Interaction of factors associated with cancer of the nasopharynx.

A retrospective study of nasopharyngeal carcinoma (NPC) revealed that smoking, working under poor ventilation, use of nasal balms or oil for nasal and throat troubles, use of herbal drugs, and anti-EBV antibody titer were found statistically associated. The dural interactions of these factors to the risk of NPC were presented. Except in work conditions with poor ventilation and when herbal drugs are used, all the combinations were synergistic. The synergistic actions were especially remarkable with smoking and other factors. The possible etiological mechanisms of NPC are discussed.     

Metastatic calcification associated with malignancy

From 1975 to 1986, 15 cases (2%) of metastatic calcification associated with an underlying malignancy were found in a review of 702 autopsied cases with histories of malignancy. These underlying malignancies included 7 cases of lung cancer, 6 cases of malignant lymphoma, one case of breast cancer, and one of urinary bladder cancer. Squamous cell carcinoma was of the histological type most often associated with metastatic calcification in lung cancer, and ATL in malignant lymphoma. Hypercalcemia was found in 10 (83%) out of cases, and almost all were accompanied by renal dysfunction. Calcium deposits were most frequently observed in the kidneys and the lungs. It has been suggested that metastatic calcification in the lungs and kidneys of a patient with a history of malignancy showing hypercalcemia is sometimes accompanied by respiratory and renal dysfunction, causing the patient's condition to deteriorate.     

Inhibition of microflora associated with oral malignancy

Changes in the microflora on oral carcinoma surfaces may lead to both local and systemic infections, which may complicate the morbidity of the patient suffering from oral malignant neoplasms. Thus, anticancer therapy, irradiation, chemotherapy or surgery impairs the defence mechanism of the oral mucosa and is accompanied by proliferation of the mucosal biofilm with overgrowth of yeast and bacteria. This study investigates the inhibition of the biofilm present on the surface of oral squamous cell carcinomas. Biofilm samples were obtained from the central surface (1 cm2) of each lesion in 10 patients (eight male, two female; mean age: 47.6 years; SD +/- 7.6) before any antibiotherapy or tumour treatment. Patients were randomly divided into two groups and were rinsed with Meridol mouthrinse (amine fluoride) or placebo (saline solution) for 7 days. Samples were repeatedly taken from the same site after rinsing. Samples were transported in pre-reduced brain heart infusion broth and cultured within 1 h of removal, using aerobic and anaerobic complete and selective media. Total aerobic and anaerobic counts were determined and isolated bacteria were identified. The median counts of colony forming units (CFU/ml) after rinsing with Meridol were significantly lower for both aerobes and anaerobes than before rinsing with Meridol. (For aerobes before rinsing: 1.35 x 10(6), after rinsing: 7.55 x 10(5); p = 0.025; for anaerobes before rinsing: 1.39 x 10(6), after rinsing: 7.15 x 10(5); p = 0.011. Rinsing with placebo: no significant difference was found. Aerobe median counts before rinsing: 1.17 x 10(6), after rinsing: 1.03 x 10(5), and for anaerobes: before rinsing 1.75 x 10(6), after rinsing: 1.51 x 10(6); p > 0.05 [Wilcoxon test].) It was concluded that 7-days (three times a day) Meridol rinsing significantly reduced the surface biofilm of oral carcinoma compared to rinsing with placebo. Clinical examination indicated no irritation of the mucosa. The mouthrinse was well tolerated by the patients, who commented on a reduction in burning sensation and bad breath. Besides routine oral hygiene, rinsing itself could reduce patient morbidity. The findings of the present study indicate that in addition to any other oral focus, the lesion itself, when ulcerated, should receive direct antimicrobial treatment so as to reduce patient morbidity and enhance quality of life.     

Deep vein thrombosis of the arm associated with malignancy

Deep vein thrombosis (DVT) of the arm unrelated to central venous cannulation is an uncommon occurrence in patients with malignancy. The author reports six cases encountered in a large county hospital over an 8-year period. Three of the patients had gastric carcinoma, esophageal adenocarcinoma, and testicular carcinoma, respectively. These neoplasms have not been previously reported to be associated with DVT of the arm. Three episodes of DVT resulted from venous compression by the tumor, and a hypercoagulable state may have contributed to the pathogenesis of DVT in the other three cases. Venography is required for confirmation of the diagnosis; however, a computed tomographic scan with contrast media may be a valuable adjunct. A review of the literature indicated that the incidence of pulmonary embolism is significant in these patients. Therefore, anticoagulation within 7 days of clinical onset is recommended.     

Tuberculosis of tonsil associated with pulmonary foci

Tuberculosis of tonsil is one of the uncommon forms of extra pulmonary tuberculosis. We report a case of tuberculosis of tonsil associated with pulmonary foci. A 48-year-old male presented with history of severe left sided throat pain of 10–15 days duration and fever of moderate degree of 7 days duration. Clinical diagnosis of left peritonsillitis was made. As the symptoms did not subside with antibiotics and analgesics malignancy was suspected, biopsy was done under local anesthesia and sent for histopathology. Histopathology revealed tuberculosis. He was evaluated further and primary foci was found in lung. The possibility of tuberculosis should be considered in a case with unilateral severe throat pain with congested tonsil not responding to usual line of treatment.     

Cutaneous manifestations associated with malignancy of the head and neck

Most cutaneous malignancies of the head and neck (HN) are non-melanoma skin cancers, predominantly basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs). Less common entities include Merkel cell carcinoma (MCC), sebaceous carcinoma (SC), and angiosarcoma. Treatment is based on histology subtype, stage, and extent of involvement. Surgery is the primary means of treatment and includes wide local excision, Mohs micrographic surgery, sentinel lymph node biopsy, and cervical lymphadenectomy. Multidisciplinary management including radiation and targeted chemotherapy are critical adjuncts to surgery. Surgical planning must balance oncologic, functional, and cosmetic considerations. This review addresses cutaneous manifestations of primary malignancies of the HN and dermatologic complications of small molecule inhibitors used for targeted therapy. A working knowledge of both the cutaneous malignancies (CM) in the head and neck as well as the secondary dermatologic manifestations is relevant to multiple disciplines including dermatology, medical oncology, radiation oncology, and surgical oncology.     

Erythropoietin for the treatment of anemia associated with hematological malignancy

Anemia is common in patients with hematological malignancy. Most patients will have their anemia attributed to the anemia of chronic disease. The anemia of chronic disease is caused by cytokine mediated suppression of erythropoiesis and low serum erythropoietin levels are found in the majority of patients with cancer. Many of these anemic patients will be symptomatic with fatigue. Data from many studies indicates that treatment of anemic patients with erythropoietin will increase their hemoglobin concentration, decrease transfusion need and also improve their quality of life. A recent study also suggests that improving the hemoglobin level may improve the patients' prognosis but this finding needs to be confirmed.     

Rb-loss is associated with high malignancy in chondrosarcoma

Loss of function of the human retinoblastoma gene (Rb) is a frequent genetic abnormality in human malignancies and causes a disturbance in the cell cycle and loss of normal proliferation and differentiation. We studied the loss of heterozygosity (LOH) of the Rb gene in 31 formalin-fixed, paraffin-embedded cartilaginous tumors using polymerase chain reaction. The tumors were subdivided into 8 cases of dedifferentiated (DD) chondrosarcoma, 17 cases of conventional chondrosarcoma (nine grade 1, seven grade 2 and one grade 3), 4 enchondromas and 2 chondroblastomas. Both components of DD chondrosarcoma, the low-grade and anaplastic components, were separated by a microdissection approach. The genetic data were correlated with the expression of the Rb protein examined by Rb immunohistochemistry. We found Rb-LOH in one grade 3 chondrosarcoma, and in the anaplastic component in 7 of 8 cases of DD chondrosarcoma (89% of all high-grade chondrosarcomas). All tumors with Rb-LOH were immunohistochemically Rb-negative. The only case of DD chondrosarcoma negative for Rb-LOH in both components of the tumor also showed weak expression of the Rb protein in the anaplastic component. All benign cartilaginous tumors, low-grade chondrosarcomas and low-grade tumor components of DD chondrosarcomas were negative regarding Rb-LOH but positive in Rb immunohistostaining. We concluded that Rb-LOH predominantly occurs in high-grade chondrosarcomas. However, it is not a marker for identifying low-grade tumors with a tendency towards progression or local recurrence.     

Undifferentiated pancreatic cancer associated with humoral hypercalcemia of malignancy

We present a case of undifferentiated pancreatic cancer associated with humoral hypercalcemia of malignancy (HHM) in which parathyroid hormone-related protein (PTH-rP) is identified as the causative factor of hypercalcemia. A 61-year-old man was hospitalized with right hypochondralgia. Ultrasound examination and computed tomography demonstrated a large mass in the pancreatic head with liver metastases. Biopsy of the pancreatic tumor demonstrated undifferentiated carcinoma. Serum calcium level and PTH-rP were elevated. Bone scan with technetium-99 demonstrated no accumulation in the bones. Immunohistochemical staining for PTH-rP was weakly positive in the tumor cells. We considered that PTH-rP was the causative factor of HHM in this case from laboratory data and immunohistochemical findings. This rare case was successfully treated with pamidronate disodium, which is a type of bisphosphonate derivative. We compared this case with previously reported cases.      

Expression of FOXG1 is associated with the malignancy of human glioma

Objective： Recent evidence indicates that the increased expression of FOXG1 is associated with tumor genesis. This study was designed to explore the expression and role which FOXG1 plays in human glioma. Methods： We detected the expression of FOXG1 by immunohistochemistry in glioma tissue samples. Following the down-regulation of FOXG1 in glioma cell lines by a specific short hairpin RNA, the function of FOXG1 in proliferation and apoptosis was assessed. Results： Glioma tissues exhibited notably higher expression of FOXG1 compared with control brain tissues and was positively corre- lated with histological malignancy. The down-regulation of FOXG1 in glioma cells led to a cell apoptosis in vitro. Cenclusion： The overexpression of FOXG1 is a novel glioma malignancy marker, and FOXG1 may be used as a new target in therapeutic strategies for human glioma.     

消化管类癌恶性程度与基因产物表达的相关性研究

目的 研究消化管类癌中分化抗原（ｃｈｒｏｍｏｇｒａｎｉｎＡ）,浸润转移相关抗原ｕｒｏｋｉｎａｓｅ,培殖细胞核抗原（ＰＣＮＡ）及细胞凋亡相关抗原ＢＭ－１的表达与该肿瘤恶性程度的关系。方法 应用免疫组化技术（ＳＡＢ法）检测随访８年以上的１３例（其中无转移９例,其他器官转移４例）消化管类癌肿瘤组织ｃｈｒｏｍｏｇｒａｎｉｎＡ,ｕｒｃｋｉｎａｓｅ,ＰＣ－ＮＡ及ＢＭ－１的表达状况,并分析这些基因产物表达与该肿     

Ultrasonographic features associated with malignancy in cytologically indeterminate thyroid nodules

Context

Thyroid nodules with indeterminate cytology usually are treated with surgery, but most are benign. Neck ultrasonography has varied results in predicting malignancy.

Objective

To evaluate the predictive value of ultrasonography and the frequency of malignancy in patients who had indeterminate thyroid nodules.

Design

Retrospective study.

Setting

University hospital.

Patients

There were 78 patients who had thyroid nodules that were diagnosed on cytology (fine needle aspiration) as a follicular lesion (atypia of undetermined significant) or follicular neoplasm. Ultrasonography was available in 69 patients (88%).

Intervention and main outcome measures

Diagnostic fine needle aspiration (cytology), ultrasonography, and surgical pathology of thyroid nodules.

Results

Fine needle aspiration was indeterminate in all patients, with follicular lesions in 60 patients (77%) and follicular neoplasm in 18 patients (23%). Ultrasonography showed micro calcification in 6 patients (9%), irregular border in 15 patients (22%), size ≥ 3 cm in 31 patients (45%), and hypoechogenicity in 43 patients (62%). Surgical pathology showed that the nodules were benign in 50 patients (64%) and malignant in 28 patients (36%).Malignancy was significantly associated with male sex (relative risk, 2.3), solid nodule structure (relative risk, 2.6), and irregular border (relative risk, 3.6). Compared with other ultrasonographic characteristics, irregular borders had the highest specificity (93%), positive predictive value (80%), and accuracy (78%) for malignancy.

Conclusions

The frequency of malignancy is high in indeterminate thyroid nodules. Based on the limited accuracy or predictive value of ultrasonographic risk factors, surgery is the treatment of choice for indeterminate thyroid nodules.     

Thymoma is associated with an increased risk of second malignancy.

BACKGROUND: An association between thymoma and second malignancy has been suggested but has not been validated. Whether the relation is due to treatment or to other thymoma-associated conditions is unclear. METHODS: The authors studied 192 consecutive patients with thymoma and compared the incidence of second malignancies with those of 206 patients who underwent thymectomy for nonthymomatous conditions and 1426 patients with nasopharyngeal carcinoma (NPC). Detailed clinicopathologic features of thymoma patients with second malignancies were described. RESULTS: Additional malignancies were detected in 15 of 192 patients (8%) during their clinical courses. The risk for those patients was significantly greater compared with the risk for patients with nonthymomatous conditions (adjusted odds ratio [OR], 3.81; 95% confidential intervals [95%CI], 1.05-13.81; P = 0.042) and patients with NPC (adjusted OR, 4.89; 95%CI, 2.26-10.53; P < 0.0001) after adjustment for age, gender, length of follow-up, myasthenia gravis, and radiation therapy. The occurrence of second malignancies did not correlate with histologic type or stage of thymoma, radiation therapy, or myasthenia gravis. CONCLUSIONS: Thymoma is associated with an increased risk of second malignancy. The association cannot be attributed to the effect of thymectomy or radiation therapy. Patients with thymoma, even if it is benign, should be followed regularly to facilitate the early detection of other malignancies.     

Remission of pure red cell aplasia associated with nonthymic malignancy.

Two patients with acquired pure red cell aplasia associated with malignancy are presented. One patient has breast cancer and the other had poorly differentiated nodular lymphoma; neither patient had evidence of a serum inhibitor of hemoglobin synthesis and both achieved complete hematologic remission following prolonged immunosuppressive therapy. The literature describing the association of pure red cell aplasia and nonthymic malignancy is reviewed and potential for responsiveness discussed.     

Erythropoietin for the treatment of anemia of malignancy associated with neoplastic bone marrow infiltration

This clinical trial was performed to study the effects of intravenously (IV) administered recombinant human (rh) erythropoietin (EPO) at escalating doses (150, 300, and 450 U/kg, administered as an IV bolus injection, twice weekly, for 6, 4, and 4 weeks, respectively) in five patients with low-grade non-Hodgkin's lymphoma (Ig NHL) and bone marrow involvement and one patient with multiple myeloma (MM). All patients were anemic due to underlying disease. None of the patients had a history of bleeding, hemolysis, renal insufficiency, or other disorders causing anemia in addition to bone marrow infiltrating malignancy. Endogenous EPO serum levels were significantly increased in all patients (74 to 202 mU/mL). Five patients (one MM, four small-cell lymphocytic [SCLC] NHL) showed a dramatic increase of hemoglobin (Hb), hematocrit (Hk) and RBC count becoming obvious on the second EPO dose level. Initial ferritin serum values, which were high mostly due to polytransfusion, were significantly reduced in responding patients. Erythropoiesis of one patient with extensive follicular mixed (fm) NHL did not respond to EPO treatment. Platelet (PLT) count increase (greater than 75% above starting levels) during and following EPO therapy was observed in one patient with MM. Adverse events due to EPO therapy have not been recorded. These findings point out a previously unrecognized capacity of EPO given at pharmacologic doses to stimulate erythropoiesis in patients with anemia due to bone marrow infiltration by neoplastic lymphocytes in spite of enhanced endogenous EPO expression.     

Chondrosarcoma of the nasopharynx

Chondrosarcoma of the nasopharynx is a rare entity, only four cases having been reported in the world literature to date one each by Wirth and Shimkin (1943), Timmis (1959) and Serba (1966) and Singh and Seth (1972). This paper adds a fifth case to the literature.     

Osteoclastoma of the nasopharynx

Osteoclastoma involves the long bones of the extremities and some of the flat bones such as the sacrum, mandible patella and vertebrae. Eggston and Wolff (1947) mentioned the possibility of its origin from bones of the upper jaw, ethmoid and sphenoid sinuses. Amongst the skull bones, Rosenwasser (1969) described a case of giant cell tumour of the middle ear, yet such a tumour arising from the nasopharynx and sphenoid seems to be extremely rare. A rare case of osteoclastoma of the nasopharynx with extensive local invasion, multiple cranial nerve involvement and fatal termination is described. The differential diagnosis and histological features have been discussed.