Adenolymphoma: an immunohistochemical study with monoclonal antibodies against lymphocyte antigens

Twenty-two adenolymphomas (Warthin's tumours) were investigated with respect to their lymphoid stroma; 4 were analyzed by monoclonal antibodies against B-cells and T-cells. A slight predominance of B-cells was found. In the T-cell fraction, the T-helper cells outnumbered the T-suppressor cells by a factor of 4. These and other cell types were found in the stroma and in the epithelium. Mast cells were associated with those adenolymphomas having a high proportion of epithelium.     

Prospective flow cytometric analysis of head and neck carcinomas. Prognostic relevance of DNA-content and S-fraction.

Flow cytometric data were obtained from 142 primary squamous cell carcinomas of the oral cavity or the oropharynx. Aneuploidy was found in 36.8% of the tumours. The DNA indices showed a significant correlation with the S-fraction, tumour size and evidence of suspicious lymphnodes. There was no clear correspondence between the S-fraction and the tumour stage. Tumour size, histopathologically-positive lymphnodes and the mode of treatment were significantly correlated with the survival rates. In contrast, there was no clear correlation between flow cytometric data and the prognosis of the whole group as well as several clinical subgroups. In 40 patients who received preoperative irradiation, DNA indices and S-fractions were compared before and after the preoperative treatment. In 12 of 14 aneuploid tumours irradiation led to a decrease in the DNA indices into the range of euploidy. Only 2 tumours remained aneuploid. After irradiation 26 of 37 tumours showed a decrease in S-fraction, 11 tumours showed an increase. Loss of aneuploidy after irradiation was associated with a histologically-proven increasing devitalization of tumour cells, decrease in S-fraction corresponded to a tendency to a better prognosis.     

癌基因c-myc抑癌基因p53在涎腺肿瘤中的表达

方法：本文采用免疫组化（ＳＰ）法，研究了３０例涎腺肿瘤。目的：观察ｃ－ｍｙｃ癌基因和ｐ５３抑癌基因在涎腺肿瘤中的表达。结果：多形性腺瘤中，ｃ－ｍｙｃ和ｐ５３阳性率分别为５０．０％和２５．０％，均分别低于恶性肿瘤的阳性率７５％和５０．８％，两组比较均有高度显著性差异（Ｐ＜０．０１）。结论：ｃ－ｍｙｃ抑癌基因ｐ５３表达与涎腺上皮细胞增殖速度加快和突变有关，ｐ５３阳性率升高，虽与细胞恶变关系密切，但仅为判断细胞分化程度的一个参考指标。     

Relationship between major and minor salivary gland mucoepidermoid carcinoma malignancy grading and presence of stromal myofibroblasts: immunohistochemical study

OBJECTIVE: Mucoepidermoid carcinoma (MEC) is the most common malignant salivary tumour, classified as low, intermediate and high grade. Myofibroblasts are the main stromal component and are included as prognostic factor in some tumours. The aim of this study was to evaluate the myofibroblasts in the stroma of MEC with possible relationship to malignancy grading. METHODS: Twenty-five cases of MEC (six low grade, 11 intermediate grade, four high grade and four metastasis) were stained for vimentin, desmin and smooth muscle actin (SMA) for the identification of myofibroblasts. Transforming growth factors (TGFbeta1 and TGFbetaRII) were also assessed in our study. RESULTS: Myofibroblasts were present in all cases, in amounts varying according to histological grading. TGFbeta1 was positive in squamous cells of intermediate grade tumours, and in the stroma of only four cases. TGFbetaRII was positive in most squamous and intermediate cells, regardless of malignancy grading. CONCLUSIONS: Our study showed that the analysis of neoplastic stroma must be added to the studies of neoplastic cells to draw a better picture leading to tumour diagnosis and prognosis.     

口腔鳞癌细胞增殖核抗原和P53免疫组化的比较研究

本文运用ＡＢＣ免疫组化结合图象分析，定量分析了ＰＣＮＡ（细胞增殖核抗原）和Ｐ５３在口腔鳞癌中的表达。探讨了两者在口腔鳞癌的临床病理、肿瘤侵龚和转移等方面的异同点。结果表明：ＰＣＮＡ的表达强度和阳性率与肿瘤的病理分级有关，与肿瘤细胞的侵龚转换无关。而Ｐ５３和肿瘤细胞的侵龚有关密切的关系（Ｐ〈０．０５）。Ｐ５３阳性者，淋巴结转移率较高（８０％）。结果表明在口腔鳞癌的临床行为恶性，预后等方面定量分析上述     

Lipomata in oral tissues.

The literature on Lipomata and intra-oral Lipomata is reviewed and a series of 24 cases presented. In this series the mean age of presentation of the male patients was 53.8 years, whereas that of females was 63.1 years 33.3% of the tumours occurred on the inner aspect of the checks and of these 8 cases, six were males. Of the eight lesions occurring the floor of the mouth and retromolar areas, all but one occurred in females. Evidence is presented to support to the claim that intra-oral lipomata are indeed common benign neoplasms.     

Delay in diagnosis and its effect on outcome in head and neck cancer

We examined the records of two cohorts of patients who were seen from 1960 to 1999 with a diagnosis of squamous cell carcinoma (SCC) of the mouth and throat, one series being retrospective (n=400) and the other prospective (n=213) to find out about delays in diagnosis. The median delay in both cohorts was 3 months and the patients were responsible for the delay in most cases (n=319, 81% and n=160, 78%, respectively). Half the patients in each cohort had delayed diagnoses (n=217, 54% and n=119, 56%, respectively) and similar percentages (n=110, 53% and n=172, 47%) presented with advanced disease (stage III or IV). These were not the same patients for there was no correlation between delay and stage or survival. Logistic regression analysis showed that non-white race (p=0.01) and high-grade histology (p=0.002) predicted advanced disease. The proportion of patients presenting with advanced disease had not changed in 40 years despite public education. We suggest that some tumours may be silent and that initial symptoms do not reliably predict early disease.     

Advanced osteosarcoma of the maxilla: a case report

Osteosarcomas are primary malignant bone tumours in which mesenchymal cells produce osteoid. It is generally the most common malignant bone neoplasm, although lesions of the jaw are uncommon. Osteosarcoma of the jaw (JOS) presents a lower incidence of metastasis and a better prognosis than osteosarcoma of the long bones. However, patients with JOS can exhibit advanced tumours, mainly when early diagnosis is not performed. This article reports on a case of an advanced osteosarcoma of the maxilla. A 38-year-old woman was referred for evaluation and treatment of recurrent fibrous dysplasia of the facial bones. The patient related that she had been diagnosed with fibrous dysplasia four years earlier and, since the first diagnosis, she was submitted to four surgical interventions, all followed by recurrences. The main clinical findings were redness and swelling of the facial skin, upper lip ulceration, and hard palate swelling. Computed tomography showed a large hyperdense mass in right maxilla extending to right orbit and left maxillary sinus. An incisional biopsy was performed and microscopic examination showed areas of osteoid and chondroid formation surrounded by a cellular stroma. The diagnosis of osteosarcoma was established and the patient was recommended for oncologic treatment. Unfortunately, she died six months after the diagnosis due to uncontrollable local spread.     

The impact of delayed diagnosis on the outcomes of oral cancer patients: a retrospective cohort study

The contemporary literature is discordant regarding the role of delayed diagnosis in the prognosis of patients with oral cancer. This study examined data on a previously reported cohort of 101 patients with oral squamous cell carcinoma diagnosed at a single institution between 2008 and 2010. The time interval between symptom onset and initial histological diagnosis (diagnostic delay) was recorded for each patient, as were demographic data and cancer features such as T stage, nodal status, and smoking status. The mean follow-up period was 4 years 10 months. The mean diagnostic delay was 4 months, mean overall survival was 5 years 6 months, and mean disease-specific survival was 4 years 9 months. No significant correlation was found between diagnostic delay and overall survival, disease-specific survival, or recurrence rates. Patients with node-positive disease were more likely to be diagnosed earlier, whereas women and non-smokers were more likely to have a delayed diagnosis. Inherent tumour biology is likely an important prognostic factor separate to diagnostic delay. Public education efforts should focus on symptom recognition and encourage early presentation for investigation of oral lesions, particularly for females and non-smokers, so that more aggressive tumours can be treated sooner to give the best chance at survival.     

48例腮腺黏液表皮样癌病理和临床分析

目的：探讨腮腺黏液表皮样癌（mucoepidermoid cancer,MEC）的病理诊断、治疗和预后。方法：分析48例腮腺黏液表皮样癌的临床和病理特征,进行P53免疫组化检查,观察其与临床、病理分级、预后的关系。结果：48例病例中,男25例,女23例,平均43岁,多数首发症状为无痛性肿块,部分伴疼痛、面瘫及淋巴结转移,病程2周至8年不等,平均1年3个月。所有病例均行P53免疫组化染色,病理分级为高、中、低分化三组,其阳性率分别为54．5％、80％和100％。随访高、中、低分化组5年生存率分别为97％、90％、60％;临床Ⅰ、Ⅱ期和临床Ⅲ、Ⅳ期5年生存率分别为100％、55．6％。结论：腮腺黏液表皮样癌手术方案应综合考虑临床分期和病理分化程度。P53对判断腮腺MEC的分化程度、评估预后有一定的意义。     

Racial disparity in stage at diagnosis and survival among adults with oral cancer in the US

OBJECTIVES: To explore distribution of stage at diagnosis and relative survival rates among US adults with oral cavity cancer in relation to race, and over time. METHODS: We obtained 1973-2002 oral cancer incidence data from the Surveillance, Epidemiology, and End Results (SEER) Program, and computed proportions for each oral cavity site by stage at diagnosis, tumor size, and 5-year relative survival rates among Whites and Blacks. RESULTS: A total of 46 855 cases of oral cavity cancer were reported to the SEER registry among adults > or =20 years between 1973 and 2002. African-Americans had a significantly higher proportion of cancer, mainly in the tongue, that had spread to a regional node or to a distant site at diagnosis than Whites: 67% versus 49% of tongue cancers reported from 1973 to 1987 (P < 0.001), and 70% versus 53% of those reported from 1988 to 2002 (P < 0.001). They had a significantly higher proportion of tongue cancer that were >4 cm in diameter at time of diagnosis (59% versus 44%; P < 0.001), and black men in particular experienced lower 5-year relative survival rates than white men, in particular, for tongue cancer (25% versus 43% from 1973 to 1987, and 31% versus 53% from 1988 to 2002). CONCLUSION: There are significant racial disparities with respect to stage at diagnosis and survival among adults with oral cancer reported to the SEER registry from 1973 to 2002. One possible explanation for the lower survival among Blacks may be a difference in access to, and utilization of, healthcare services.     

Analysis of the proportion of salivary gland tumors in 528 elder patients]

OBJECTIVE: To analyse the clinical characteristic, evolution and prognosis of undifferentiated carcinoma with lymphoid stroma(malignant lymphoepithelial The purpose of this study was to investigate the present proportional ratio of salivary gland tumors in elder patients, to provide references for early diagnosis and treatment clinically. METHODS: The medical data of 528 elder patients with salivary gland tumors treated in our department in 1990s were reviewed and analyzed. RESULTS: The number of salivary gland tumors in elder patients had increased in recent years. These tumors were frequently found in patients of 60-74 years. The ratio of benign to malignant was 1.7:1. In benign tumors, the proportion of adenolymphoma approached pleomorphic adenoma. While in malignant tumors, adenoid cystic carcinoma accounted the most. These tumors were most commonly found in the parotid gland, followed by the palate. The prevalence of female had an increase trend. CONCLUSION: The proportion of salivary gland tumor in elder patients in 1990s was different from that in 1980s. This change should attract enough attention form the surgeons.     

Calcifying epithelioma (pilomatrixoma) of the head and neck: analysis of 37 cases

Objective: To review all cases of pilomatrixoma (calcifying epithelioma) of the head and neck published in Japanese dental journals 1977–1994. Design: Retrospective review. Setting: University hospital, Japan. Subjects: 37 Patients with 38 tumours, mean age 23 years, female: male ratio 2.4:1. Interventions: Enucleation alone (n=29, 78%), excision including covering skin (n=7, 19%), or excision including superficial lobe of parotid (n=1, 3%). Main outcome measure: Presentation, site, recurrence, and histological features. Results: Two patients had multiple tumours (5%). Most of the tumours were firm nodules covered with normal skin varying in size from 5 to 30 mm. The most common site was the preauricular region; 22 (58%) were in the anterior part. The follow up period ranged from 7 to 43 months during which there was only one recurrence. Tumours were encapsulated and solid composed of either shadow and basophilic cells or shadow cells alone, and the stroma contained varying amounts of calcification, ossification, and keratinization. Conclusions: The diagnosis should be suspected when the mass is adherent to the skin but not fixed to the underlying tissue. It is difficult to distinguish between benign and malignant tumours by imaging methods alone, so the recommended treatment must be complete excision including adherent skin.     

Diagnosis and treatment of epithelial salivary gland tumours in children and adolescents

In a series of 2,871 epithelial salivary gland neoplasms managed in the Peking University School of Stomatology between 1974 and 1999, 86 arose in children <16 years of age (52 parotid, 12 submandibular gland, 2 sublingual gland, and 20 minor salivary gland). Considerable delay was encountered in diagnosis (benign 24 months and malignant 16 months). In this group of children, 46 tumours (53%) proved to be malignant, with an incidence in the parotid, submandibular, sublingual, and minor salivary glands of 31/52 (60%), 2/12, 0/2, and 13/20 (65%), respectively. Sixty-six of 86 neoplasms (77%) occurred in children between 10 and 16 years of age. Only six neoplasms were encountered in children of 5 years or younger, four of which were high-grade malignant tumours. Benign tumours were successfully treated by local excision with only one recurrence. Of 46 malignant neoplasms, 8 were treated palliatively; of the remainder 8 were lost to follow-up and 2 patients died of their disease.     

Expression and mutations of p53 in salivary gland tumours

A series of 219 salivary gland tumours (103 carcinomas and 116 benign tumours) were analysed for p53 protein expression using immunohistochemistry, and for mutations in p53 gene using non-radioactive single strand conformation polymorphism (SSCP). p53 expression was present in 36% (42/116) of the benign tumours and in 54% (56/103) of the carcinomas. The highest prevalence of p53 expression was found in adenoid cystic carcinomas (69%). followed by mucoepidermoid carcinomas (67%). Of the benign tumours, pleomorphic adenomas showed the highest prevalence of p53 positivity (41%). In malignant tumours, expression of p53 bore no correlation to local recurrence, metastatic disease or survival of the patients. Exons 5 through 9 were analysed and four mutations were found in 20 cases of p53-immunopositive tumours and two in 20 p53-negative tumours. Each of the exons 5.6 and 8/9 had two mutations, whereas no mutations were detected in exon 7.     

Evaluation of p53 protein as a prognostic factor for oral cancer surgery

We have analysed concentrations of the p53 protein in advanced oral carcinomas immunohistochemically and genetically to detect the percentage of overexpression of this antioncogene that indicates a high probability of mutation. This would point to it being a useful prognostic factor, if we consider the importance of the relation between genetic alterations of p53 and poor overall survival. Seventy-five non-consecutive patients with oral squamous cell carcinoma and metastatic nodes were enrolled if there was homogeneity in histopathological grading (G2) of their tumours, and they were treated according to a multidisciplinary treatment plan. Monoclonal antibodies, extraction of DNA, and amplification of the polymerase chain reaction (PCR) were used for the immunohistochemical and genetic analyses. There was a significant inverse correlation between p53 overexpression and response to chemotherapy and a stronger association between high P53 overexpression (%) and a genetic mutation of p53 (p = 0.0001). More than 50% overexpression indicated a strong probability of genetic mutation. There was no association between response to chemotherapy and age-groups or TNM classification (p = 0.2), but there was a significant one between sex and site of tumour (p < 0.001). Three prognostic factors were significantly related to prognosis: site of tumour (p = 0.01), response to chemotherapy (p = 0.002), and immuno p53 (p = 0.0001). A tumour that is characterised by p53 overexpression of more than 50% indicates a poor prognosis.     

Periodontitis in smokers and non-smokers: intra-oral distribution of pockets

AIM: The purpose of the present study was to establish retrospectively whether the disease severity differs between smokers and non-smokers. METHODS: The study population consisted of 183 periodontitis patients, 79 smokers and 104 non-smokers. These subjects had been referred by general dentists to the Clinic for Periodontology, Utrecht, because of periodontal problems and were selected on the basis of the clinical diagnosis: adult periodontitis. The proportion of bleeding sites and the intra-oral distribution of probing pocket depth was evaluated. RESULTS: No statistically-significant differences between smokers (SM) and non-smokers (NSM) were found regarding the mean % of sites that bled upon probing (SM=76%, NSM=72%). Overall differences in the prevalence of probing depths > or =5 mm between smokers and non-smokers were found (SM=44%, NSM=34%). The proportion of sites with a probing pocket depth of > or =5 mm was consistently higher in smokers in the anterior, premolar and molar regions. The data also show that in the upper jaw at the anterior and premolar teeth, the largest differences are found between smokers and non-smokers. Smokers have more sites with a pocket depth > or =5 mm, especially on the lingual surfaces of these teeth. CONCLUSIONS: The present study indicates that cigarette smoking is a factor associated with deeper periodontal pockets and an intra-oral distribution that is suggestive of a local effect.     

Odontogenic tumours in children and adolescents: a study of 78 Nigerian cases.

BACKGROUND: There is paucity of literature on odontogenic tumours in children and adolescents. Available records are difficult to compare due to differences in study criteria. To contribute to the records, a 20-year study of odontogenic tumours on the basis of the WHO classification (Kramer et al., 1992) in Nigerian African children and adolescents < or =18 years of age was undertaken. MATERIAL: A retrospective survey of oral/jaw tumours and allied lesions in children and adolescents < or =18 years of age seen at the Maxillofacial Unit, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria between 1979 and 1998. Data collected were histopathologic type, age, clinical features, radiologic appearance, treatment and record of recurrence. METHOD: Odontogenic tumours selected using the WHO classification were used for further study. Data were collected from case notes, radiographs, histopathologic reports and follow-up records. Information retrieved was used to complete a questionnaire and subjected to analysis. RESULTS: Two hundred and fifty-two (252) subjects < or =18 years were recorded, from which 78 (31%) had odontogenic tumours. Among seven types of odontogenic tumours seen, ameloblastoma (54%), odontogenic myxoma (19%) and adenomatoid odontogenic tumour (9%) were predominant. All patients seen were from 6 to 18 years with more than half (53%) between 15 and 18 years of age. A patient with multiple, bilateral odontomas of the maxilla and mandible resembling Herrmann's syndrome was recorded. Seventy-three patients were treated using enucleation (37%), dentoalveolar resection with preservation of lower border (15%) and segmental resection (48%). Five patients absconded after tumour diagnosis. No tumour recurrence was recorded in 65 treated cases followed-up for between 2 months and 10 years. CONCLUSION: This report shows that while ameloblastoma was the predominant odontogenic tumour, its frequency in Nigerian African children was lower than in the adult population. A case resembling Herrmann's syndrome is also presented.     

Adenoid cystic carcinoma. Analysis of fifty oral cases.

Fifty cases of oral minor salivary gland adenoid cystic carcinoma (ACC) are analyzed and reported. Oral ACC frequently masquerades as a benign neoplasm, and in the majority of cases there is no pain or ulceration. The most common location is in the palate; a plea is made for incisional biopsy of all oral lesions suspected of salivary gland origin. Survival rates show a progressive decrease with time, and there were no survivors beyond 20 years. In this study, there was a positive correlation between duration of the lesion before diagnosis and the salvage rate, but no correlation was found with the size of the presenting lesion.     

p53 mutations and human papillomavirus infection in oral squamous cell carcinomas: correlation with overall survival.

PURPOSE: The study investigated the pattern of p53 gene mutations and human papillomavirus (HPV) infection concerning their relation to overall survival in patients with oral squamous cell carcinomas of the tongue and floor of the mouth. PATIENTS AND METHODS: The presence of HPV infection in 50 patients, and p53 gene mutations (42 patients from the same group) in the tumour specimens were analysed by polymerase chain reaction and single-stranded conformational polymorphism method. The follow-up period ranged from 12 to 48 (median 29) months. RESULTS: p53 mutations were identified in 11/42 tumours. HPV infection was detected in 32/50 cases, mostly HPV16 (10/32), HPV18 and HPV31 (6/32). A significantly higher incidence of HPV infection was found among smokers (p<0.05) and among patients with poor oral hygiene (p<0.01). The highest incidence of p53 mutations was detected in tumours of histological grade I and nuclear grade III. Patients with p53 mutation or with HPV infection had significantly shorter overall survival when compared with those that were without p53 mutations (p<0.01) or HPV infection (p<0.05). HPV-infected patients with p53 mutation had the worst prognosis when compared with patients with HPV infection only (p<0.01) or with patients negative for both HPV and p53 (p<0.01). CONCLUSION: The results stress once more the importance of HPV for the prognosis of survival of patients with squamous cell carcinoma of lower parts of the oral cavity. The presence of p53 mutations in HPV-infected tumours was associated with an even poorer prognosis for the patients.