Primary squamous cell carcinoma of the stomach

Gastric cancer ranks as the fourth leading cause of cancer deaths in Hong Kong according to the Hong Kong Cancer Registry. The major histopathology of gastric cancer is adenocarcinoma. Squamous cell carcinoma of the stomach is an extremely rare entity. Only 85 cases of primary gastric squamous cell carcinoma worldwide have been reported in the literature. Diagnostic criteria have been set to differentiate from adenosquamous gastric carcinoma. The origin of this malignancy is not yet certain although there have been proposed theories as to its pathogenesis. It is difficult to clearly define its prognosis. The role of adjuvant chemotherapy and radiotherapy to long‐term survival still cannot be justified. We present probably the first reported case of pure primary squamous cell carcinoma of the stomach in Hong Kong in a 70‐year‐old man who underwent a distal radical gastrectomy in our department.     

Primary squamous cell carcinoma of the thyroid gland —A case report

Primary squamous cell carcinoma of the thyroid gland is rare. We report here a case of primary squamous cell carcinoma of the thyroid gland in a middle aged woman who had a thyroid nodule of 12 years duration with a recent rapid increase in size and associated with pressure symptoms. There was massive enlargement of the thyroid with retrosternal extension and fixity. Cervical nodes were also enlarged. The X-rays revealed calcification. A palliative thyroidectomy was done leaving the residual tumour behind. Endotracheal intubation and tracheostomy were required for respiratory distress in the postoperative period.     

Ulceration as a possible link between duodenogastric reflux and neoplasms in the stomach of rats

BACKGROUND: Duodenogastric reflux predisposes to gastric cancer. This study investigates whether ulceration induced by duodenogastric reflux is associated with the development of neoplasms in the stomach. MATERIALS AND METHODS: In a rat experiment, duodenal fluid was directed into the corpus (jejunal reflux) or through the pylorus into the antrum (pyloric reflux). Sham-operated animals served as controls. The animals were sacrificed after 24, 36, or 52 weeks. RESULTS: Ulcerations and neoplasms occurred more frequently in the corpus than in the antrum. In the corpus, ulceration was observed significantly more often in animals with jejunal reflux (62, 55, and 53% at 24, 36, and 52 weeks, respectively) than in animals with pyloric reflux (15, 21, and 30%). The incidence of neoplasm in the corpus increased significantly with time from 38% at 24 weeks to 89% at 52 weeks in animals with jejunal reflux and from 12 to 33% in animals with pyloric reflux. Ulceration and neoplasms shared location in the corpus adjacent to the gastrojejunostomy and by 24 weeks, all but one neoplasm in the jejunal reflux and one in pyloric reflux groups occurred adjacent to ulceration. In the antrum, 37% of the animals had a prepyloric ulceration after 24 weeks of pyloric reflux and only one of these animals had a neoplasm. By 52 weeks 20% of animals with pyloric reflux had a neoplasm that appeared in the prepyloric area. CONCLUSIONS: Ulceration and neoplasm occurred at the same sites in the stomach, and ulcerations preceded the development of neoplasms in the antrum and very likely in the corpus. The results suggest that ulceration plays an important role in the genesis of neoplasms in the stomach and that the vulnerability to duodenogastric reflux is more pronounced in the corpus than in the antrum mucosa.     

Testicular metastasis from squamous cell carcinoma of the lung

We present a case of squamous cell carcinoma of the testis that metastasized from lung cancer. The patient, who had received left pneumonectomy 2 years earlier for squamous cell carcinoma (SCC) of the lung, developed pulmonary metastasis, which was treated with chemotherapy. Although the recurrence regressed after treatment, the testicular tumor progressed gradually. Left radical orchiectomy was performed. Pathological examination revealed metastatic SCC. Testicular metastasis from lung cancer is a very rare disease.     

Primary squamous cell carcinoma of the breast in a pregnant woman: Report of a case

Although reports on primary squamous cell carcinoma of the breast have been increasing in number, the morbidity rate of the disease is comparatively low. Its onset in pregnant women, especially, is quite rare. We herein report a case of primary squamous cell carcinoma of the breast in a pregnant woman. A 33-year-old woman was admitted with a lump in the right breast and an abnormal bloody nipple discharge. The breast mass was 5.6×5.4 cm in size, and both ultrasonogram and CT scanning showed that it consisted of a cystic tumor for the most part. A large amount of bloody cystic fluid was aspirated by fine-needle aspiration; squamous cell carcinoma of the breast was suspected by a cytological study on the fluid. Twelve days after an induced abortion was performed, a modified radical mastectomy was carried out. Histological findings of the resected specimen demonstrated that the tumor was squamous cell carcinoma which had been well differentiated with partial keratinization and cancer pearls. Noninvasive ductal carcinoma was also observed in a very small region of the specimen, which indicated that the tumor was probably originally adenocarcinoma which later transformed into squamous cell carcinoma.     

Primary squamous cell carcinoma of the prostate

BACKGROUND: Primary squamous cell carcinoma (SCC) is an uncommon tumor of the prostate gland. A 65-year old man complained of obstructive symptoms. METHODS/RESULTS: Transrectal palpation and diagnostic imaging indicated an ordinary adenocarcinoma, although serum prostate-specific antigen (PSA) was normal. Biopsy specimens revealed SCC with the serum SCC antigen elevated. The patient was treated with pelvic irradiation and systemic administration of cis-platinum and peplomycin, which resulted in shrinkage of the cancer. CONCLUSION: No evidence of recurrence has been seen for 18 months.     

原发性甲状腺鳞状细胞癌七例分析

目的 提高对原发性甲状腺鳞状细胞的认识。方法 结合文献对我院收治的7例患者进行分析讨论。结果 原发性甲状腺鳞状细胞癌主要临床表现为甲状腺结节短期内迅速增大,伴有声音嘶哑、呼吸困难、体重下降等。肿瘤质硬,固定,边界不清,侵犯喉周围组织及血管,在就诊时已均属晚期且对放、化疗无效。7例患者均于姑息性手术后4个月内死亡。结论 甲状腺鳞癌与甲状腺鳞状细胞化生有着密切的关系,失去手术根治机会者预后极差。因此早期发现和治疗是提高生存率的关键。     

Ezrin和AQP3在皮肤鳞状细胞癌中表达的研究

目的：检测Ezrin和AQP3在皮肤鳞状细胞癌（SCC）中的表达。方法：应用免疫组化SP法检测Ezrin和AQP3的表达水平。结果：Ezrin和AQP3在SCC中的表达显著高于正常皮肤且在SCC不同分化组织中存在差异。Ezrin和AQP3的表达呈正相关（r=0.573,P〈0.05）。结论：Ezrin和AQP3的高表达可能在SCC的发生发展中起重要作用,并与其恶性程度相关。     

The treatment of squamous cell carcinoma of the tonsil with neck node metastases

BACKGROUND: Patients with tonsillar carcinoma and neck nodes seen at the clinic are not an uncommon occurrence in head and neck practice. Over the years, treatment has ranged from radical jaw neck dissection to radical neck dissection for the nodes and primary radiotherapy to the primary site. Much controversy exists as to which treatment modality yields the best survival. Certainly, surgery to the oropharynx leads to gross morbidity, with problems of swallowing, speech, and cosmesis, although it has been claimed that radiotherapy with neck dissection yields a lower cure rate. METHODS: We investigated a retrospective series of 96 patients all of whom had squamous cell carcinoma of the tonsil and associated lymph node metastases. Of these, 44 primary tumors were treated with surgery and 52 with irradiation. All 44 patients in the surgery group had a radical neck dissection, as did all but 12 in the radiotherapy group. RESULTS: Of the tabulations, patients in good general condition were more likely to receive primary surgery. Overall cause-specific survival for all patients was 69%. Multiple logistic regression revealed no associations; thus, the radiotherapy and surgery groups were well matched. Five-year actuarial survival for those having irradiation was 74%. The five-year survival for the group receiving surgery was 63% (p =.4372). This lack of difference between survival for surgery and radiotherapy was confirmed using Cox's proportional hazards model. CONCLUSION: We conclude that tonsillar carcinoma with lymph nodes can be safely treated by applying appropriate radiotherapy to the tonsillar region and treating the neck with radical surgery, if the disease is more than N1.     

Cutaneous metastatic squamous cell carcinoma to the parotid gland: analysis and outcome

BACKGROUND: Our aim was to review the presentation, treatment, and outcome of patients with metastatic cutaneous squamous cell carcinoma involving the parotid gland at a tertiary referral center. METHODS: We performed a retrospective chart review of the cancer registry at the Princess Margaret Hospital, Toronto, from 1970 to 2001. All patients had a previously untreated metastatic cutaneous head and neck squamous cell carcinoma involving the parotid gland. A minimal follow-up of 1 year was mandatory for inclusion in the study. RESULTS: Fifty-six white patients (43 men and 13 women), with a median age of 76 years (range, 49-97 years), were eligible for inclusion. The disease in all patients was retrospectively staged according to a new system. Twenty patients had P1 disease, 14 had P2, and 22 had P3. Therapy included surgery and adjuvant external beam radiation in 37 patients, single-modality external beam radiation in 12, and surgery alone in seven patients. The overall recurrence rate was 29%. The disease-specific survival was significantly worse in patients treated with external beam radiation alone (p <.05). Tumor size >6 cm (p <.01) and the presence of facial nerve involvement (p <.01) were poor prognostic factors. CONCLUSIONS: Metastatic cutaneous squamous cell carcinoma to the parotid gland is an aggressive neoplasm that requires combination therapy. The presence of a lesion in excess of 6 cm or with facial nerve involvement is associated with a poor prognosis.     

Risk stratification for metastasis from cutaneous squamous cell carcinoma of the head and neck

Background: The purpose of the study was to develop a system of risk stratification, based on clinical and histological factors that would aid prediction of metastasis from cutaneous squamous cell carcinoma (SCC) of the head and neck. Method: The method used was a retrospective case control study comparing clinical and histological parameters of 78 patients who developed metastasis with 92 patients who did not develop metastasis over a 5‐year period. Results: The two ‘absolute’ (highest) risk factors for development of metastatic disease are poor histological differentiation and perineural/lymphovascular infiltration. The three ‘relative’ risk factors are moderate histological differentiation, diameter ≥20 mm and Clark level 5. Risk stratification: High‐risk lesions have either one of the absolute risk factors or all three of the relative risk factors with a predicted incidence of metastasis of 37%. Intermediate risk lesions have two of three relative risk factors and a predicted incidence of metastasis of 5%. Low‐risk lesions have one or none of the relative risk factors and a predicted incidence of meatstasis of 0.3%. Conclusion: Ongoing management of patients with histo‐pathologically proven invasive SCC of the head and neck should be based upon risk stratification for metastasis.     

Primary squamous cell carcinoma of the breast after cured Hodgkin's disease

An unusual case of primary squamous cell carcinoma of the breast occurring after cured Hodgkin's disease is reported herein. A 27-year-old woman developed a left breast mass 2 years after chemotherapy and radiation for nodular sclerosing stage IIB Hodgkin's disease. Excisional biopsy revealed squamous cell carcinoma of the breast and a modified radical mastectomy was performed, however, no metastasis was found in the axillary nodes. She received etoposide, mitomycin-C, and doxifluoridine as adjuvant chemotherapy, and remains well without any evidence of recurrent Hodgkin's disease or breast cancer. To our knowledge, this is the first reported case of primary squamous cell carcinoma of the breast associated with Hodgkin's disease. The risk of patients treated for Hodgkin's disease developing breast cancer as a second malignant neoplasm is discussed following the report of this case.     

Review: Palliative gastrectomy for stage IV carcinoma of stomach

Currently, there is still controversy on the issue of palliative gastrectomy for patients with advanced carcinoma of stomach in terms of safety and its benefits. From the data available in the literature, palliative gastrectomy seems to be associated with a better survival rate, better relief of symptoms and similar rates of perioperative morbidity and mortality when compared with laparotomy with or without gastrojejunostomy. However, all these studies are retrospective comparative studies or series that carried significant biases. This makes interpretation of the outcome difficult. A selective approach is advocated as palliative gastrectomy carries significant risks. Chinese Abstract

Figure Chinese Abstract Open in figure viewer PowerPoint

Volume 6 , Issue 3 August 2002

Pages 65-70     

颊黏膜鳞状细胞癌的治疗及预后分析

目的总结颊黏膜鳞癌的治疗方法及分析影响预后的因素。方法回顾我科于1987～1999年收治的52例颊黏膜鳞癌患者，分析病理分期、淋巴结情况、上下颌骨受侵与否、治疗失败等对预后的影响。结果52例颊黏膜鳞癌，11例单纯手术，41例术前放疗。5年生存率为56．4％，早期（Ⅰ＋Ⅱ期）和晚期（Ⅲ＋Ⅳ期）5年生存率分别为64．6％、53．0％。影响预后的因素有：（1）鳞癌病理分级，高分化者明显好于低分化者；（2）颈部淋巴结情况，cN0术后淋巴结阳性率为14％，cN1-3术后淋巴结阳性率为44％，病理淋巴结阳性和阴性的5年生存率分别为35．7％和64．8％；多因素分析发现影响预后的因素包括临床和病理分期的早晚。治疗失败以局部复发占多数，共出现11例局部复发，3例颈部淋巴结复发或转移，4例远处转移。结论颊黏膜鳞癌手术中的局部处理很重要，应注意保留足够的安全界，并需提高一期修复的能力。要重视对颈部淋巴结的处理，对cN0病例应行肩胛舌骨肌上清扫。     

Carcinomas of the stomach in the young adults

The clinical and pathologic characteristics of the gastric carcinomas in the young adults were described in special comparison with the carcinomas in the old men. They were found to be similar in many respects, but had some different features like the histologic findings with particular references to the histogenetic background.     

The National Cancer Data Base report on squamous cell carcinoma of the base of tongue

BACKGROUND: This study provides the largest contemporary overview of presentation, care, and outcome for base of tongue squamous cell carcinoma (SCC). METHODS: We extracted 16,188 cases from the National Cancer Data Base (NCDB). Chi-square analyses were performed on selected cross-tabulations. Observed and disease-specific survival were used to analyze outcome. RESULTS: Three-quarters had advanced-stage (III-IV) disease. Radiation therapy alone (24.5%) and combined with surgery (26.9%) were the most common treatments. Five-year observed and disease-specific survival rates were 27.8% and 40.3%, respectively. Poorer survival was significantly associated with older age, low income, and advanced-stage disease. For early-stage disease, surgery with or without irradiation had higher survival than irradiation alone. For advanced-stage disease, surgery with irradiation had the highest survival. CONCLUSIONS: Survival rates were low for base of tongue SCC, with most deaths occurring within the first 2 years. Income, stage, and age were significant prognostic factors. In this nonrandomized series, surgery with radiation therapy offered patients with advanced-stage disease the best survival.