adenoidectomy in young children and serum IgG antibodies to pneumococcal surface protein A and choline binding protein A. Int J Pediatr Otorhinolaryngol 2012; 76:1569-74. [PMID: 22835927 DOI: 10.1016/j.ijporl.2012.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 07/05/2012] [Accepted: 07/06/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE We have previously reported that surgical removal of the nasopharyngeal adenoid in young children resulted in increased risk of nasopharyngeal colonization by pneumococci. We now investigated whether adenoidectomy influences the development of serum IgG antibodies to pneumococcal choline-binding protein A (CbpA) and pneumococcal surface protein A (PspA). METHODS Altogether 217 children aged 12-48 months who had recurrent or persistent otitis media were randomized to undergo or not to undergo adenoidectomy. All the children underwent insertion of tympanostomy tubes. 166 children were followed-up for 3 years. The main outcome measures were concentrations of serum IgG antibodies to CbpA and PspA three years after randomization. Nasopharyngeal colonization by pneumococci was assessed 1, 2, and 3 years after randomization. RESULTS Adenoidectomy decreased concentrations of CbpA antibodies by ca. 25% independently of the observed increase in pneumococcal carriage (OR of log(10) transformed concentrations 0.74, 95% CI 0.58-0.94, P=0.016). Concentrations of PspA antibodies were lower and they seemed not to be influenced by adenoidectomy. CONCLUSIONS Adenoidectomy in young children causes a small but detectable impairment in the development of serum IgG antibodies to pneumococcal CbpA. The adenoid seems to have a role in augmenting systemic immunity against pneumococci.
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Affiliation(s)
- Petri S Mattila
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Finland.
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29
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Malila N, Leinonen M, Kotaniemi-Talonen L, Laurila P, Tarkkanen J, Hakama M. The HPV test has similar sensitivity but more overdiagnosis than the Pap test--a randomised health services study on cervical cancer screening in Finland. Int J Cancer 2012; 132:2141-7. [PMID: 22987601 DOI: 10.1002/ijc.27850] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/09/2012] [Accepted: 08/31/2012] [Indexed: 11/10/2022]
Abstract
We compared test sensitivity (in terms of prevented cancers) and overdiagnosis (in terms of non-progressive pre-invasive lesions) between the human papillomavirus test (HPV test, Hybrid Capture 2) and the traditional Pap test in routine screening for cervical cancer. The design was a randomised (1:1) health services study in Finland with intake between 2003 and 2007. We estimated sensitivity by the incidence method within one screening round. Overdiagnosis was based on the rate of cervical intraepithelial Grade 3 (CIN3) lesions diagnosed at screen and during the following interval. Out of 203,788 randomised women 132,298 attended (65% in both study arms) and 600,753 person-years accumulated among attenders up to the end of 2010. In all attenders, 34 invasive cervical cancers and 288 CIN3 lesions were diagnosed at screen or during the following interval. The interval cancer incidence was 2.5/10(5) person-years (sensitivity 0.87) and 1.4 (sensitivity 0.93) in the HPV arm and Pap test arm, respectively. The rate of CIN3 lesions was 57.1 and 38.8, respectively. In conclusion, sensitivity of HPV testing was similar to that of Pap testing but caused more overdiagnosis. Therefore, implementation of HPV testing needs to be reconsidered especially in countries with well organised programmes.
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Affiliation(s)
- Nea Malila
- Finnish Cancer Registry, Helsinki, Finland.
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30
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Kivi N, Rönty M, Tarkkanen J, Auvinen P, Auvinen E. Cell culture model predicts human disease: Altered expression of junction proteins and matrix metalloproteinases in cervical dysplasia. BMC Clin Pathol 2012; 12:9. [PMID: 22863036 PMCID: PMC3495715 DOI: 10.1186/1472-6890-12-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 07/30/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical cancer is necessarily caused by human papillomaviruses, which encode three oncogenes manifesting their functions by interfering with a number of cellular proteins and pathways: the E5, E6, and E7 proteins. We have earlier found in our microarray studies that the E5 oncogene crucially affects the expression of cellular genes involved in adhesion and motility of epithelial cells. METHODS In order to biologically validate our previous experimental findings we performed immunohistochemical staining of a representative set of tissue samples from different grades of high-risk human papillomavirus associated cervical disease as well as normal squamous and columnar cervical epithelium. Three-dimensional collagen raft cultures established from E5-expressing and control epithelial cells were also examined. The expression of p16, matrix metalloproteinase (MMP) -7, MMP-16, cytokeratin (CK) 8/18, laminin, E-cadherin and beta-catenin was studied. RESULTS In agreement with our previous microarray studies, we found intense staining for E-cadherin and beta-catenin in adherens junctions even in high-grade cervical lesions. Staining for MMP-16 was increased in severe disease as well. No significant change in staining for MMP-7 and cytokeratin 8/18 along with the grade of cervical squamous epithelial disease was observed. CONCLUSIONS Here we have confirmed, using tissue material from human papillomavirus associated lesions, some of the cellular gene expression modifications that we earlier reported in an experimental system studying specifically the E5 oncogene of papillomaviruses. These findings were partially surprising in the context of cervical carcinogenesis and emphasize that the complexity of carcinogenesis is not yet fully understood. Microarray approaches provide a wide overwiev of gene expression in experimental settings, which may yield biologically valid biomarkers for disease diagnostics, prognosis, and follow-up.
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Affiliation(s)
- Niina Kivi
- Haartman Institute, Department of Virology, University of Helsinki, POB 21 (Haartmaninkatu 3), FIN-00014, Helsinki, Finland
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Lönnberg S, Nieminen P, Kotaniemi-Talonen L, Kujari H, Melkko J, Granroth G, Vornanen M, Pietiläinen T, Arola J, Tarkkanen J, Luostarinen T, Anttila A. Large performance variation does not affect outcome in the Finnish cervical cancer screening programme. Cytopathology 2011; 23:172-80. [DOI: 10.1111/j.1365-2303.2011.00849.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mattila PS, Hammarén-Malmi S, Saxen H, Kaijalainen T, Käyhty H, Tarkkanen J. Adenoidectomy and nasopharyngeal carriage of Streptococcus pneumoniae in young children. Arch Dis Child 2010; 95:696-702. [PMID: 20504840 DOI: 10.1136/adc.2009.165654] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The effect of adenoidectomy on nasopharyngeal colonisation of pathogens has not previously been evaluated. The authors studied the effect of adenoidectomy on nasopharyngeal colonisation by bacteria causing otitis media and the effect of adenoidectomy on the development of pneumococcal capsular polysaccharide antibodies. DESIGN Randomised controlled study. SETTING Tertiary care centre. PATIENTS 217 children aged 12-48 months who had recurrent or persistent otitis media were randomised. 166 children were followed up for 3 years. INTERVENTION Random allocation to undergo adenoidectomy or not to undergo adenoidectomy. All the children underwent insertion of tympanostomy tubes. MAIN OUTCOME MEASURES Nasopharyngeal colonisation by pneumococci, Haemophilus influenzae and Moraxella catarrhalis 1, 2 and 3 years after randomisation. Serum IgG antibodies against pneumococcal capsular polysaccharide serotypes 6B, 14, 19F and 23F 3 years after randomisation. RESULTS After the first year of randomisation adenoidectomy increased nasopharyngeal carriage of pneumococci (RR, 1.47; 95% CI 1.04 to 2.07) but it did not influence the carriage of H influenzae or M catarrhalis. Among carriers of serotype 6B pneumococci, adenoidectomy resulted in lower concentrations of pneumococcal serotype 6B polysaccharide antibodies (ratio of geometric means of antibody concentrations, 0.37; 95% CI 0.16 to 0.85). Concentrations of serotype 14, 19F and 23F antibodies seemed not to be influenced by adenoidectomy. Despite this, adenoidectomy resulted in a significant increase in nasopharyngeal carriage of serotype 19F pneumococci. CONCLUSIONS Adenoidectomy increases the risk of nasopharyngeal carriage of pneumococci in children younger than 4 years of age. This may be independent of the development of serum IgG capsular polysaccharide antibodies.
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Affiliation(s)
- Petri S Mattila
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Finland.
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Pradhan-Palikhe P, Vesterinen T, Tarkkanen J, Leivo I, Sorsa T, Salo T, Mattila PS. Plasma level of tissue inhibitor of matrix metalloproteinase-1 but not that of matrix metalloproteinase-8 predicts survival in head and neck squamous cell cancer. Oral Oncol 2010; 46:514-8. [DOI: 10.1016/j.oraloncology.2010.03.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 03/03/2010] [Accepted: 03/04/2010] [Indexed: 10/19/2022]
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Leinonen M, Nieminen P, Kotaniemi-Talonen L, Malila N, Tarkkanen J, Laurila P, Anttila A. Response: Re: Age-Specific Evaluation of Primary Human Papillomavirus Screening vs Conventional Cytology in a Randomized Setting. J Natl Cancer Inst 2010. [DOI: 10.1093/jnci/djq115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Anttila A, Kotaniemi-Talonen L, Leinonen M, Hakama M, Laurila P, Tarkkanen J, Malila N, Nieminen P. Rate of cervical cancer, severe intraepithelial neoplasia, and adenocarcinoma in situ in primary HPV DNA screening with cytology triage: randomised study within organised screening programme. BMJ 2010; 340:c1804. [PMID: 20423964 PMCID: PMC3191726 DOI: 10.1136/bmj.c1804] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the performance and impact of primary human papillomavirus (HPV) DNA screening with cytology triage compared with conventional cytology on cervical cancer and severe pre-cancerous lesions. DESIGN Randomised trial. SETTING Population based screening programme for cervical cancer in southern Finland in 2003-5. PARTICIPANTS 58 076 women, aged 30-60, invited to the routine population based screening programme for cervical cancer. INTERVENTIONS Primary HPV DNA test (hybrid capture II) with cytology triage if the result was positive or conventional cytological screening (reference). MAIN OUTCOME MEASURES Rate of cervical cancer, cervical intraepithelial neoplasia (CIN) grade III, and adenocarcinoma in situ (as a composite outcome referred to as CIN III+) during 2003-7 through record linkage between files from the screening registry and the national cancer registry. RESULTS In the HPV and conventional arms there were 95 600 and 95 700 woman years of follow-up and 76 and 53 cases of CIN III+, respectively (of which six and eight were cervical cancers). The relative rate of CIN III+ in the HPV arm versus the conventional arm was 1.44 (95% confidence interval 1.01 to 2.05) among all women invited for screening and 1.77 (1.16 to 2.74) among those who attended. Among women with a normal or negative test result, the relative rate of subsequent CIN III+ was 0.28 (0.04 to 1.17). The rate of cervical cancer between arms was 0.75 (0.25 to 2.16) among women invited for screening and 1.98 (0.52 to 9.38) among those who attended. CONCLUSIONS When incorporated into a well established organised screening programme, primary HPV screening with cytology triage was more sensitive than conventional cytology in detecting CIN III+ lesions. The number of cases of cervical cancer was small, but considering the high probability of progression of CIN III the findings are of importance regarding cancer prevention. TRIAL REGISTRATION Current Controlled Trials ISRCTN23885553.
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Affiliation(s)
- Ahti Anttila
- Mass Screening Registry of the Finnish Cancer Registry, Pieni Roobertinkatu 9, FIN-00130 Helsinki, Finland.
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Leinonen M, Nieminen P, Kotaniemi-Talonen L, Malila N, Tarkkanen J, Laurila P, Anttila A. Age-specific evaluation of primary human papillomavirus screening vs conventional cytology in a randomized setting. J Natl Cancer Inst 2009; 101:1612-23. [PMID: 19903804 DOI: 10.1093/jnci/djp367] [Citation(s) in RCA: 175] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) DNA testing has shown higher sensitivity than cytology for detecting cervical lesions, but it is uncertain whether the higher sensitivity is dependent on the age of the woman being screened. We compared the age-specific performance of primary HPV DNA screening with that of conventional cytology screening in the setting of an organized population-based cervical cancer screening program in Finland. METHODS From January 1, 2003, to December 31, 2005, randomized invitations were sent to women aged 25-65 years for routine cervical cancer screening by primary high-risk HPV DNA testing (n = 54 207) with a Hybrid Capture 2 assay followed by cytology triage for women who were HPV DNA positive or by conventional cytology screening (n = 54 218). In both screening arms, cytology results of low-grade squamous intraepithelial lesion or worse triggered a referral for colposcopy. Relative rates (RRs) of detection to assess test sensitivity, specificity, and positive predictive values (PPVs) with 95% confidence intervals (CIs) were calculated for the histological endpoints of cervical intraepithelial neoplasia (CIN) grade 1 or higher (CIN 1+), CIN grade 2 or higher (CIN 2+), and CIN grade 3 or higher (CIN 3+). All statistical tests were two-sided. RESULTS The overall frequency of colposcopy referrals was 1.2% in both screening arms. Women younger than 35 years were referred more often in the HPV DNA screening vs the conventional screening arm (RR = 1.27, 95% CI = 1.01 to 1.60). The prevalence of histologically confirmed CIN or cancer was 0.59% in the HPV DNA screening arm vs 0.43% in the conventional screening arm. The relative rates of detection for CIN 1, CIN 2, and CIN 3+ for HPV DNA screening with cytology triage vs conventional screening were 1.44 (95% CI = 0.99 to 2.10), 1.39 (95% CI = 1.03 to 1.88), and 1.22 (95% CI = 0.78 to 1.92), respectively. The specificity of the HPV DNA test with cytology triage was equal to that of conventional screening for all age groups (99.2% vs 99.1% for CIN 2+, P = .13). Among women aged 35 years or older, the HPV DNA test with cytology triage tended to have higher specificity than conventional screening. The PPVs for HPV DNA screening with cytology triage were consistently higher than those for conventional screening. In both screening arms, the test specificities increased with increasing age of the women being screening, whereas the highest PPVs were observed among the youngest women being screened. Overall, 7.2% of women in the HPV DNA screening arm vs 6.6% of women in the conventional screening arm were recommended for intensified follow-up, and the percentages were highest among 25- to 29-year-olds (21.9% vs 10.0%, respectively). CONCLUSIONS Primary HPV DNA screening with cytology triage is more sensitive than conventional screening. Among women aged 35 years or older, primary HPV DNA screening with cytology triage is also more specific than conventional screening and decreases colposcopy referrals and follow-up tests.
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Affiliation(s)
- Maarit Leinonen
- Mass Screening Registry, Finnish Cancer Registry, Pieni Roobertinkatu 9, FI-00130 Helsinki, Finland.
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Mattila PS, Hammarén-Malmi S, Pelkonen AS, Malmberg LP, Mäkelä MJ, Saxen H, Tarkkanen J. Effect of adenoidectomy on respiratory function: a randomised prospective study. Arch Dis Child 2009; 94:366-70. [PMID: 19131420 DOI: 10.1136/adc.2008.145664] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Risk of childhood asthma is increased in children with recurrent otitis media. This may be associated with recurrent respiratory tract infections in these children, but the role of adenoidectomy, a frequent operation during childhood, is unknown. Therefore, the role of adenoidectomy in the development of atopy and respiratory function changes characteristic of asthma was evaluated. DESIGN Randomised controlled study. SETTING Tertiary care centre. PATIENTS 166 children aged 12-48 months who had recurrent or persistent otitis media and who were followed-up for 3 years after randomisation. INTERVENTION Randomisation to undergo insertion of tympanostomy tubes with or without adenoidectomy. MAIN OUTCOME MEASURES The primary outcome measure was exercise-induced bronchoconstriction as evaluated by impulse oscillometry. The secondary outcome measures were bronchial inflammation as evaluated by exhaled nitric oxide and atopy as evaluated by skin prick tests. During the 3-year follow-up period otitis media episodes were documented in patient diaries. RESULTS Adenoidectomy did not significantly influence baseline lung function, exercise-induced bronchoconstriction, exhaled nitric oxide concentration, the development of positive skin prick tests, or doctor-diagnosed asthma. Adenoidectomy did not significantly prevent otitis media. Recurrent otitis media (>or=4 episodes) during the first follow-up year was associated with an abnormal exercise-induced bronchoconstriction (OR 6.62, 95% CI 1.27 to 34) and an elevated exhaled nitric oxide concentration (OR 3.26, 95% CI 0.98 to 10.8) regardless of adenoidectomy. CONCLUSIONS Adenoidectomy did not promote asthma or allergy. Recurrent respiratory tract infections during early childhood are associated with the risk of bronchial hyper-reactivity.
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Affiliation(s)
- P S Mattila
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland.
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Kotaniemi-Talonen L, Malila N, Nieminen P, Anttila A, Tarkkanen J, Laurila P, Hakama M. Test positivity cutoff level of a high risk human papillomavirus test could be increased in routine cervical cancer screening. Int J Cancer 2008; 123:2902-6. [DOI: 10.1002/ijc.23839] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Leinonen M, Kotaniemi-Talonen L, Anttila A, Dyba T, Tarkkanen J, Nieminen P. Prevalence of oncogenic human papillomavirus infection in an organised screening population in Finland. Int J Cancer 2008; 123:1344-9. [PMID: 18566992 DOI: 10.1002/ijc.23670] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A persistent high-risk human papillomavirus (hrHPV) infection is a necessary condition for developing a cervical intraepithelial neoplasia and cervical cancer. The viral aetiology in cervical carcinogenesis has stimulated attempts to use HPV DNA detection in cervical cancer screening. In Finland there is an ongoing study assessing the benefits of primary HPV DNA testing in the setting of centrally organised mass screening for cervical cancer. Here we present the age-specific prevalence of hrHPV infection and associated sociodemographic factors of 16,895 women aged 25-65 years attending the 5-yearly cervical cancer screening between years 2003 and 2004. The overall hrHPV prevalence rate was 7.5%. The peak prevalence at the age group of 25-29 was 24.1% decreasing steadily thereafter to approximately 2.9% in women aged 65 years. Young age and marital status were the main determinants for oncogenic HPV types. Our study confirms the inverse relationship between age and hrHPV prevalence reported in many developed countries. As our prevalence rates and hence background risk for cervical cancer are not lower than in other European countries, it is likely that our lowest cervical cancer burden in Europe is due to health care actions justifying the organised cervical cancer screening.
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Affiliation(s)
- Maarit Leinonen
- Mass Screening Registry, Finnish Cancer Registry, Pieni Roobertinkatu 9, FI-00130 Helsinki, Finland.
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Pajusto M, Toivonen TH, Tarkkanen J, Jokitalo E, Mattila PS. Reactive oxygen species induce signals that lead to apoptotic DNA degradation in primary CD4+ T cells. Apoptosis 2008; 10:1433-43. [PMID: 16215680 DOI: 10.1007/s10495-005-2050-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Reactive oxygen species are toxic to cells but they may also have active roles in transducing apoptotic events. To study the role of reactive oxygen species in growth factor depletion induced apoptosis of human primary CD4+ T cells, we used a synthetic manganese porphyrin superoxide dismutase mimetic to detoxify superoxide anions formed during apoptosis. Apoptosis of primary CD4+ T cells was characterized by generation of superoxide anions, plasma membrane phosphatidyl-serine translocation, loss of mitochondrial membrane potential, activation of caspase 3, condensation of chromatin, as well as DNA degradation. The detoxification of superoxide anions did not influence plasma membrane phosphatidyl-serine translocation, or chromatin condensation, and only marginally inhibited the loss of mitochondrial membrane potential and the formation of DNA strand breaks. In contrast, the detoxification of superoxide anions significantly reduced caspase 3 activity and almost completely inhibited the apoptotic decrease in total cellular DNA content as measured by propidium iodide staining. Our results indicate that reactive oxygen anions induce signals leading to efficient DNA degradation after the initial formation of DNA strand breaks. Thus, reactive oxygen anions have active roles in signaling that lead to the apoptotic events.
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Affiliation(s)
- M Pajusto
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland
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Kotaniemi-Talonen L, Anttila A, Malila N, Tarkkanen J, Laurila P, Hakama M, Nieminen P. Screening with a primary human papillomavirus test does not increase detection of cervical cancer and intraepithelial neoplasia 3. Eur J Cancer 2008; 44:565-71. [DOI: 10.1016/j.ejca.2007.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Revised: 11/26/2007] [Accepted: 12/10/2007] [Indexed: 10/22/2022]
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Hernberg M, Mattila PS, Rissanen M, Hansson J, Aamdal S, Bastholt L, von der Maase H, Schmidt H, Stierner U, Tarkkanen J. The prognostic role of blood lymphocyte subset distribution in patients with resected high-risk primary or regionally metastatic melanoma. J Immunother 2007; 30:773-9. [PMID: 17893569 DOI: 10.1097/cji.0b013e31814e0898] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The aim of this study was to investigate whether the profile of peripheral blood lymphocyte subsets of patients with high-risk malignant melanoma is associated with prognosis. Blood samples were systematically obtained from 31 patients with high-risk melanoma eligible for the Nordic Melanoma Cooperative Group adjuvant interferon study. The frequencies of peripheral blood lymphocyte subsets were monitored by flow cytometry using CD3, CD4, CD8, CD56, and CD69 monoclonal antibodies. Patients with low proportions of CD3+CD4+CD69+ cells and of CD3+CD56+ cells before treatment had an improved disease-free survival compared to those with high proportions [77.7 vs. 16.8 mo, hazard ratio (HR) 0.25, confidence interval (CI) 0.09-0.71, P=0.005 and 77.2 vs. 16.0 mo, HR: 0.25, CI 0.086-0.73, P=0.001, respectively]. Low pretreatment levels of these cell populations also correlated with a better overall survival (79.2 vs. 22.6 mo, HR: 0.17, CI 0.05-0.52, P=0.0005 and 78.2 vs. 21.4 mo, HR: 0.2, CI 0.07-0.59, P=0.001, respectively). In the multivariate analysis both the pretreatment proportion of CD3+CD4+CD69+ cells (P=0.01, HR: 0.21, CI 0.07-0.67) and CD3+CD56+ cells (P=0.01, HR: 0.22, CI 0.062-0.65) were independent prognostic factors for overall survival. Our data show that both the proportions of CD3+CD4+CD69+ cells and of CD3+CD56+ cells seem to have a prognostic potential in the natural course of melanoma. These results need to be confirmed in larger studies.
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Affiliation(s)
- Micaela Hernberg
- Department of Oncology, HUSLAB, Helsinki University Central Hospital, Finland.
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Aalto SM, Juvonen E, Tarkkanen J, Volin L, Haario H, Ruutu T, Hedman K. Epstein-Barr Viral Load and Disease Prediction in a Large Cohort of Allogeneic Stem Cell Transplant Recipients. Clin Infect Dis 2007; 45:1305-9. [DOI: 10.1086/522531] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Accepted: 07/21/2007] [Indexed: 01/06/2023] Open
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Hammarén-Malmi S, Saxen H, Tarkkanen J, Mattila PS. Passive smoking after tympanostomy and risk of recurrent acute otitis media. Int J Pediatr Otorhinolaryngol 2007; 71:1305-10. [PMID: 17582514 DOI: 10.1016/j.ijporl.2007.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 05/09/2007] [Accepted: 05/14/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Exposure to environmental tobacco smoke has been reported to be a risk factor for childhood otitis media. The effect of parental smoking on the risk of otitis media after the insertion of tympanostomy tubes is unknown. We evaluated the effect of parental smoking on the risk of recurrent otitis media in children who had received tympanostomy tubes. METHODS We enrolled 217 children aged 1-4 years who underwent insertion of tympanostomy tubes because of middle ear disease. The children were followed-up for 12 months. Otitis media episodes were recorded in patient diaries by primary care physicians. Parental smoking habits were assessed by a questionnaire at the start of the trial and after the 12 month follow-up had ended. The main outcome measure was risk of recurrent otitis media as defined by four or more otitis media episodes after tympanostomy. Altogether 198 children completed the follow-up. RESULTS Maternal smoking was associated with a highly increased risk of recurrent acute otitis media (OR 4.15, 95% CI 1.45-11.9) after the insertion of tympanostomy tubes. CONCLUSION Exposure to passive smoking is associated with four-fold risk of recurrent otitis media after tympanostomy. This finding should be used to encourage parents to stop smoking even after the insertion of tympanostomy tubes to their children.
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Affiliation(s)
- Sari Hammarén-Malmi
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland
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Juvonen E, Aalto S, Tarkkanen J, Volin L, Hedman K, Ruutu T. Retrospective evaluation of serum Epstein Barr virus DNA levels in 406 allogeneic stem cell transplant patients. Haematologica 2007; 92:819-25. [PMID: 17550855 DOI: 10.3324/haematol.10751] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND OBJECTIVES An HLA-mismatched donor and a T-cell-depleted graft are known risk factors for Epstein-Barr virus (EBV) reactivation after stem cell transplantation. We studied the frequency and outcome of serum EBV DNA levels in patients transplanted with an unmanipulated graft from an HLA-identical donor. DESIGN AND METHODS Overall, 5479 serial serum samples from 406 consecutive allogeneic stem cell transplant recipients were analyzed retrospectively for EBV DNA with quantitative polymerase chain reaction (PCR). RESULTS EBV DNA was found in the serum of 56 of the 406 patients (14%). EBV positivity was seen in 9 % of the recipients of a graft from a sibling donor and in 29 % of those with an unrelated donor. EBV-PCR positivity resolved without specific treatment in a third of the cases, in another third the copy number increased progressively or was high in the last serum sample, and in the remaining third the copy numbers were low in all positive sera including the last sample. In multivariate analysis antithymocyte globulin given for any reason and grade III-IV acute graft-versus-host disease were the only statistically significant risk factors for EBV reactivation. Only 8/56 patients with EBV-DNA positivity were alive at the time of the present analysis. The outcome of EBV-PCR positivity could not be predicted by the copy number or the timing of the first positive sample. INTERPRETATION AND CONCLUSIONS EBV reactivation was a common phenomenon in allogenic stem cell transplant recipients. In many patients the viremia resolved without EBV-directed treatment. Severe acute graft-versus-host disease and antithymocyte globulin given for any reason were risk factors for EBV viremia.
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Affiliation(s)
- Eeva Juvonen
- Helsinki University Central Hospital, Department of Medicine, Helsinki, Finland.
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Nieminen P, Kotaniemi-Talonen L, Hakama M, Tarkkanen J, Martikainen J, Toivonen T, Ikkala J, Anttila A. Randomized evaluation trial on automation-assisted screening for cervical cancer: results after 777,000 invitations. J Med Screen 2007; 14:23-8. [PMID: 17362568 DOI: 10.1258/096914107780154468] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES New cervical screening methods have been developed. They seem to become accepted in routine use without randomized trials, within existing screening programmes. Our aim was to evaluate, in a randomized setting, the performance of automation-assisted cytological screening in routine use compared with conventional Papanicoalou (Pap) screening. SETTING This prospective study was based on a 1:2 individually randomized design. Altogether 777,144 women were invited to attend the routine screening programme. RESULTS Automation-assisted screening found more Pap class III (LSIL+) findings compared with conventional study arm, relative risk (RR) 1.08 (confidence interval 1.01-1.15). Also, detection rates of verified pre-cancers were more common in automation-assisted arm, RR 1.11 (1.02-1.21). CONCLUSIONS Automation-assisted screening performed well compared with conventional screening. The difference was smaller than reported in non-randomized studies. A new technique may assume several years to reach the ultimate quality and can add costs without improving efficacy. Follow-up of prevented cervical cancers is required.
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Affiliation(s)
- Pekka Nieminen
- Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Box 140, FIN-00029, Helsinki, Finland.
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Tarkkanen J, Auvinen E, Nieminen P, Malmi R, Vartiainen J, Timonen T, Laurila P, Räisänen I, Unnerus HA, Sakki A, Mattila P, Van Den Brule AVD, Tapper AM. HPV DNA testing as an adjunct in the management of patients with low grade cytological lesions in Finland. Acta Obstet Gynecol Scand 2007; 86:367-72. [PMID: 17364315 DOI: 10.1080/00016340601185343] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with recurrent low grade cytological abnormalities are at increased risk for high grade lesions. We wanted to see whether these patients could be identified by HPV DNA and pap tests. METHODS A prospective study of 663 patients referred for a colposcopy on the basis of ASC-US or LSIL cytology. High-risk HPV DNA positivity and cytology were compared with histology. RESULTS In total 65.6% samples were positive for HC2, and the overall proportion of CIN2+ lesions was 14.6%. No CIN2+lesions were found in patients testing HC2-, pap-. There were 5/97 (5.2%) high grade lesions, which were HC2-negative but pap-positive, including 1 cervical adenocarcinoma in situ. The corresponding histological sections were all positive for p16INK in immunostaining. In further analysis by PCR, 3 samples were positive for HPV DNA. High-risk HPV type 67, which is not included in the HC2 probe cocktail, was found in 1 case, and 2 cases were HPV positive but could not be typed. One CIN3 and one AIS remained HPV negative. In these 5 cases, the concomitant pap smear showed ASC-USx1, LSILx1, HSILx2 and AGCx1. During 6-month follow-up, a relatively high number of CIN2+(28/557, 5.0%) emerged from the non-CIN-CIN1 group. CONCLUSIONS The HC2 test or pap test alone were not sensitive enough to detect all CIN2+lesions. A relatively high number of CIN2+cases emerged from the non-CIN-CIN1 group after 6 months. Adequate follow-up of patients with mild cytological abnormalities, including a repeat pap smear taken during colposcopy and control at 6 months is underscored. Combination of hrHPV DNA and pap test should be considered, since it had high negative predictive value.
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Affiliation(s)
- Jussi Tarkkanen
- Department of Pathology, Helsinki University Central Hospital, Finland.
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Kotaniemi-Talonen L, Nieminen P, Hakama M, Seppänen J, Ikkala J, Martikainen J, Tarkkanen J, Toivonen T, Anttila A. Significant variation in performance does not reflect the effectiveness of the cervical cancer screening programme in Finland. Eur J Cancer 2006; 43:169-74. [PMID: 17049228 DOI: 10.1016/j.ejca.2006.08.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Revised: 08/16/2006] [Accepted: 08/22/2006] [Indexed: 11/15/2022]
Abstract
AIM To characterise the variation in performance indicators of the Finnish cervical screening programme by screening laboratory and to assess whether the performance affects cervical cancer incidence. METHODS Cervical cancer screening data from 1999 to 2003 from six well-established laboratories were used to analyse rates for follow-up recommendations, referrals and histologically confirmed dysplastic lesions. Laboratory-specific cervical cancer incidences for 1954-2003 were assessed using the cancer registry files. RESULTS Differences in follow-up recommendations were up to 3.1-fold and 2.2-fold in referrals; differences in the rates for CIN1, CIN2 and CIN3+ were up to 4.5-, 4.7-, and 1.5-fold, respectively. Pre-screening incidence rates for cervical cancer varied 1.5-fold by laboratory, with no major differences in the incidence trends since the onset of screening. CONCLUSION The performance of a cervical screening programme differs by screening laboratory but does not materially affect the overall programme effectiveness. This leads to variation in cost-effectiveness and probably in avoidable adverse effects. In cervical cancer screening studies, the outcome should be selected as closely as possible to the true measure of programme effectiveness, prevented invasive cervical cancers and subsequent deaths.
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Abstract
The aim of this study was to clarify the roles of the tumour proliferation marker Ki-67, the anti-apoptotic protein Bcl-2 and the cell cycle regulator p53 in primary cutaneous and metastatic melanoma. One hundred and seventeen primary melanomas and 18 metastatic tissue samples were analysed for immunohistochemical expression of Ki-67, Bcl-2 and p53. The staining results were correlated with disease progression and clinical outcome. The patient population comprised patients diagnosed with melanoma between 1988 and 1991. The clinical follow-up period for disease recurrence was 4.6 years (median; range, 0.2-7.5 years) and the follow-up period for overall survival was 10.0 years (median; range, 8.6-15.6 years). Ki-67 expression was not a prognostic factor in primary melanoma. High Bcl-2 expression was associated with such adverse prognostic factors as male gender, old age of the patient and tumour ulceration. High Bcl-2 expression was also associated with an adverse prognosis in intermediate-thickness (1.01-4.0 mm) melanomas (n=52) for disease-free (P=0.09) and overall (P=0.08) survival. In multivariate analysis, tumour thickness was the strongest prognostic factor for disease-free survival (P<0.01). High p53 expression indicated a poorer prognosis (P=0.05). In metastatic melanoma, the expression levels of Bcl-2 and p53 were lower than those in their primary counterparts (P=0.08 for each). Ki-67 expression showed no remarkable changes. It can be concluded that high p53 expression in tumour cells is associated with a poorer prognosis in primary melanoma, and high Bcl-2 expression in tumour cells is an adverse prognostic marker in intermediate-thickness primary melanoma.
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Affiliation(s)
- Suvi Ilmonen
- Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.
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