Undifferentiated Head And Neck Tumors: The Contribution Of Immunohistochemical Technique To Differential Diagnosis.

Undifferentiated head and neck and skull base tumors are not unusual. They can arise in mucosa as well as in salivary glands, soft tissues or lymph nodes. Suitable therapy and prognosis for each case depends upon precise histopathological diagnosis. To evaluate the role of immunohistochemical techniques in determining the conclusive diagnosis. The occurrence of these tumors in our service and the way in which they were distributed according to cell pattern, patient's age and tumor location was also evaluated. Cross-sectional study. Hospital das Clínicas, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil. 43 biopsies performed between January 1990 and December 1997, diagnosed as undifferentiated head and neck tumors. We applied an immunohistochemical panel in accordance with the avidin-biotin-peroxidase complex method. The final diagnosis was achieved after new analysis in conjunction with biopsies stained using the hematoxylin-eosin technique. This study evaluated undifferentiated tumors in head and neck, and the way in which they were distributed, according to cell pattern, patient's age and tumor location. The most frequent locations for undifferentiated tumors were the lymph nodes, 20.9%; pharynx and neck, 16.3%; paranasal sinus, 14%; and nose, 11.6%. They were most prevalent during the seventh decade of life (34.9%), and twice as prevalent in men as in women. The immunohistochemical technique allowed conclusive diagnosis for 60.5% of the tumors and was suggestive for 20.9% of the biopsies. The most prevalent cell pattern was round cells (51.2%), followed by epithelioid cells (20.9%), spindle cells (16.3%), myxoid pattern (9.3%) and pleomorphic cells (2.3%). Our results demonstrate the fundamental role of the immunohistochemical technique for conclusive diagnosis of undifferentiated tumors.121244-

Laryngeal Adenoid Cystic Carcinoma: Case Report.

Adenoid cystic carcinomas are malignant tumors that occur in both the major and the minor salivary glands. A laryngeal location is rare because of the paucity of accessory salivary glands in this area. Adenoid cystic carcinomas account for less than 1% of all malignant tumors in the larynx, and only about 120 cases have been reported in the literature. These tumors have a slight female predisposition, and their peak incidence is in the fifth and sixth decades of life. In this article, we describe a case of laryngeal adenoid cystic carcinoma and discuss its clinical characteristics and treatment. We report on a case of laryngeal adenoid cystic carcinoma in a 55 year-old female patient who presented with dyspnea and hoarseness. Features of the diagnostic and therapeutic evaluation are described and the clinical management of such cases is outlined. The clinical course, definitive treatment strategy and surgical procedure, and also adjuvant treatment with irradiation are discussed. Although the tumor is radiosensitive, it is not radiocurable.125295-

Synchronous metastatic cutaneous squamous cell carcinoma and chronic lymphocytic leukaemia/small lymphocytic lymphoma in a cervical lymph node: case report of an unusual event

The synchronous occurrence of two different neoplasias is an uncommon event, which may arise between tumors originating in the same organ or in cancer-to-cancer metastasis. We report a rare case of chronic lymphocytic leukaemia / small lymphocytic lymphoma associated with a cutaneous metastatic squamous cell carcinoma in a cervical lymph node. In the affected lymph node, it was observed an effacement of the normal architecture by neoplastic lymphocytes and it was noted the presence of neoplastic invasive epithelial islands. Immunohistochemical analysis demonstrated that lymphocytic proliferation was positive for CD20, CD5, CD23 and Kappa, and negative for CD3, CD10, Cyclin D1 and Lambda. The morphological and immunohistochemical profile lead to a phenotype of B-cell chronic lymphocytic leukaemia / small lymphocytic lymphoma. The epithelial cells were positive for CK5, thus rendering the diagnosis of synchronous metastatic cutaneous squamous cell carcinoma and chronic lymphocytic leukaemia/small lymphocytic lymphoma. Literature supports the poor prognosis in cases that present coexistence of squamous cell carcinoma and chronic lymphocytic leukaemia / small lymphocytic lymphoma. Thus, it is necessary to be aware about this unusual finding in order to provide specific treatment

The stem cell marker BMI-1 is sensitive in identifying early lesions of carcinoma ex pleomorphic adenoma

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)In the present study, we evaluated and described the sensitivity of the stem cell marker B cell-specific moloney murine leukemia virus integration site 1 (Bmi-1) in identifying early lesions of carcinoma ex pleomorphic adenoma (CXPA). While invasive CXPAs are tumors with a prominent and easily recognizable malignant component, the identification of early carcinomatous changes in PA remains a diagnostic challenge due to the lack of objective morphological criteria. The immunohistochemical expression of Bmi-1 was assessed in both adenomatous and carcinomatous components of 9 CXPA cases at an early phase of histological progression (6 intracapsular and 3 minimally invasive) grouped according to the cellular differentiation as luminal (7 cases) or myoepithelial (2 cases). A selective nuclear expression of Bmi-1 was found exclusively in the malignant component of 8 cases (6 luminal type and 2 myoepithelial type), including intraductal carcinoma areas, except for 1 case in which scarce cells of the remnant PA were positive. Thus, Bmi-1 is expressed from the earliest morphologically detectable stages of PA malignant transformation. When faced with atypical features in PA, evaluation of Bmi-1 expression can provide more objective criteria for identification and diagnosis of early lesions of CXPA. This is applied to carcinomas with luminal or myoepithelial differentiation.In the present study, we evaluated and described the sensitivity of the stem cell marker B cell-specific moloney murine leukemia virus integration site 1 (Bmi-1) in identifying early lesions of carcinoma ex pleomorphic adenoma (CXPA). While invasive CXPAs9427FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)FAPESP [process 2012/00786-1]2012/00786-

Apresentação não usual de um caso de adenoma pleomórfico de glândula lacrimal

Tumors of the lacrimal gland are rare in clinical practice. Among all of them, the most common epithelial tumor is the lacrimal gland pleomorphic adenoma, which is a benign indolent tumor that usually affects adults in the third and fourth decades of life. We present an unusual case of lacrimal gland pleomorphic adenoma. Its management, radiological findings and outcomes are also described, along with a brief review of the literature.Os tumores da glândula lacrimal são raros na prática clínica. Dentre eles, o tumor epitelial mais comum é o adenoma pleomórfico da glândula lacrimal, que consiste em um tumor benigno, indolente, que geralmente acomete adultos na terceira e quarta décadas de vida. Apresentaremos um caso raro de adenoma pleomórfico de glândula lacrimal, bem como a condução do caso, achados radiológicos e o seu desfecho, além de um breve resumo da literatura.33834

Management Of Salivary Gland Adenoid Cystic Carcinoma: Institutional Experience Of A Case Series.

Salivary gland tumor management requires long-term follow-up because of tumor indolence and possible late recurrence and distant metastasis. Adenoid cystic carcinoma (ACC) accounts for 10-15% of such tumors. The aim here was to evaluate surgical and clinical management, staging and follow-up of ACC patients in one academic institution. Retrospective study at Head and Neck Service, Universidade Estadual de Campinas. Data on 21 patients treated between 1993 and 2003 were reviewed. Management utilized clinical staging, histology and imaging. Major salivary gland tumor extent was routinely assessed by preoperative ultrasonography. Diagnosis, surgery type, margin type (negative/positive), postoperative radiotherapy and recurrence (presence/absence) were evaluated. There were eleven major salivary gland tumors (52.3%), seven submandibular and four parotid. Ten patients (47.7%) had minor salivary gland ACC (all in palate), while the submandibular was the most frequently affected major one. Diagnoses were mostly via fine-needle aspiration (FNA) and incision biopsy. Frozen sections were used for six patients. There was good ultrasound/FNA correlation. Sixteen (76%) had postoperative radiotherapy. One (4.7%) died from ACC and five now have recurrent disease: three (14.2%) locoregional and two (9.5%) distant metastases. Adenoid cystic carcinoma has locally aggressive behavior. In 21 cases, of ACC, the facial nerve was preserved in all except in the few with gross tumor involvement. Treatment was defined from physical examination, imaging, staging and histology.12426-3

Nucleolar Organizer Region (NORs) in pseudocarcinomatous hyperplasia and squamous cell carcinoma of the oral mucosa

Counts of nucleolar regions (NORs) demonstrated by a silver staining technique in paraffin sections, have been used to distinguish benign from malignant lesions. AgNORs were studied in 24 biopsies from oral cavity (5 cases of normal oral mucosa, 5 of pseudocarcinomatous hyperplasia and 14 of squamous cell carcinoma, subdivided according to degree of differentiation: 5 grade 1, 5 grade 2 and 4 grade 3) to find whether they were helpful in distinguishing pseudocarcinomatous hyperplasia due to chronic parasitic infections from squamous cell carcinoma. Two methods of counting AgNORs were used: (A) a simpler one which counts nucleolar clusters (AgNU) and satellite AgNORs and the other (B) counting all individual AgNORs, including those within AgNUs. In both methods the lowest mean values were observed for grade 3 carcinoma, while the highest belonged to grade 2 carcinoma. The simpler method (A) was the most useful because AgNU counts showed significant difference when pseudocarcinomatous hyperplasia was compared with grade 1 and 2 carcinomas, which are the most difficult to discriminate from it. However the overlapping of values render the technique of limited use in individual cases.INTRODUÇÃO E OBJETIVOS: Regiões organizadoras do nucléolo podem ser detectadas através do nitrato de prata em secções de parafina. A contagem de AgNORs tem sido utilizada para distinguir entre lesões benignas e malignas. MATERIAL E MÉTODOS: AgNORs foram contados em 24 biopsias da cavidade oral (5 casos de mucosa oral normal, 5 de hiperplasia pseudocarcinomatosa e 14 de carcinoma epidermóide, subdivididos segundo o grau de diferenciação: 5 grau 1; 5 grau 2 e 4 grau 3) para verificar sua utilidade no diagnóstico diferencial entre hiperplasia pseudocarcinomatosa, secundária a infecções parasitárias crônicas, e carcinoma epidermóide. Foram usados dois métodos de contagem de AgNORs: um mais simples(A), que conta os agregados nucleolares (AgNU) e AgNOR satélites e o outro (B) que conta todos os AgNORs, inclusive aqueles dentro do AgNUs. RESULTADOS E CONCLUSÃO: Em ambos os métodos as médias mais baixas foram do carcinoma grau 3 e as mais altas do carcinoma grau 2. O método mais simples (A) foi o mais útil, pois a contagem de AgNU mostrou valores significantemente diferentes quando comparou-se hiperplasia pseudocarcinomatosa e carcinomas graus 1 e 2, que são os mais difíceis de distinguir da hiperplasia. Entretanto, devido à sobreposição de valores a técnica foi de utilidade limitada em casos individuais.69369

Genomic profile of a squamous cell carcinoma ex pleomorphic adenoma compared to a head and neck squamous cell carcinoma

FAPESPUniv Estadual Campinas UNICAMP, Dept Patol, Fac Ciencias Med, Campinas, SP, BrazilUniv Estadual Campinas UNICAMP, Fac Ciencias Med Cirurgia Cabeca & Pescoco, Campinas, SP, BrazilAC Camargo Canc Ctr, Dept Cirurgia Cabeca & Pescoco, Sao Paulo, SP, BrazilUniv Sao Paulo UNIFESP, Inst Biociencias, Dept Genet & Biol Evolucionaria, Sao Paulo, SP, BrazilUniv Sao Paulo UNIFESP, Inst Biociencias, Dept Genet & Biol Evolucionaria, Sao Paulo, SP, BrazilFAPESP: 2011/23204-5FAPESP: 2011/23366-5SciEL

The effect of fibroblast growth factors in grafted fascia into the vocal fold of rabbits

The human larynx is a very important organ for communication. Many conditions lead to scarring of the vocal folds, decreasing voice quality. Objective We aimed to determine whether fibroblast growth factors (FGFs) may influence tissue integration of grafted fascia into the vocal folds of an animal model. This is an experimental animal study with 12 adult rabbits that were submitted to a grafting fragment obtained from superficial cervical fascia into the vocal fold lamina propria, bilaterally. The right vocal fold was injected with FGFs. The animals were sacrificed after 1 month or 12 months, depending on the group they were assigned to, and a histological analysis of their vocal folds was performed. We analyzed the histological changes (such as the presence of fibrosis and neovascularization) induced by the acute or chronic inflammatory reactions. Results The FGFs induced acute inflammatory changes in all animals after 1 month of the initial experiment. The presence of FGFs triggered more fibrosis than the expected due to the surgical procedure itself when compared with the control side of all animals after 12 months of the initial experiment. Conclusions Fibroblast growth factors alone do not represent a good therapeutic option in phonosurgery, since we observed higher levels of fibrosis in the vocal fold lamina propria. Further studies combining more substances may be necessary to elucidate the best option to be used in this kind of surgery.231606