Dendritic cells mediate NK cell help for Th1 and CTL responses: two-signal requirement for the induction of NK cell helper function

Early stages of viral infections are associated with local recruitment and activation of dendritic cells (DC) and NK cells. Although activated DC and NK cells are known to support each other's functions, it is less clear whether their local interaction in infected tissues can modulate the subsequent ability of migrating DC to induce T cell responses in draining lymph nodes. In this study, we report that NK cells are capable of inducing stable type 1-polarized "effector/memory" DC (DC1) that act as carriers of NK cell-derived helper signals for the development of type 1 immune responses. NK cell-induced DC1 show a strongly elevated ability to produce IL-12p70 after subsequent CD40 ligand stimulation. NK-induced DC1 prime naive CD4+ Th cells for high levels of IFN-gamma, but low IL-4 production, and demonstrate a strongly enhanced ability to induce Ag-specific CD8+ T cell responses. Resting NK cells display stringent activation requirements to perform this novel, DC-mediated, "helper" function. Although their interaction with K562 cells results in effective target cell killing, the induction of DC1 requires a second NK cell-activating signal. Such costimulatory signal can be provided by type I IFNs, common mediators of antiviral responses. Therefore, in addition to their cytolytic function, NK cells also have immunoregulatory activity, induced under more stringent conditions. The currently demonstrated helper activity of NK cells may support the development of Th1- and CTL-dominated type 1 immunity against intracellular pathogens and may have implications for cancer immunotherapy.

Use of integrated 18F-FDG PET/CT to improve the accuracy of initial cervical nodal evaluation in patients with head and neck squamous cell carcinoma

BACKGROUND

We investigated the accuracy of performing cervical nodal evaluation with using integrated (18)F-fluoro deoxyglucose positron emission tomography (PET)/CT for squamous cell carcinoma (SCC) of the head and neck as compared with using PET and contrast-enhanced CT (CECT) alone.

METHODS

The presence of metastatic lymphadenopathy in each cervical nodal group (level I-VI) and the nodal (N) classification of 47 patients with SCC of the head and neck were determined by using PET, CECT, and PET/CT, respectively, and the results were verified according to the histopathologic findings.

RESULTS

Among the 91 foci that had abnormal uptake on PET, the combined PET/CT images provided additional information over PET for the anatomical localization and lesion characterization of 18 sites (19.8%) in 17 patients (36.2%). PET/CT also showed the best results among the three imaging modalities for the sensitivity, specificity, and accuracy (91.8, 98.9, and 97.1%, respectively) for predicting metastatic nodes on a level-by-level analysis, and PET/CT had a higher accuracy (85.1%) for the pathologic nodal classification over the clinical examinations (68.1%) or PET (70.2%).

CONCLUSIONS

Combined PET/CT images are more accurate than the PET or CECT images alone for conducting cervical node evaluation in the patients suffering with head and neck SCC.

Integrated 18F-FDG PET/CT for the initial evaluation of cervical node level of patients with papillary thyroid carcinoma: comparison with ultrasound and contrast-enhanced CT

OBJECTIVE

To compare the diagnostic accuracy of integrated 18F-fluorodeoxyglucose PET/CT with ultrasonography (US) and contrast enhanced CT (CECT) alone in the initial evaluation of cervical lymph node levels of patients with papillary thyroid carcinoma.

PATIENTS AND MEASUREMENTS

From July 2004 to March 2005, 26 consecutive patients with papillary thyroid carcinoma, confirmed by aspiration cytology analysis, underwent US, CECT and PET/CT. The sensitivity, specificity and diagnostic accuracy of the US, CECT and PET/CT studies for the final status of 312 cervical node levels (levels I-V: 260, level VI: 52) were compared by employing a generalized estimating equation test. The final status of cervical node levels was determined by the surgical pathology and follow-up data.

RESULTS

At all lymph node levels (levels I-VI), PET/CT showed a sensitivity of 30.4%, a specificity of 96.2% and a diagnostic accuracy of 86.9%. The corresponding values for US and CECT were 41.3%, 97.4%, 89.1% (US) and 34.8%, 96.2%, 87.2% (CECT). Considering only the lateral cervical node group (levels I-V), PET/CT showed a sensitivity of 50.0%, a specificity of 97.0% and a diagnostic accuracy of 92.3%. The corresponding values for US and CECT were 53.9%, 97.9%, 93.5% (US) and 42.3%, 96.6%, 91.2% (CECT). The diagnostic results for US, CECT and PET/CT upon initial evaluation of the cervical lymph nodes did not differ significantly on a level-by-level basis.

CONCLUSION

Our preliminary results suggest that integrated PET/CT does not provide any additional benefit when compared to US and CECT for the initial evaluation of cervical node levels in patients with papillary thyroid carcinoma.

A novel bulk-culture method for generating mature dendritic cells from mouse bone marrow cells

We established a novel culture method for generating dendritic cells (DC) from mouse bone marrow (BM) cells. Unfractionated bulk BM cells were cultured in the presence of granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-4 (IL-4) for 5-7 days and a DC population was isolated by gradient centrifugation with 14.5% (w/v) metrizamide. Through this method, 30-40 x 10(6)/mouse DC with 85-95% purity was obtained on day 7; this yield was higher than those of conventional DC generated by Inaba's method either with GM-CSF alone (conventional-GM DC) or GM-CSF and IL-4 (conventional-GM/4 DC). Bulk-cultured DC have a more matured phenotype than both conventional-GM and -GM/4 DC as shown by higher expression of CD86, MHC class II and CD40. Functional analyses reveal that (1) bulk-DC show less ability in endocytosis than conventional-GM DC and are comparable in IL-12 p70 production with conventional-GM and -GM/4 DC. (2) Bulk-DC exhibit stronger stimulatory capacity in allogeneic T-cell proliferation than conventional DC. (3) By using ovalbumin (OVA) and OVA-specific T-cell receptor (TCR) transgenic mice (DO11.10) system, OVA protein-loaded bulk-DC stimulated CD4 T cells of DO11.10 mice more than conventional-GM DC and comparable with conventional-GM/4 DC. (4) Furthermore, OVA peptide-pulsed bulk-DC stimulated CD4 T cells more than conventional-GM and -GM/4 DC. These data indicate that bulk-DC are functionally more mature than conventional DC. Taken together, bulk-culture method is a simple technique for generating functionally mature BM-DC in large quantities and high purity.

Interleukin 12 gene therapy of cancer by peritumoral injection of transduced autologous fibroblasts: outcome of a phase I study

A phase I dose-escalation clinical trial of peritumoral injections of interleukin 12 (IL-12)-transduced autologous fibroblasts was performed in patients with disseminated cancer for whom effective treatment does not exist. The goals of this study were to assess the safety and toxicities as well as the efficacy, and ancillarily the immunomodulatory effects, of peritumoral IL-12 gene transfer. Primary dermal fibroblasts cultured from the patients were transduced with retroviral vector carrying human IL-12 genes (p35 and p40) as well as the neomycin phosphotransferase gene (TFG-hIL-12-Neo). Patients received four injections at intervals of 7 days. Nine patients were enrolled in this dose-escalation study, with secreted IL-12 doses ranging from 300 ng/24 hr for the first three patients to 1000, 3000, and 5000 ng/24 hr for two patients in each subsequent dosage level. Although a definite statement cannot be made, there appears to be perturbation of systemic immunity. Also, the locoregional effects mediated by tumor necrosis factor alpha (TNF-alpha) and CD8+ T cells were observed with tumor regression. Treatment-related adverse events were limited to mild to moderate pain at the injection site; clinically significant toxicities were not encountered. Transient but clear reductions of tumor sizes were observed at the injected sites in four of nine cases, and at noninjected distant sites in one melanoma patient. Hemorrhagic necrosis of tumors was observed in two melanoma patients. These data indicate that gene therapy by peritumoral injection of IL-12-producing autologous fibroblasts is feasible, and promising in patients with advanced cancer.

Prognostic value of 18F-FDG PET/CT in patients with squamous cell carcinoma of the tonsil: comparisons of volume-based metabolic parameters

BACKGROUND

The prognostic significance of volume-based metabolic parameters measured by (18)F-fluorodeoxyglucose positron emission tomography/CT ((18) F-FDG PET/CT) is not established. We evaluated the prognostic value of metabolic parameters in patients with squamous cell carcinoma (SCC) of the tonsil.

METHODS

We enrolled a total of 69 patients with SCC of the tonsil who underwent pretreatment (18)F-FDG PET/CT. We measured maximum standardized uptake value (SUV(max)), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and asymmetry indices (of SUV(max), MTV, and TLG). The prognostic significance of these parameters and clinical variables was assessed by Cox proportional hazards regression analysis.

RESULTS

Multivariate analyses with adjustments for age, sex, and American Joint Committee on Cancer stage showed that only TLG (hazard ratio = 1.020, 95% confidence interval 1.003-1.037, p = .023) was an independent predictive factor associated with decreased overall survival.

CONCLUSION

TLG is a significant independent metabolic prognostic factor for overall survival in patients with SCC of the tonsil.

Lateral lymph node metastasis in papillary thyroid carcinoma: A systematic review and meta-analysis for prevalence, risk factors, and location

BACKGROUND

Lymph node metastasis (LNM) is frequent in papillary thyroid carcinoma (PTC) and is associated with a poor prognosis. Unlike central LNM (CLNM), there are few studies focusing on LLNM. We aimed to investigate the prevalence and the risk factors for LLNM, with its most prevalent sites.

METHODS

We performed a comprehensive literature search using the PubMed and EMBASE databases for relevant studies published prior to November 2016 that examined the risk factors for LLNM.

RESULTS

Twenty-three studies, including 18,741 patients, were included. The prevalence of LLNM was 20.9% in all patients. CLNM (pooled OR = 7.84, 95% CI = 6.13-10.02, p < .0001), extrathyroidal extension (pooled OR = 3.22, 95% CI = 2.21-4.70, p < .0001), tumor multifocality (pooled OR = 2.19, 95% CI = 1.67-2.89, p < .0001), male sex (pooled OR = 1.72, 95% CI = 1.50-1.98, p < .0001), upper pole location (pooled OR = 2.96, 95% CI = 1.93-4.53, p < .0001), tumor size ≥1.0 cm (pooled OR = 2.49, 95% CI = 1.71-3.61, p < .0001), lymphovascular invasion (pooled OR = 3.96, 95% CI = 2.61-6.03, p < .0001) and tumor bilaterality (pooled OR = 1.31, 95% CI = 1.12-1.53, p = .0006) were significantly associated with LLNM. Most frequently affected areas were levels III and IV.

CONCLUSIONS

The prevalence of LLNM was high although the prognostic impact is unknown. The significant risk factors for LLNM were not much different from known risk factors for CLNM.

Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma: influence on serum thyroglobulin level, recurrence rate, and postoperative complications

BACKGROUND

In papillary thyroid microcarcinoma (PTMC), regional lymph node metastasis (LNM) is associated with a increased locoregional recurrence rate. Yet, prophylactic central lymph node dissection (CLND) targeting subclinical central LNM continues to be a matter of debate in the treatment of PTMC, which generally carries an excellent prognosis. The aim of our study was to investigate the benefits and risks of prophylactic CLND in patients with clinically node-negative PTMC.

METHODS

This study included 232 patients who underwent surgery for clinically node-negative PTMC from 1999 to 2006. Of these 232 patients, 113 underwent only total thyroidectomy (TT) and 119 underwent TT in conjunction with prophylactic bilateral CLND (TT with CLND). We then compared serum thyroglobulin (Tg) levels, recurrence rates, and postoperative complications between the 2 groups (TT only and TT with CLND).

RESULTS

The postoperative stimulated serum Tg level was significantly less in the TT with CLND group than in the TT only group (1.07 vs. 2.24 ng/mL, respectively; P = .022). The stimulated Tg levels in the 2 groups became similar, however, after low-dose radioactive iodine treatment (0.44 ng/mL vs. 0.69 ng/mL, respectively; P = 0.341). There was no significant difference in 3-year locoregional control rates after TT with CLND and TT only (98.3% vs. 96.5%, respectively; P = .368). Although the frequency of permanent hypocalcemia was approximately 3 times greater in the TT with CLND group (5.6%) than in the TT only group (1.8%), this finding did not reach statistical significance.

CONCLUSION

With prophylactic CLND, the postoperative Tg level can significantly decrease. However, prophylactic CLND is not helpful in decreasing short-term locoregional recurrence in patients with clinically node-negative PTMC. Finally, the risk of permanent hypocalcemia may increase after CLND.

Paucity of dendritic cells in pancreatic cancer

BACKGROUND

The number of dendritic cells (DC) in the local tumor environment correlates with patient survival in numerous tumors. The relationship of DC infiltration in the tumor microenvironment and prognosis was examined in patients with pancreatic adenocarcinoma.

METHODS

Forty-seven pancreatectomy specimens with a diagnosis of pancreatic adenocarcinoma were identified retrospectively and analyzed with the dendritic cell markers S-100 and CD1a. Patient survival was correlated with these markers and with p53, CD3, CD20, CD68, Ki-67.

RESULTS

Significant numbers (>3 per high-powered field) of tumor-associated S100(+) or CD1a(+) cells were found in only 2/47 patients (4%). When present, dendritic cells were located outside the margin of the tumor. CD3, CD68, and CD20 positive cells were rare or absent in 96%, 92%, and 93% of the specimens. A correlation with survival and numbers of immune cells could not be made secondary to their rarity. The median survival was 18.9 months. No other indices measured correlated with survival.

CONCLUSIONS

In patients with pancreatic adenocarcinoma, there is a paucity of immune cells within the tumor.

Extent of prophylactic lymph node dissection in the central neck area of the patients with papillary thyroid carcinoma: comparison of limited versus comprehensive lymph node dissection in a 2-year safety study

BACKGROUND

To compare the "comprehensive" (including bilateral paratracheal, pretracheal, prelaryngeal lymph nodes) (CCND) with "limited" (saving contralateral paratracheal lymph nodes) central node dissection (LCND) for postoperative complications and disease recurrence rate in sonographically node-negative papillary thyroid carcinomas.

MATERIALS AND METHODS

From 2003 to 2005, 114 consecutive patients, diagnosed as sonographically node-negative thyroid papillary carcinomas, were included retrospectively. Among them, the LCND was performed in 56 patients and CCND in 58 patients, in combination with total thyroidectomy, based on the operator-dependent decision. We compared the complication rates and the recurrence rates between these two groups with a mean follow-up duration of 2 years.

RESULTS

Transient hypocalcemia was more frequent in the CCND group than in the LCND group (48.3% vs 26.8%, P = .02, odds ratio [OR] = 2.55). However, the other complication rates were similar in the two groups. In addition, the immediate postoperative reduction of parathyroid hormone (PTH) was more evident in the CCND group. The postoperative PTH levels increased up to a similar level (12.4 vs 11.8 pg/mL) over 6 months. The incidence of permanent hypocalcemia did not differ significantly between the two groups. Four (7.1%) and five recurrences (8.6%) were found in two groups, respectively, implying similar oncological safety during the 2-year follow-up.

CONCLUSION

The LCND with total thyroidectomy could be an alternative treatment option for node-negative papillary thyroid carcinomas, because LCND had fewer short-term hypocalcemia and similar oncological outcomes during the 2-year follow-up. Further study enrolling a large number of patients with long-term follow-up is needed.

Role of 18F-FDG PET/CT in Management of High-Grade Salivary Gland Malignancies

The role of 18F-FDG PET/CT for planning the treatment of high-grade salivary gland malignancies was investigated and was compared with that with using contrast-enhanced CT.

METHODS

The subjects chosen for the study had high-grade cancer of the salivary gland, as confirmed by surgical pathology. The diagnostic values from 37 CT and PET/CT scans of 33 subjects were compared. The ability to predict the extent of the disease was compared by performing a subsite-based analysis for the primary lesions and a level-by-level analysis for the neck node levels as well as for the final TNM staging. The surgical pathology (67.6%) and clinical follow-up examinations (32.4%) were used as the reference standards. Furthermore, the changes made in each subject's care, based on a PET/CT examination, were compared with the treatment received without using the PET/CT data.

RESULTS

Using a primary subsite-based analysis, the diagnostic accuracy for predicting the pathologic tumor extent was significantly higher for PET/CT (91.0%) compared with that using CT alone (70.1%, P < 0.001). For the neck nodes on a level-by-level analysis, the metastasis could be predicted more accurately on the basis of a PET/CT examination (97.6%) than with using only CT (86.0%, P = 0.01). PET/CT was also far superior to CT in terms of the TNM staging (83.7% vs. 62.1%, P = 0.03). For 43.2% of the subjects, changes in the clinical decision making were made as a result of the PET/CT scan data over what was previously determined by using the CT scans alone.

CONCLUSION

PET/CT provides more accurate diagnostic information for the evaluation of high-grade salivary cancer than does CT and it has a major impact on making treatment decisions for patients with a high-grade salivary malignancy.

Incidence of postoperative facial weakness in parotid tumor surgery: a tumor subsite analysis of 794 parotidectomies

Background

The reported incidence of facial weakness immediately after parotid tumor surgery ranges from 14 to 65%. The purpose of this study was to evaluate the incidence of postoperative facial weakness related to parotidectomy with use of preoperative computed tomography (CT), intraoperative facial nerve monitoring, and surgical magnification. Also, we sought to elucidate additional information about risk factors for postoperative facial weakness in parotid tumor surgery, particularly focusing on the tumor subsites.

Methods

We retrospectively reviewed 794 cases with parotidectomy for benign and malignant tumors arising from the parotid gland (2009–2016). Patients with pretreatment facial palsy were excluded from the analyses. Tumor subsites were stratified based on their anatomical relations to the facial nerve as superficial, deep, or both. Multivariable logistic regression analyses were conducted to identify risk factors for postoperative facial weakness.

Results

The overall incidences of temporary and permanent (more than 6 months) facial weakness were 9.2 and 5.2% in our series utilizing preoperative CT, intraoperative facial nerve monitoring, and surgical magnification. Multivariable analysis revealed that old age, malignancy, and recurrent tumors (revision surgery) were common independent risk factors for both temporary and permanent postoperative facial weakness. In addition, tumor subsite (tumors involving superficial and deep lobe) was associated with postoperative facial weakness, but not tumor size. Extent of surgery was strongly correlated with tumor pathology (malignant tumors) and tumor subsite (tumors involving deep lobe).

Conclusion

Aside from risk factors for facial weakness in parotid tumor surgery such as old age, malignant, or recurrent tumors, the location of tumors was found to be related to postoperative facial weakness. This study result may provide background data in a future prospective study and up-to-date information for patient counseling.

Prognostic value of volume-based (18)F-fluorodeoxyglucose PET/CT parameters in patients with clinically node-negative oral tongue squamous cell carcinoma

Objective

To evaluate the prognostic value of volume-based metabolic parameters measured with ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET) in patients with clinically node-negative (cN0) oral tongue squamous cell carcinoma (OTSCC) as compared with other prognostic factors.

Materials and Methods

In this study, we included a total of 57 patients who had been diagnosed with cN0 tongue cancer by radiologic, ¹⁸F-FDG PET/CT, and physical examinations. The maximum standardized uptake value (SUV_max), average SUV (SUV_avg), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for primary tumors were measured with ¹⁸F-FDG PET. The prognostic significances of these parameters and other clinical variables were assessed by Cox proportional hazards regression analysis.

Results

In the univariate analysis, pathological node (pN) stage, American Joint Committee on Cancer (AJCC) stage, SUV_max, SUV_avg, MTV, and TLG were significant predictors for survival. On a multivariate analysis, pN stage (hazard ratio = 10.555, p = 0.049), AJCC stage (hazard ratio = 13.220, p = 0.045), and MTV (hazard ratio = 2.698, p = 0.033) were significant prognostic factors in cN0 OTSCC patients. The patients with MTV ≥ 7.78 cm³ showed a worse prognosis than those with MTV < 7.78 cm³ (p = 0.037).

Conclusion

The MTV of primary tumor as a volumetric parameter of ¹⁸F-FDG PET, in addition to pN stage and AJCC stage, is an independent prognostic factor for survival in cN0 OTSCC.

Muscle tension dysphonia in children: Voice characteristics and outcome of voice therapy

OBJECTIVE

The main object of this study is to elucidate the voice characteristics and the efficacy of voice therapy in children with muscle tension dysphonia (MTD).

METHODS

A retrospective file review was undertaken of eight Korean male children diagnosed as having MTD. All subjects received perceptual, acoustical and laryngoscopic evaluation before and after the treatment.

RESULTS

Markedly strained and breathy voices were detected in all patients. Pitch breaks and/or inadequately high or low speaking fundamental frequencies were noticed in five subjects. Laryngoscopic evaluation revealed anteroposterior contraction, false vocal fold approximation, decreased vibration of true vocal folds and incomplete glottal closure. Notably, seven out of eight subjects had bilateral vocal nodules. Voice therapy was focused on the awareness, relaxation, respiration and easy-onset phonation to reduce the tension around the laryngeal muscles. A few sessions of voice therapy resulted in dramatic improvement of their voice quality and pitch adjustment. Hyper-contraction of the supraglottic structures was also relieved.

CONCLUSIONS

These findings suggest that the proper diagnosis of MTD in children warrants prompt and favorable responses to voice therapy regardless of coexistence of vocal nodules.

Tumor volume assessment by 18F-FDG PET/CT in patients with oral cavity cancer with dental artifacts on CT or MR images

The purpose of this study was to investigate the clinical usefulness of PET/CT or CT-attenuated PET in the evaluation of patients with oral cavity cancer (OCC) in whom dental artifacts distorted the conventional CT or MR images of the oral cavity.

METHODS

A PET/CT scan, in addition to a CT or MRI scan, was performed in 69 patients with OCC who had dentures or dental implants. A total of 64 PET/CT, 64 CT, and 27 MR images were analyzed including images from scans performed on 40 patients with OCC without dental artifacts on the conventional images; these were used for comparison. The CT-attenuated PET scan for the detection of primary tumors was compared with the CT or MRI scan. We also evaluated the correlation between the PET/CT volume and the pathologic volume using a regression analysis. In addition, subgroup analysis was performed to determine what proportion of subjects benefited most from the PET/CT.

RESULTS

CT-attenuated PET detected more primary tumors than did CT in patients with OCC with dental artifacts (95.3% vs. 75.0%, respectively; P=0.0016). PET/CT volume with a standardized uptake value (SUV) cutoff point of 3.5 predicted the pathologic volume more accurately than did the other cutoff points in patients with OCC with or without artifacts. After comparing pathologic volume and PET/CT(SUV 3.5) volume, the following regression equation was developed: log (pathologic volume)=0.6 x log (PET/CT(SUV 3.5) volume) + 1.3 (R(2) = 0.42, P<0.0001). Subgroup analysis showed that the prediction of the pathologic volume from the PET/CT images was more reliable for tumors that were more than 2 cm in depth (R(2)=0.72).

CONCLUSION

For patients with OCC with dental artifacts on the conventional imaging, PET/CT could provide useful clinical information about the primary tumors, particularly in cases with advanced tumors.

High-throughput profiling identifies clinically actionable mutations in salivary duct carcinoma

Background

Salivary duct carcinoma (SDC) is a highly aggressive subtype of salivary gland cancers and there is no established standard therapy for this disease. Thus, development of molecular markers for SDC will be important to guide the diagnosis and therapy of this aggressive tumor.

Methods

We performed next-generation sequencing using the Ion Torrent AmpliSeq cancer panel, which explores the mutational status of hotspot regions in 50 cancer-associated genes, and we analyzed copy number variations (CNVs) of 21 genes by NanoString nCounter for 37 patients with SDC. Fluorescent in situ hybridization was also conducted to confirm ERBB2 gene amplification. Clinical records and tumor histopathology of the patients were retrospectively reviewed.

Results

Genetic alterations were detected in 29 of 37 (78.3%) tumors, including mutations in PIK3CA (N = 9, 24.3%), ERBB2 (N = 4, 10.8%), and EGFR (N = 4, 10.8%). To our knowledge, this is the first time that ERBB2 mutations have been reported in this tumor type. Both PIK3CA and ERBB2 mutation status were associated with poor overall survival, but without statistical significance. ERBB2 amplification was strong and common in SDC and almost all cases also exhibited EGFR and ERBB3 amplifications.

Conclusions

This study reports the largest and most comprehensive analysis of DNA aberrations in SDC. Our results show that PIK3CA and/or ERBB2 alterations in the development of SDC might be a useful diagnostic tool and could serve as a potential therapeutic target.

Treatment for extracranial arteriovenous malformations of the head and neck

CONCLUSIONS

For extracranial arteriovenous malformations of the head and neck (HNAVMs), in which the nidus was accessible via the percutaneous route, ethanol sclerotherapy was a feasible and safe first-line treatment, although successful outcomes were obtained for only about half of the subjects. For other HNAVMs, surgical excision with embolization may be the best choice of treatment.

OBJECTIVE

To suggest a treatment protocol for patients with HNAVMs by comparing the treatment outcomes and complications of ethanol sclerotherapy with those of surgical excision combined with embolization.

MATERIAL AND METHODS

Twenty patients who had been diagnosed with HNAVM and treated between 1995 and 2002 were retrospectively reviewed. Ethanol sclerotherapy, surgical excision and embolization were used as treatments, either alone or in various combinations. The treatment outcomes and complications with the different modalities were analyzed.

RESULTS

Ethanol sclerotherapy was used for 12 cases, with a success rate of 50.0% and a permanent complication rate of 8.3%. Surgical excision combined with embolization was used for 13 patients. Although all patients achieved successful resolution of their HNAVM after surgical excision, 15.4% suffered from permanent complications. In total, 16/20 patients (80.0%) eventually achieved a > or = 75% reduction in the size of their lesions.

Lymphatic vessels and high endothelial venules are increased in the sentinel lymph nodes of patients with oral squamous cell carcinoma before the arrival of tumor cells

PURPOSE

To investigate the change of vasculature in the sentinel lymph node (SLN) of patients with oral squamous cell carcinoma.

METHODS

Immunohistochemical staining of SLNs in 58 patients was performed with two monoclonal antibodies (MAb): anti-D2-40 MAb for lymphatic endothelial cells, and anti-MECA-79 MAb for high endothelial venules (HEV). Twelve metastatically involved (m(+)) SLNs, 120 uninvolved (m(-)) SLNs, and 35 non-SLNs (control) were available for analyses. Vessel densities were measured by computer-assisted analyses in the entire region of SLN. Correlations were assessed between vessel density and clinicopathologic variables, including vascular endothelial growth factor C of primary tumor.

RESULTS

Lymphatic vessel density (LVD) in SLNs was higher than that in control LNs [2361.8 μm(2)/high-power field (HPF) (624.3-4758.5) vs. 1621.9 μm(2)/HPF (465.3-3453.5), P = 0.005]. LVD of m(-) SLNs [2662.4 μm(2)/HPF (624.3-4758.5)] and m(±) SLNs [4946.6 μm(2)/HPF (2009.3-8698.8)] were both statistically significantly higher compared to control. HEV densities in m(-) SLNs [14029.7 μm(2)/HPF (10465.7-17927.1)] as well as m(±) SLNs [18258.5 μm(2)/HPF (8408.9-27706.0)] were also significantly higher than those in control [10350.5 μm(2)/HPF (7807.8-12541.1)]. By multivariate analysis, the degree of vascular endothelial growth factor C expression of primary tumor showed significant correlation with LVD of SLNs (odds ratio 9.46, 95% confidence interval 1.73-51.5, P = 0.009), which was not the case in HEV.

CONCLUSIONS

Lymphatic vessels and HEVs were increased in SLNs, regardless of metastatic status of SLNs. Vascular endothelial growth factor C expression of primary tumor may contribute to the premetastatic change within SLNs of oral squamous cell carcinoma.

The cytological, clinical, and pathological features of the cribriform-morular variant of papillary thyroid carcinoma and mutation analysis of CTNNB1 and BRAF genes

BACKGROUND

The cribriform-morular variant of papillary thyroid carcinoma (CMVPTC) is an unusual subtype of papillary thyroid carcinoma. The goal of this study was to determine the clinicopathological features of CMVPTC and whether the tumor can be diagnosed by fine-needle aspiration cytology.

METHODS

We retrospectively analyzed the clinical appearance and pathological findings in five patients with CMVPTC and sequenced exon 3 of CTNNB1 and exon 15 of BRAF in tumor tissue.

RESULTS

All patients were young women, 15-34 years of age at the time of the cancer diagnosis. Preoperative cytological examination showed scattered tall columnar cells, fascicular spindle cells, and cribriform and morular patterns in the fine-needle aspirates of the thyroid from the five patients. Grossly, all tumors were well-circumscribed, solid or cystic. Immunohistochemically, most tumor cells showed nuclear expression of thyroid transcription factor-1, estrogen and progesterone receptors, and p53; cytoplasmic expression of cytokeratins 7 and 19, vimentin, and bcl-2; and cytoplasmic and nuclear accumulation of beta-catenin and galectin-3. There was no expression of thyroglobulin, cytokeratin 5/6, or human mesothelial cell-1. However, among these markers, the morular cells showed only positive immunostaining for beta-catenin, galectin-3, p53, and bcl-2. A CTNNB1 mutation was identified in only one case and no BRAF mutation was found in any of the five cases.

CONCLUSIONS

Taken together, these data suggest that CMVPTC can be diagnosed preoperatively, based on careful cytology examination, and shows unique immunohistochemical findings.

Salivary duct carcinomas: clinical and CT and MR imaging features in 20 patients

INTRODUCTION

Salivary duct carcinoma (SDC) is an uncommon high grade adenocarcinoma of the salivary gland with a grave prognosis. The aim of this study was to investigate the clinical and CT and MR imaging features of SDC.

METHODS

We retrospectively evaluated the clinical and CT and MR imaging findings in 20 patients (14 men and six women; mean age, 59 years) with histologically proved SDC. We also tried to correlate clinicoradiological tumor staging with pathologic tumor staging in 17 patients who underwent surgery.

RESULTS

The tumor originated in the parotid gland (n = 11; 55%), the submandibular gland (n = 7; 35%) and the buccal space along the distal Stensen's duct (n = 2; 10%). Locoregional recurrence occurred in 41% and distant metastasis in 47%. Fifty-eight percent died of the disease with a mean survival period of 32 months after diagnosis. On CT and MR images, SDC was mostly seen as an ill-defined (85%) and infiltrative (60%) mass with frequent calcification (50%) and necrosis (80%). Although various signal intensities were seen on MR images, six of nine tumors contained the areas of marked hypointensity on T2-weighted images. Clinicoradiological tumor staging correlated well with pathologic tumor staging in 82% of the patients.

CONCLUSION

Ill-defined, infiltrative mass with calcification on CT scans and the areas of marked hypointensity on T2-weighted MR images may be useful radiologic features to suggest the diagnosis of SDC. CT and MR imaging are useful for staging of SDC.

Intraoral Sonography–Assisted Resection of T1–2 tongue Cancer for Adequate deep Resection

Objective

To investigate the clinical usefulness of intraoral sonography-assisted resection for securing adequate deep resection margins in T1–2 tongue cancers.

Study Design

Prospective clinical trial.

Materials and Methods

Twenty consecutive patients with clinical T1–2 tongue cancers were enrolled and their lesions were removed by intraoral sonography-assisted resection. We then retrospectively collected data from 20 T stage-matched patients without intraoral sonography-assisted resection as the control group. All resections were performed with a goal of 15 mm margin. The mucosal and deep safety margins were compared between the two groups.

Results

Intraoral sonography could predict the paraffin-embedded tumor thickness with an error of 3.16 ± 2.24 mm. The deep safety margins were more adequate for intraoral sonography–assisted resection (9.8 ± 5.2 mm) than for conventional resection (4.0 ± 2.03 mm) ( P < 0.001), while the mucosal safety margins were not different

Conclusion

Intraoral sonography-assisted resection provides a more adequate deep resection margin for early T-stage tongue cancers.

The effect of vocal hygiene education for patients with vocal polyp

Objective

The authors aimed to assess the effect of vocal hygiene education for patients suffering with vocal polyp and to discover the meaningful factors that can predict better outcomes with performing vocal hygiene.

Study Design and Setting

Voice evaluation and vocal hygiene education were provided to 340 consecutive patients with vocal polyp. Three months later, 175 of the 340 patients completed a follow-up evaluation. According to the change in polyp size, these patients were divided into two groups: the “improvement” and the “no improvement.” The effect of vocal hygiene was assessed. Eight parameters were compared between these two groups.

Results

The “improvement” group was composed of 20% of the 340 patients and 38% of the 175 patients. Multivariate analyses demonstrated that nonsmokers with a small polyp had the greatest possibility of improvement with vocal hygiene and so avoid unnecessary surgery.

Conclusion

Patients who do not smoke and who have a polyp that is small in size have a much better chance to improve their voice by performing vocal hygiene.

Voice Outcomes of Polyacrylamide Hydrogel Injection Laryngoplasty

OBJECTIVES

Polyacrylamide hydrogel (PAAG, Aquamid) is widely used as permanent facial tissue filler during facial plastic surgery. In this study, we examined the long-term effects and safety aspects of PAAG as a vocal fold augmentation material for patients with permanent unilateral vocal cord paralysis.

STUDY DESIGN

Prospective clinical trials.

METHODS

PAAG injection laryngoplasty was performed in 34 consecutive patients with permanent unilateral vocal cord paralysis. Percutaneous injection was performed under local anesthesia into the vocalis muscle using disposable 25 gauge long needles. Of the 34 patients, 16 completed acoustic, perceptual, stroboscopic, and subjective evaluations prior to the injection and at 6 and 12 months after the injection.

RESULTS

Acoustic and perceptual parameters (GRBAS [Overall grade of dysphonia, Roughness, Breathiness, Aesthenia, Strain], Maximal phonation time [MPT], jitter, and shimmer) were significantly improved (P < .05) after injection and remained stable over 12 months. The grades of mucosal waves and glottic closure were also significantly improved (P < .01). The voice handicap index (VHI), as well as the visual analogue scale (VAS) of hoarseness and aspiration significantly improved over 12 months. No adverse effects were observed except for a decrease in the mucosal wave of one patient, after injection into a superficial area of the vocal fold.

CONCLUSION

Based on the preliminary results of this trial, PAAG appears to be a long-lasting and safe injection material that is suitable for the treatment of glottal insufficiency caused by permanent unilateral vocal cord paralysis.