Androgen receptors in normal and neoplastic laryngeal tissue

Androgen cytoplasmic (ARc) and nuclear (ARn) receptors were analyzed in normal and cancerous laryngeal tissue obtained from male and female patients. In men, neither ARc nor ARn were detectable in most of the normal larynx tissue specimens, while either ARc, ARn, or both were present in eight of 16 laryngeal carcinomas. In women, all three normal and two of four malignant laryngeal tissue specimens possessed ARc without ARn. The presence of androgen receptors in some laryngeal carcinomas shows that these tumors are possibly hormone sensitive, and hormonal therapy should be considered in treating these tumors.     

喉癌颈部转移淋巴结分布研究

目的 :回顾分析我院 1990年 4月～ 2 0 0 0年 4月收治的喉癌患者 2 89例颈部转移淋巴结的分布情况 ,指导颈清扫手术。方法 :将 2 89例分为 3组 :第 1组 :颈清扫术后有转移淋巴结的分布 (181例 ) ;第 2组 :术后病理诊断阴性淋巴结的免疫组化研究 (71例 ) ;第 3组 :未清扫者随访中再转移淋巴结的分布研究 (37例 )。结果 :第 1组清扫 2 4 2侧 ,颈部Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ区转移率分别为 2 .8%、98.3%、32 .6 %、15 .0 %、13.0 %、2 1.4 % ;第 2组 71例 ,其中 4 6例 (5 0侧 )免疫组化研究发现 13个淋巴结内有微灶转移 ,分布于 11例患者中 ,所有转移淋巴结均分布在Ⅱ区 ;第 3组 37例 ,施行挽救性手术共 4 5侧 ,Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ区转移率分别为 2 .2 %、10 0 %、4 8.9%、2 6 .7%、13.3%。结论 :喉癌首先转移和主要转移部位为Ⅱ区 ,其次为Ⅲ区 ;Ⅳ、Ⅴ区发生率则较低 ,颌下区几乎不发生转移。喉癌患者的颈清扫应在常规清扫颈侧Ⅱ～Ⅳ区淋巴结的同时 ,根据病变范围情况行Ⅳ区的清扫 ,对颌下三角和颈后三角 (Ⅴ区 )在无影像学和术中证实的条件下 ,应予以保留 ,以缩短手术操作时间和减少术后并发症的发生     

Concentration of estrogen and progesterone receptors in normal and neoplastic tissue in patients with laryngeal neoplasm

The analysis of larynx cancer localisation inside the larynx and hypopharynx indicate that there are some places prone to cancerogenesis. Differences in morbidity, organ localisation and prognosis of larynx cancer can be explained not only by exogenic factors but also by endogenic ones, including hormones. The estrogen (ER) hormone receptor concentration and progesterone (PgR) concentration was estimated in the neoplastic tissue in 18 patients (16 men, 2 women). In the control group, in 10 patients (9 men, 1 women) the concentration receptor was assessed in surrounding, macroscopically unchanged tissue. The quality assessment was done both in cytoplasmatic and nuclear receptors. 6 specimens of neoplastic tissue was taken from vocal folds, 7 from vestibular folds, 2 from subglottic space, 2 from epiglottic petiolus and 1 from pyriform sinus. Control group consist of 10 healthy tissue specimens including 4 taken from the vocal cords. 4 from vestibular folds, 2 from free edge of epiglottis. All samples were examined by pathologist. The concentration of cytoplasmatic and nuclei receptors (ER and PgR) was estimated by immunoenzymatic essay by ER-EIA and PgR-EIA monoclonal antibodies (Abbott). The highest concentration of receptors in larynx cancer was stated in tissue coming from vestibular folds and epiglottic petiolus in healthy objects in the region of vestibular folds.     

Incidence of metastatic well-differentiated thyroid cancer in cervical lymph nodes

OBJECTIVE: To determine the incidence of clinically positive lateral cervical nodes at presentation and after initial treatment in patients with well-differentiated thyroid cancer. DESIGN: Retrospective chart review. SETTING: University-affiliated teaching hospitals. PATIENTS: A total of 508 patients who underwent a thyroidectomy as part of their initial treatment for well-differentiated thyroid carcinoma between January 1978 and December 1999. Neck dissections were performed only for clinically palpable cervical nodes. MAIN OUTCOME MEASURES: Recurrence in the neck and survival. RESULTS: Forty-four patients (9%) had palpable lateral cervical lymph nodes at the time of surgery. All 31 patients younger than 45 years presenting with palpable positive nodes are alive and free of disease; 4 of 13 patients 45 years or older have died of thyroid cancer. Only 16 (3%) of 464 patients who did not undergo initial neck dissection had recurrence in lateral cervical nodes. Recurrence is more likely when the initial tumor is larger than 4 cm. In 216 patients younger than 45 years, there were 5 (2%) recurrences in lateral cervical nodes; these patients remain alive and free of disease. In 248 patients 45 years or older, there were 11 (4%) with recurrent disease in the lateral neck; 4 of these patients have died of thyroid cancer. CONCLUSIONS: An aggressive approach to detecting and treating occult lateral cervical nodes by techniques such as jugular node sampling, sentinel node biopsy, or image-guided needle biopsy is not necessary in most patients. Attempts to detect and remove occult lateral cervical lymph node metastases might be considered in older patients with large primary tumors.     

喉癌颈淋巴结抗肿瘤免疫状态的研究

目的　通过对肿瘤引流淋巴结中增生性滤泡反应和树突状细胞 (dendriticcell,DC)浸润密度进行定量分析 ,探讨其在喉癌患者抗肿瘤免疫反应中的作用。方法　重新制备 4 7例行选择性颈淋巴结清扫术的喉癌患者的 15 7枚颈淋巴结石蜡切片 ,用抗S 10 0、CD4 5RO和CD2 0单克隆抗体免疫组化抗生物素 生物素过氧化物酶复合物 (avidin biotinperoxidase,ABC)法显示DC和增生性滤泡的分布并检测其密度。根据增生性滤泡反应的特点进行分型研究。结果　增生型滤泡反应的程度与类型和DC浸润密度有明显的相关性。术后生存 5年以上的患者淋巴结中滤泡计数和DC浸润密度明显多于生存期少于 5年者 (P <0 0 0 1)。无淋巴结转移组患者淋巴结中的滤泡计数和DC浸润密度较有转移组亦有明显增加 (P <0 0 0 1)。具有T细胞增生型滤泡反应的患者比T细胞非增生型患者有较高的 5年生存率 (P <0 0 1)和较低的淋巴结转移率 (P <0 0 5 )。结论　颈淋巴结中增生性滤泡反应和树突状细胞的浸润反映了机体免疫系统的抗肿瘤潜能。树突状细胞的浸润密度和增生性滤泡反应的程度及分型反映了该患者的抗肿瘤免疫状态 ,可以共同作为预后判定的重要指标。     

舌鳞状细胞癌颈部淋巴结转移的治疗

目的 分析舌鳞状细胞癌颈部淋巴结转移性的分布规律,探讨舌鳞状细胞癌cN0患者的颈部处理。方法 回顾性分析1975年1月-2000年12月初次在我院诊治的329例舌鳞状细胞癌患者的临床资料。cN0 179例,cN1 131例,cN2＋3 19例（2例出现双侧颈淋巴结转移）。在cN0患者中,肩胛舌骨肌上清扫或单纯颔下清扫20例,根治性颈清扫93例,扩大的肩胛舌骨上（包括Ⅳ区）清扫8例。在cN1患者中,30例接受颈部单纯放疗;肩胛舌骨肌上清扫6例,根治性颈清扫94例,扩大的肩胛舌骨上清扫1例。所有cN2＋3患者均行根治性颈清扫。结果 舌鳞状细胞癌颈部淋巴结隐性转移率为8．3％（10／121）,其中T1为1．3％（1／76）,T2为4．3％（4／93）,T3为44．4％（4／9）,T4 100％（1／1）。实际颈部淋巴结转移率为71．7％（81／113）。91例患者组织学检查发现颈清扫标本中淋巴结转移阳性,Ⅰ区淋巴结转移占39．6％（36／91）、Ⅱ区71．4％（65／91）、Ⅲ区19．8％（18／91）和Ⅳ区8．8％（8／91）。有2例患者发生对侧Ⅰ、Ⅱ和Ⅳ区的淋巴结转移。在cN0患者中,颈部单纯放疗的同侧颈部复发率为7．5％（3／40）,综合治疗为7．5％（6／80）,单纯手术为2．4％（1／41）,等待观察为16．7％（3／18）;颈部单纯放疗的5年生存率分别为42.0％,综合治疗为55．6％,单纯手术为79．6％,等待观察为48．6％。结论 Ⅱ区是舌鳞状细胞癌最易转移的部位,不主张对所有cN0患者实施择区性颈清扫,对T3和T4患者可考虑扩大的肩胛舌骨肌上清扫（Ⅰ～Ⅳ）。     

树突状细胞在喉癌颈淋巴结中的浸润

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A retrospective study of dual-energy CT for clinical detecting of metastatic cervical lymph nodes in laryngeal and hypopharyngeal squamous cell carcinoma

Conclusion: After the reconstruction of imaging in dual-energy CT gemstone spectral imaging, the ratio of the two slopes curves, the target lymph node and primary lesion, respectively, might contribute to the clinical diagnosis of cervical lymph nodes in laryngeal and hypopharyngeal squamous carcinoma. Objective: To investigate the value of the dual-energy CT gemstone spectral imaging for clinical detecting of metastatic cervical lymph nodes in laryngeal and hypopharyngeal squamous carcinoma. Methods: Forty-seven cases who were suffering from laryngeal or hypopharyngeal squamous carcinoma and had complete clinical and pathological data were included, and 79 cervical lymph nodes were studied retrospectively (including 31 metastatic nodes and 48 non-metastatic nodes). Contrast-enhanced energy spectral imaging and reconstruction were performed. After the reconstruction, the slope of the curve in the target lymph node and the lesion were calculated. The ratio of the two slopes was studied. The pathological data of cervical lymph node and primary lesion were also collected. Results: The ratios were 1.20 ± 0.09 and 0.82 ± 0.12 in metastatic and non-metastatic lymph nodes, respectively. The difference was statistically significant (p < 0.05). The ratio was positively correlated to the stasis of lymph nodes only, rather than their morphological appearance, the pathological classification, or the individual difference (p < 0.05).     

Interest in frozen section examination of margins and lymph nodes in laryngeal surgery

One hundred and one patients presenting with a squamous cell carcinoma of the larynx underwent surgery in our department between January 1980 and May 1985. In most of these patients, nodes were removed from the main lymphatic drainage pathways and subjected to immediate frozen section examination. The results from frozen section examination of the nodes were then compared with those from the surgical specimens of cervical neck dissections performed on the patients according to the classic rules. In addition, margin resections were made and examined by frozen section after removal of the tumour. In the event of a positive finding, these resections were continued until healthy tissue was reached, the specimens being examined in addition by classic methods. Immediate frozen sections enable the margins of the resection to be verified correctly. In our series we were brought to extend the limits of resection in 10 cases out of 68 (15 per cent). It can also be seen that the accuracy of the pathologist's reading of the frozen sections is satisfactory. The overall level of error is three out of 68 (4.5 per cent). All the errors correspond to false negatives. The aim of avoiding neck dissections in the presence of N0, thanks to nodal selection with frozen section, is not attained. We find a 6/61 rate of false negatives for N0-N1 (10 per cent) when we compare the frozen sections of the selected nodes and the neck dissections. This is due to the fact that the surgeon may be led astray by a reactive hyperplastic node whilst other less inflammatory neighbouring nodes are in fact the site of metastasis.     

Estrogen receptor in normal and neoplastic human thyroid tissue

Clinical evidence suggests the possible influence of estrogen on the biologic behavior of thyroid neoplasm. In this study we evaluated the distribution and characteristics of intracellular receptors for estrogen in normal and neoplastic thyroid tissue obtained from 54 patients. Forty-two percent of all specimens assayed by the protamine sulfate precipitation technique had a detectable intracellular binding site for estrogen. Differentiated carcinomas (eight of eight) and adenomas (seven of nine) had high incidences of receptors compared with goiter (five of 23) and normal thyroid (three of eight). However, there were no detectable receptors for estrogen in medullary carcinomas of the thyroid (0 of six). Also, carcinomas and adenomas had higher receptor contents than did goiter and normal differentiated thyroid tissue. There was no significant difference in the affinity of estrogen for receptors among the different histologic groups. There were both 4S and 8S receptor types, which were specific for estrogen. The binding of estrogen to thyroid tissue and differentiated neoplasm originating from thyroid tissue were comparable to the binding of estrogen to other hormone-dependent normal and neoplastic tissues.     

Ultrasonographic evaluation of metastatic cervical lymph nodes in head and neck cancers

This study evaluates the use of ultrasonography (USG) to diagnose metastatic cervical lymph nodes. Three-hundred and one lymph nodes were removed from 58 patients with squamous cell carcinomas of the head and neck. None of the patients had received any preoperative treatments for cancer. The lymph nodes were then histopathologically examined: 139 metastatic lymph nodes and 162 non-metastatic nodes were found. USG was then used to evaluate the size, internal echo, and margin of each lymph node. Size was found to be the best criteria for distinguishing metastatic lymph nodes from non-metastatic lymph nodes in all cervical regions (78% accuracy). Superior internal jugular lymph nodes and submandibular lymph nodes larger than 7 mm and mid and inferior internal jugular lymph nodes larger than 6 mm were regarded as metastatic. Internal echoes were classified into five patterns: homogeneous hypoechoic, homogeneous hyperechoic, heterogeneous, eccentric hyperechoic, and centric hyperechoic. Homogeneous hyperechoic and heterogeneous patterns were characteristic of metastatic nodes, while eccentric hyperechoic patterns were characteristic of non-metastatic nodes. Homogeneous hypoechoic patterns were observed in both metastatic and non-metastatic nodes. Regular margins were found in 81% of the metastatic nodes. Of the 22 lymph nodes with irregular margins, however, 91% were metastatic. Evaluations using a combination of USG and clinical feature criteria were compared with evaluations using only thickness as a criterium. Although thickness is the single most important factor in diagnosing metastatic nodes, the combination of USG and clinical feature criteria improved the accuracy of diagnosis to 83%. Thus, diagnostic methods involving a combination of several criteria are more accurate than methods involving only a single criterium.     

KAI1基因在喉癌及转移淋巴结中的表达

目的 通过研究KAI1基因在人类喉鳞状细胞癌及转移淋巴结中的蛋白表达情况,试图阐明KAI1基因蛋白的表达与喉癌转移之间的关系。方法 取喉鳞状细胞癌组织标本蜡块40例及转移的淋巴结13例,以癌旁正常组织标本蜡块30例作为对照,采用免疫组织化学SP法,检测KAI1单克隆抗体在喉鳞状细胞癌、转移淋巴结及癌旁正常组织标本中蛋白的表达,并结合患者临床病理资料进行统计学分析。结果 KAI1基因在癌旁正常组织、喉鳞状细胞癌及转移淋巴结中的表达率分别为93.33%（28/30）、62.50%（25/40）、30.77%（4/13）,且各组之间差异均有统计学意义（P＜0.05）。KAI1基因的蛋白表达与喉鳞状细胞癌的临床分期差异有统计学意义（P＜0.05）,与性别、年龄、原发部位、病理学分级及有无淋巴结转移无关(P＞0.05)。 结论 KAI1基因在喉鳞状细胞癌转移淋巴结中的表达较在喉鳞状细胞癌中的表达呈显著性下降,该基因可能在喉癌转移过程中起一定作用。     

Prognostic importance of harvested lymph node number,metastatic lymph node number,and lymph node ratio in surgically managed laryngeal squamous cell carcinoma

IntroductionLymph node metastasis is a well-known prognostic factor for laryngeal carcinoma. However, current nodal staging systems provide limited information regarding prognosis. Additional parameters should be considered to improve prognostic capacity.ObjectivesTo assess the prognostic values of metastatic lymph node number, ipsilateral/contralateral harvested lymph nodes, and lymph node ratio in patients undergoing surgical treatment of laryngeal squamous cell carcinoma.MethodsSeventy-four patients diagnosed with laryngeal squamous cell carcinoma primarily managed surgically were included in this study. The patients’ pathological and survival data were obtained from their medical records. The effects of harvested lymph nodes and lymph node ratio on disease-free survival, disease-specific survival, and overall survival were analyzed.ResultsIpsilateral, contralateral, and bilateral evaluations of harvested lymph nodes showed no significant associations with prognosis. Lymph node ratio was significantly associated with overall survival when evaluated bilaterally. Metastatic lymph node number showed more suitable stratification than TNM classification.ConclusionsMetastatic lymph node number and bilateral lymph node ratio parameters should be taken into consideration to improve the prognostic capacity of TNM.     

Infiltration of dendritic cells into cervical lymph nodes in laryngeal carcinoma]

OBJECTIVE: Dendritic cells(DC) form a system of highly efficient antigen-presenting cells. An immunohistochemical study was performed to prove their role in immune responses against cancer. METHODS: Paraffin blocks were prepared for staining with antibody against S-100 proteins in 157 lymph nodes obtained from elective cervical lymphadenectomy in 47 cases of laryngeal squamous cell carcinomas. RESULTS: The extent of infiltration by DC into the regional lymph nodes was evaluated in two groups according to negative and positive lymph node metastasis. Densities of DC ranged from 23.0 to 111.9, with an average of 57.2 +/- 16.0, in the negative metastasis nodes; and from 17.5 to 63.6, with an average of 38.3 +/- 14.9, in the positive metastasis nodes. The test revealed that the differences in population density between the two groups were significant (P < 0.001). Quantitative analysis showed that patients who survived longer than 5 years had significant higher numbers of DC in the lymph nodes than those who lived less than 5 years (P < 0.001). Densities of DC ranged from 32.0 to 111.9, with an average of 61.6 +/- 19.6, in the nodes of 20 cases of patients who survived longer than 5 years and from 17.5 to 65.8, with an average of 37.9 +/- 13.7, in the nodes of 27 cases of patients who survived less than 5 years. CONCLUSION: DC may be more directly involved in the host immune reaction against tumor by means of the most important antigen-presenting cells. DC in the cervical lymph nodes are important for establishing immunologic defense mechanisms in cases of laryngeal carcinomas, and the densities of DC can serve as a useful indicator in assessing prognosis of laryngeal carcinomas.     

喉癌颈淋巴结抗肿瘤免疫状态的研究

OBJECTIVE: Densities of dendritic cells (DC) and hyperplastic follicular response in cervical lymph nodes were performed to prove their roles in immune responses against cancers. METHODS: Paraffin blocks were prepared for staining with monoclonal antibodies against CD45RO, CD20 and S-100 proteins,in 157 lymph nodes obtained from elective cervical lymphadenectomy in 47 cases of laryngeal squamous cell carcinomas. RESULTS: Quantitative analysis showed that the patients who survived longer than 5 years had significant higher number of follicles and higher extent of infiltration by DCs in the lymph nodes than those who less than 5 years (P < 0.001). According to negative or positive lymph node metastasis, there were statistically significant differences between two groups (P < 0.001). The patients who possessed T cell increase type follicular reaction had significant higher five-year survival rate ( P < 0.01) and lower lymph node metastasis rate (P < 0.05) than those who possessed T cell decrease type reaction. CONCLUSION: DCs and hyperplastic follicular response may be more directly involved in the host immune reaction against tumor. The classification of follicular reaction, the densities of DCs and follicular reaction, can serve as important indicators in assessing prognosis of laryngeal carcinomas.     

Immunohistological reaction patterns of cervical lymph nodes in patients with laryngeal carcinomas

Summary An attempt was made to assess the immunological importance of regional lymph node histology in relation to the survival of 107 patients with carcinoma of the larynx, operated on from 1973 to 1982 at the ENT-Clinic in Marburg. A total of 2765 sections of lymph nodes removed during neck dissections were examined microscopically to evaluate the morphological patterns of response. Microscopically, four distinct patterns were defined. Patients whose lymph nodes demonstrated immunological responses according to patterns I and II in the form of either expanded inner cortices or increased numbers of germinal centers had a greater 5-year survival rate than those patients whose lymph nodes showed an unstimulated pattern. Eight patients whose lymph nodes showed a depleted pattern, IV, did not survive more than 3 years. Morphological assessment of immunological activity in lymph nodes draining malignant tumors seems to be of value in predicting survival. The evaluation of the reaction pattern and difficulties in methodology, however, set definite limitations to our study.