Squamous cell carcinoma and lingual thyroid

This report represents the first known case of squamous cell carcinoma associated with lingual thyroid tissue. Clinical examination of an exophytic mass at the base of tongue, CT imaging and a preoperative biopsy established a diagnosis of squamous cell carcinoma of the midline base of tongue. The therapeutic options and management of this carcinoma by surgical resection, irradiation or combined modalities were analyzed. The surgical option was chosen. This was accomplished via a midline labiomandibulo glossal split and primary repair of the wound. The final pathology report revealed a squamous cell carcinoma of the mucosa of the base of tongue directly over a benign lingual thyroid mass. Post-operative thyroid function studies were consistent with hypothyroidism and a thyroid scan confirmed the absence of thyroid tissue.     

Establishment and characterization of a human cell line from a squamous carcinoma of the tongue

A human squamous carcinoma cell line, PWH-S1, has been established from the metastatic lymph node of a Chinese patient with a squamous cell carcinoma of the tongue. The fibroblast-free culture has been propagated in DMEM supplemented with 10% fetal bovine serum for more than 100 passages. PWH-S1 cells showed anchorage-independent growth in 0.3% agar solution. PWH-S1 cell line exhibited a monolayer growth and loss of contact inhibition. The in vitro doubling time of the PWH-S1 cell line was approximately 28 h. PWH-S1 was tumourigenic after inoculation into nude mice. Karyotype analysis showed the chromosome abnormality with a modal number of 69. Electron microscopy demonstrated poorly differentiated neoplastic cells with some features of squamous cell differentiation. No human papillomavirus (type 6, 11, 16, 18, 31) was detected in the PWH-S1 cell line by the polymerase chain reaction. Keywords cell line establishment and characterization tongue cancer     

Basaloid squamous carcinoma of the larynx: Report of a case

Basaloid squamous carcinoma (BSC) is a rare neoplasm. We present a case of basaloid squamous carcinoma of the larynx in a 57-year-old male patient. The diagnosis before treatment was supraglottic carcinoma (T3N1MO) and biopsy of the larynx revealed a poorly differentiated squamous cell carcinoma. Total laryngectomy and right radical neck dissection were performed, and pathological studies of a specimen removed from the larynx revealed BSC of the larynx. The patient's postoperative progress was uneventful, however, 12 months later he developed lung metastasis of the left side. The patient underwent partial resection of the lung. He developed recurrence of lung metastasis 6 months later. Chemotherapy with cisplatin (CDDP) and vindesine sulfate (VSD) was administered in two courses, but the efficacy was evaluated as no change (NC). At present, 26 months after the first visit, he has been asymptomatic with lung metastasis, and there was no evidence of recurrence in the neck.     

The suprahyoid approach for squamous cell carcinoma of the base of the tongue.

The suprahyoid pharyngotomy is a well-recognized surgical approach to the base of the tongue. However, its use has been widely criticized for squamous cell carcinomas. Some surgeons believe this approach offers limited exposure and that violating the preepiglottic space increases the risk of recurrence. A retrospective study of squamous cell carcinoma of the base of tongue was carried out to address these surgical concerns. Nineteen patients presented with T1 or T2 lesions, 13 of whom underwent suprahyoid pharyngotomy with neck dissection. Those with nodal disease underwent adjunctive irradiation therapy and those with extracapsular spread also received subsequent adjuvant chemotherapy. At present, all patients are disease free. The suprahyoid pharyngotomy is an ideal surgical approach in the management of T1 or T2 squamous cell carcinoma of the base of tongue.     

Expression of epidermal growth factor receptor in laryngeal dysplasia and carcinoma

The immunoreactivity of epidermal growth factor receptor (EGFR) was studied in laryngeal biopsy specimens from 24 patients. The study comprised 5 cases of normal laryngeal mucosa, 5 cases of dysplasia, 7 cases of well differentiated squamous cell carcinoma, and 7 cases of poorly to moderately differentiated squamous cell carcinoma. EGFR was in general not expressed in normal and dysplastic epithelia, whilst all carcinomas showed a rather strong positive immunoreactivity. There was no significant difference in staining patterns between the well and poorly to moderately differentiated carcinomas. The results suggest that EGFR constitutes a component of neoplastic, but probably not preneoplastic, laryngeal disease. The study failed to reveal any difference in staining pattern between different types of laryngeal squamous cell carcinoma.     

Immunohistochemical identification of squamous carcinoma of the head and neck with monoclonal antibody SQM1

Frozen tissue sections of biopsies from head and neck squamous cancer lesions were examined for immunohistochemical staining with a recently developed monoclonal antibody, designated as SQM1 antibody and directed against the surface membrane of squamous carcinoma cells. SQM1 antibody stained selectively squamous carcinoma, while normal mucosa and cells of the stroma were non-reactive. Positive staining of tumor was found in 33/35 specimens obtained from several major sites of the head and neck area and was observed in primary manifestations and lymph node metastases as well as in recurrences. The most consistent reactivity was seen with carcinomas of the tongue. Well differentiated squamous carcinomas contained a higher proportion of SQM1 positive tumor cells than poorly differentiated carcinomas. We suggest that the SQM1 antibody may aid in the immunohistochemical identification of squamous carcinoma of the head and neck area.     

Mixed squamous cell carcinoma and follicular carcinoma of the thyroid gland

Primary squamous cell carcinoma of the thyroid gland (PSCCT) is rare and its aetiology is debated. A 67-year-old man presented with neck mass. Fine-needle-aspiration (FNA) cytology and through-cut biopsy were suggestive of poorly differentiated or anaplastic carcinoma. The patient was offered tracheostomy and palliative cure for unresectable tumor of the thyroid; he refused and decided for other opinion. Lobe-isthmusectomy was performed with diagnostic and debulking intent. Final pathology report was of mixed squamous cell and follicular carcinoma of the thyroid. The tumor was a PSCCT. The patient underwent adjuvant chemoradiotherapy. After 2 years, an iliac crest metastasis of follicular carcinoma was diagnosed. The patient is disease free, after surgery and radio-active-iodine treatment. The hypothesis of squamous cell carcinoma transformation from well differentiated thyroid cancer has to be considered in case of PSCCT. Primary squamous cell carcinoma of the thyroid gland (PSCCT) is rare [1-3]; different theories on its aetiology do exist [4-6]. Mixed squamous cell and follicular carcinoma is even more rare than pure squamous cell of the thyroid gland and only few cases are reported in literature [7]. Preoperative diagnosis can be very challenging and the differential diagnosis with secondary squamous cell carcinoma of the thyroid (SSCCT) is manadatory in order to plan a correct management of the disease. The presence of PSCCT with distant metastasis of follicular carcinoma supports the histogenesis of squamous cell carcinomas arising from follicular epithelial cells.     

Bilateral primary carcinoma of the external auditory meatus]

We report an extremely rare case of bilateral primary carcinoma of the external auditory meatus. A 50-year-old man suffered 1 month from left-ear discharge and otalgia. Examination revealed a tumor of the left ear canal and a biopsy showed well-differentiated squamous cell carcinoma. The patient underwent 60 Gy radiotherapy and left subtotal temporal bone resection. A tumor with irregular swelling of the right external canal was found 8 months after the first diagnosis. Biopsy of the right external canal confirmed the same squamous cell carcinoma. Genetic examination that the carcinoma of the right ear was probably not a metastatic from the carcinoma of the left ear.     

Prognostic value of p53 expression and histopathological parameters in squamous cell carcinoma of oral tongue.

The TNM staging system is helpful but not enough to determine prognosis of the patients with squamous cell carcinoma of the oral tongue. T-stage alone is not suggestive for prediction of occult nodal metastases. For this reason, histopathological examination of 70 patients with squamous cell carcinoma of the oral tongue was done retrospectively. The histological differentiation, tumour thickness, perineural and lymphovascular space invasions, the amount of lymphocyte infiltration and pattern of tumour invasion were examined. Immunohistochemical examination was used to determine p53 immunoreactivity as well. The effect of these histopathological parameters and p53 immunoreactivity on nodal metastases and locoregional recurrence were analyzed using the chi-squared test. In terms of nodal metastases the only statistically significant difference between the two groups was tumour thickness, either < 9 mm or > 9 mm (p < 0.05, chi 2 = 17.182). Tumour thickness, perineural invasion, lymphovascular space invasion, the amount of lymphocyte infiltration all correlated statistically with locoregional recurrence (p < 0.05, chi 2 = 6.293 for tumour thickness; p < 0.06, p = 0.054 for perineural invasion; p < 0.05, chi 2 = 8.689 for lymphovascular space invasion; p < 0.05, chi 2 = 5.320 for lymphocyte infiltration). The immunoreactivity of p53 correlated significantly with larger primary tumour size (p < 0.05, chi 2 = 5.440, lymph node metastases (p < 0.05, chi 2 = 4.093) and with pathological tumour stage (p < 0.05, chi 2 = 5.713). These results reveal that the above-mentioned histological parameters and p53 determination could be used for handling a specimen from an anterior tongue squamous cell carcinoma.     

舌根鳞状细胞癌37例临床分析

目的 总结舌根癌的手术方法及功能重建经验。方法 回顾性分析1994年3月～2006年3月我院手术治疗的37例原发于舌根的鳞状细胞癌患者的临床资料。结果 37例患者均行颈淋巴结清扫术,病理报告颈淋巴结转移率达64.9％(24/37)。肿瘤切除的手术方式以咽侧径路为主,占59.5％(22/37),缺损修复主要采用胸骨舌骨肌肌筋膜瓣及胸大肌肌皮瓣修复。术后发生并发症共8例。患者术后经康复训练逐步恢复了饮食功能;除4例未拔除气管套管外,全部恢复了言语功能;3年、5年生存率分别为62.2％(23/37)、51.4％(19/37)。结论 术前对肿瘤范围及颈淋巴结转移情况进行准确评估,以选择合适的手术入路及缺损修复方式,是彻底切除肿瘤、进行功能重建并提高生存质量的重要前提。     

Incidence of Unsuspected Metastases in Lateral Cervical Cysts

Objective Solitary cystic squamous cell carcinoma metastases may be difficult to distinguish clinically from a benign cervical cyst. We sought to identify the incidence of solitary cystic squamous cell carcinoma metastasis in patients presenting with apparently benign cervical cysts. Study Design Retrospective review. Methods The records of all patients who presented with isolated lateral cervical cysts between 1983 and 1999 were reviewed. Patients with a clinically apparent primary malignancy, a history of head and neck cancer, a history of irradiation, or age less than 18 years were excluded from analysis, as were patients with a histological diagnosis of nonsquamous cell malignancy or those without a final histological diagnosis. Results One hundred twenty‐one adult patients presented with an initial diagnosis of lateral cervical cyst. Metastatic squamous cell carcinoma was demonstrated histologically after surgical excision in 12 patients (9.9%). The incidence of malignancy was significantly greater in patients greater than 40 years of age (23.5%, P < .0001). Results of preoperative fine‐needle aspiration (FNA) were negative for malignancy in five cases of metastatic squamous cell carcinoma. Panendoscopy with directed biopsies revealed an occult primary in the base of tongue in three patients, tonsil in one patient, and nasopharynx in one. No primary was found in six patients, despite repeated examinations and close follow‐up. Conclusions Solitary cervical cysts in patients older than 40 years of age should be presumed to be carcinoma until proven otherwise. A negative FNA result may be misleading, because of hypocellularity of the cyst fluid. Excisional biopsy should be undertaken with provisions made for frozen‐section analysis of the specimen and contingency panendoscopy with directed biopsies of Waldeyer's ring if frozen‐section histological examination reveals malignancy.     

Guanylate cyclase activity in normal and neoplastic squamous epithelia from the upper aero-digestive tract

Cyclic nucleotides (cAMP, cGMP) are suggested to participate in the regulation of cell growth and differentiation. Guanylate cyclase is the enzyme which catalyzes the synthesis of cGMP. The basal guanylate cyclase activity was slightly higher in well-differentiated squamous cell carcinomas than in normal mucosa, but was two-fold higher in papillomas. Poorly differentiated squamous cell carcinoma did not show any increased basal activity. Stimulation with nitroprusside (NP) resulted in a 20% increased activity for normal mucosa and a 30% increase for poorly differentiated carcinomas, whereas enzyme prepared from well-differentiated squamous carcinomas and papillomas showed a two-fold increase.     

Tongue viability after bilateral lingual artery ligation and surgery for recurrent tongue-base cancer

A 73-year-old man came to us with a second primary tumor of the tongue base. He had undergone a total laryngectomy, neck dissections, and radiation for squamous cell carcinoma of the glottis 25 years earlier. Surgery was performed, including a subtotal tongue-base resection and pectoralis myocutaneous flap reconstruction. Intraoperative findings confirmed tumor involvement of the left lingual artery and hypoglossal nerve, both of which were sacrificed. Dissection revealed an intact but apparently thrombosed right lingual artery, and this was verified by intraoperative Doppler evaluation. Postoperatively, the preserved oral tongue remained well perfused and viable, and tongue mobility was good. In patients who have undergone previous head and neck cancer resections, collateral blood supply to the tongue might develop if the flow of one or both of the lingual arteries is interrupted. This possibility can be fully evaluated by preoperative angiography, which might offer these patients the potential for tongue preservation.     

Metastatic endometrial carcinoma of the neck

We report a case of metastatic endometrial carcinoma of the neck. A patient with a past medical history of squamous cell carcinoma of the larynx, breast carcinoma and endometrial carcinoma presented with a neck mass. Fine needle aspiration cytology (FNAC) showed this to be a poorly differentiated carcinoma with squamoid features and thus a potentially curative neck dissection was performed. Histology of the mass showed a clear cell endometrial carcinoma. Metastatic gynacecological malignancies to the head and neck are rare and this is the first reported case of metastatic endometrial carcinoma in the neck.     

P-Glycoprotein expression in the squamous cell carcinoma of the tongue base

P-glycoprotein (PGP), which is a product of the multidrug resistance gene (MDR1), is an active transmembrane efflux pump responsible for detoxifying normal cells as well as rendering tumor cells resistant to chemotherapy. It has also been implicated to be expressed by more aggressive cancers. It has not been well described in squamous cell carcinoma of the head and neck. In this investigation, an attempt was made to characterize advanced squamous cell carcinoma of the base of tongue with respect to expression of PGP. Using immunohistochemical techniques two anti-PGP monoclonal antibodies (JSB1and C494) were used to detect PGP in these lesions, and an attempt was made to correlate levels of PGP staining and various tumor parameters. Usefulness of PGP in predicting survival and time to recurrence was also examined for these advanced lesions. All 33 base of tongue lesions showed staining for PGP with these monoclonal antibodies. This was the first study examining utility of C494 in detecting PGP in squamous cell carcinoma at this site. Increased level of PGP expression was seen in better-differentiated tumors as well as in tumors with diploid DNA. A trend of higher PGP expression and decreased survival emerged. This may represent a true relationship, but inherent heterogeneity of PGP expression within cells cannot be excluded. Both antibodies examined appear to be useful in the investigations of PGP distribution in squamous cell carcinomas of the head and neck sites by immunohistochemical techniques. Prognostic value of the level of PGP expression remains to be seen.     

多重癌的临床分析

目的探讨先证舌鳞状上皮癌(简称鳞癌)多重癌的临床特点和预后。方法中山大学肿瘤防治中心头颈科1992年1月～2001年12月收治580例舌鳞癌患者中,48例多重癌,其中先证舌鳞癌19例,回顾分析其临床和随访资料,探讨其临床特点和预后;Kaplan- Meier方法计算累积生存率。结果全组患者总的3年、5年生存率分别为30.3%、20.2%;第二原发癌19例包括口腔鳞癌9例(舌癌5例、软腭癌2例,口底和牙龈癌各1例)、食管鳞癌4例(其中发生在颈段1例)、肺癌3例,腮腺腺癌、喉鳞癌和乳腺腺癌各1例。两癌发生的中位时间间隔为78个月(范围:6～132个月)。结论舌鳞癌多重癌占全部舌鳞癌患者的8.1%,其中39.5%为先证舌鳞癌;第二原发癌63.1%发生在头颈部,该类患者预后较差,故加强舌鳞癌患者的随访及时发现第二原发癌甚为重要。     

Spindle cell carcinoma as a locally recurrent malignancy after surgery for early lingual squamous cell carcinoma

Spindle cell carcinoma (SpCC) of the tongue is a relatively rare malignancy. We treated a patient with metachronous early squamous cell carcinoma (SCC) in both margins of the tongue (right side first followed by left side). Eight years after treatment for the first SCC by surgery and radiotherapy, the second SCC occurred in the contralateral margin of the tongue. Surgical resection was performed for the second SCC, with local recurrence 8 months later associated with pathological change from SCC to SpCC. The SpCC was completely resected with wide surgical margins in combination with bilateral neck dissection. However, the patient developed pulmonary metastasis and died of respiratory failure 4 months after the final surgery. Postoperative inflammatory reaction followed by scar formation in the previously irradiated surgical site might have caused the transition from SCC to SpCC during the process of recurrence.     

Spindle cell carcinoma as a locally recurrent malignancy after surgery for early lingual squamous cell carcinoma

Spindle cell carcinoma (SpCC) of the tongue is a relatively rare malignancy. We treated a patient with metachronous early squamous cell carcinoma (SCC) in both margins of the tongue (right side first followed by left side). Eight years after treatment for the first SCC by surgery and radiotherapy, the second SCC occurred in the contralateral margin of the tongue. Surgical resection was performed for the second SCC, with local recurrence 8 months later associated with pathological change from SCC to SpCC. The SpCC was completely resected with wide surgical margins in combination with bilateral neck dissection. However, the patient developed pulmonary metastasis and died of respiratory failure 4 months after the final surgery. Postoperative inflammatory reaction followed by scar formation in the previously irradiated surgical site might have caused the transition from SCC to SpCC during the process of recurrence.     

Immunohistochemical detection of epidermal growth factor receptor in laryngeal squamous cell carcinomas.

Laryngeal squamous cell carcinomas from 15 consecutive preoperatively irradiated patients were investigated for the expression of epidermal growth factor receptor (EGF receptor). The study was performed on frozen sections by means of the 5-layer APAAP technique employing an antibody recognizing the extracellular part of the EGF receptor. In sections from 9 of the patients with laryngeal squamous cell carcinoma, normal differentiated epithelia were included. Sections from 6 of these patients, in addition, contained dysplastic epithelia. Expression of EGF receptor-like material was demonstrated in the basal cell layer of normally differentiated laryngeal epithelial and in dysplastic epithelia. Fourteen of the squamous cell carcinomas proved EGF receptor positive. Nearly all cells in the poorly differentiated carcinomas showed positive staining with the antibodies. In moderately to well differentiated carcinomas a reduction in the extent of staining was seen in certain areas. Especially for the epithelial pearls, the staining reaction was localized to the undifferentiated cells in the periphery. This finding corresponds to the staining pattern observed in the basal cell layers of normal epithelial. The present investigation confirms the expression of EGF receptor-like material in normal laryngeal epithelial, dysplastic epithelial and squamous cell carcinoma. The staining pattern was similar to that observed in oral squamous cell carcinomas, predominantly varying inversely with cellular differentiation.