A case of squamous cell carcinoma of the anal cancer with associated human immunodeficiency virus

A 62-year-old man with internal piles tested positive for infection with HIV and was admitted to our hospital. He presented with an anal tumor with bilateral inguinal nodal metastasis and pain in the anus; the tumor was diagnosed as stage IIIb (cA1N2M0). The patient's immune system was unstable. Therefore, he was administered chemoradiotherapy [low dose 5-fluorouracil plus cisplatin (FP) and radiotherapy (RT)] following HAART. Chemoradiotherapy resulted in complete response. However, CT performed 2 years after the diagnosis showed a recurrence in the hilar and mediastinal lymph node. The patient was administered chemotherapy with 5-fluorouracil and cisplatin (5-FU/CDDP) to the metastatic lymph node. However, the treatment response was graded as progressive disease, and the treatment was changed from CDDP to mitomycin C (MMC). The patient developed non-hematologic toxicity and died within 3 years of the diagnosis. We report a case of squamous cell carcinoma of the anus with associated HIV infection.     

重组人内皮抑素对肺鳞癌放射增敏作用的体外实验研究

目的 探讨国产重组人内皮抑素是否对肺鳞癌细胞系H-520具有放射增敏作用.方法 取指数生长期的人肺鳞癌细胞系H-520细胞,用成克隆实验检测内皮抑素的细胞毒性和各实验组的克隆形成能力,计算各组细胞存活分数,利用多靶单击模型拟合细胞存活曲线.流式细胞术检测细胞凋亡、细胞周期分布变化及活化的Caspase蛋白片段水平.结果 成克隆实验中内皮抑素联合照射组较照射组D0、Dq、D10、SF2值均低,放射增敏比为1.50(D0值之比).流式细胞术检测细胞凋亡示内皮抑素+照射组细胞凋亡率分别为22.38%±1.61%、35.01%±1.16%、46.83%±2.06%、64.08%±4.28%,照射组分别为4.27%±0.29%、14.3%±1.15%、28.49%±1.58%、54.79%±1.89%,两组凋亡率差异有统计学意义(t=19.17、17.79、25.64、3.44,P值均<0.05).内皮抑素可诱导H-520细胞G0+G1阻滞,而照射则诱导G2+M期阻滞.内皮抑素+照射组活化Caspase蛋白片段表达增加(62.7%±1.9%)较对照组(12.1%±0.1%)、内皮抑素组(54.6%±1.0%)和照射组(34.1%±1.2%)显著增高(t=46.69、6.55、22.54,P值均<0.05;).结论 内皮抑素可通过抑制H-520细胞牛长、促进凋亡、细胞周期重分布来达到放射增敏作用.     

Fast-growing squamous cell lung cancer

We here report a case of squamous cell carcinoma of the lung, with an unusually fast tumor growth rate, so fast that its early detection was impossible even with two sequential chest roentgenograms taken only 36 days apart. Literature related to the concept of cell growth kinetics was reviewed, and the tumor volume doubling time that characterizes any measurable tumor was calculated for our case accordingly, based on the single lesion found on the plain chest film, with the best possible estimation of its volume. We concluded that, to the best of our knowledge, a squamous cell carcinoma of the lung that grew so fast (with a tumor doubling time less than 7.5 days) has not yet been reported to date; neither has a bronchogenic carcinoma of any cell type been reported with such a presentation. Given that a patient aged 81 belonged to a group usually with slower growth in tumor cell kinetics, the behavior of his tumor was indeed uncommon.     

A HLA-A2-restricted CTL epitope induces anti-tumor effects against human lung cancer in mouse xenograft model

Cancer immunotherapy is attractive for antigen-specific T cell-mediated anti-tumor therapy, especially in induction of cytotoxic T lymphocytes. In this report, we evaluated human CTL epitope-induced anti-tumor effects in human lung cancer xenograft models. The tumor associated antigen L6 (TAL6) is highly expressed in human lung cancer cell lines and tumor specimens as compared to normal lung tissues. TAL6 derived peptides strongly inhibited tumor growth, cancer metastasis and prolonged survival time in HLA-A2 transgenic mice immunized with a formulation of T-helper (Th) peptide, synthetic CpG ODN, and adjuvant Montanide ISA-51 (ISA-51). Adoptive transfer of peptide-induced CTL cells from HLA-A2 transgenic mice into human tumor xenograft SCID mice significantly inhibited tumor growth. Furthermore, combination of CTL-peptide immunotherapy and gemcitabine additively improved the therapeutic effects. This pre-clinical evaluation model provides a useful platform to develop efficient immunotherapeutic drugs to treat lung cancer and demonstrates a promising strategy with benefit of antitumor immune responses worthy of further development in clinical trials.     

Paraneoplastic syndromes associated with lung cancer

Paraneoplastic syndromes are signs or symptoms that occur as a result of organ or tissue damage at locations remote from the site of the primary tumor or metastases. Paraneoplastic syndromes associated with lung cancer can impair various organ functions and include neurologic, endocrine, dermatologic, rheumatologic, hematologic, and ophthalmological syndromes, as well as glomerulopathy and coagulopathy (Trousseau’s syndrome). The histological type of lung cancer is generally dependent on the associated syndrome, the two most common of which are humoral hypercalcemia of malignancy in squamous cell carcinoma and the syndrome of inappropriate antidiuretic hormone secretion in small cell lung cancer. The symptoms often precede the diagnosis of the associated lung cancer, especially when the symptoms are neurologic or dermatologic. The proposed mechanisms of paraneoplastic processes include the aberrant release of humoral mediators, such as hormones and hormone-like peptides, cytokines, and antibodies. Treating the underlying cancer is generally the most effective therapy for paraneoplastic syndromes, and treatment soon after symptom onset appears to offer the best potential for symptom improvement. In this article, we review the diagnosis, potential mechanisms, and treatments of a wide variety of paraneoplastic syndromes associated with lung cancer.     

Hypercalcemia-leukocytosis syndrome associated with lung cancer

Hypercalcemia and leukocytosis are two of the most common paraneoplastic syndromes associated with various malignancies. Of note, concomitant manifestation of hypercalcemia and leukocytosis are occasionally observed in the same cancer patients. However, the relationship between these two paraneoplastic syndromes and clinical outcome is unclear. In the present study, we retrospectively investigated the occurrence of hypercalcemia (> or = 10.2 mg/dl after adjustment for serum albumin concentration), leukocytosis (> or = 14,000/mm3 with no evidence of infection) or both in lung cancer patients (1149 cases). There were 65 cases (5.7%) of hypercalcemia, 16 cases (1.4%) of leukocytosis and six cases (0.5%) of both hypercalcemia and leukocytosis at the time of first presentation. The occurrence of these two distinct paraneoplastic syndromes in the same patients was more frequent than could have been expected by chance alone (P < 0.001). There was a significant correlation between the hypercalcemia-leukocytosis syndrome and performance status (P = 0.002). Survivals of patients with hypercalcemia alone (median survival time: MST 3.8 months, n = 59), leukocytosis alone (MST 1.9 months, n = 10), and the hypercalcemia-leukocytosis syndrome (MST 1.5 months, n = 6) were significantly shorter than those without them (MST 9.5 months, n = 1074; P < 0.001). Moreover, survival of patients with the hypercalcemia-leukocytosis syndrome was significantly shorter than that of patients with hypercalcemia alone (P = 0.013). On the other hand, there was no significant difference in survival between the hypercalcemia-leukocytosis syndrome and leukocytosis alone (P = 0.47). Multivariate analysis of prognostic factors using the Cox proportional hazards model could not demonstrate that the hypercalcemia-leukocytosis syndrome had independent prognostic significance. In conclusion, our results suggest that the hypercalcemia-leukocytosis syndrome is an additional clinical entity of paraneoplastic syndrome and is an indicator for poorer outcome in lung cancer patients, although the frequency of the combined syndrome is very rare (0.5% of cases over a 10 year interval.     

Factors associated with human small aggressive non small cell lung cancer.

BACKGROUND: Some non-small cell lung cancers (NSCLC) progress to distant lymph nodes or metastasize while relatively small. Such small aggressive NSCLCs (SA-NSCLC) are no longer resectable with curative intent, carry a grave prognosis, and may involve unique biological pathways. This is a study of factors associated with SA-NSCLC. METHODS: A nested case-case study was embedded in the National Cancer Institute's Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. SA-NSCLC cases had stage T1, N3, and/or M1 NSCLC (n = 48) and non-SA-NSCLC cases had T2 to T3, N0 to N2, and M0 NSCLC (n = 329). Associations were assessed by multiple logistic regression. RESULTS: SA-NSCLCs were associated with younger age at diagnosis [odds ratio (OR)(>or=65 versus <65), 0.44; 95% confidence interval (95% CI), 0.22-0.88], female gender, family history of lung cancer, and the interaction gender*family history of lung cancer and were inversely associated with ibuprofen use (OR(yes versus no), 0.29; 95% CI, 0.11-0.76). The ORs for associating gender (women versus men) with SA-NSCLC in those with and without a family history of lung cancer were 11.76 (95% CI, 2.00-69.22) and 1.86 (95% CI, 0.88-3.96), respectively. These associations held adjusted for histology and time from screening to diagnosis and when alternative controls were assessed. CONCLUSION: SA-NSCLC was associated with female gender, especially in those with a family history of lung cancer. If these exploratory findings, which are subject to bias, are validated as causal, elucidation of the genetic and female factors involved may improve understanding of cancer progression and lead to preventions and therapies. Ibuprofen may inhibit lung cancer progression.     

TA-MUC1 epitope in non-small cell lung cancer

MUC1 (CD227), an established tumor marker, is expressed on glandular epithelia and on epithelial tumors. Tumor MUC1 differs from normal MUC1 by modified glycan side chains. Recently, a novel carbohydrate-induced conformational tumor-associated MUC1 epitope (TA-MUC1) was described, whose clinical relevance in lung cancer is not known. Eighty-five paraffin embedded tissue sections of non-small cell lung cancer (NSCLC) patients (73% male; mean age 64+/-9 years) were stained with the monoclonal antibody PankoMab (against TA-MUC1) and compared with the established antibodies E29 and 214D4 regarding prognostic relevance. TA-MUC1 is virtually absent in bronchial epithelium. As shown by multivariate analysis, only staining with PankoMab, but not with E29 or 214D4, was correlated with patients' survival (p=0.029). Moreover, when regarding interactions of MUC1 antibody staining results and clinico-pathological parameters, patients with lymph node metastasis lacking PankoMab staining were attributed the highest risk by far (Hazard ratio=4.6, 95% CI: 2.1-9.7, p=0.000). In summary, the presence of TA-MUC1 is a favorable prognostic factor in this cohort of NSCLC patients, in particular if lymph node metastases are present. This is in contrast to the results for E29 and 214D4, which recognize less or not glycosylation dependent epitopes. As this is the first report on a well-defined MUC1 epitope associated with improved survival in NSCLC, a more differentiated view on MUC1 may be mandatory.     

Cross-linked envelope-related markers for squamous differentiation in human lung cancer cell lines

Lung carcinoma cell lines were analyzed in culture and in nude mouse xenograft for both morphological appearance and expression of specific proteins that participate in cross-linked envelope formation during normal squamous cell terminal differentiation. Cross-linked envelope formation, induced by artificial influx of millimolar Ca2+ into the cultured cells, was an exclusive trait of squamous, adenosquamous, and mucoepidermoid carcinomas. Small cell lung carcinoma and non-squamous non-small cell lung carcinoma lines, such as adenocarcinoma and large cell carcinoma, were uniformly negative for cross-linked envelope formation. Involucrin, which is incorporated into the cross-linked envelope by the enzyme transglutaminase, was expressed at highest levels in squamous tumors, but several of the non-squamous non-small cell lung carcinoma lines also expressed comparable amounts. On the other hand, transglutaminase activity was consistently higher in squamous as opposed to non-squamous lines, so that in cell culture, a clear contrast between the groups could be observed. A Mr 195,000 protein that is incorporated into cultured human epidermal cell cross-linked envelopes was also observed in some but not all of the squamous lines. Two forms of transglutaminase are expressed in cultured keratinocytes. One of them, tissue transglutaminase, was expressed in the majority of squamous cell lines even though it is not a normal product of squamous differentiation in vivo. Keratinocyte transglutaminase, which is distinct from the tissue form and is normally expressed during terminal differentiation in squamous epithelia. was measurably present in only one of the six squamous cell lines tested. In nude mouse xenografts, keratinocyte transglutaminase, localized immunohistochemically with a biotinylated mouse monoclonal antibody, was again present only in a minority of the squamous lines whereas involucrin was expressed in all. In contrast to involucrin, keratinocyte transglutaminase is not an obligatory component of squamous differentiation in the pulmonary carcinoma cell lines tested. Its expression may be of value in further refining their classification.     

Radiotherapy of squamous cell lung cancer

A retrospective study was made of 56 patients with squamous cell lung cancer, who were inoperable or unresectable and had completed a course of radiotherapy at Jichi Medical School Hospital from August, 1973 to December, 1986. All cases had a performance status score of 80-100 (Karnofsky), no evidence of a distant metastases and tumors that had received a minimum total dose of 50 Gy. The patients were treated with one of three therapy regimens: split course (SC, 32 Patients), conventional fractionation (CF, 13), or multiple daily fractionation (MDF, 11). The over-all median survival time was 13.0 months, and the 2 and 5-year survival rates were 29.2% and 14.7%, respectively. The patients treated with the split course had the lowest survival rate in comparison with the other two groups. Comparison of the patients with the continuous course (CF + MDF) were significantly higher (P less than 0.025) than that of the split course. Patients with MDF had better local control. Age, tumor stage, and the size of the booster field were found to be factors which influenced the survival rate with a fair statistical significance. The survival rate increased with an increase in age, a decrease in the tumor stage, and in the size of the booster field. These findings have important implications for the design of future clinical trials for patients with squamous cell lung cancer.     

Respiratory infections associated with lung cancer]

We have analyzed the clinical significance of secondary infections associated with lung cancer patients. The incidence of secondary infections was 51.4% in 214 in-patients with lung cancer admitted to our institution in 1988 and 1989, and almost all of them had respiratory tract infections. The incidence was high in patients with cell types other than adenocarcinoma, and in those with hypoproteinemia, impaired cellular immunity and obstruction of the airway. The prognosis in patients with infection was much poorer than that in patients without infection. Major causative pathogens were Staphylococcus aureus including methicillin-resistant S. aureus (MRSA), Haemophilus influenzae, Klebsiella spp. and Pseudomonas aeruginosa. These pathogens except for H. influenzae were isolated at the terminal stage, in cases with airway obstruction and in post cancer-chemotherapeutic phase. The efficacy rate of 194 chemotherapeutic regimens against infection was 57.7%. Although the efficacy rate in 1988 and 1989 exceeded that in the 1970s, there was no significant difference in the efficacy rate between monotherapy (57.1%) and combined therapy (59.3%). The effectiveness was very poor for infections caused by P. aeruginosa and MRSA, or for cases with airway obstruction and marked impairment of pulmonary blood flow. The above results showed that a new combined therapy as well as the measures to improve the general condition of compromised hosts are required in the treatment of secondary infections in these patients.     

肺癌相关血清学肿瘤标志物研究进展

肿瘤生物标志物近年来一直是肿瘤基础和临床研究的一个十分活跃的领域.尽管迄今尚未找到肺癌特异性抗原,国内外研究人员已发现多种有潜力用于肺癌早期诊断、临床分型和分期、预后判断和疗效观察等的肿瘤生物标志.本文以癌胚抗原、神经元特异性烯醇化酶、细胞角蛋白19片段抗原、碳水化合物抗原242、粘蛋白1抗原、神经细胞粘附分子、组织多肽特异性抗原、干细胞因子、血管内皮生长因子、肝细胞生长因子、肺癌相关抗原和磷脂酰肌醇蛋白聚糖等为例,对肺癌相关血清学肿瘤生物标志物的研究进展作一综述.     

蛋白质组学方法筛选早期肺鳞癌相关蛋白

目的:应用蛋白质组学技术筛选早期肺癌癌变相关蛋白.方法:利用双向凝胶电泳方法分离人早期肺鳞癌组织和相应癌旁正常组织总蛋白,选择差异蛋白质点进行质谱分析.免疫组织化学法验证部分差异蛋白质的表达差异.结果:肺鳞癌组织与癌旁正常组织的双向凝胶电泳图谱中平均蛋白质点数分别为626和602个.选择在癌组织中高表达的10个差异蛋白点进行质谱分析,最终鉴定为膜联蛋白1 (annexin-1, Anx-A1)、热休克蛋白27(heat shock protein 27, HSP27)等与细胞周期、信号转导等功能相关的蛋白质.免疫组织化学检测结果显示,Anx-A1和HSP27蛋白在肺鳞癌组织中的阳性表达率均显著增高(P<0.05).结论:蛋白质组学方法是一种应用于初步筛选早期肺癌相关蛋白的有效方法,所鉴定的蛋白为进一步筛选用于肺癌早期诊断及其治疗的分子标志物奠定了前期基础.     

Multiple pulmonary infarctions associated with lung cancer

We present a case of right lung adenosquamous cell carcinoma that had obstructed the main pulmonary artery and superior pulmonary vein, causing multiple pulmonary infarctions in the right upper and middle lobes. Multiple peripheral pulmonary nodules showed clinical features that are characteristic of pulmonary infarction: rapid appearance and gradual reduction in size, pleural-based parenchymal density with a truncated apex and a round nodular shadow with a blurred margin and a centrally directed linear shadow. The nodules were more intense than the primary tumor in both T1- and T2-weighted magnetic resonance imaging (MRI). We conclude that pulmonary infarction can look like a nodule when lung cancer invades both the pulmonary artery and vein and that such cases can be distinguished from pulmonary metastasis by MRI, computed tomography and a series of radiological examinations.     

Overexpression of TMPRSS4 in non-small cell lung cancer is associated with poor prognosis in patients with squamous histology

Background:

Mortality rates in lung cancer patients have not decreased significantly in recent years, even with the implementation of new therapeutic regimens. One of the main problems is that a large proportion of patients present local or distant metastasis at the time of diagnosis. The need for identification of novel biomarkers and therapeutic targets for a more effective management of lung cancer led us to investigate TMPRSS4, a protease reported to promote tumour growth and metastasis.

Material and methods:

In all, 34 lung cancer cell lines were used to evaluate the TMPRSS4 expression. Cell migration and clonogenic assays, and an in-vivo lung metastasis model were used for functional analysis of the TMPRSS4 downregulation in H358, H441 and H2170 cell lines. The TMPRSS4 expression analysis in normal and malignant lung tissue samples was performed by qPCR. Five different microarray-based publicly available expression databases were used to validate our results and to study prognosis.

Results:

The TMPRSS4 knock down in H358, H441 and H2170 cells resulted in a significant reduction in proliferation, clonogenic capacity and invasion. A significant (P<0.05) decrease in the lung colonisation and growth was found when mice were injected with TMPRSS4-depleated H358-derived clones, as compared with controls. Expression of TMPRSS4 showed a >30-fold increase (P<0.001) in tumours in comparison with non-malignant samples. Levels in tumours with squamous cell carcinoma (SCC) histology were found to be significantly higher (P<0.001) than those with adenocarcinoma (AC) histology, which was confirmed in data retrieved from the microarrays. Kaplan–Meier curves demonstrated that high levels of TMPRSS4 were significantly associated (P=0.017) with reduced overall survival in the patients with SCC histology, whereas no correlation was found for the AC histology.

Conclusion:

Our results demonstrate that TMPRSS4 has a role in the lung cancer development. The potential use of TMPRSS4 as a biomarker for lung cancer detection or as a predictor of patient''s outcome warrants further investigation.