Primary adenoid squamous cell carcinoma of the upper lip associated with a locoregional metastasis: a case report and review of the literature.
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Aged↗
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Results for “MOUTH NEOPLASMS”
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Dental management of the irradiated patient.
There is an increasing number of patients receiving radiation therapy for oral malignancies. In many malignant tumors, radiation is often the treatment of choice, while in others it may be used in conjunction with surgery or chemotherapy. There are inherent dental and oral problems associated with radiation therapy. It is the purpose of this paper to deal briefly with the physical principles and the biological basis of radiation therapy. In addition, the specific radiation effects on oral mucous membranes, taste buds, salivary glands, bone, the periodontium and teeth will be discussed. Radiation complications in edentulous patients, and in particular the problems of wearing dentures in such patients will be evaluated. An approach to the problem of dental extractions and other dental treatments in the pre- and post-irradiated patient is suggested.
Bone and Bones↗
The nuclear DNA-content of turnover cells in the oral cavity.
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Carcinoma, Squamous Cell↗
Mortality following operations of the head and neck.
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Age Factors↗
Post mortem recovery of mandibular osseous graft with cellulose acetate filter. A case report.
A surgical procedure was performed to re-establish both aesthetics and functional form to a post partial mandibulectomy patient. A particulate, autogenous osseous graft from the hip was supported by a mandibular tantalum splint lined with a cellulose acetate filter. The patient developed metastatic carcinoma in the donor graft site and lung. The mandibular graft and supporting tissue was removed postmortem and examined histologically. It was observed that normal bone reconstruction was taking place and that union of mandibular bone and graft was evident. Secondary squamous cell carcinoma had invaded the symphysis area of the graft. It is also of interest to note that the tumour was mot able to penetrate those areas where the cellulose acetate filter was present.
Aged↗
Therapeutic implications of an intraoral malignancy complicated by Darier-White's disease.
A 69-year-old white male with a long history of severe Darier-White's disease presented with an extensive intraoral malignancy. High dose external supervoltage radiotherapy (Cobalt-60) to the tumour caused remarkable clearing of the hyperkeratotic lesions involving the overlying skin. Subsequently, surgical resection of the tumour with staged reconstruction of the jaw was carried out. The presence of the skin disorder did not adversely affect the surgical procedure nor the subsequent wound healing. Darier-White's disease, therefore, should not be a deterrent to radical radiotherapy and/or surgery for concomitant malignancy.
Aged↗
Recurrence of carcinoma of the oral cavity, oropharynx and maxillary sinus after radical neck dissection.
Cervical recurrence was studied in 63 patients who had undergone radical neck dissection for the treatment of carcinoma of the oral cavity, oropharynx and maxillary sinus. Over the whole series, recurrence occurred in 17 patients (27%). The rate of recurrence did not decrease in patients who remained free of carcinoma at the primary site, but was significantly lower in patients in whom elective neck dissection was performed than in those who were treated by therapeutic or secondary neck dissection. With the exception of two patients, cervical recurrence was associated with the presence of metastatic lymph nodes. Although the rate of recurrence was not affected by the number of metastatic lymph nodes, it was very high (80%) in patients having metastatic lymph nodes with histological evidence of extra-nodal spread. The results indicate that elective treatment by irradiation or surgery may be needed to reduce cervical recurrence because of a high tendency of carcinoma of the oral cavity and adjacent regions to metastasize.
Carcinoma, Squamous Cell↗
High frequency of homozygous deletion and methylation of p16(INK4A) gene in oral squamous cell carcinomas.
p16(INK4A) inactivation was analyzed in ten squamous cell carcinoma (SCC) cell lines and 32 primary SCCs, using the polymerase chain reaction (PCR), PCR-single-strand conformation polymorphism, methylation-specific PCR, and cycle sequencing. In the study of cell lines, we detected three deletions in exon 1alpha and exon 2, and detected two methylations. Among tumor samples, we detected the homozygous deletions (HDs) of 43.8% in exon 1alpha 34.4% in exon 2, and methylation was found in 50.0%. The lack of p16(INK4A) with immunohistochemistry was detected in 71.9% and matched the alteration of p16(INK4A) gene. These results suggest that p16(INK4A) inactivation is predominantly caused by HD and methylation, and immunohistochemical evaluation of p16(INK4A) is a useful method.
Carcinoma, Squamous Cell↗
New approaches to the causation and prevention of cancers of epithelial surfaces.
Environmental rather than genetic factors appear to be responsible for the causation of cancers involving epithelial surfaces, especially oropharyngeal cancers, cancers of the gastro-intestinal tract, cancers of the liver and gall-bladder, cancers of the cervix uteri and lung cancers. Epithelial surfaces which have mucus-bearing cells are particularly prone, because if these mucus cells are surrounded by an alkaline milieu over a prolonged period, the mucous of the epithelial cells is rendered fluid and is removed from the cells, of which it forms an integral part. This leads to proliferative changes with metaplasia, cell-atypia and a very significant increase in mitotic activity. Such changes are a prelude to carcinogenesis. In the case of many oropharyngeal cancers in Asia and Africa it is the alkaline slaked lime in the betel quid which is responsible; in the case of gastric cancers it is the reflux of the alkaline duodenal contents into the stomach; in the case of colon it is the absence of roughage, cellulose and vegetable fibres from the diet; in the case of the cervix uteri it is the frequency of coitus which gives rise to a highly alkaline seminal fluid; and in the case of cancer lung it is the alkaline cigarette smoke.
Bile Acids and Salts↗
DNA-measurements on formalin-fixed, paraffin-embedded squamous cell carcinomas from different ENT-regions.
DNA measurements were performed on formalin-fixed, paraffin-embedded squamous cell carcinomas, using the method of Hedley et al. Ultrasonication was sometimes necessary after enzymatic disintegration to dispose of residual cytoplasm. The isolated nuclei were stained with Hoechst 33258. DNA measurements were performed using a rapid system for static fluorometry (FLUORA-programme). The method proved to be highly accurate. The mean CV of the stem cell peaks from different tumours was 5.3. There was no difference between material less or more than 5 years old (mean CVs 5.2 and 5.5 respectively). RNase treatment had no effect and was therefore not considered necessary. The proliferative activity was calculated by computer assuming a rectilinear distribution of S-phase cells. Because routinely paraffin-embedded material can be used, DNA analysis can be performed on tumour material where the clinical outcome is known, in order to evaluate certain DNA variables.
Carcinoma, Squamous Cell↗
Elevated tumor lactate concentrations predict for an increased risk of metastases in head-and-neck cancer.
PURPOSE: Hypoxia shifts the balance of cellular energy production toward glycolysis with lactate generation as a by-product. Quantitative bioluminescence imaging allows for the quantitation of lactate concentrations in individual tumors. We assessed the relationship between pretreatment tumor lactate concentrations and subsequent development of metastatic disease in patients with newly diagnosed head-and-neck cancer. METHODS AND MATERIALS: At the time of biopsy of the primary site, a separate specimen was taken and flash-frozen for subsequent quantitation of lactate concentration using a luciferase bioluminescence technique. The two-dimensional spatial distribution of the bioluminescence intensity within the tissue section was registered directly using a microscope and an imaging photon counting system. Photon intensity was converted to distributions of volume-related tissue concentrations (micromol per gram wet weight). Treatment consisted of either surgery and postoperative radiotherapy or primary radiotherapy, based on presenting disease stage and institutional treatment policies. The subsequent development of metastatic disease constituted the primary clinical endpoint. RESULTS: Biopsies obtained from 40 patients were evaluable in 34. The larynx was the most frequent primary site (n = 25). Other sites included oropharynx (n = 5), hypopharynx (n = 3), and oral cavity (n = 1). Most patients (74%) presented with an advanced stage T3 or T4 primary tumor. Nodal involvement was present in 19 (54%) patients. The median tumor lactate concentration was 7.1 micromol/g. Tumors were classified as having either low or high lactate concentrations according to whether these values were below or above the median. The median follow-up time for surviving patients is 27 months. Two-year actuarial survival was 90% for patients with low-lactate-concentration tumor vs. 35% for patients with high-lactate-concentration primaries (<0.0001). Two-year metastasis-free survival was adversely influenced by high tumor lactate concentrations (90% vs. 25%, p < 0.0001). The median lactate concentration for tumors that subsequently metastasized was 12.9 micromol/g vs. 4.8 micromol/g for patients who remained continuously free of disease (p < 0.005). Lactate concentration was not correlated with presenting T stage or N stage. DISCUSSION: Elevated tumor lactate concentrations are associated with the subsequent development of nodal or distant metastases in head-and-neck cancer patients. This more aggressive malignant phenotype is probably associated with hypoxia-mediated radioresistance and the upregulation of metastasis-associated genes.
Biomarkers, Tumor↗
P105 as a prognostic indicator in patients irradiated for locally advanced head-and-neck cancer: a clinical/laboratory correlative analysis of RTOG-9003.
PURPOSE: In a previous retrospective study, p105 AD, a proliferation-associated nuclear antigen density (AD), was found to be an independent prognostic factor for patients irradiated for locally advanced head-and-neck cancer. We sought to confirm this finding by analyzing patients entered on RTOG 9003, a Phase III randomized trial of altered fractionation radiotherapy. METHODS AND MATERIALS: Paraffin blocks of pretreatment biopsies of the primary tumor of patients with Stage III or IV squamous cell carcinoma of the oral cavity, oropharynx, or supraglottic larynx, or Stage II squamous cell carcinoma of the hypopharynx or base of tongue entered on RTOG 9003 were prospectively collected at patient entry. From these paraffin blocks, areas of tumor were selected based on histologic examinations and sectioned. Nuclear suspensions were then prepared and processed for p105 antibody and DNA staining. Flow cytometric quantification of p105 labeling indices and DNA content were then performed for correlation with local-regional control and survival. RESULTS: Paraffin blocks of tumor biopsies from 457 of 1073 patients entered were available for p105 determination. There was no significant difference in pretreatment characteristics between patients who had paraffin blocks available or not available. The median (range) of p105 labeling index (LI-C), p105 labeling index of cells in S phase (p105 LI-S), and p105 AD were 56 (range: 6-99), 8.255 (range: 0.913-23), and 67 (range: 5-364), respectively. Multivariate analysis of prognostic factors showed that T stage, N stage, Karnofsky performance status, and fractionation schedule were significant for local-regional control (p < 0.0001, 0.0011, <0.0001, and 0.007, respectively) and T stage, N stage, Karnofsky performance status, and tumor grade were significant for survival (p = 0.018, 0.002, <0.0001, and 0.0058, respectively). Neither p105 LI-C nor p105 LI-S nor p105 AD nor DNA ploidy was significant for local-regional control or survival. CONCLUSION: p105 labeling indices, antigen density, and DNA ploidy do not predict the outcome of patients irradiated for advanced squamous cell carcinomas of the head and neck.
Antigens, Neoplasm↗
Reconstructive surgery of head and neck cancer using various pedicle flaps.
Various pedicle flaps were used for the reconstruction of large defects following extirpation of head and neck malignant tumors of 55 patients. Although there are several complications, myocutaneous (MC) island flap surpassed the deltopectoral (DP) flap in the reconstruction of the pharyngo-esophagus, tongue, oral cavity, mandible, and of a massive defect. However, DP flap is still valuable material because of its steadiness in pharyngo-esophageal reconstruction in patients who have background disorders, such as serious heart disease and diabetes. Forehead or DP flap is valuable in the reconstructive surgery of full-thickness defect of the cheek. Reconstruction of extremely large defect of the head and neck could be accomplished by use of latissimus dorsi flap and/or combination with DP flap. Selection of the flap should be made in accordance with the region of the reconstruction, size of region, sex, and individual considerations.
Esophageal Neoplasms↗
Role of human papillomaviruses in cancer of the respiratory and upper digestive tract.
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Esophageal Neoplasms↗
The implication of DNA content and S-phase fraction in oral carcinomas with and without metastasis.
Flow cytometry DNA analysis was performed on fresh tissue samples of 90 primary lesions and 32 metastatic lymph nodes of squamous cell carcinomas of the oral cavity and related regions to elucidate the characteristics of tumors with metastatic potency. The incidence of aneuploidy for carcinomas with metastasis was 67%, which was significantly higher than the 44% of carcinomas without metastasis, and aneuploid carcinomas (39%) had a higher tendency to metastasis than diploid carcinomas (20%). The incidence of aneuploidy and metastasis was related to the T classification, the degree of differentiation, and the histologic grade of malignancy. The incidence of aneuploidy and mean DNA index of metastatic lesions were 31% and 1.12, respectively, and the values were significantly lower than the 67% and 1.30 of the corresponding primary lesions. The results indicate that the chance of evolution of metastatic cell lines is higher in aneuploid carcinomas than diploid carcinomas, possible because the former is more heterogeneous than the latter, but most of the cell lines causing lymph-node metastasis are diploid cell lines. Metastatic lesions had a lower S-phase fraction than primary lesions, indicating that a high S-phase fraction does not always reflect the presence of metastatic cell lines.
Aneuploidy↗
Tasks and objectives of the German-Austrian-Swiss working group on tumors in the maxillo-facial region (DOSAK).
The German-Austrian-Swiss working group on tumors in the maxillo-facial region (DOSAK) comprises 61 hospitals in German-speaking countries. The working group is concerned with multicentre problems of tumor documentation, tumor diagnosis and tumor therapy. DOSAK can look back on almost 20 years of work. It therefore seems appropriate to report on the organization, methods and objectives and to make previous work as well as future tasks known beyond German-speaking countries.
Austria↗
Spinal cord dose is higher than expected in head and neck radiation.
Myelopathy is a feared consequence of radiation therapy. Risk factors are multifocal; therefore, total dose calculation is crucial. We evaluated the contribution of scatter radiation to obtain an accurate cumulative spinal cord dose. Twenty patients undergoing three field head and neck radiation by Cobalt or 6 MV Linac had a total cord dose calculated from direct and scatter radiation. The cord was removed from the radiation field at tumor doses no higher than 4,400 cGy. Total tumor dose ranged from 5,400-7,400 cGy (mean 6060). All patients achieved the prescribed dose and none were lost to follow up (mean 36 months). It was found that scatter radiation can contribute as much as 20% extra dose to the spinal cord. Mean extra dose was 9% (range 1%-20%). This additional dose ranged from 52-810 cGy (mean 339 cGy). No apparent difference was seen with Cobalt or Linac source. Our conclusion was that significant additional dose is delivered to the spinal cord by scatter radiation and that scatter may contribute more to the development of myelopathy than previously believed.
Cobalt Radioisotopes↗
Mandibular invasion by oral squamous cell carcinoma. Clinical aspects.
In this paper we have tried to correlate the clinical and radiological aspects to the histological findings in squamous cell carcinomas of the oral cavity, in relation to bone involvement in the mandible. 52 patients were analyzed and we conclude that there is a positive indication for mandible sparing surgery, even if there is fixation to the jaw or radiologically visible bone involvement.
Alveolar Process↗