Primary acantholytic squamous cell carcinoma of the cecum: a case report

<p>Abstract</p> <p>Background</p> <p>Acantholytic squamous cell carcinoma (ASCC) is an uncommon histopathologic variant of SCC, characterized by marked acantholysis, wherein the tumor cells demonstrate defective cohesion to one another in the cancer nest leading to a pseudoglandular or pseudovascular appearance. The most common site of ASCC is the sun-exposed areas of the skin. Sporadic cases of ASCC have also been reported in various mucosal membranes and organs but to our knowledge this is the first case of primary ASCC of the large bowel.</p> <p>Case presentation</p> <p>A 59-year-old woman underwent right hemicolectomy due to large tumor in cecum and initial part of the ascending colon. Microscopically, the tumor consisted of nests of focally keratinizing large, atypical, squamous epithelial cells. Approximately 70% of the tumor showed acantholytic changes and acantholysis was equally distributed through the entire tumor. Immunohistochemically tumor cells were diffusely positive for cytokeratin (CK) AE1/AE3 and focally positive for epithelial membrane antigen and syndecan 1. All other tested antibodies (CK7, CK 20, CK MNF116, E-cadherin, beta-catenin, p63, p16, CD31, CD34, CEA, estrogen, progesterone) showed negative reaction. Periodic acid Schiff and alcian blue staining showed no intracellular or extracellular mucinous material in the tumor. The diagnosis of acantholytic squamous cell carcinoma of the cecum was suspected and additional examination was recommended to exclude possibility of metastatic carcinoma. Extensive clinical examination which also included whole-body PET/CT scan showed no additional tumors. After the exclusion of possible metastatic disease the diagnosis of primary acantholytic squamous cell carcinoma of the cecum was confirmed. Six months after surgery the metastasis in small intestine and recurrence in the abdominal cavity at the site of surgery appeared and had the same morphological characteristic as the primary tumor in the cecum.</p> <p>Conclusion</p> <p>We report a unique case of ASCC arising in cecum and on this way expands the range of tumors originating in colon. Reports of more cases of colonic ASCC would possibly help to elucidate origin, clinical behavior and therapy of these tumors.</p

Ortostatika i kronična venska insuficijencija u hrvatskih stomatologa

The purpose of the study was to point to occupational exposure of dental medicine doctors in Croatia and to the effect of static performance on developing venous disease. The study included 120 subjects, 60 of them doctors of dental medicine and 60 from other professions. The study was focused on finding a way to upgrade preventive measures against developing chronic venous insufficiency and the quality of life of dental medicine doctors. Study subjects underwent verbal testing (questionnaire), clinical examination and ultrasonography (color Doppler).U radu se ukazuje na utjecaj profesionalne izloženosti doktora dentalne medicine u Hrvatskoj te na statičko opterećenje u odnosu na razvoj bolesti venskog sustava. Istraživanje je obuhvatilo 120 ispitanika, od toga 60 doktora dentalne medicine i 60 ispitanika drugih struka. Cilj istraživanja ponajprije je unaprjeđenje preventivnih mjera kojima bi se spriječio razvoj kronične venske insuficijencije, ali i poboljšanje kvalitete života naših ispitanika. Ispitanici su podvrgnuti usmenom anketiranju (anketni upitnik), kliničkom pregledu te ultrazvučnoj dijagnostici (obojeni Doppler)

Pozitivna ekspresija NEDD9 u karcinomima glave i vrata povezana je s boljim preživljenjem

The aim was to determine immunohistochemical expression of NEDD9 protein in head and neck squamous cell carcinoma (HNSCC) and the possible relation of its expression with primary tumor size (T), regional lymph node status (N), stage of disease (TNM) and survival period. A total of 131 patients with primary tumor localization in the area of oropharynx, hypopharynx and larynx, monitored for at least 5 years after initial surgical treatment were analyzed. The study included 128 male and three female patients, median age 62.0 (range 53.0-68.0) years. Of these, 105 (95%) patients showed positive NEDD9 expressed by dyed cytoplasm. There were no significant differences in NEDD9 expression according to TNM tumor status. Patients with positive NEDD9 expression had a significantly higher median (IQR) survival time 51.0 (15.0-60.0) months as compared to 22.5 (9.0-55.0) months in patients with negative NEDD9 expression (p=0.048). NEDD9 negative expression, controlled for the influence of other variables included in the Cox’s proportional hazards model, had a significant hazard ratio (HR) of 2.10 (95% CI: 1.23-3.58; p=0.006). The results of our study showed that NEDD9 expression might be an independent prognostic marker in patients with HNSCC regarding data on overall survival and mortality.Cilj je bio utvrditi imunohistokemijsku ekspresiju proteina NEDD9 i moguću povezanost ekspresije s veličinom tumora (T), statusom regionalnih limfnih čvorova (N), kliničkim statusom bolesti (TNM) i preživljenjem bolesnika s planocelularnim karcinomom glave i vrata. Analiziran je 131 bolesnik s primarnim tumorom lokaliziranim u orofarinksu, hipofarinksu i larinksu, a bolesnici su praćeni najmanje pet godina nakon inicijalnog kirurškog liječenja. Studija je uključivala 128 muškaraca i tri žene, medijan životne dobi od 62,0 (raspon 53,0-68,0) godine. Ukupno je 105 (95%) bolesnika imalo pozitivan NEDD9 vidljiv imunohistokemijskim bojanjem citoplazme. Nije nađeno značajne razlike u ekspresiji NEDD9 u odnosu na status TNM. Bolesnici s pozitivnom ekspresijom NEDD9 imali su značajno viši medijan (IQR) razdoblja preživljenja: 51,0 (15,0-60,0) mjesec prema 22,5 (9,0-55,0) mjeseca kod bolesnika s negativnom ekspresijom NEDD9 (p=0,048). Negativna ekspresija NEDD9 pod kontrolom utjecaja drugih varijabla imala je značajan omjer rizika, uključujući Coxov proporcionalni model rizika (HR) od 2,10 (95% CI: 1,23-3,58; p=0,006). Rezultati naše studije su pokazali da ekspresija NEDD9 može biti nezavisan prognostički biljeg u bolesnika s karcinomom glave i vrata s obzirom na podatke o ukupnom preživljenju i smrtnosti

Prognostic significance of immunohistochemical expression of NEDD9 protein in patients with head and neck squamous cell carcinoma

Planocelularni karcinomi glave i vrata po učestalosti su peti najčešći karcinomi u svijetu te su povezani s pušenjem, konzumacijom alkohola i HPV virusima. Dijagnoza se često postavlja u uznapredovalom stadiju bolesti, a petogodišnje preživljenje iznosi oko 50 posto. Osim ranog prepoznavanja prekanceroznih lezija i istraživanja kojima bi se postigao napredak u liječenju, nužno je pronaći nove dijagnostičke i prognostičke biljege. Pozitivna izraženost proteina NEDD9 prepoznata je kao prognostički nepovoljan čimbenik u karcinomima dojke, pluća, želuca, debelog crijeva, jetre, bubrega, jajnika, glioblastoma te malignog melanoma. U ovom istraživanju po prvi put je analizirana imunohistokemijska izraženost NEDD9 u planocelularnim karcinomima orofarinksa, hipofarinksa i larinksa. Pozitivna izraženost NEDD9 bila je prisutna u 105 od ukupno 131 bolesnika (95 posto). Nije dokazana povezanost izraženosti NEDD9 s lokalizacijom i patohistološkim gradusom primarnog tumora ni ukupnim stadijem bolesti (TNM). Skupina bolesnika koja je imala negativnu izraženost NEDD9 imala je značajno veći mortalitet, što pokazuje kako je NEDD9 značajni neovisni pokazatelj mortaliteta u bolesnika s planocelularnim karcinomima glave i vrata. Prosječno preživljenje za bolesnike s negativnom izraženosti NEDD9 je bilo kraće, što NEDD9 čini važnim neovisnim prediktorom preživljenja. Istraživanjem nije potvrđena hipoteza da je povećana izraženost proteina NEDD9 u bolesnika s planocelularnim karcinomima glave i vrata pokazatelj lošijeg preživljenja.Head and neck squamous cell carcinomas (HNSCC) are the fifth most common cancer worldwide. Smoking, alcohol consumption and HPV viruses are important risk factors. Frequently, they are diagnosed in advanced stages where overall 5-year survival rate is around 50%. Apart from early recognition of the precancerous lesion and investigations of new therapeutical modalities, there is a need to find new diagnostic and prognostic markers. Expression of protein NEDD9 has been recognized as a negative prognostic indicator in breast, lung, gastric, colorectal, hepatocellular, kidney and ovarian cancer, glioblastoma and malignant melanoma. In this study the expression of NEDD9 immunohistochemicaly is analyzed for the first time in HNSCC of oropharynx, hypopharynx and larynx. Positive NEDD9 expression was evident in 105 of 131 included patients (80.2%). NEDD9 expression did not show significant difference according to tumour location, stage of disease (TNM) and PH grade. A group of patients with negative NEDD9 had significantly higher mortality, indicating that NEDD9 is a significant independent mortality predictor. Average survival for patients with negative NEDD9 expression was shorter, making NEDD9 an important independent predictor of survival. The hypothesis that the positive NEDD9 expression in patients with HNSCC is indicator of the poorer survival was not confirmed