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Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years.

CONTEXT: The incidence of nonmelanoma skin cancer is increasing rapidly among elderly persons, but little is known about its incidence in the population younger than 40 years. OBJECTIVES: To estimate the sex- and age-specific incidences of basal cell carcinoma and squamous cell carcinoma in persons younger than 40 years in Olmsted County, Minnesota, and to evaluate change in incidence over time; to describe the clinical presentation, rate of recurrence and metastasis, and histologic characteristics of these tumors in this population-based sample. DESIGN: Population-based retrospective incidence case review. SETTING: Residents of Olmsted County, Minnesota, a population with comprehensive medical records captured through the Rochester Epidemiology Project. PARTICIPANTS: Patients younger than 40 years with basal cell carcinoma or squamous cell carcinoma diagnosed between 1976 and 2003. MAIN OUTCOME MEASURES: Incident basal cell carcinomas and squamous cell carcinomas and change in incidence of these tumors over time. RESULTS: During the study period, 451 incident basal cell carcinomas were diagnosed in 417 patients and 70 incident squamous cell carcinomas were diagnosed in 68 patients. Of these tumors, 328 were histologically confirmed basal cell carcinomas and 51 were histologically confirmed squamous cell carcinomas. Overall, the age-adjusted incidence of basal cell carcinoma per 100,000 persons was 25.9 (95% confidence interval [CI], 22.6-29.2) for women and 20.9 (95% CI, 17.8-23.9) for men. The incidence of basal cell carcinoma increased significantly during the study period among women (P<.001) but not men (P = .19). Nodular basal cell carcinoma was the most common histologic subtype; 43.0% of tumors were solely nodular basal cell carcinoma and 11.0% had a mixed composition, including the nodular subtype. The incidence of squamous cell carcinoma was similar in men and women, with an average age- and sex-adjusted incidence per 100 000 persons of 3.9 (95% CI, 3.0-4.8); the incidence of squamous cell carcinoma increased significantly over the study period among both women (P = .01) and men (P = .04). CONCLUSIONS: This population-based study demonstrated an increase in the incidence of nonmelanoma skin cancer among young women and men residing in Olmsted County, Minnesota. There was a disproportionate increase in basal cell carcinoma in young women. This increase may lead to an exponential increase in the overall occurrence of nonmelanoma skin cancers over time as this population ages, which emphasizes the need to focus on skin cancer prevention in young adults.

Adult↗

Diagnosis of squamous cell carcinoma arising from mature cystic teratoma of the ovary.

BACKGROUND: The prognoses of patients with squamous cell carcinoma of the ovary are quite poor. However, preoperative diagnosis is difficult due to the rarity of this tumor and its similarity to mature cystic teratoma (MCT). The objective of this study was to assess the value of tumor markers and clinical characteristics in making a differential diagnosis between MCT and squamous cell carcinoma arising from MCT. METHODS: Between September 1979 and June 1996, 37 patients with ovarian squamous cell carcinoma arising from MCT were treated by the Tokai Ovarian Tumor Study Group. The authors evaluated tumor markers, tumor size, and age as parameters for differentiation between MCT and squamous cell carcinoma arising from MCT. Diagnostic efficiency was calculated as the sensitivity multiplied by the specificity. RESULTS: There were significant differences (P < or = 0.0002) in age, tumor size, and levels of squamous cell carcinoma antigen (SCC), CA125, and CEA, as well as a significant difference (P < or = 0.0396) in the CA19-9 level between MCT and squamous cell carcinoma arising from MCT. Diagnostic efficiency was highest for SCC (63.0%), followed by CA125 (50.7%). Receiver operating characteristic (ROC) curves demonstrated that CEA was the best screening marker for squamous cell carcinoma arising from MCT, whereas age and tumor size were better markers than CA125 or CA19-9. The optimal cutoff values for age and tumor size were 45 years and 99 mm, respectively, according to ROC analysis. CONCLUSIONS: These findings demonstrate that age and tumor size are important factors in making a differential diagnosis. In addition, SCC and CEA levels should be measured in patients age 45 years or older who have an MCT-like ovarian tumor larger than 99 mm in greatest dimension.

Adult↗

The significance of squamous differentiation in endometrial carcinoma. Data from a Gynecologic Oncology Group study.

Squamous differentiation is identified in about 25% of endometrial adenocarcinomas (AC). Its significance has been the subject of debate for decades, and it has been reported that the prognosis of adenoacanthoma (AA) is better than, the same as, and worse than that of AC. Part of this confusion has resulted from semantic differences relating to the use of AA and adenosquamous carcinoma (AS). To investigate the prognostic importance of squamous differentiation in endometrial carcinomas and compare the prognostic utility of two classification systems, 456 women were studied who had typical AC and 175 women who had typical AC containing areas of squamous differentiation (AC + SQ) and who had been entered in a Gynecologic Oncology Group protocol of Stage I and II endometrial adenocarcinoma. Assessment of histologic grade and depth of invasion was done both by the pathologist at the member institution and at a second highly structured review. Differentiation of the squamous component of endometrial carcinomas was found to parallel that of the glandular component in most tumors. The biologic behavior of endometrial carcinomas with squamous elements was similar, but not identical, to that of typical AC. Although the frequency of nodal metastasis was similar for both AC and AC + SQ, the presence of squamous elements was associated with an increased probability of survival. Division of AC + SQ by depth of myometrial invasion and by architectural grade of the glandular component provided useful prognostic information that was superior to that resulting simply from division of AC + SQ into AA or AS. The authors recommend that these terms be replaced by "adenocarcinoma with squamous differentiation" and that the pathologist provide information on the architectural grade and depth of myometrial invasion to guide the gynecologist in determining appropriate therapy.

Adenocarcinoma↗

Invasive squamous-cell carcinoma in ThinPrep specimens: diagnostic clues in the cellular pattern.

Despite the increasing utilization of the ThinPrep Pap Test (TP), limited data exist regarding the cytomorphologic features and patterns of invasive squamous-cell carcinoma in TP specimens. We analyzed a series of TP specimens from patients with histologically confirmed invasive squamous carcinomas of the cervix. Patients with biopsy-proven invasive squamous-cell carcinoma of the cervix with a TP cervical cytologic specimen within the previous 2 mo were identified. The TP slides were analyzed for overall cellularity (percent circle coverage by epithelial cells), tumor cellularity, tumor diathesis, inflammation, coexistent dysplasia, and keratinization. Tumor cellularity was defined as <5%, 5-50%, and >50% of slide cellularity. In all 13 cases that were identified, a cytologic diagnosis of either invasive squamous-cell carcinoma or suspicious for invasive squamous-cell carcinoma was made. In 7/13 cases (54%), epithelial cells covered <40% of the slide circle. Epithelial cells covered >40% of the slide circle in 6/13 cases (46%). Tumor cellularity covered <5% of the slide circle in 4/13 cases (31%), 5-50% in 7/13 cases (54%), and >50% in 2/13 cases (15%). A tumor diathesis was present in 12/13 cases (92%). Inflammation was absent in 1/13 cases (8%), mild in 8/13 cases (62%), moderate in 2/13 cases (15%), and severe in 1/13 cases (8%). Coexistent dysplasia was identified in 12/13 cases (92%). Keratinization was identified in 9/13 specimens (69%). In the vast majority of patients, a diagnosis of squamous-cell carcinoma was rendered on the TP cervical specimen, despite a pattern of decreased cell coverage. It could be hypothesized that tumor diathesis and inflammation may be the etiology for decreased cellularity by blocking filter coverage by epithelial cells. This cellular pattern with diathesis in the ThinPrep smear may be a useful clue to look carefully for diagnostic cells of squamous-cell carcinoma.

Adult↗

Increased expression of inducible nitric oxide synthase for human buccal squamous-cell carcinomas: immunohistochemical, reverse transcription-polymerase chain reaction (RT-PCR) and in situ RT-PCR studies.

BACKGROUND: The inducible nitric oxide synthase (iNOS) is involved primarily in inflammatory and carcinogenesis processes. An enhanced expression of iNOS at the protein level has been reported previously for human oral squamous cell carcinoma; however, the expression of iNOS at the mRNA level has not yet been demonstrated. Furthermore, no studies have addressed whether iNOS expression at mRNA level correlates with cervical lymph node metastasis. METHODS: Specimens of the squamous cell carcinoma of the buccal mucosa obtained from tissue samples of surgically resected tumors from 25 male patients were evaluated with immunohistochemical assessment of iNOS protein and IS-RT-PCR, as well as RT-PCR for iNOS mRNA. We also analyzed the iNOS expression status with clinical parameters to determine whether it had any prognostic significance in this homogenous population. RESULTS: Inducible NOS protein (16 of 25, 64%) and mRNA (13 of 25, 53%) activities were detected for the oral carcinoma specimens examined in this study. Cytoplasmic and/or nuclear stainings were observed in the specimens of both well-differentiated SCC (10 of 15, 67%), and moderately to poorly differentiated SCC (6 of 10, 60%). The cellular location of iNOS mRNA was noted to be consistent with the finding using immunohistochemical technique (cytoplasm and/or nuclei stainings of the tumor islands). Using in situ RT-PCR, iNOS mRNA activity was detected in nine specimens of well-differentiated squamous cell carcinoma (9 of 15, 60%) and four specimens of moderately to poorly differentiated squamous cell carcinoma (4 of 10, 40%). With RT-PCR, an electrophoretic band corresponding to a 907-bp PCR product was observed for nine specimens of well-differentiated squamous cell carcinoma (9 of 15, 60%) and four specimens of moderately to poorly differentiated squamous-cell carcinoma (4 of 10, 40%). Neither iNOS protein nor mRNA was noticed in the samples of normal buccal mucosa or in the negative control samples. There was a significant relationship between iNOS expression (at both protein and mRNA levels) and whether patients had nodal disease. CONCLUSIONS: We have demonstrated an enhanced expression of iNOS protein and mRNA in a number of human buccal carcinomas compared with normal buccal mucosa. Such an observation suggests that the iNOS protein and mRNA expression is chiefly derived from a subset of oral cancerous tissues. Our observation also indicates that iNOS expression correlates with cervical lymph node metastasis in oral squamous cell carcinomas. Therefore, it may also indicate that a subset of oral cancers with greater metastatic potential, as evidenced by increased expression iNOS protein and mRNA, is identified.

Adult↗

Prevalence of alpha-papillomavirus genotypes in cervical squamous intraepithelial lesions and invasive cervical carcinoma in the Italian population.

The aim of the present investigation was to define the spectrum of mucosotropic human papillomaviruses among 414 Italian women with normal cervices (n = 183), low- and high-grade cervical squamous intraepithelial lesions (n = 101 and 65, respectively), and invasive squamous cervical carcinomas (n = 65). Human papillomaviruses were detected by broad spectrum consensus-primer-pairs MY09/MY11 and GP5+/GP6+-based polymerase chain reaction using three amplification methods and were characterized by nucleotide sequence analysis. The prevalence rates of HPV infections was 19.7%, 63.4%, 80%, and 81.5% in patients with normal cervices, low-grade, and high-grade squamous intraepithelial lesions, and cervical carcinomas, respectively. Among the 205 HPV-positive patients, a total of 31 mucosal HPV genotypes were identified of which 16 types, epidemiological classified as high-risk viruses (HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 66, 68, 73, and 82), have been found in 16.9%, 50.1%, 69.2%, and 78.5% of normal cervix, low-, and high-grade cervical squamous intraepithelial lesions, and cervical carcinoma groups, respectively. As expected, the HPV16 was the most represented viral type in all groups examined with frequency rates ranging from 8.7% in normal subjects to 58.5% in invasive carcinoma patients. Ten epidemiologically defined low-risk HPV types (HPV6, 11, 42, 54, 61, 70, 71, 72, 81, 83) were detected in 2.7%, 7.9%, and 6.1% of normal cervix, low-, and high-grade cervical squamous intraepithelial lesions, respectively, and in none of invasive carcinomas. Furthermore, five unknown risk viruses were detected in 3% of low-grade cervical squamous intraepithelial lesions (HPV30, 32, 67), in 3.1% of high-grade cervical squamous intraepithelial lesions (HPV62, 90), and in 1.5% of cervical carcinomas (HPV62). Larger epidemiological screening studies, with PCR amplification and followed by either hybridization-based procedures against sequence targets of all known HPV types or sequence analysis studies, are needed in order to assess the epidemiological risk of less represented HPV types, to identify unknown viruses, and to monitor the future eventual spread of unusual viral types related to vaccination programs and/or population mobility.

Adult↗

Expression of the 3-fucosyl N-acetyllactosamine (CD 15) antigen in normal, metaplastic, dysplastic, and neoplastic squamous epithelia.

The 3-fucosyl N-acetyllactosamine residue is the antigen recognized by the monoclonal antibody MC2. Using MC2, we demonstrated the distribution of this antigen in a variety of squamous epithelia. The antigen is expressed to a variable degree on supra-basal cells in most normal non-keratinizing squamous mucosae, with a similar distribution in metaplastic squamous epithelia; antibody-labelled latex microspheres and immunogold electron microscopy show the antigen to form part of the glycocalyx. In dysplastic and neoplastic squamous lesions, expression is reduced or absent except in cells around areas of differentiation. Prior neuraminidase treatment of sections had little effect on the amount or distribution of demonstrable antigen. Expression of this antigen by cells in non-keratinizing squamous epithelia gives an indication of cell maturity and may provide a histological marker for the grading of dysplastic and malignant squamous mucosal lesions. A possible role for these carbohydrate residues in squamous mucosal defence is discussed.

Antigens, Neoplasm↗

The distribution of immuno-reactive tenascin in the epithelial-mesenchymal junctional areas of benign and malignant squamous epithelia.

Tenascin is an extra cellular matrix glycoprotein which is distributed in the mesenchyme surrounding various organs during embryogenesis. It has also been demonstrated in some normal adult tissues and in the matrix of human tumours. The present study has been carried out to analyse the distribution of tenascin in non malignant and malignant skin disorders, in squamous cell carcinomas of the head and neck, in squamous cell carcinoma xenografts and in a squamous cell carcinoma cell line grown on collagen gel. Immunohistochemical localisation of tenascin was performed, using a monoclonal antibody specific for tenascin, by the indirect immunoperoxidase method with silver enhancement. Tenascin was heterogeneously distributed in the extra cellular matrix of squamous cell carcinomas and in squamous cell carcinoma xenografts. It was absent in basal cell carcinoma and in the squamous cell carcinoma cell line grown on collagen gel. The distribution of tenascin in squamous cell carcinoma and basal cell carcinoma is discussed in relation to tumour invasion and differentiation.

Animals↗

Thyroid papillary carcinoma recurring as squamous cell carcinoma: report of a case.

We report a case of local squamous cell carcinoma recurrence of thyroid papillary carcinoma, 4 years after subtotal thyroidectomy, in an 82-year-old woman. The papillary cancer of the right thyroid was histopathologically classified as T2a, N0, M0, Ex1; pT2a, pN1b, pEx1; Stage III. Fine-needle aspiration cytology of the recurrent tumor revealed atypical squamous epithelium-like cells with keratinization. The tumor was judged cytologically to be class III, defined as a suspicious malignancy and, after reoperation, it was diagnosed histopathologically as papillary carcinoma recurrence with extensive squamous metaplasia. The recurrent papillary carcinoma was thought to have changed to a squamous cell carcinoma because most of the tumor was occupied by atypical squamous cells, with a small amount of glandular tissue. The primary tumor was histologically diagnosed as a well-differentiated papillary carcinoma at the initial operation. It contained numerous tall neoplastic cells with eosinophilic granules and pseudostratified nuclei, indicating that it could potentially transform into squamous cell carcinoma. We report this case as an example of how squamous cell carcinoma of the thyroid can develop.

Adenocarcinoma, Follicular↗

Recurrent squamous cell carcinoma of the breast with undifferentiated features: report of a case.

Squamous cell carcinoma of the breast is a rare type of cancer, the origin of which is still uncertain. We report a case of squamous cell carcinoma of the breast with a recurrent tumor that showed undifferentiated features. The patient was a 55-year-old woman who originally presented with a left breast mass in the upper outer quadrant. Echography showed a 46 x 29 x 23-mm mass with cavity formation, and aspiration cytology confirmed a diagnosis of squamous cell carcinoma. A modified radical mastectomy with level III lymph node dissection was performed. Pathologically, the tumor was composed of squamous cell carcinoma and noninvasive ductal carcinoma. A recurrent tumor showing undifferentiated features was detected in the left forechest 3 months after the operation, and tumorectomy with partial resection of the major and minor pectoralis muscles was performed. Despite intensive therapy including chemotherapy (CEF: cyclophosphamide, epirubicin, 5-fluorouracil) and irradiation (50 Gy), the patient died from pulmonary and skin metastases 20 months after her initial operation. The squamous cell carcinoma of the breast in this patient grew rapidly and her prognosis was poor. Immunohistochemical findings indicated the possibility that the squamous cell carcinoma developed from noninvasive ductal carcinoma of the comedo type, and that the undifferentiated cells from the site of recurrence developed from dedifferentiation of the squamous cell carcinoma.

Breast Neoplasms↗

Human papillomavirus DNA sequences in esophagus squamous cell carcinoma.

BACKGROUND/AIMS: Esophagus squamous cell carcinoma has much geographic variation. A variety of genetic and environmental factors have been implicated in the pathogenesis of esophagus squamous cell carcinoma. This study was undertaken to determine whether the human papillomavirus is present in these tumors. METHODS: A radioactive nested polymerase chain reaction was used to determine the presence of human papillomavirus in esophagus squamous cell carcinoma DNA and adjacent normal mucosa DNA from different regions of the world. Restriction fragment length polymorphism analysis was used to determine which particular human papillomavirus genotype was present. RESULTS: Human papillomavirus was identified in 14% of esophageal squamous cell cancer DNA but in none of the adjacent normal mucosa DNA available for some of the samples. Positive samples were found to contain sequences specific for high-risk human papillomaviruses, either types 16 or 18. In addition, a novel human papillomavirus genotype was detected in another 10% of the samples. CONCLUSIONS: Esophagus squamous cell carcinoma is associated with the expression of human papillomavirus genotypes 16 and 18, which are linked to transformation of squamous epithelial cells. In addition, a novel human papillomavirus genotype that was identified may be associated with pathogenesis in esophagus squamous cell cancer.

Adult↗

Squamous cell carcinoma of the eyelid.

The occurrence of squamous cell carcinoma of the lid is reviewed with emphasis upon the incidence, clinical presentation, pathophysiology and methods of treatment. Squamous cell carcinoma accounts for about 9% of all eyelid malignancies, although it is frequently over-diagnosed by pathologists and confused histologically with other benign entities. This lesion occurs most commonly in elderly, fair-complexioned individuals with a history of chronic sun exposure and skin damage. In the lids, squamous cell carcinoma shows a variety of clinical appearances although it usually presents as a painless, hyperkeratotic lesion that gradually enlarges and eventually ulcerates. There is a tendency for lower lid and lid margin involvement. This potentially lethal neoplasm is capable of aggressive local spread or metastasis to regional lymph nodes. The development of squamous cell carcinoma is thought to progress through phases of intraepithelial squamous dysplasia and intraepidermal squamous cell carcinoma before invasive squamous cell carcinoma occurs. Various treatment modalities have been advocated including surgical extirpation with histologic control, radiation therapy and cryotherapy.

Aged↗

Occurrence of human papillomavirus type 16 DNA in cutaneous squamous and basal cell neoplasms.

Sixty-eight cutaneous squamous cell neoplasms (in situ and invasive) and 26 basal cell carcinomas from 89 patients were analyzed for DNA sequences homologous to the human papillomavirus (HPV) types found predominantly in the genital tract. Thirty-six (53%) of the squamous cell neoplasms contained HPV DNA as detected by filter or in situ hybridization analysis. The frequency of detection of HPV DNA was dependent on the site of the lesion. Of 40 genital squamous cell neoplasms (penile, vulvar, and perianal), 27 (68%) had detectable HPV DNA. In 25 of these, the HPV type was 16 or HPV-16-related, which was similar to the results for the squamous cell neoplasms of the finger (HPV DNA in 9 of 11 tumors with HPV-16 in seven). None of 16 squamous cell neoplasms from sites other than the genital tract or the finger had detectable HPV DNA. HPV DNA was detected in one of the 26 basal cell carcinomas (4%). We conclude that, for cutaneous epithelial malignancies, HPV-16 is restricted to squamous cell neoplasms of the genital tract and finger. These data are consistent with venereal transmission of HPV-16 to the periungual region and suggests a role for this virus in the evolution of squamous cell carcinoma at this site.

Adult↗

Aberrant p16 methylation is a biomarker for tobacco exposure in cervical squamous cell carcinogenesis.

OBJECTIVE: The purpose of this study was to determine the association between active tobacco exposure and aberrant p16 promoter methylation in primary cervical squamous cell cancer and high-grade squamous cervical dysplasia. STUDY DESIGN: p16 methylation-specific polymerase chain reaction was performed on DNA that was extracted from 60 cervical cancers, 30 high-grade dysplasia specimens, and 78 normal cervical cytologic specimens. Patient data were obtained by medical record review or were collected prospectively. RESULTS: Aberrant p16 methylation was significantly higher in squamous cell cervical cancers (61%) than in squamous high-grade dysplasia (20%) or normal cytologic specimens (7.5%). Approximately one half the women with squamous cancer and one half of the women with high-grade dysplasia were active smokers. Aberrant p16 methylation was associated with active tobacco use in patients with squamous carcinoma (odds ratio, 20.6; 95% CI, 3.6-118; P<.001) and high-grade dysplasia (odds ratio, 4.57; 95% CI, 1.63-12.78; P=.002). CONCLUSION: Aberrant p16 methylation is associated strongly with active tobacco use in squamous cell cervical cancers and high-grade dysplasia.

Carcinoma, Squamous Cell↗

In situ adenocarcinoma and squamous carcinoma of uterine cervix. Pathological and immunohistochemical analysis with cytokeratin 13.

OBJECTIVES: The aim of the study was the pathological and immunohistochemical analysis of cytokeratin 13 (CK13) in intraepithelial cervical tumors. STUDY DESIGN: We studied 415 in situ squamous carcinomas and 13 in situ mucinous cervical type adenocarcinomas of the uterine cervix. All patients underwent laser cervical conization and had a follow-up ranging 12-135 months. RESULTS: 3% of the squamous carcinoma patients recurred during the follow-up period, while the percentage of recurrence of in situ adenocarcinoma patients was 7.6%. We observed positive surgical edges in 46.1% of glandular tumors, and in 5% of squamous tumors. The percentage of recurrence was high among the cases with positive borders independently from their histopathologic type (14.3% in the squamous carcinomas versus 50% in the adenocarcinomas), compared to cases with negative edges (2.3% in the squamous carcinomas versus 0% in the adenocarcinomas). We observed CK13 positive staining in cervical squamous tumors and in mucinous cervical type adenocarcinomas, while there was no positive staining in non-neoplastic cervical glandular elements. CONCLUSION: CK13 positive immunostaining among in situ squamous and in situ mucinous cervical type adenocarcinoma cases adds additional evidence to data supporting a common origin of the two lesions.

Adenocarcinoma, Mucinous↗

Histologic results of EMR for esophageal lesions diagnosed as high-grade intraepithelial squamous neoplasia by endoscopic biopsy.

BACKGROUND: Biopsy specimens obtained from esophageal lesions detected in endoscopic screening with iodine staining have often been diagnosed as high-grade intraepithelial squamous neoplasia (WHO 2000). However, a management strategy for such lesions has not been established. The purpose of this study was to perform EMR for such lesions and to determine the actual tumor stage in patients with complete resection and the outcomes after EMR. PATIENTS: During the study period, 51 patients were found to have esophageal lesions diagnosed as high-grade intraepithelial squamous neoplasia by using endoscopic iodine staining in biopsy specimens. All of the patients underwent EMR, and resected specimens were reviewed microscopically. RESULTS: Histologic examination of totally resected specimens revealed that 12 (23.5%) of the 51 patients had tumor invasion of the lamina propria mucosae and that 4 (7.8%) had tumor invasion of the muscularis mucosae. The remaining 35 patients (68.6%) were confirmed to have high-grade intraepithelial squamous neoplasia. The invasive focus in all of the 16 lesions of invasive squamous-cell carcinoma was surrounded by high-grade intraepithelial squamous neoplasia. After a median of 23 months of follow-up, there were two recurrences, and those patients required second EMR. CONCLUSIONS: Histologic results suggested that high-grade intraepithelial squamous neoplasia of the esophagus has characteristics of carcinoma in the preinvasive stage. EMR should be performed for esophageal lesions diagnosed by endoscopic biopsy as high-grade intraepithelial squamous neoplasia, not only because of its probable malignant potential but also because more than 30% of such lesions are actually invasive carcinoma.

Aged↗

The value of squamous cell carcinoma antigen in patients with locally advanced cervical cancer undergoing neoadjuvant chemotherapy.

Serum levels of squamous cell carcinoma antigen were measured in 688 samples from 119 patients with cervical cancer. Ninety-seven patients had primary tumors and 22 had recurrent disease. Serum samples were obtained before each cycle of chemotherapy, before surgery, at least 4 weeks after surgery, and at 2- to 3-month intervals during follow-up from 78 of the patients with locally advanced cervical cancer who were receiving neoadjuvant chemotherapy. Squamous cell carcinoma antigen serum levels were elevated (greater than 2.5 ng/ml) in 71% of the patients with primary tumors and in 77% of the patients with recurrent carcinomas. The percentage of positivity increased significantly with stage (p = 0.03) and was higher in squamous cell tumors than in adenocarcinomas (p less than 0.001). Pretreatment squamous cell carcinoma antigen levels were not predictive of neoadjuvant chemotherapy response; however, the serial measurement during chemotherapy showed a good correlation with clinical response. In the patients who had surgery, squamous cell carcinoma antigen positivity did not correlate to pathologic findings (lymph node status, cervical and parametrial infiltration). Disease-free survival was significantly longer in patients with squamous cell carcinoma antigen pretreatment values that were lower than 5 ng/ml, compared with patients with marker higher than 5 ng/ml (p less than 0.01). Abnormal squamous cell carcinoma antigen serum levels preceded the clinical detection of recurrence in eight of 11 patients with a median lead time of 5 months.

Adenocarcinoma↗

Oncogenic human papillomaviruses are rarely associated with squamous cell carcinoma of the bladder: evaluation by differential polymerase chain reaction.

While a strong association between oncogenic human papillomaviruses and squamous cell cancers of the genital tract (penis, urethra and cervix) is known to exist, there is substantial controversy regarding the association of human papillomaviruses and cancers of the bladder. Technical issues regarding assay technique and concern about potential contamination have marred interpretation of previous work. Moreover, because human papillomavirus has been associated predominantly with squamous cell cancers at other sites, any involvement of human papillomavirus and bladder epithelial carcinogenesis must address whether any association between human papillomavirus and squamous cell carcinoma of the bladder exists. Differential polymerase chain reaction and a rigorous protocol to avoid crossover contamination were used to analyze archival bladder carcinoma specimens (22 squamous cell carcinomas and 20 transitional cell carcinomas). Type specific primers for human papillomavirus types 16 and 18 were used as were general primers to detect types 6b, 11, 13, 16, 18, 31, 32, 33, 35, 45 and 51. Only 1 of 22 squamous cell carcinoma specimens (4.4%) was positive (human papillomavirus type 18)--a cadaveric renal transplant patient on chronic immunosuppression. Cervical specimens were human papillomavirus negative in this patient. No human papillomavirus deoxyribonucleic acid was detected in the 20 transitional cell carcinoma cohort. Our results confirm that these human papillomavirus types appear to have little association with invasive transitional cell cancers. Of greater significance, despite this (to our knowledge) first reported case of human papillomavirus type 18 detected in squamous cell carcinoma of the bladder (seen in an immunocompromised patient), we conclude that these oncogenic human papillomavirus types do not have a significant role in squamous cell carcinogenesis of the bladder.

Adult↗