Human papillomavirus DNA in head and neck squamous cell carcinomas in the Free State,South Africa

Human papillomaviruses (HPVs) have been associated with a subset of head and neck squamous cell carcinomas (HNSCCs). The aim of this study was to determine the prevalence of HPV DNA in archived formalin-fixed paraffin-embedded tissue from patients with histologically confirmed HNSCCs in a South African cohort. A nested PCR was used for the detection of HPV DNA targeting the L1 gene. Positive samples were confirmed using an in-house hemi-nested PCR targeting the E6 gene and genotyped by sequence determination of amplicons. HPV DNA was detected in 57/780 (7.3%) samples, with the highest prevalence being in the sinonasal tract (16.0%) and oropharynx (10.8%). HPV16 was the most frequently detected type, being found in 26/57 (45.6%) positive samples. The prevalence of HPV DNA in HNSCCs found in this study was lower than that found in developed countries     

Identification of High-Risk Human Papillomavirus DNA,p16, and E6/E7 Oncoproteins in Laryngeal and Hypopharyngeal Squamous Cell Carcinomas

Human papillomavirus (HPV) was proven to play a significant role in cancer development in the oropharynx. However, its role in the development of laryngeal (LSCC) and hypopharyngeal squamous cell carcinoma (HPSCC) remains to be clarified. High-risk HPV (HR-HPV) viral proteins E6 and E7 are considered to be pertinent to HPV-related carcinogenesis. Hence, our aim was to estimate LSCC and HPSCC for HR-HPV DNA, p16, and E6/E7 oncoprotein status by using molecular virology and immunohistochemistry methods. The prevalence of HPV16 infection was 22/41 (53.7%) and 20/31 (64.5%) for LSCC and HPSCC, accordingly. The majority of HPV16+ tumor samples were stage III or IV. In most samples, the presence of either HPV16 E6 or HPV16 E7 viral protein in dysplastic or tumor cells was confirmed using immunohistochemistry. Our results suggest a high prevalence of HPV16 as a primary HR-HPV type in LSCC and HPSCC. The lack of HPV E6/E7 oncoproteins in some tumor samples may suggest either the absence of viral integration or the presence of other mechanisms of tumorigenesis. The utilization of p16 IHC as a surrogate marker of HR-HPV infection is impractical in LSCC and HPSCC.     

带蒂胸大肌岛状肌皮瓣在晚期下咽癌手术中的应用

报道了60例晚期下咽癌术后,利用胸大肌岛状肌皮瓣移植、修复与重建下咽及颈段食道。通过分析手术操作优、缺点及术中注意事项等,认为应用带蒂胸大肌岛状肌皮瓣具有其它皮瓣不具备的优点,操作简便易行,效果满意。     

Carcinoma of the posterior wall of the hypopharynx: surgical treatment with larynx preservation

IntroductionPosterior pharyngeal wall is the most rare subsite for hypopharyngeal carcinomas. Because of its rarity, there are few studies published in the literature specifically concerning posterior pharyngeal wall carcinoma.ObjectivesTo report our functional results in patients with the carcinoma of the posterior wall of the hypopharynx after surgical treatment by resection via a lateral or infrahyoid pharyngotomy approach, with the preservation of the larynx and reconstruction with a radial forearm free flap.MethodsThe study included 10 patients who underwent surgery for a carcinoma of the posterior wall of the hypopharynx over a 6 year period. The associated postoperative morbidity was investigated and functional results were analyzed.ResultsNine patients had T3 lesions and one patient had a T2 lesion. The preferred approach to access the hypopharynx was a lateral pharyngotomy in 5 patients and lateral pharyngotomy combined with infrahyoid pharyngotomy in 5 patients with superior extension to oropharynx. The pharyngeal defects were reconstructed successfully with radial forearm free flaps. Four patients received adjuvant radiotherapy only, and 4 patients with N2b and N2c neck diseases received adjuvant chemoradiotherapy. The mean duration of hospitalization was 15.6 days (range, 10–21 days). All patients achieved oral intake in a median time of 74 days (range, 15–180). Decannulation was achieved in all patients and the median time for decannulation was 90 (range, 21–300 days). The mean followup duration was 38.3 months (range, 10–71 months) and 8 patients survived. One patient died due to regional recurrence in the retropharyngeal lymph nodes and 1 patient died due to systemic metastasis.ConclusionPrimary surgery is still a very effective treatment modality for the carcinoma of the posterior wall of the hypopharynx and does not permanently compromise the swallowing and laryngeal functions if pharyngeal reconstruction is performed with a free flap.     

Killian‐Jamieson diverticulum

Killian‐Jamieson diverticulum (KJD) is rare hypopharyngeal defect. As in other forms of esophageal diverticuli (i.e., Zenker's), recent literature has described minimally invasive endoscopic approaches to its management. 1 , 2 We present a case of a 62‐year‐old female with symptoms consistent with an esophageal diverticulum. A barium swallow study was consistent with a KJD. The patient was brought to the operating room and endoscopically examined to confirm the presence of this entity. A open transcervical approach was performed to remove the diverticulum without complication. During our dissection, the recurrent laryngeal nerve (RLN) was noted to be adherent to the base of the diverticulum and needed to be freed prior to performing the diverticulectomy. We provide a review of recent literature and medical illustrations to highlight the importance of the open transcervical approach in the management of KJD to avoid inadvertent transection of the RLN.     

Carcinoma of the hypopharynx results of primary radical radiation therapy

The results of radiation therapy as applied to patients with squamous cell carcinoma of the hypopharynx seen during the period 1972–1976 at the Princess Margaret Hospital are presented. Approximately $\text{2}\text{3}$ of the patient population presented with disease involving the regional lymph nodes or with systemic metastases. Ninety percent ($\text{127}\text{141}$) of all patients registered were treated primarily with radiation therapy with surgery reserved for the management of residual or recurrent disease only. Seventy-seven percent ($\text{98}\text{127}$) of those who received radiation therapy were treated with radical intent. The uncorrected actuarial 5 year survival rate for those patients treated radically was 19%. Five year actuarial survival rates by the UICC TNM (1974) staging system, showed that nodal disease was the most significant determinant of survival. Five year survival rates were as follows: N₀ 36%; N₁ 20%; N₂N₃0%. When considered within each nodal category the survival of the combined T₁T₂ group was not significantly different from the T₃ category. Forty-five percent of those patients who failed with local or regional disease had an attempt at salvage surgery. Of these, $\text{6}\text{24}$ ultimately achieved local and regional control. Comparisons with other series in the literature are discussed and reasons for differences in published results are considered.     

Loss of HOP tumour suppressor expression in head and neck squamous cell carcinoma

We report that homeodomain-only protein (HOP) is expressed in the suprabasal layer of normal upper aerodigestive tract epithelium and expression strongly decreases in hypopharyngeal carcinoma. Interestingly, HOP has very recently been shown to be a tumour suppressor involved in differentiation, suggesting that HOP may have a similar role in head and neck squamous cell carcinoma (HNSSC).