Peritumoral infiltrate in the prognosis of epidermoid carcinoma of the oral cavity

IntroductionPatients with squamous cell carcinoma of the oral cavity present deficits in their cellular immunity that contribute to neoplastic growth. Thus, the inflammatory activity, such as the immunological response to the tumor, can be used as a prognostic factor.ObjectivesTo evaluate the correlation between peritumoral inflammation and clinical characteristics of the patients, survival, and the disease-free interval.MethodsThe study sample consisted of a retrospective hospital-based cohort of patients undergoing surgery for resection of oral cavity tumor. The inflammatory infiltrate on the slides was evaluated semi-quantitatively, and were divided into minor and major inflammatory processes.ResultsThis study included 57 tumor samples, with infiltration of lymphocytes, plasma cells, and histiocytes. The log-rank test showed no significance for the survival curves and recurrence of the “minor inflammatory” and “major inflammatory” processes, with p = 0.14 and p = 0.24, respectively. A direct association between age and inflammation (p = 0.04) was observed, as well as an indirect association between the degree of tumor differentiation and inflammation (p = 0.01).ConclusionAlthough associated with histological differentiation, the peritumoral inflammatory process cannot be considered a prognostic factor in squamous cell carcinoma of the oral cavity, as it is not related to survival and disease-free interval.     

Bilateral acinous cell tumors of the parotid gland

Acinous cell tumors are uncommon neoplasms which arise either from the secretory cells of the salivary gland acini or from pluripotential duct cells and occur almost exclusively in the parotid gland. Nine previous instances of the bilateral occurrence of this tumor in the parotid gland have been reported. We present a tenth case and illustrate several aspects of the clinical behavior of this unique tumor. The histological pattern of this type of tumor was considered universally to be benign until 1953 when attention was called to a malignant variant. It is difficult to find reference to a benign form after that time. It is, in fact, impossible to forecast the clinical behavior of an individual specimen based upon its histopathology. In order to recognize this unpredictability, the World Health Organization Classification of Epithelial Tumors of Salivary Gland Origin proposed a category, “Acinic Cell Tumors,” separate from clearly benign or malignant neoplasms. Later, attention was called to the grammatical designation, “acinous cell tumor.” Because acinous cell tumors are uncommon, numerically significant series are gathered from several institutions or over several decades during which treatment methods vary widely. This makes it difficult to accept the validity of conclusions based upon the reported data. There is, however, a clearly documented tendency of the tumor to recur after long symptomless intervals so that extended follow-up is necessary before “cure” is established. Treatment of acinous cell tumors is surgical. The value of radiation therapy in the management of recurrent tumors is not firmly established.     

Klinische und pathologische Untersuchungen über das Abwehrsystem des Tumorwirtes

Summary The skin-reaction on DNCB was studied in 41 patients with squamous cell carcinoma in the E.N.T. area. Furthermore the absolute lymphocyte count per mm³ blood was evaluated. In excisions of the tumor-tissue we determined simultaneously the differentiation of the tumor, the polymorphism of the tumor cell nuclei, the nature of its growth and the grade of its infiltration and we studied furthermore the vascular invasion and cellular infiltration of the peritumoral region. No significant correlation between the clinical and most of the histological parameters was observed. However, a close connexion of the tumor with its environment seems to be necessary for the development of an immunological response. Consequently a positive DNCB-test is not only a sign for a good immunological response but also for a more extensive infiltration, whereas negative DNCB-tests are not only a sign for the immunological insufficience but also for a limited growth of the tumor. Yet, the clinical prognosis is in general more promising in positive DNCB-skin-tests than in negative ones.The missing correlation between the appearance of general and local immunological reactions shows, that a more favourable prognosis must depend on other criteria than in those which can be demonstrated morphologically.     

Tumor biologic prognostic parameters in T1N0M0 squamous cell carcinoma of the oral cavity

BACKGROUND: Conventional prognostic factors in squamous cell carcinomas are tumor stage, tumor size, evidence of lymph node metastases, extracapsular spread of lymph node metastases, and Broder's grading. Unfortunately these parameters are only of limited value in predicting the biological behavior and ultimately the prognosis of a particular tumor. The present study was conducted for determining objective prognostic factors based on tumor biologic examinations in patients with squamous cell carcinomas of the oral cavity. These parameters were compared to the conventional prognostic factors. PATIENTS AND METHODS: Operative specimens of fourty-two patients who underwent surgery for a squamous cell carcinoma of the oral cavity with clinical TNM stage T1N0M0 were examined. All tumors were radically excised with histologic clear margins, which were confirmed by serial sections. The examinations included morphologic multifactorial tumor front grading, quantitative DNA analysis, and immunohistochemical assessment of proliferation markers (i.e. proliferating cell nuclear antigen [PCNA] and MIB1) and of oncogene products (i.e. p53; nm23). Prognostic significance of particular parameters was evaluated by univariate and multivariate Cox regression models. RESULTS: In clinical follow-up of 70 months on average, 6 patients developed local recurrences and 5 patients lymph node metastases. Three patients died of disease. Tumors which recurred had increased values for 2 c Deviation Index, 5 c Exceeding Rate along with high tumor front grading scores and proliferation scores. Using multivariate Cox regression analysis, parameters which were highly significant for prognosis were 5 c Exceeding Rate, tumor front grading score and PCNA score. None of the clinical parameters achieved statistical significance in the multivariate model. Tumors which recurred had also increased expression rates for p53 and nm23. Nevertheless this was statistically not significant. CONCLUSIONS: Tumor biologic examinations provide important informations about the clinical aggressiveness and ultimately about the prognosis of a particular tumor. Tumors with aggressive behavior can already be identified during initial diagnosis, which has consequences for the therapeutic management of the patients.     

Tumors of the Nasal Columella Treated by Mohs Micrographic Surgery

Primary nasal columellar tumors are rare but can exhibit aggressive clinical behavior, often leading to devastating outcomes if these tumors are not completely removed. Eleven patients with nonmelanoma nasal columellar lesions were evaluated. All lesions were excised by obtaining tumor-free margins with Mohs micrographic surgery. Seven of eight cases with basal cell carcinoma have been tumor free for more than 5 years, the eighth case remains tumor free at 4 years. The primary squamous cell carcinoma lesions treated in this study have fared well; one patient has been tumor free for the past 4.3 years. No local recurrence or distant metastasis has occurred to date for all cases. We conclude that intervention with Mohs micrographic surgery for the treatment of early nasal columellar tumors may lead to improved outcomes.     

头颈部鳞状细胞癌远处转移的相关因素分析

目的探讨头颈肿瘤远处转移的相关影响因素。方法对532例头颈部原发鳞状细胞癌患者的临床病理资料进行回顾性分析。选择性别、年龄、临床分期、T分级、N分级、原发癌部位、原发癌浸润深度、原发癌病理分级、有无颈淋巴结转移、颈阳性淋巴结数目、颈淋巴结转移累及区域、颈阳性淋巴结破膜情况等临床病理因素，用)(2检验和Logistic回归进行单因素和多因素分析，并用．Kaplan-Meier法对发生远隔部位转移患者进行生存分析。结果在532例头颈部原发鳞状细胞癌患者中，60例(11．3％)发生远处转移。单因素分析显示，临床分期(P=0．0126)、T分级(P=0．0082)、原发癌部位(P=0．0011)、原发癌浸润深度(P=0，0005)、有无颈淋巴结转移(P=0．0057)、颈阳性淋巴结数目(P=0．0149)、颈淋巴结转移累及区域(P=0．0034)、颈阳性淋巴结破膜情况(P=0．0118)与发生远处转移有关。多因素分析结果表明，仅原发癌部位、原发癌浸润深度与发生远处转移明显相关。用Kaplan-Meier法进行生存分析，结果显示60例发生远隔部位转移患者的1年生存率、3年生存率、5年生存率分别为51．7％、13．3％、6．5％。结论原发肿瘤部位和浸润深度是发生远处转移的共同决定性因素。而原发癌临床分期、T分级和有无颈淋巴结转移是头颈鳞癌远处转移的影响因素，但不是导致远处转移的初始和根本因素。喉癌、下咽癌以及原发癌侵犯肌肉、骨或软骨患者易发生远处转移。     

Small cell epidermoid carcinoma of salivary glands. 'Pseudo'-oat cell carcinoma

Two patients had small cell carcinomas of the salivary glands, with pathological features indicating squamous differentiation, heretofore not described. One is free of disease at seven years, and the second is alive, with regional metastases at four years. Sections from one tumor were studied by electron microscopy and revealed tonofilaments and desmosomes. Most cases of small cell carcinomas of the salivary glands have been considered akin to bronchogenic oat cell carcinoma. Their less aggressive behavior, however, suggests that at least some of these tumors were not true oat cell carcinomas. Our findings, and those of others, indicate that small cell carcinomas of the salivary glands (or head and neck) represent a heterogeneous group. Electron microscopy should be used to determine the exact nature of these neoplasms. If an oat cell nature is ruled out, local and regional treatment should be aggressive, since small cell carcinomas other than oat cell appear not to have a dismal prognosis.     

Medullary carcinoma of the thyroid gland

Endocrine as well as oncologic attributes mark this rare tumor as unique. It is derived from “C cells” resembling the parafollicular cells of lower animals; these cells elaborate Calcitonin which acts as a sensitive signal of the presence of the tumor. Other endocrinopathies are present in 70 percent of cases so that the tumor may present as part of a complex but increasing well known clinical picture. In 10 percent the tumor occurs as an autosomal dominate trait; in the remainder, the occurrence is sporadic. As expected the lesions are “cold” on I¹³¹ scan. The histologic appearance of amyloid is characteristic. Regional lymph node metastasis occurs early. The tumor deserves appropriate aggressive management. Essentially surgical therapy should begin early and vigorously; the minimum procedure should be total thyroidectomy. Frequent lymph node metastasis speaks for the need for radical neck dissection which should be extended into the superior mediastinum. Management should also include the frequently associated endocrinopathies, particularly pheochromocytomas which must be suspected and eradicated prior to treatment of the thyroid tumor. A genetic workup should be included. Six cases are described, ranging in age from the third to the eighth decade. Only two were free of disease at this writing, two were alive with their disease and two were dead of their disease. All were of the sporadic group, and only one had associated endocrinopathies. None of these cases were diagnosed preoperatively.     

Tumefactive fibroinflammatory lesions of the head and neck

We use the term “tumefactive fibroinflammatory lesion” to describe an unusual Although the biologic behavior and the surgical findings suggest that this lesion is an invasive, aggressive malignancy, the histologic appearance is a benign lesion consisting of an admixture of fibrous tissue and inflammatory cells. Treatment has included     

头颈部鳞癌颈淋巴结隐匿性转移

目的 探讨头颈部鳞癌隐匿性颈淋巴结转移的特点和规律。方法 对111例头颈部鳞癌N_0M_0患者的颈淋巴结清扫标本进行切片观察。结果 隐匿性转移总体发生率为26.12％(29/111)。其中口腔癌18.75％(15/80),口咽癌25.00％(1/4),下咽癌54.54％(6/11),喉癌43.75％(7/16)。原发癌临床分期、肿瘤细胞分化程度是影响颈淋巴结隐匿性转移的重要因素。111例N_0M_0患者5年生存率为66.7％,其中pN~-为74.39％(61/82),pN~ 为44.82％(13/29)。结论 对临床T_3和T_4期、癌组织分化程度低和深度浸润的cN_0头颈部鳞癌应行选择性颈清扫术以治疗颈淋巴结隐匿性转移并提高患者的生存率。     

Adenoid cystic carcinoma of the lacrimal gland with wide and severe myoepithelial differentiation.

Adenoid cystic carcinoma (ACC) of the lacrimal gland is the second most common epithelial tumor for which different biologic courses can be predicted by histologic criteria. Three main types of growth patterns, cribriform; tubular; and solid have been identified. Tumors with solid components frequently follow a more aggressive clinical course and show worse prognosis than those with other patterns. We herein report a case of ACC with wide and severe myoepithelial differentiation arising from the lacrimal gland and presenting with aggressive clinical behavior. Postoperative radiotherapy may be the treatment of choice to control residual lesions and provide long-term survival even in the case of incomplete resection. Despite extensive surgery and radiation therapy, the prognosis of these tumors, especially with solid components, remains extremely poor. Accurate diagnosis is important because tumor histopathology is generally believed to be the most significant factor in patient survival.     

Langerhans cells related to prognosis in patients with laryngeal carcinoma

Intratumoral and peritumoral infiltration of T-zone histiocytes, mainly of mature Langerhans cells, was investigated in 88 patients with squamous cell carcinoma of the larynx by immunohistochemical methods using polyclonal antibodies against S100 protein and lysozyme. Granulocytic and lymphoid inflammatory infiltration and its relationship to the presence of Langerhans cells were also evaluated. Langerhans cells were present within the cancer tissues and showed a relationship with lymphoid infiltrate. No significant correlation was present among the density of Langerhans cells and the site of neoplastic growth (supraglottic or subglottic), granulocytic inflammatory infiltration, histological tumor grade, or clinical stage. Patients with high or intermediate density of Langerhans cells survived longer than those with low density (mean survival, 61%, 62%, and 0%, respectively). The number of Langerhans cells was relevant in patients with evident infiltration of lymphocytes and plasma cells, according to their ability to present antigens to sensitized T cells. Our results indicate that the presence of high or intermediate density of Langerhans cells and of marked lymphoid inflammation may be considered favorable prognostic factors for patients with squamous cell carcinoma of the larynx.     

Amyloid deposits in the trachea and esophagus — ultrastructural confirmation

The clinical details of two patients suffering from amyloid infiltration of the trachea and esophagus respectively are presented. The “amyloid tumor” in the trachea presented with dysphonia and a swelling in the lower subglottic region. Attempts at complete surgical excision of it were unsuccessful. The patient with esophageal amyloid presented acutely with dysphagia and features of dehydration and malnutrition. Systematized amyloidosis was discovered at autopsy, but no primary initiating cause for it was found. In both cases it was possible to confirm the diagnosis by electron microscopy. The current views on the composition, structure, causation and treatment of amyloid disease are reviewed.     

Neuroendocrine neoplasms of the larynx

Neuroendocrine neoplasms of the larynx are a rare group of tumors that include carcinoid tumor, atypical carcinoid tumor, and small cell carcinoma. These neoplasms pose interesting diagnostic, prognostic, and therapeutic dilemmas, and they are, as a whole, aggressive tumors with a tendency for local and distant spread. The authors of this study examined six new cases of laryngeal neuroendocrine neoplasms. One case manifested itself as a primary atypical carcinoid tumor and caused a “carcinoid syndrome.” The remaining five cases were small cell carcinomas of the larynx. Histologic, immunocytochemical, DNA flow cytometric, and p⁵³ studies were performed on all cases. The expression of neuron-specific enolase and chromogranin were the most useful markers in this group of tumors. Overexpression of p⁵³ protein was present in the majority of cases, including the atypical carcinoid tumor. The implications of these studies for diagnosis, classification, and treatment are discussed.     

Malignancy of the larynx in a child

Squamous cell carcinoma of the larynx in children is rare. The management of laryngeal malignancy is more difficult in children than adults for several reasons: the aggressive nature of a tumor that is often diagnosed late in children; the delicacy of pediatric anatomic structures; intraoperative blood loss; long-term post-treatment complications; and psychological factors particular to children. A tracheostomized 13-year-old boy came to us with a 4-month history of hoarseness, breathing difficulty, and swelling in the neck. A detailed examination revealed that a transglottic tumor had infiltrated the thyroid and cricoid cartilage, the upper two tracheal rings, and the thyroid gland. Such an infiltration has not been previously reported. The lesion proved to be a well-differentiated squamous cell carcinoma. We performed a wide-field total laryngectomy, which was followed by radiotherapy. Unfortunately, the child survived only 3 years postoperatively.     

Basaloid squamous carcinoma of the larynx

BACKGROUND: Basaloid squamous cell carcinoma (BSCC) is a distinct variant of squamous cell carcinoma that was first described by Wain et al in 1986. Since then, about 160 cases have been reported in the literature. Only 40 cases have been described in the larynx. METHODS: Four cases of BSCC of the larynx treated in our department between 1986 and 2000 are presented. The clinical features, biological behavior, and histopathological and immunohistochemical characteristics of this uncommon tumor are described, and the relevant literature is reviewed. RESULTS: The main clinical presentation did not differ from other histological types of laryngeal carcinoma. The clinical course, however, was much more aggressive. All the patients received aggressive therapy including radical surgery and radiation. Two patients received chemotherapy. Two of the 4 patients presented died of distant metastasis shortly after diagnosis and treatment. CONCLUSIONS: The finding of this study with a limited number of patients supports previous reports suggesting that BSCC is a highly aggressive tumor that presents in older population with male predominance. The frequency of associated regional as well as distant metastases suggests that aggressive treatment is indicated and that systemic chemotherapy should be contemplated.     

The effect of hyperbaric oxygen on growth of human squamous cell carcinoma xenografts.

Hyperbaric oxygen is an important adjunct to the treatment of patients with head and neck cancer with existing or recurrent wound healing problems. Anecdotal clinical observations and a recent study of chemically induced oral cancer in hamsters have raised concern that hyperbaric oxygen therapy may accelerate tumor growth in such patients. This study evaluated the effect of hyperbaric oxygen therapy on the growth of human squamous cell carcinoma xenografts in a proved animal model. Fresh tumor specimens from three patients with head and neck squamous cell carcinoma of varying degrees of differentiation were first subcutaneously transplanted into a nude mouse host. Growing xenografts were then transplanted into one of three mouse groups. Half of the mice in each group were given hyperbaric oxygen therapy. The transplant volume as an index of tumor growth was measured in controls and mice given hyperbaric oxygen therapy six times during the 3-week course. Xenograft growth was almost linear in all mice. No statistical difference in overall group mean growth rates was observed in mice given hyperbaric oxygen or control mice regardless of the degree of tumor differentiation. Xenograft tissue from all mice was microscopically examined for tumor mitotic indices and degree of differentiation. This study suggests that hyperbaric oxygen therapy has no effect on established tumor xenograft growth.     

Malignant ameloblastoma: classification, diagnostic, and therapeutic challenges.

Ameloblastoma is a benign odontogenic neoplasm of the mandible and maxilla that rarely exhibits malignant behavior. We report the case of an aggressive malignant ameloblastoma of the mandible that presented with an unusual multiphasic, histologic pattern. Initial fine needle aspiration and radiographic findings showed features consistent with a benign, fibro-osseous lesion. However, aggressive growth and the association of enlarged submandibular lymph nodes suggested a more malignant potential. Treatment consisted of an angle-to-angle composite mandibular resection, right modified neck dissection, left functional supraomohyoid neck dissection, and anterior chin skin resection with iliac crest osteocutaneous free flap reconstruction. Microscopic evaluation showed primarily malignant ameloblastoma without cellular atypia and extensive fields of fibro-osseous tissue with smaller fields of clear cell odontogenic tumor. This multiphasic, histologic arrangement may explain the perplexing preoperative microscopic diagnosis, suggesting a benign fibro-osseous lesion. Of the lymph nodes analyzed, one from the right submandibular triangle exhibited metastatic, benign-appearing ameloblastoma without fibro-osseous or clear cell features. The absence of cellular features of malignancy in the tumor mass and lymph node metastasis suggest that the lesion should be classified as malignant ameloblastoma rather than ameloblastic carcinoma or odontogenic carcinoma. A malignant ameloblastoma with all 3 of the aforementioned microscopic features has not been previously reported. We review the classification of epithelial odontogenic malignancies. Lesions showing multiphasic patterns can create diagnostic dilemmas and may require extensive surgical sampling and/or removal to establish an accurate diagnosis.     

Factors associated with incomplete surgical margins in basal cell carcinoma of the head and neck

IntroductionCutaneous basal cell carcinoma recurrence is associated with inadequate surgical margins. The frequency of and the factors associated with compromised or inadequate surgical margins in head and neck basal cell carcinoma varies.ObjectiveThe purpose of this study was to evaluate the clinical and pathological factors associated with inadequate surgical margins in head and neck basal cell carcinoma.MethodsWe developed a cross-sectional study comprising all patients who had undergone resection of head and neck basal cell carcinoma from January 2017 to December 2019. Data on age, sex, head and neck topography, histopathological findings, and staging were retrieved and compared. Each tumor was considered an individual case. Compromised and close margins were termed “inadequate” or “incomplete”. Variables that were significantly associated with the presence of incomplete margins were further assessed by logistic regression.ResultsIn total, 605 tumors from 389 patients were included. Overall, sixteen cases (2.6%) were classified as compromised, 52 (8.5%) as close, and 537 (88.7%) as free margins. Presence of scleroderma (p = 0.005), higher Clark level (p < 0.001), aggressive variants (p < 0.001), invasion beyond the adipose tissue (p < 0.001), higher T stage (p < 0.001), perineural invasion (p = 0.002), primary site (p = 0.04), multifocality (p = 0.01), and tumor diameter (p = 0.02) showed association with inadequate margins. After Logist regression, multifocality, Clark level and depth of invasion were found to be independent risk factors for inadequate margins.ConclusionGross clinical examination may be sufficient for determining low prevalence of inadequate surgical margins when treating head and neck basal cell carcinoma in highly experienced oncologic centers. Multifocality, Clark level and depth of invasion were found to be independent risk factors for incomplete margins.     

Insular carcinoma of the thyroid

Thyroid surgeons are becoming increasingly more aware of a histologically distinct subset of thyroid carcinoma whose classification falls between well-differentiated and anaplastic carcinomas with respect to both cell differentiation and clinical behavior. This subtype of tumors has been categorized as poorly differentiated or insular carcinoma, based on its characteristic cell groupings. Although the differentiation of insular carcinoma from other thyroid carcinomas has important prognostic and therapeutic significance, relatively little about insular carcinoma has been published in the otolaryngology literature. In this article, we describe a new case of insular carcinoma and we discuss the findings of our review of the literature. We conclude that insular thyroid carcinoma warrants aggressive management with total thyroidectomy followed by radioactive iodine ablation of any remaining thyroid tissue.