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[Multiple cutaneous neoplasms in cyclosporine therapy after kidney transplantation].

We report on a 56-year-old renal allograft recipient receiving cyclosporin A immunosuppression. During this therapy he subsequently developed the following cutaneous neoplasms: squamous cell carcinomas, basal cell carcinomas, Bowen's disease, actinic keratosis, sebaceous hyperplasia, a dysplastic naevus and, finally a nodular malignant melanoma. Adverse effects of the cyclosporin A therapy are discussed, with special reference to dermatologic effects and the implications for patient and doctor.

Bowen's Disease↗

Neoplasms of the limbus.

One hundred consecutively excised and histologically diagnosed limbal neoplasms were analyzed. Majority (56%) of the affected patients were less than 30 years old. Benign tumours (77%) outnumbered the malignancies. Dermoids (29%) and hyperplastic squamous epithelium or 'epidermalization' (26%) were the commonest benign neoplasms. Squamous cell carcinoma, including frank and non-invasive carcinoma (23%) was the most frequent malignant tumour. These observations were compared with previous Indian and Western studies and the implications discussed.

Adolescent↗

Papillary carcinoma of the thyroid metastatic to the parapharyngeal space.

The parapharyngeal space is a complex anatomic area which can give rise to a variety of both primary and metastatic neoplasms. Squamous cell carcinoma can also present as a parapharyngeal space mass, either by direct extension or by metastases. Occult thyroid carcinoma presenting as a parapharyngeal space mass is a rare clinical occurrence which has been only sporadically reported in the medical literature. We present a case of occult papillary thyroid cancer with parapharyngeal space metastasis in the form of an isolated tumor, as well as a review of the literature on similar presentations. This rare situation has been previously described only once in the medical literature. Metastatic thyroid cancer should be considered in the differential diagnosis of a parapharyngeal space mass.

Carcinoma, Papillary↗

Inhibition of oral carcinogenesis by the arotinoid mofarotene (Ro 40-8757) in male F344 rats.

The chemopreventive effect of dietary administration of a new arotinoid, mofarotene (Ro 40-8757), which contains a morpholine structure in the polar end group, during the initiation phase of 4-nitroquinoline 1-oxide (4-NQO)-induced oral carcinogenesis was investigated in male F344 rats. Also, modulatory effects of this compound on polyamine levels (biomarkers of proliferation), the 5-bromodeoxyuridine-labeling index and the number of silver stained nucleolar organizer region proteins (AgNORs)/nucleus were assessed in the target epithelium. Rats were fed Ro 40-8757 at concentrations of 250 and 500 p.p.m. for 10 weeks. One week after the commencement of the diets, 4-NQO (20 p.p.m.) was administered in the drinking water for 8 weeks. Feeding of Ro 40-8757 at both doses caused a 78% reduction in the incidence of tongue neoplasms (squamous cell papilloma and carcinoma) by 32 weeks when compared with rats treated with 4-NQO alone (P < 0.05). Similarly, in rats treated with 4-NQO together with Ro 40-8757 the incidence of preneoplastic lesions (hyperplasia and dysplasia) was significantly less than the 4-NQO alone group (P < 0.05). Expression of three biomarkers was also decreased significantly by dietary treatment with Ro 40-8757. Thus a new arotinoid, Ro 40-8757, inhibited the oral carcinogenesis induced by 4-NQO when it was administered concurrently with the carcinogen. These results might suggest the possible application of Ro 40-8757 for cancer chemoprevention in the oral cavity, in addition to the breast.

Animals↗

Pathways sufficient to induce epidermal carcinogenesis.

Abnormal epidermal proliferation is characteristic of a number of disorders, including the two most common cancers in the United States, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Both cancers display a disruption in the normal homeostatic balance between cell division and programmed cell death. While abnormal activation of the sonic hedgehog/patched pathway has been established as sufficient to induce hallmark features of BCC in both human and murine epidermis, pathways sufficient to convert normal epidermis into SCC have been less well defined. Building on findings that indicate a potent role for Ras and NF-kappaB in normal epidermal growth regulation, recent work indicates that activation of Ras signaling in concert with inhibition of NF-kappaB function is entirely sufficient to transform normal human epidermis into tumor tissue with all the cardinal features of SCC.

Animals↗

NTP Toxicology and Carcinogenesis Studies of Benzyl Acetate (CAS No. 140-11-4) in F344/N Rats and B6C3F1 Mice Feed Studies).

Benzyl acetate is used as a flavoring agent in foods, as a fragrance in soaps and perfumes, as a solvent for cellulose acetate and nitrate, and as a component of printing inks and varnish removers. The NTP previously studied the toxicology and carcinogenicity of this chemical in F344/N rats and B6C3F1 mice using the gavage route of administration and corn oil as a vehicle. Benzyl acetate increased the incidences of pancreatic acinar cell adenomas in male rats and the incidences of hepatocellular adenomas and forestomach neoplasms in male and female mice. Because of the confounding effect of corn oil on the incidences of pancreatic neoplasms and because of controversy over the use of the gavage route of administration, the NTP decided to restudy benzyl acetate using the dosed feed route of administration. In these repeat studies, male and female F344/N rats and B6C3F1 mice received benzyl acetate (at least 98% pure) in feed for 13 weeks and 2 years. Genetic toxicology studies were conducted in Salmonella typhimurium nunnery, cultured Chinese hamster ovary cells, LS178Y mouse lymphoma cells, Drosophila melanogaster, and mouse bone marrow and peripheral blood cells. 13-WEEK STUDY IN RATS: Groups of 10 male and 10 female F344/N rats were fed diets containing 0, 3,130, 6,250,12,500, 25,000, or 50,000 ppm (0, 230, 460, 900,1,750, or 3,900 mg/kg body weight for males and 0, 240, 480, 930,1,870, or 4,500 mg/kg for females) benzyl acetate for 13 weeks. Nine male and nine female rats receiving 50,000 ppm benzyl acetate died or were killed moribund between weeks 2 and 8 of the study. The mean body weight gain and the final mean body weight of 25,000 ppm males were significantly lower (P</=0.01) than those of the control group. Feed consumption by exposed rats, except the 25,000 and S0,000 ppm males and 50,000 ppm females, was similar to that by the controls. The reduced feed consumption by 25,000 and 50,000 ppm males and 50,000 ppm females may have been due to toxicity or decreased palatability. Tremors and ataxia occurred only in the 50,000 ppm rats. These findings were first observed on day 15 in nine males and six females and continued until the end of the study. Cholesterol levels in 12,500 and 25,000 ppm females and triglyceride levels in 25,000 ppm females were lower than those in the controls. Chemical-related lesions occurred in the brain, kidney, tongue, and skeletal muscles of the thigh. Necrosis of the brain involving the cerebellum and/or hippocampus, degeneration and regeneration of the renal tubule epithelium, and degeneration and sarcolemma nuclear hyperplasia of the tongue and skeletal muscles occurred in most male and female 50,000 ppm rats. This effect was observed in the 1,000 mg/kg group in the previous gavage study (NTP, 1986). 13-WEEK STUDY IN MICE: Groups of 10 male and 10 female B6C3F1 mice were fed diets containing 0, 3, 130, 6,250, 12,500, 25,000, or 50,000 ppm (0, 425, 1,000, 2,000, 3,700, or 7,900 mg/kg body weight for males and 0, 650, 1,280, 2,980, 4,300, or 9,400 mg/kg for females) benzyl acetate. One 50,000 ppm male mouse died and one 50,000 ppm female mouse was killed moribund before the end of the study. Mean body weight gains and final mean body weights of all exposed male and female mice were significantly lower than those of the controls and the mean body weight gains decreased with increased exposure level. Feed consumption by 3,130 ppm males and all exposed females was lower than that by the controls. Tremors occurred only in females and were first observed on day 16 in three females receiving 50,000 ppm, day 94 in one female receiving 25,000 ppm, and day 93 in one female receiving 12,500 ppm. The tremors continued until the end of the study. Necrosis of the brain involving the hippocampus occurred in four 50,000 ppm mice, one male and three females. Hepatocellular necrosis also occurred in the male with brain lesions. On reexamination of the previous 13-week gavage study (NTP, 1986), a similar lesion was seen in the brain of one 1,000 mg/kg female mouse; none were seen in 1,000 mg/kg male mi male mice. The lesion was less severe than that described in the present dosed feed study. The highest dose used in the gavage study was 1,000 mg/kg compared to an estimated high dose of 7,200 mg/kg for the feed study. 2-YEAR STUDY IN RATS: The doses selected for the 2-year feed study of benzyl acetate in F344/N rats were based on lower survival, mean body weights, and feed consumption, and on increased incidences of histopathologic brain lesions in 50,000 ppm male and female rats in the 13-week study. Groups of 60 male and 60 female F344/N rats were fed diets containing 0, 3,000, 6,000, or 12,000 ppm benzyl acetate for 2 years. Survival, Body Weights, Feed and Compound Consumption, and Clinical Pathology: Survival of exposed rats was similar to that of the controls. The mean body weights of the 12,000 ppm males and exposed females were approximately 5&percnt; lower than those of the controls throughout most of the study. The feed consumption by 12,000 ppm males was slightly lower than that by the controls. Dietary levels of 3,000, 6,000, and 12,000 ppm benzyl acetate were estimated to result in average daily consumption levels of 130, 260, and 510 mg/kg body weight (males) and 145, 290, and 575 mg/kg (females). No biologically significant changes in hematology or clinical chemistry parameters were found that could be attributed to benzyl acetate administration. Pathology Findings: No compound-related increased incidences of neoplasms or nonneoplastic lesions occurred in male or female F344/N rats receiving benzyl acetate for as long as 2 years. 2-YEAR STUDY IN MICE: The doses selected for the 2-year feed study of benzyl acetate in B6C3F1 mice were based primarily on lower body weight gains and lower final mean body weights of exposed mice in the 13-week study. Groups of 60 male and 60 female B6C3F1 mice were fed diets containing 0, 330, 1,000, or 3,000 ppm benzyl acetate for 2 years. Survival, Body Weights, Feed and Compound Consumption, and Clinical Pathology: Survival of all exposed mice, except the 3,000 ppm females, was similar to that of the control groups. Survival of 3,000 ppm females was significantly higher than that of the control group. Throughout the 2-year study, the mean body weights of 1,000 and 3,000 ppm males and females were 2&percnt; to 14&percnt; lower than those of the control groups. Dietary levels of 330, 1,000, and 3,000 ppm benzyl acetate were estimated to result in average daily consumption levels of 35, 110, and 345 mg/kg (males) and 40, 130, and 375 mg/kg (females). No biologically significant changes in hematology or clinical chemistry parameters were observed in mice receiving 330,1,000, or 3,000 ppm benzyl acetate. Pathology Findings: No increase in neoplasm incidence in mice could be attributed to benzyl acetate administration in feed. This contrasts with the previous finding that administration of benzyl acetate in corn oil by gavage once daily 5 days a week for as long as 2 years was carcinogenic to mice, causing increased incidences of hepatocellular neoplasms and forestomach neoplasms. The contrast in results between the two studies may be due to differences in the dose levels used (highest dose: gavage, 1,000 mg/kg a day; feed, 360 mg/kg a day). Dose-related increased incidences or severities of nonneoplastic nasal lesions occurred in the most posterior portions of the nasal cavity in all exposed groups. The lesions occurred in the majority of the exposed mice and consisted of atrophy and degeneration, primarily of the olfactory epithelium, cystic hyperplasia of the nasal submucosal glands, pigmentation of the mucosal epithelium, and exudate accumulation. GENETIC TOXICOLOGY: Benzyl acetate was not mutagenic in Salmonella typhimurium strains TA98, TA100, TA1535, or TA1537, with or without exogenous metabolic activation (S9). However, a positive response was observed for benzyl acetate, with and without S9, in the mouse lymphoma assay for induction of trifluorothymidine resistance in L5178Y cells. No significant increases in the frequencies of sister chromatid exchanges or chromosomal aberrations occurred in cultured Chinese hamster ovary cells treated with benzyl acetate in vitro, with or without S9, and no increases in either sister chromatid exchanges or chromosomal aberrations occurred in bone marrow cells of male mice treated in vivo by intraperitoneal injection. No increase in sex-linked recessive lethal germ cell mutations occurred in male Drosophila melanogaster administered benzyl acetate in feed or by injection. Tests of benzyl acetate for induction of micronucleated erythrocytes in bone marrow and peripheral blood of mice were also negative. CONCLUSIONS: Under the conditions of these 2-year feed studies, there was no evidence of carcinogenic activity of benzyl acetate in male or female F344/N rats receiving 3,000, 6,000, or 12,000 ppm; however, rats may have tolerated higher doses. There was no evidence of carcinogenic activity of benzyl acetate in male or female B6C3F1 mice receiving 330, 1,000, or 3,000 ppm. Nasal lesions associated with benzyl acetate exposure in male and female mice included nasal mucosa atrophy and degeneration (primarily of the olfactory epithelium), cystic hyperplasia of the nasal submucosal gland, and luminal exudate and pigmentation of the nasal mucosal epithelium. In previous 2-year gavage studies (TR-250), benzyl acetate increased the incidence of acinar cell adenomas of the exocrine pancreas in male F344/N rats; the gavage vehicle may have been a contributing factor. There was no evidence of carcinogenic activity in female F344/N rats receiving 250 or 500 mg/kg a day. There was some evidence of carcinogenic activity in male and female B6C3F1 mice, indicated by the increased incidences of hepatocellular adenomas and squamous cell neoplasms of the forestomach. Synonyms: acetic acid benzyl ester, acetic acid phenyl methyl ester, (acetoxymethyl)benzene, acetoxytoluene, benzyl ethanoate, phenylmethyl acetate

Journal Article↗

Occupational respiratory cancer and exposure to asbestos: a case-control study in a cohort of workers in the electricity and gas industry.

Cancers of the pleura, lung, and larynx between 1978 and 1989 among active male workers of Electricité de France-Gaz de France were studied in association with asbestos exposure using a case-control design nested within the cohort of workers of the company. The cohort included about 1,400,000 person-years, corresponding to a mean of 117,000 men per year. Exposure to asbestos and to some potential occupational confounders selected among agents from groups I, IIa, and IIb of the International Agency for Research on Cancer was assessed by a job-exposure matrix specific to the company. During the observation period, 12 cases of pleural cancer, 310 cases of lung cancer, and 116 cases of larynx cancer were registered in the cancer register of the company social security department. Four controls per case, matched for year of birth, were randomly selected among the cohort. Conditional logistic regression was used to estimate the odds ratios. A first analysis was conducted in order to assess the validity of the job-exposure matrix by investigating already known relationships between asbestos exposure and asbestosis. For asbestosis, a strong exposure-response relation was found with an odds ratio (OR) of 57.4 [95% confidence interval (CI): 17.0-194.0] in the highest exposure group. There was an elevated risk of pleural cancer (OR, 4.8, CI, 1.2-19.8). For lung cancer, significant ORs of 2.0 (CI, 1.3-3.2) and 1.9 (CI, 1.2-3.0) were found among the two highest cumulative exposure groups; adjustement for confounders slightly decreased the ORs. Squamous cell neoplasm of the lung was associated with asbestos exposure. The association between larynx cancer and asbestos exposure showed a tendency towards a nonsignificant increase in ORs in the highest cumulative exposure categories; this tendency disappeared when adjusting for occupational confounders. This study showed that occupational exposure to asbestos could increase the risk of pleural and lung cancer in a sector in which exposure levels are not considered to be high compared with other industrial settings.

Asbestos↗

NTP Toxicology and Carcinogenesis Studies of Marine Diesel Fuel (NO CAS) and JP-5 Navy Fuel (CAS No. 8008-20-6) in B6C3F1 Mice (Dermal Studies).

Toxicology and carcinogenesis studies were conducted by applying marine diesel fuel or JP-5 navy fuel to clipped dorsal interscapular skin of male and female B6C3F1 mice to determine both systemic and dermal effects. Doses for the 2-year studies were set by conducting 14-day and 13-week studies. Doses of 2,000-40,000 mg/kg marine diesel fuel were applied neat in the 14-day studies; in the 13-week studies, doses of 250-4,000 mg/kg marine diesel fuel in acetone were applied with a dose volume of 0.1 ml. Doses of 5,000-40,000 mg/kg JP-5 navy fuel in ethanol were applied in the 14-day studies with a dose volume of 0.5 ml; in the 13-week studies, doses of 500-8,000 mg/kg JP-5 navy fuel in acetone were applied with a dose volume of 0.2 ml. For the 2-year studies, doses were selected which did not cause deaths, decrease body weight gain, or produce excessive dermatitis in the 14-day or 13-week studies. Two-year studies were conducted by administering marine diesel fuel or JP-5 navy fuel by dermal application to groups of 49 or 50 male and 50 female B6C3F1 mice at doses of 0, 250, or 500 mg/kg in an acetone vehicle with a dose volume of 0.1 ml. Both sexes of mice dosed with 500 mg/kg marine diesel fuel (84-week exposure) and female mice dosed with 500 mg/kg JP-5 navy fuel (90-week exposure) were killed early because of excessive irritation and ulceration at the site of application and to prevent the spread of infection. Survival rates at those times were 26/50 males and 29/50 females dosed with marine diesel fuel and 17/50 females dosed with JP-5 navy fuel. Survival rates at the end of the studies (104 weeks) were reduced (P<0.01) in low dose female mice receiving marine diesel fuel (40/50 in vehicle controls compared with 12/50 in the low dose group) or with JP-5 navy fuel (44/50 in vehicle controls compared with 33/50 in the low dose group). Body weight gain was decreased below that of the vehicle controls after week 30 in all groups of mice receiving marine diesel fuel and in both sexes of mice receiving the high dose of JP-5 navy fuel. There was a marked increase in the incidence of chronic dermatitis in mice receiving marine diesel fuel or JP-5 navy fuel. Chronic dermatitis was defined as a composite lesion of epidermal histopathologic changes generally consisting of acanthosis, hyperkeratosis, and in some instances necrosis and ulceration of the overlying epidermis. Dermal changes frequently included fibrosis, increased amounts of melanin, and the presence of acute and chronic inflammatory cell infiltrates. A dose-related, proportional increase in the severity of the lesions was twofold to threefold greater in the dosed groups than in the vehicle controls. The averagedegree of severity of the lesions was judged to be minimal in the vehicle controls, mild in the low dose groups, and moderate in the high dose groups of mice dosed with marine diesel fuel or JP-5 navy fuel. There were similar responses at the site of inguinal skin to which the chemicals had migrated after application, but the degree of severity of the lesions was judged to be minimal to mild in the vehicle control and dosed groups of mice. Squamous cell papillomas or carcinomas (combined) occurred with a positive trend (P<0.05) at the site of application in male mice administered marine diesel fuel (vehicle control, 0/49; low dose, 0/49; high dose, 3/49). The total numbers of mice with squamous cell papillomas or carcinomas (combined) both for the site of application and the adjacent inguinal skin were 1/50, 2/49, and 3/50 for the vehicle control, low dose, and high dose groups of male mice and 0/50, 1/45, and 2/48 for female mice. There are no NTP historical data for B6C3F1 mice that received acetone by dermal application. The NTP historical incidence of squamous cell papillomas or carcinomas (combined) in untreated male and female B6C3F1 mice is 0.3%-0.4% in over 3,500 observations. Marine diesel fuel was not mutagenic in Salmonella typhimurium TA98, TA100, TA1535, or TA1537, and JP-5 navy fuel was not mutagenic in strains TA97, TA98, TA100, or TA1535 in th100, or TA1535 in the presence or absence of Aroclor 1254-induced male Sprague-Dawley rat or male Syrian hamster S9 when tested according to the preincubation protocol. Audits of the experimental data were conducted for these 2-year studies on marine diesel fuel and JP-5 navy fuel. No data discrepancies were found that influenced the final interpretations. Under the conditions of these 2-year dermal studies, marine diesel fuel at doses of 250 and 500 mg/kg resulted in dose-related increased incidences of squamous cell neoplasms of the skin (primarily carcinomas), providing equivocal evidence of carcinogenicity for male and female B6C3F1 mice. The sensitivity for detecting systemic carcinogenicity in female mice dosed with marine diesel fuel was reduced by poor survival. Under the conditions of these 2-year dermal studies, JP-5 navy fuel at doses of 250 and 500 mg/kg provided no evidence of carcinogenicity for male and female B6C3F1 mice.

Journal Article↗

Bioassay of hydrazobenzene for possible carcinogenicity.

A bioassay of technical-grade hydrazobenzene for possible carcinogenicity was conducted using Fischer 344 rats and B6C3F1 mice. Hydrazobenzene was administered in the feed, at either of two concentrations, to groups of 50 male and 47 to 50 females animals of each species. The time-weighted average dietary concentrations used in the rat bioassay were 0.008, 0.03, 0.004, and 0.01 percent for low dose males, high dose males, low dose females, and high dose females, respectively. The time-weighted average dietary concentrations used in the mouse bioassay were 0.008, 0.04, 0.004, and 0.04 percent for low dose males, high dose males, low dose females, and high dose females, respectively. After a 78-week period of compound administration, observation of the rats continued for an additional 28 to 30 weeks and observation of the mice continued for an additional 17 or 18 weeks. For each species, 47 to 50 animals of each sex were placed on test as controls. In both, species, adequate numbers of animals in all groups survived sufficiently long to be at risk from late-appearing tumors. The incidence of hepatocellular carcinomas was significantly increased in dosed male rats and the incidence of neoplastic nodules of the liver was significantly increased in dosed female rats. A significant increase in the combined incidence of squamous-cell carcinomas or squamous-cell papillomas of the Zymbal's gland, the ear canal, or the skin of the ear was observed among high dose male rats. A significant increase in mammary adenocarcinomas was observed among dosed female rats. The incidence of hepatocellular carcinomas was significantly increased among female mice, but no significant increase in liver tumors was observed among male mice. Under the conditions of this bioassay, hydrazobenzene was carcinogenic to Fischer 344 rats of both sexes, causing increased incidences of hepatocellular carcinoma and Zymbal's gland squamous-cell neoplasms in male rats, neoplastic nodules of the liver in female rats, and mammary adenocarcinomas in female rats. Hydrazobenzene was also carcinogenic to female B6C3F1 mice, causing an increased incidence of hepatocellular carcinomas. The compound was not carcinogenic to male B6C3F1 mice.

Journal Article↗

Epithelioma cuniculatum: verrucous carcinoma of the foot.

A patient with epithelioma cuniculatum, an unusual, highly keratinizing squamous cell neoplasm of the foot with locally aggressive behavior, is presented herein. Review of the literature reveals several similar cases that are reported under the names of epithelioma cuniculatum, papillomatosis cutis carcinoides, and verrucous carcinoma of the skin. The relationship of this neoplasm to other forms of verrucous carcinoma is noted. Lack of metastatic involvement indicates that a conservative surgical approach should be used, when possible, in the therapeutic management of this lesion.

Carcinoma, Papillary↗

Primary multipotential malignant neoplasm of bone: chondrosarcoma associated with squamous cell carcinoma.

A primary neoplasm of the proximal humerus in a 68-year-old woman was unique histologically in that it contained both malignant cartilaginous and squamous cell components. The epithelial differentiation was confirmed by the demonstration of keratin by immunohistochemical techniques and of basement membrane, tonofilaments, and well-formed desmosomes by electron microscopy. The patient died 3 1/2 years after the onset of symptoms, without clinical evidence of either a primary tumor elsewhere or metastasis. The differential diagnosis from other bone tumors with epithelial differentiation, such as adamantinoma and "primitive multipotential primary sarcoma," is discussed. This is a rare primary neoplasm of bone of unknown histogenesis. Intermutability or metaplasia between mesenchymal and epithelial tissues is a possibility. The tumor probably originated from multipotential stem cells with the ability to undergo biphasic or dual differentiation toward mesenchymal and epithelial elements.

Aged↗

[A rare case of multiple primary malignant neoplasms of parotid gland: fibrosarcoma and squamous cell carcinoma].

Primary multiple malignant neoplasms and multifocal neoplasms are a very complex problem and therefore have been a topic of many articles. The mechanism of origin, frequency of occurrence, co-existence of neoplasms in functionally similar organs (uterus, mammary gland), heredity, a possibility of diagnostic and therapy are the most interesting aspects. Frequency of multiple primary malignant neoplasms occurrence is about 2-8% and still increases. Pathogenesis of multifocal and multiple neoplasms has rarely been a subject of articles. A simultaneous exposure of a tissue to damaging factors and special tissue sensitivity are the main reasons for neoplasms origin in this group. The authors present a rare case of parotid gland multiple neoplasm: fibrosarcoma and squamous cell carcinoma, as well as discuss the diagnostics, therapy, and prognosis of multiple neoplasms.

Antineoplastic Agents↗

The choline/creatine ratio in five benign neoplasms: comparison with squamous cell carcinoma by use of in vitro MR spectroscopy.

BACKGROUND AND PURPOSE: The choline (Cho)/creatine (Cr) ratio has been shown to be a reliable proton MR spectroscopy metabolic marker for differentiating squamous cell carcinoma (SCCA) from normal muscle in the upper aerodigestive tract. However, it is unclear whether the Cho/Cr ratio can be used to differentiate a malignant tumor from a benign neoplasm in the extracranial head and neck. Our purpose was to determine whether the Cho/Cr ratio can be used to differentiate benign from malignant tumors in this region. METHODS: In vitro one-dimensional proton MR spectroscopy (2,000/136,272 [TR/TE]) was performed at 11 T on tissue specimens obtained from glomus tumors (n = 3), inverting papilloma (n = 1), and schwannoma (n = 1). Cho/Cr area ratios were calculated and compared with similar, previously reported in vitro (11 T) findings and with samples of SCCA and normal muscle. RESULTS: The Cho/Cr ratio was elevated in relation to muscle in all benign tumors at TE = 136 (glomus tumors = 4.52, inverting papilloma = 3.85, schwannoma = 2.2) and at TE = 272 (glomus tumors = 8.01, inverting papilloma = 2.1, schwannoma = 4.28). The average Cho/Cr ratio for benign lesions was 3.92 (TE = 136) and 6.11 (TE = 272). The Cho/Cr ratio was significantly higher in benign tumors than in both SCCA and muscle. The average Cho/Cr ratio for muscle at TEs of 136 and 272 was 1.16 and 1.31, respectively, whereas for SCCA the average Cho/Cr ratio at TEs of 136 and 272 was 1.67 and 2.45, respectively. CONCLUSION: In our small group, the Cho/Cr ratio was significantly higher in benign tumors than in muscle and SCCA of the extracranial head and neck.

Area Under Curve↗