Squamous Cell Carcinoma of the Oral Tongue: a Single Institution Retrospective Cohort Study From Mansoura University Hospital

Background: Egyptian hospital–based statistics showed that head & neck carcinomas represent 18% of all cancers and mostly diagnosed at advanced stages. Our Clinical Oncology & Nuclear Medicine Department of Mansoura Faculty of Medicine serves a large rural area of the Delta region of Egypt. There is no previous study in our institution that focused on oral tongue carcinoma alone. This study aims in establishing the demographics, treatment outcome and prognostic factors of oral tongue squamous cell carcinoma (SCC). Methods: We retrospectively reviewed data of 50 cases with oral tongue SCC treated in our department from January 2014 to December 2016 to evaluate the demography, pathological characteristics, and therapeutic modalities. We estimated the survival rates during the entire follow-up period by the Kaplan–Meier method. The univariate and multivariate Cox proportional hazards analysis were performed for prognostic factors determination. Results: The median follow-up was 30 months (range: 4-45 months). The 3-year overall survival (OS) and disease-free survival (DFS) rates were 68% and 60% respectively. By univariate analysis, both advanced stages (III, IVA) and depth of invasion >0.5 cm were statistically significant as prognostic factors for 3-year DFS and OS rates. DFS rates were 34% vs. 98% for stage III and IVA vs. stage I and II respectively (p = 0.001); 52% vs. 78% for >0.5 cm vs. ≤0.5 cm depth of invasion (p = 0.003). OS rates were 36% vs. 99% for stage III and IVA vs. stage I and II respectively (p = 0.002); 52% vs. 80% for >0.5 cm vs. ≤0.5 cm depth of invasion (p = 0.001). Multivariate analysis of prognostic factors affecting 3-year DFS and OS rates confirmed the statistical significance of the same 2 factors. Conclusions: The majority of our patients were males below 60 years. Tumors were mainly found at stage III and were moderately differentiated. Vascular invasion and lymphatic permeation were uncommon. Staging and tumor invasion depth significantly affected the outcome. The 3-year OS and DFS were 68% and 60% respectively

Incomplete Excision of Cutaneous Squamous Cell Carcinoma; Systematic Review of the Literature

The treatment of choice for cutaneous squamous cell carcinoma is complete surgical excision. Incomplete excision of cutaneous squamous cell carcinoma has an increased risk of local recurrence, deep subclinical progression, and metastasis. This study aimed to investigate the proportion and risk factors of incomplete excised cutaneous squamous cell carcinoma. A systematic review of the literature was performed. Incomplete excision rates for cutaneous squamous cell carcinoma ranged from 0.4% to 35.7%. The pooled incomplete excision risk estimate was 13% (95% confidence interval 9-17%). Risk factors noted in more than one study for incomplete excision included tumor depth and size, type of operator, head and neck localization, and former incomplete excision. We found an overall incomplete excision rate of 13% for cutaneous squamous cell carcinoma. Risk factors should be taken into account in the management of cutaneous squamous cell carcinoma surgical treatment

Role of Oral Exfoliative Cytology in Oral Leukoplakia and Squamous cell Carcinoma

Squamous cell carcinoma is the most common cancer of the oral cavity. Unlike other cancer, due to its accessibility the oral cancer can detected at the early stage. Oral exfoliative cytology is the simple, sensitive and valuable adjuvant for gold standard Biopsy. In our study we have included 17 cases of oral leukoplakia, and 20 cases of oral squamous cell carcinoma to analze the sensitivity and specificity of oral exfoliative cytology. We have also included the cytological features noticed in leukoplakia and squamous cell carcinoma. Result was suggestive of 69% of sensitivity in leukoplakia and 75% of sensitivity in squamous cell carcinoma and both has 100% specificity in oral exfoliative cytology.KEYWORDS: Oral exfoliative cytology, Squamous cell carcinoma, Oral cytology

Helicobacter Pylory infection in patients with esophageal squamous cell carcinoma

OBJECTIVE: Esophageal squamous cell carcinoma is one of the most common esophageal diseases in the developing world, but the relationship between esophageal squamous cell carcinoma and Helicobacter pylori infection remains a neglected topic. The primary objective of this study was to determine the association between Helicobacter pylori infection and esophageal squamous cell carcinoma. A second purpose was to determine the incidence and factors associated with Helicobacter pylori infection following esophagectomy. METHOD: The microorganism was identified by testing the gastric biopsy materials from 95 esophageal squamous cell carcinoma patients (66 females; 39 were esophagectomized) for urease activity in a medium containing urea and a power of hydrogen detection reagent and comparing the results with those from a healthy population. Differences in patient characteristics were assessed with chi-square tests and t-tests for categorical and continuous factors, respectively. RESULTS: The patients with esophageal squamous cell carcinoma had a significantly lower prevalence of Helicobacter pylori compared with the healthy population (p;0.005). Patients with esophageal squamous cell carcinoma showed a significant association between leukocytosis and hypoglobulinemia and the presence of Helicobacter pylori infection (p=0.023 and p=0.045, respectively). CONCLUSION: These results suggest that Helicobacter pylori is not an etiological factor in patients with esophageal squamous cell carcinoma. We found a statistically significant negative correlation between esophageal squamous cell cancer and Helicobacter pylori infection. These findings may guide new strategies for esophageal squamous cell carcinoma therapy

Salivary Composition of Oral Squamous Cell Carcinoma Patients

OBJECTIVES: The purpose of the study was to determine the salivary composition of Oral squamous cell carcinoma patients. METHODOLOGY: A retrospective study was conducted over 6 months on data of 60 Oral squamous cell carcinoma patients obtained from the patient records of the Institute of Radiotherapy and Nuclear Medicine, Peshawar. Salivary pH, Sodium, Potassium, and total proteins of Oral squamous cell carcinoma patients were recorded. RESULTS: Sodium, Potassium, and total protein concentration in saliva of oral squamous cell carcinoma patients were 23.5 mM/L, 96.7mM/L, and 234.6 mM/L, respectively. These values were significantly higher than normal salivary concentration. CONCLUSION: It was concluded that the saliva of oral squamous cell carcinoma patients contains higher concentrations of Sodium, Potassium, and total proteins

EVALUATION OF P16INK4A PROTEIN AS A BIOMARKER FOR CERVICAL INTRAEPITHELIAL NEOPLASIA AND SQUAMOUS CELL CARCINOMA OF THE UTERINE CERVIX

The association of human papilloma virus (HPV) infection and cervical intraepithelial neoplasia (CIN) is well known. Interaction of HPV proteins with cellular regulatory proteins leads to up regulation of p16INK4A. The aim of this study was to evaluate p16INK4A protein as a biomarker for CIN lesions and squamous cell carcinoma on biopsy specimens of patients who underwent biopsy of the uterine cervix due to abnormal cytological finding.The authors analyzed biopsies from 50 patients with CIN and invasive squamous cell carcinoma of the uterine cervix. Expression of p16INK4A in CIN and invasive squamous cell carcinoma was immunohistochemically analyzed by using monoclonal anti-p16INK4A antibody.A total of 50 patients with CIN and invasive squamous cell carcinoma of the uterine cervix (mean age 40.2±11.5 years, range 20-74 years) were analyzed. CIN I lesions were found in 27 (54%), CIN II/CIN III lesions in 9 (18%), and invasive squamous cell carcinoma in 14 (28%) patients. Differences in the expression of p16INK4A between CIN I, CIN II/CIN III and squamous cell carcinoma were statistically significant (p<0.0001). Expression of p16INK4A showed low sensitivity (7%), specificity (8%), positive predictive value (8%), and negative predictive value (7%) for CIN I. Sensitivity, specificity, positive predictive value, and negative predictive value of p16INK4A were 78%, 61%, 30%, and 93% for CIN II/CIN III, and 100%, 75%, 61%, and 100% for squamous cell carcinoma, respectively.Results of this study suggest that p16INK4A protein may be a sensitive biomarker for CIN II/CIN III lesions and invasive squamous cell carcinoma of the uterine cervix

Pure Basaloid Squamous Cell Carcinoma of the Uterine Cervix: A Case Report

Basaloid squamous cell carcinoma of the uterine cervix is an extremely rare malignancy of the female genital tract with a poorer clinical outcome than squamous cell carcinoma of the uterine cervix. We report a case of pure basaloid squamous cell carcinoma of the uterine cervix. A 70-yr-old woman with vaginal bleeding was referred to our institute. A basaloid squamous cell carcinoma of the uterine cervix, of International Federation of Gynecology and Obstetrics (FIGO) stage Ib1, was diagnosed by a loop electrosurgical excision procedure cone biopsy. A radical hysterectomy was performed, along with bilateral salpingo-oophorectomy, pelvic lymph node dissection, and para-aortic lymph node sampling. Pathologic findings were consistent with a basaloid squamous cell carcinoma confined to the cervix without an extracervical tumor. No further treatment was administered and there was no clinical evidence of recurrence during the 12 months of follow-up. Follow-up for the patient is ongoing. Although basaloid squamous cell carcinoma of the uterine cervix is thought to behave aggressively, accumulation of data on these rare tumors is necessary to determine whether their behavior differs significantly from that of conventional cervical squamous cell carcinoma of similar clinical stage. These data would be useful for defining the best diagnosis and treatment for these rare tumors

Overexpression of Serpin Squamous Cell Carcinoma Antigens in Psoriatic Skin

Squamous cell carcinoma antigen belongs to the serpin family and is used for the diagnosis and management of squamous cell carcinoma. We investigated the involvement of squamous cell carcinoma antigen in psoriasis, as it is always detected in the sera of patients with psoriasis. Squamous cell carcinoma antigen localization in psoriatic epidermis varied depending on its concentration in the patient's sera. When its level was low in serum, weak and scattered staining was observed in the granular layer. With a high concentration of squamous cell carcinoma antigen, strong staining through the suprabasal to granular layer and condensed staining around the plasma membrane or intracellular space was detected in the affected epidermis. Interestingly, squamous cell carcinoma antigen was abundant in nuclei of the granular layer cells and elongated rete ridges. Immunoelectron microscopy confirmed the localization of squamous cell carcinoma antigen in the nuclei as well as in the periphery of the cell membrane. A cDNA library was constructed from psoriatic epidermis and both clones, SCCA1 and SCCA2, were obtained. Attempts to raise specific antibodies or to prepare cRNA probes for SCCA1 and SCCA2 were unsuccessful because of their nearly identical structures. A primer pair from each reactive site sequence enabled us to give a distinctive product for SCCA1 and SCCA2 by reverse transcription polymerase chain reaction. Analysis using these primers demonstrated that the SCCA2 transcript was specifically expressed in psoriatic skin tissues. Our results suggest that overexpression of squamous cell carcinoma antigens is associated with the disease activity of psoriasis

Incidence and Risk Factors Associated with a Second Squamous Cell Carcinoma or Basal Cell Carcinoma in Psoralen + Ultraviolet A Light-treated Psoriasis Patients

Psoralen + ultraviolet A-treated psoriasis patients are at increased risk for squamous cell carcinomas and basal cell carcinomas; however, the incidence and risk factors associated with second squamous cell carcinomas and basal cell carcinomas in this population are not well qualified. Incidence and risk factors for second squamous cell carcinomas and basal cell carcinomas were studied in a cohort of 1380 psoralen + ultraviolet A-treated psoriasis patients prospectively followed for over 20 y; 264 had a squamous cell carcinoma and 258 a basal cell carcinoma after beginning psoralen + ultraviolet A therapy. After a first squamous cell carcinoma, the risk of a second squamous cell carcinoma was 26% at 1 y, 62% at 5 y, and 75% at 10 y. Risk increased with high psoralen + ultraviolet A exposure prior to the first squamous cell carcinoma (hazard ratio 3.32, 95% confidence interval 1.53, 7.18). Higher rates of post-first squamous cell carcinoma psoralen + ultraviolet A treatment also were associated with greater risk (hazard ratio 1.56 for every additional 10 treatments per year for patients with low pre-first squamous cell carcinoma psoralen + ultraviolet A exposure, 95% confidence interval 1.35, 1.81). Patients exposed to high levels of tar and/or ultraviolet B before a first squamous cell carcinoma were also at higher risk (hazard ratio 1.72, 95% confidence interval 1.14–2.60). Risk of a second basal cell carcinoma was 21% at 1 y, 49% at 5 y, and 61% at 10 y. There was some evidence that high exposure to psoralen + ultraviolet A before a first basal cell carcinoma was associated with increased risk of second basal cell carcinoma (hazard ratio 1.45, 95% confidence interval 0.97–2.17). Higher post-first tumor psoralen + ultraviolet A treatment rates also increased risk (hazard ratio 1.24 for every additional 10 treatments per year, 95% confidence interval 1.06–1.47). Psoralen + ultraviolet A-treated psoriasis patients appear to have a greatly increased incidence of second squamous cell carcinoma compared with the general population. Patients who develop a squamous cell carcinoma after starting psoralen + ultraviolet A therapy should be closely monitored for a subsequent squamous cell carcinoma

Dermoscopy and Reflectance Confocal Microscopy in the Diagnosis and Management of Nail Fold Squamous Cell Carcinoma

The management and prognosis of squamous cell carcinoma largely depend on its invasiveness and grade of differentiation. Pigmented nail fold squamous cell carcinoma represents a therapeutic challenge, needing careful treatment to preserve nail function. Here, we report the use of dermoscopy and Reflectance Confocal Microscopy to monitor nail fold squamous cell carcinoma in situ and its response to treatment with topical imiquimod