p16基因与头颈部鳞状细胞癌的研究进展

细胞周期受控于周期蛋白与抑制蛋白的相互作用，细胞周期失调导致细胞增殖失控是肿瘤形成的主要原因。p16为细胞周期蛋白依赖性激酶(Cyclin dependent kinase，CDK)的主要抑制因子，是迄今为止所发现的人类第一个最直接抑制肿瘤发生的细胞固有成分。其编码基因是CDKN2A／p16INK4A基因，又名多肿瘤抑制基因，简称p16基因。p16基因在诸多肿瘤中的改变及其抑癌特性，使它成为近年来抑癌基因研究的热点。     

双路动脉化疗治疗头颈部鳞状细胞癌

目的总结动脉直接灌注大剂量化疗药物顺铂,同时静脉注射硫代硫酸钠进行中和的双路动脉化疗治疗头颈部鳞状细胞癌的临床经验。方法头颈部鳞状细胞癌患者16例,采用股动脉径路进入病变的供血动脉,以供血动脉的血流速度为灌注速度,按150mg/m2的顺铂每周进行1次动脉灌注,4～6次为一疗程。静脉同时予以注射硫代硫酸钠进行解毒。结果头颈部鳞状细胞癌常有明确的血供,表现为病变局部的异常血管团着色。该组晚期头颈部鳞状细胞癌患者中,动脉化疗近期有效率100%,表现为肿瘤在化疗后当日或第2日疼痛和肿胀感缓解,口、鼻腔内出现分泌物或坏死组织脱落。在可随访的病例中,CR4例,PR8例,NR1例。结论双路动脉化疗是治疗头颈部鳞状细胞癌的有效手段之一,可以作为手术治疗的重要补充。     

食管癌多层螺旋CT灌注成像研究进展

CT灌注成像是活体状态下评价组织微循环的一种无创性手段,可以客观反映病变血流动力学变化,为肿瘤临床诊断、分期及治疗效果评估提供重要信息。CT灌注参数可作为一种有价值的放射学定量指标,应用于食管癌的早期诊断,评价肿瘤血管生成、分期及分级,预测放化疗疗效或治疗前后的变化情况。综述食管癌CT灌注成像的研究现状及发展前景。     

头颈部肿瘤病人肺部CT检查的初步经验

头颈部肿瘤绝大多数是鳞状上皮细胞癌，虽然这些肿瘤主要沿颈部淋巴结扩散，但有11％到23％的病人在确诊时已有远隔转移。转移病灶一般局限于肺部。鳞癌可以多处同时发生，15％到30％的病人在食管及肺部等存在第二原发肿瘤。鉴于上述原因，对头颈部肿瘤病人的胸部应做仔细的检查。CT对于肺部结节较平片敏感。本文初步总结利用CT检测头颈部肿瘤病人肺部肿瘤的经验。     

乳腺鳞状细胞癌1例

病人，女，44岁，维吾尔族。因左乳房逐渐增大性包块5月余。病程中，包块表面皮肤出现红肿，局部有灼热感，且包块中心部位皮肤破溃，有淡黄色稀薄液体流出，每天量约10ml，行乳房溢液涂片中可见大量中性粒细胞及轻度核异质细胞。查体：左腋下可们及一直径约1cm肿大淋巴结，质地较硬，表面光滑，活动度良好。左侧乳房略增大，乳     

乳腺鳞状细胞癌一例

乳腺鳞状细胞癌少见,现报道一例。 患者女,52岁。1989年6月发现右乳头内下方有核桃大小肿物,伴有轻痛感。10月在纽约Buffalo总医院活检病理报告:右乳鳞状细胞癌。活检后肿物增长快,伤口不愈,溃烂,于11月4日入院。查体:右乳头内陷外偏,右乳头内侧有8×8cm大小溃疡面,菜花样,有脓性分泌及坏死组织,周围皮肤红肿淤血,青紫,溃疡基底部可触及10×12cm大小之肿块,质硬,不规则,与皮肤粘连固定,右腋下、锁骨上区可触及淋巴结各3枚1.0～1.5cm大小。质硬,活动度差。左乳未见异常。复阅Buffalo总医院病理片,镜下所见:皮肤组织表皮及皮肤附件未见异常,真皮深层可见一囊腔,内壁被复复层鳞状上皮,被复上皮自基底层至表层均呈异型增生,细胞大小不一?核深染,核分裂象易见,细胞间桥清晰,表层细胞明显角化。异型增生的上皮细胞突破基底向四周广泛浸润呈大小不等的     

肝细胞癌CT灌注参数与VEGF表达的相关性研究

目的: 探讨肝细胞癌(HCC)CT灌注参数与血管内皮生长因子(VEGF)表达的相关性,以期获得在活体评价肿瘤血管生成状况的途径.材料和方法: 经手术病理证实的肝细胞癌组24例,对照组15例.患者均依次行常规全肝平扫、CT灌注扫描及常规全肝增强扫描.用免疫组化SP法检测HCC中VEGF的表达.结果: 肝癌组肝动脉灌注量(HAP)明显升高,门静脉灌注量(HPP)显著降低,肝癌组比对照组肝动脉灌注指数(HAI)明显升高而门静脉灌注指数(PPI)显著下降;不同VEGF表达组的HCC灌注参数不同,HAP值与VEGF表达存在正相关.结论: 肝细胞癌CT灌注参数HAP与VEGF表达存在正相关,灌注参数在一定程度上反映活体的肿瘤血管生成状况和恶性程度,有助于临床制定治疗方案,判断疗效及预后.     

原发性甲状腺鳞状细胞癌1例

患者男性 ,75岁。因咳嗽 5周诊断为急性支气管炎于 1 999- 0 5- 1 7入院。因声嘶发现左侧声带麻痹。钡餐显示食管上段充盈缺损 ,外压 3～ 4cm,粘膜未破坏。支纤镜发现声门左侧一 0 .5cm× 0 .8cm小息肉 ,气管环结构消失 ,粘膜活检为慢性炎症 ,痰涂片未见瘤细胞。甲状腺 B超 :左叶下极 3.6cm×2 .7cm× 4.1 cm低回声区 ,分布不均匀 ,边界欠规则。ECT:左叶下极不规则放射状稀疏 ,为冷结节。CT:左侧胸廓入口处、甲状腺下方见一形态不规则软组织致密影 ,2 .0 cm× 4.0 cm× 4.0 cm,CT值56.81～ 48.37Hu,密度不均匀 ,边界不清 ,气管、食管受…     

输尿管鳞状细胞癌一例

患者,妇,67岁。1个月前感左侧下腹部疼痛并左下肢肿胀,活动后加重。外院超声,MRI检查提示左侧盆腔肿物伴左输尿管扩张,左侧肾盂积水。患者无尿膜,尿急,尿痛,血尿等症状。腹部平片;双肾区,输尿管走行及膀胱区无异常;左肾影略小。静脉肾盂造影;左肾及左侧输尿管未显影,右肾,输尿管及膀胱未见异常。     

皮肤基底细胞癌,鳞状细胞癌表皮生长因子及其受体免疫组化研究

应用免疫组化法观察了４３例基底细胞癌（ＢＣＣ）、２６例鳞状细胞癌（ＳＣＣ）表皮生长因子（ＥＧＦ）及其受体（ＥＧＦＲ）的表达。结果表明：ＥＧＦ及ＥＧＦＲ在所有ＢＣＣ中表达均有增强，且在边缘肿瘤组织表达强于中央肿瘤组织。ＳＣＣ组织中ＥＧＦ及ＥＧＦＲ表达强度与肿瘤分化程度呈负相关。提示ＥＧＦ和ＥＧＦＲ对ＢＣＣ及ＳＣＣ的发展可能起促进作用；ＳＣＣ组织中ＥＧＦ及ＥＧＦＲ表达有助于识别其生物学行为及估计预后。     

64-row MDCT perfusion of head and neck squamous cell carcinoma: technical feasibility and quantitative analysis of perfusion parameters

Objectives  

To evaluate the technical feasibility of 64-row computed tomography (CT) quantitative perfusion imaging of head and neck squamous cell carcinoma (SCC).     

Whole tumour quantitative measurement of first-pass perfusion of oesophageal squamous cell carcinoma using 64-row multidetector computed tomography: Correlation with microvessel density

Purpose

To assess correlations between whole tumour first-pass perfusion parameters obtained with 64-row multidetector computed tomography (MDCT), and microvessel density (MVD) in oesophageal squamous cell carcinoma.

Materials and Methods

Thirty-one consecutive patients with surgically confirmed oesophageal squamous cell carcinomas were enrolled into our study. All the patients underwent whole tumour first-pass perfusion scan with 64-row MDCT. Perfusion parameters, including perfusion (PF), peak enhanced density (PED), blood volume (BV), and time to peak (TTP) were measured using Philips perfusion software. Postoperative tumour specimens were assessed for MVD. Pearson correlation coefficient tests were performed to determine correlations between each perfusion parameter and MVD.

Results

Mean values for PF, PED, BV and TTP of the whole tumour were 28.85 ± 20.29 ml/min/ml, 23.16 ± 8.09 HU, 12.13 ± 5.21 ml/100 g, and 35.05 ± 13.85 s, respectively. Mean MVD in whole tumour at magnification (×200) was 15.75 ± 4.34 microvessel/tumour sample (vessels/0.723 mm²). PED and BV were correlated with MVD (r = 0.651 and r = 0.977, respectively, all p < 0.05). However, PF and TTP were not correlated with MVD (r = 0.070 and r = 0.100, respectively, all p > 0.05).

Conclusion

The BV value of first-pass perfusion CT could reflect MVD in oesophageal squamous cell carcinoma, and can be an indicator for evaluating the tumour angiogenesis.     

CT-guided lymphoscintigraphy in patients with squamous cell carcinoma of the head and neck: a feasibility study

Accurate knowledge of lymphatic drainage facilitates planning of surgery for patients with squamous cell carcinoma of the head and neck. The aim of this study was to evaluate the feasibility of a new injection technique for lymph node detection in patients with squamous cell carcinoma of the hypopharynx and larynx, in whom simple peritumoural injection is hampered by the tumour localisation. Computed tomography (CT)-guided lymphoscintigraphy was performed in a total of 13 patients with squamous cell carcinoma of the hypopharynx and larynx who could not be injected by simple visual inspection. In a first step, contrast medium-enhanced axial 5-mm-thick CT slices of the neck were obtained. After tumour localisation on these CT images, 1–2 ml contrast medium and, in the event of appropriate distribution, subsequently 50 MBq technetium-99m colloid were injected at one to three peritumoural sites under CT guidance. Peritumoural tracer distribution was controlled by thin-slice CT. Subsequently, planar scintigrams from anterior, right and left lateral views were obtained. In all patients, peritumoural colloid application was feasible, as shown on control CT scans. Post injection, neither severe nor minor complications were noted. The patients complained of only low pain sensations with an average score of 1.8 on a pain scale from 0 to 10. Lymphatic drainage was identified in nine of the 13 patients, with a total of 14 detected lymph nodes. In six patients, ipsilateral sentinel lymph nodes were visualised; bilateral sentinel lymph nodes were identified in one patient and contralateral lymphatic drainage was observed in two patients. CT-guided lymphoscintigraphy is a feasible and minimally invasive diagnostic tool for sentinel lymph node detection in patients with squamous cell carcinoma of the hypopharynx and the larynx. In contrast to endoscopic colloid injection under general anaesthesia, this technique seems to be a well-tolerated method for lymphatic mapping prior to surgical procedures.     

Whole-body-MR imaging including DWIBS in the work-up of patients with head and neck squamous cell carcinoma: A feasibility study

Objectives

To assess the feasibility of whole-body magnetic resonance imaging (WB-MRI) including diffusion-weighted whole-body imaging with background-body-signal-suppression (DWIBS) for the evaluation of distant malignancies in head and neck squamous cell carcinoma (HNSCC); and to compare WB-MRI findings with ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) and chest-CT.

Methods

Thirty-three patients with high risk for metastatic spread (26 males; range 48–79 years, mean age 63 ± 7.9 years (mean ± standard deviation) years) were prospectively included with a follow-up of six months. WB-MRI protocol included short-TI inversion recovery and T1-weighted sequences in the coronal plane and half-fourier acquisition single-shot turbo spin-echo T2 and contrast-enhanced-T1-weighted sequences in the axial plane. Axial DWIBS was reformatted in the coronal plane. Interobserver variability was assessed using weighted kappa and the proportion specific agreement (PA).

Results

Two second primary tumors and one metastasis were detected on WB-MRI. WB-MRI yielded seven clinically indeterminate lesions which did not progress at follow-up. The metastasis and one second primary tumor were found when combining ¹⁸F-FDG-PET/CT and chest-CT findings. Interobserver variability for WB-MRI was κ = 0.91 with PA ranging from 0.82 to 1.00. For ¹⁸F-FDG-PET/CT κ could not be calculated due to a constant variable in the table and PA ranged from 0.40 to 0.99.

Conclusions

Our WB-MRI protocol with DWIBS is feasible in the work-up of HNSCC patients for detection and characterization of distant pathology. WB-MRI can be complementary to ¹⁸F-FDG-PET/CT, especially in the detection of non ¹⁸F-FDG avid second primary tumors.     

Functional imaging of head and neck squamous cell carcinoma with diffusion-weighted MRI and FDG PET/CT: quantitative analysis of ADC and SUV

Purpose

Head and neck squamous cell carcinoma (HNSCC) may cause a decreased apparent diffusion coefficient (ADC) on diffusion-weighted magnetic resonance imaging (DW MRI) and an increased standardized uptake value (SUV) on fluorodeoxyglucose (FDG) positron emission tomography (PET/CT). We analysed the reproducibility of ADC and SUV measurements in HNSCC and evaluated whether these biomarkers are correlated or independent.

Methods

This retrospective analysis of DW MRI and FDG PET/CT data series included 34 HNSCC in 33 consecutive patients. Two experienced readers measured tumour ADC and SUV values independently. Statistical comparison and correlation with histopathology was done. Intra- and inter-observer agreement for ADC and SUV measurements was assessed.

Results

Intraclass correlation coefficient (ICC) analysis showed almost perfect reproducibility (>0.90) for ADC_mean, ADC_min, SUV_max and SUV_mean values for intra-observer and inter-observer agreement. Mean ADC_mean and ADC_min in HNSCC were 1.05?±?0.34 × 10^?3?mm²/s and 0.65?±?0.29 × 10^?3?mm²/s, respectively. Mean SUV_mean and mean SUV_max were 7.61?±?3.87 and 12.8?±?5.0, respectively. Although statistically not significant, a trend towards higher SUV and lower ADC was observed with increasing tumour dedifferentiation. Pearson’s correlation analysis showed no significant correlation between ADC and SUV measurements (r ?0.103, ?0.051; p 0.552, 0.777).

Conclusion

Our data suggest that ADC and SUV values are reproducible and independent biomarkers in HNSCC.     

Calcified nodal metastasis from squamous cell carcinoma of the head and neck

Calcification within cervical lymph nodes is relatively rare, and most commonly ascribed to benign inflammatory or infectious processes. We present a case of a calcified submandibular nodal metastasis from squamous cell carcinoma of the lip and review the current published literature on nodal calcifications in the neck. To the authors' knowledge, calcification resulting from metastatic squamous cell carcinoma of the head and neck has been described only once previously.     

Hyaluronic acid carrier-based photodynamic therapy for head and neck squamous cell carcinoma

PurposeConventional photosensitizers for photodynamic therapy (PDT) typically have wide tissue distribution and poor water solubility. A hyaluronic acid (HA) polymeric nanoparticle with specific lymphatic uptake and highly water solubility was developed to deliver pyropheophorbide-a (PPa) for locally advanced head and neck squamous cell carcinoma (HNSCC) treatment.Methods and ResultsPPa was chemically conjugated to the HA polymeric nanoparticle via an adipic acid dihydrazide (ADH) linker. The conjugates were injected subcutaneously in a region near the tumor. Near-infrared (NIR) imaging was used to monitor distribution, and diode laser was used to activate PPa. The singlet oxygen generation efficiency of PPa was not affected by conjugation to HA nanoparticles at a PPa loading degree of 1.89 w.t.%. HA-ADH-PPa inhibited human HNSCC MDA-1986 cell growth only when photo-irradiation was applied. After HA-ADH-PPa treatment and radiation, NU/NU mice bearing human HNSCC MDA-1986 tumors showed reduced tumor growth and significantly enhanced survival time compared with an untreated group (p < 0.05).ConclusionsThese results demonstrate that HA-ADH-PPa could be useful for in vivo locoregional photodynamic therapy of HNSCC.