[Value and utility of minimal-invasive automatic cutting-needle biopsy as a diagnostic technique in the head and neck]

BACKGROUND

Lymphadenopathies and unclear masses in the head and neck often require tissue sampling to establish a diagnosis and to guide therapy. Open biopsy and lymph node excision is invasive and may entail general anaesthesia. Fine needle aspiration cytology is minimal-invasive and widely used but includes a high rate of non diagnostic samples and false negative results. Cutting needle biopsy is an established technique outside the head and neck but has found little attention among otorhinolaryngologists up to now.

PATIENTS AND METHODS

Between April 2003 and May 2007 we performed a total of 307 cutting-needle biopsies in 143 patients with unclear cervicofacial masses, using side-notch-needles with a diameter of 12-16 Gauge.

RESULTS

High-quality tissue cores without crushing artefacts for histopathological studies were obtained without complications from all patients. The target tissue was obtained in 132 of 143 patients, in these cases the sensitivity and accuracy rate for the diagnosis of malignant lesions was 98.9% and 99.2%, respectively.

CONCLUSIONS

Ultrasound-guided Cutting-needle biopsy in the head and neck is a safe and reliable biopsy tool with an excellent diagnostic efficacy, which can be performed as an outpatient procedure with low expenditure of time and manpower. Performing the procedure requires substantiated experience in topographic head and neck anatomy as well as sonography of this body region.

Endothelin-1 and endothelin converting enzyme-1 in human atherosclerosis--novel targets for pharmacotherapy in atherosclerosis

The role of chronic inflammation in the pathogenesis of the acute coronary syndromes has received increasing attention since active plaques rich in macrophages (Mphi's) are more prone to rupture whereas plaques rich in myofibroblasts are considered to be stable. Functionally, active plaques show a locally enhanced vasoreactivity. Endothelin-1 (ET-1) a potent vasoconstrictor acts in a paracrine fashion to regulate vascular tone. ET-1 is also produced by inflammatory cells suggesting a role for ET-1 in inflammation. Additionally, ET-1 is a mitogen. Endothelin converting enzyme-1 (ECE-1) activates ET-1 and may thus contribute to the regulation of vascular tone and cell growth during atherosclerosis. We evaluated the presence of ECE-1 and big ET-1/ET-1 and the activity of ECE-1 in different plaque types. Together with ET-1, ECE-1 is present in endothelial cells (ECs), vascular smooth muscle cells (VSMCs) and Mphi's. ECE-1 activity and ET-1-immunoreactivity (IR) both are upregulated during the progression of atherosclerosis from a non-inflammatory to an inflammatory stage. Thus, enhanced production of active ET-1 may contribute to cell growth and regulation of vascular tone in advanced plaques and also in very early stages of atherosclerosis. Furthermore, we examined the presence of ET-1 in coronary plaque tissue obtained by directional coronary atherectomy. ET-1 IR localized to plaque components indicative of chronic inflammation. Semiquantitative analysis of ET-1 IR revealed significantly higher staining grades in active coronary lesions compared with nonactive lesions. The increased ET-1 content in active coronary lesions may be beneficial to the stabilization of the vessel wall after plaque rupture and disadvantageous because it may lead to vasospasm and to the progression of atherosclerosis.

Solitary fibrous tumour of the liver: case report and review of the literature

BACKGROUND

Solitary fibrous tumours (SFTs) of the liver are very rare entities. Although firstly described to be tumours of pleural origin, SFTs have been reported in various organs such as the meninges, orbit, upper respiratory tract, thyroid, peritoneum, retroperitoneum and soft tissues. Histologically, this tumour often shows alternating cellular and relatively acellular areas. The cellular areas show a wide variety of patterns, making it difficult for it to be differentiated from other mesenchymal tumours. Its immunohistochemical positivity for CD34 and vimentin is believed to be unique. Histiogenesis of SFTs, however, is not yet fully understood. They are known to be usually benign, with only few reports indicating their ability to metastasize.

PATIENTS AND METHODS

We review the literature on SFTs of the liver and report on the case of a 63-year-old female patient with a large SFT of the right liver.

CONCLUSIONS

Surgical resection seems to be the treatment of choice. Local recurrence is scarce. Due to the very limited number of cases, data regarding the long-term survival of patients are lacking.

Influenza A virus infection of mice induces nuclear accumulation of the tumorsuppressor protein p53 in the lung

To investigate whether the tumor suppressor p53 protein, an indicator of DNA damage and cell stress, accumulates in the course of influenza-virus-induced murine pneumonia at the site of inflammation, female BALB/c mice were infected each with 5 x 10(4) infectious units of influenza virus A, strain Puerto Rico (PR) 8, by instillation into the nose and the pharynx. Two days later the mice became sick. Three and 6 days after infection the lungs of sacrificed infected and uninfected mice were examined. We assessed the presence and localisation of inflammation, the expression of influenza viral and p53 protein, as well as of the WAF1/Cip1/SDI gene product p21. Further, the appearance of nitrotyrosine, as an indicator of the formation of peroxynitrite, and eventually of apoptotic cells was examined. No significant nuclear p53 accumulation was found in influenza virus-infected murine cells in vitro. The results show, that in the course of influenza A virus-mediated murine pneumonia inflammatory bystander cells may cause activation of the tumor suppressor protein p53, due to oxidative stress and DNA damage, with ensuing p53-dependent upregulation of p21. Apoptosis is then mainly due to these indirect processes, with possible involvement of p53.

Evidence that wild-type p53 in neuroblastoma cells is in a conformation refractory to integration into the transcriptional complex

Neuroblastoma (NB) cells reportedly accumulate wild-type p53 exclusively in the cytoplasm. However, immunofluorescence assays with five different antibodies showed that p53 accumulates in the nucleus of up to 10% of NB cells. PAb1801 detected cytoplasmic 'punctate structures' which were also found in p53-null cells, rendering this antibody unsuitable for p53 detection. A comparison of DO-1 and PAb1801 staining in NB tissue sections confirmed the results obtained with NB cells. Nuclear accumulation of p53 was induced in NB cells using substances which disturb p53's tertiary structure at its zinc finger motif, or by treatment with mitomycin C. Constitutive nuclear accumulation was observed in an SK-N-SH variant, AW-1, which has a point mutation in p53 at Cys176>Ser, disturbing the same motif. Even though p53 showed DNA-binding capability after mitomycin C treatment of NB cells, the target gene products MDM2 and p21(WAF1,CIP1,SDI1) were not synthesized and no p53 transactivating activity measured in a reporter gene assay. Therefore we suggest that p53 in NB cells might be predominantly in a conformation refractory to integration into the transcriptional complex, resulting in at least partial transcriptional inactivity, hyperactive nuclear export and resistance to degradation by exogenously expressed MDM2.

[Neck abscess as primary manifestation of head and neck carcinoma: implications for diagnostic management]

BACKGROUND

Neck abscesses and deep neck infections are common diseases in the field of otorhinolaryngology. However, malignant lymph node metastases presenting as abscesses are uncommon and have rarely been described up to now.

PATIENTS

A retrospective review between March 1997 and August 1999 was conducted of 40 patients with deep neck abscesses.

RESULTS

In five patients (12.5%) the histological diagnostics revealed a malignancy. From these, in 3 cases the cervical abscess was the primary clinical symptom of an oropharyngeal as well as a hypopharyngeal carcinoma. With further 2 patients, the neck-abscess was located as first clinical sign of a metachronous lymph node metastases after oropharyngeal carcinoma. Aerobic bacteria were recovered in 18 patients, anaerobes alone in 3 and mixed aerobic and anaerobic bacteria in 6 patients. Bartonella henselae was recovered in 7, Mycobacterium tuberculosis in 3 and Actinomyces israelii in 1 patient.

CONCLUSIONS

A biopsy of the abscess wall is recommended in establishing the diagnosis. The indication for a simultaneous panendoscopy--especially in patients with typical risk for malignancies--to exclude a primary tumor in the aerodigestive tract should be regarded generously. Neck abscesses should be considered in the differential diagnosis of head and neck carcinoma.