Diagnosis and treatment of carotid body paraganglioma: 21 years of experience at a clinical center of Serbia

BACKGROUND: The carotid body paraganglioma (chemodectoma) is a relatively rare neoplasm of obscure origin. These are usually benign and commonly present as asymptomatic cervical mass. PATIENTS AND METHODS: Records of 12 patients (9 female and 3 male) with carotid body tumors treated between 1982 and 2003, treated at our center were retrospectively reviewed. Data on classification, clinical presentation, and surgical treatment were extracted from the case records. Surgical complications and treatment outcome were noted and survival was calculated by actuarial method. The literature on carotid body paraganglioma was reviewed. RESULTS: The average age of the patients was 52 years (range 30–78 years). Eight of these cases presented as a large asymptomatic non-tender neck mass, and two each presented with dysphagia, and hoarseness of voice. As per Shamblin classification seven of tumors were type II and 5 were types III. In 7 cases subadventitial tumor excision was performed, while in 5 associated resection of both external and internal carotid arteries was carried out. The artery was repaired by end-to-end anastomosis in one case, with Dacron graft in one case, and with saphenous vein graft in 3 cases. There was no operative mortality. After a mean follow-up of 6.2 years (range 6 months to 20 years), there were no signs of tumor recurrence in any of the cases. CONCLUSIONS: Surgical excision is the treatment of choice for carotid body paragangliomas although radiation therapy is an option for patients who are not ideal candidates for surgery. For the tumors that are in intimate contact with carotid arteries, the treatment by vascular surgeon is recommended

Treatment of recurrent respiratory papillomatosis and adverse reactions following off-label use of cidofovir (Vistide®)

Recurrent respiratory papillomatosis (RRP) is caused by a human papilloma virus (HPV). It is a rare, sometimes debilitating disease compromising voice and airway. RRP is characterized by a variable course of disease, potentially leading to frequent annual surgical procedures, the number of which may exceed a hundred during the life time. The therapy focuses on surgical removal of the mucosal lesions in order to keep the airway open and the voice satisfactory. Till now, there is no curative therapy for the virus infection in itself. As recurrent surgery alone has proven to be insufficient in many cases, adjuvant therapy is increasingly being used. One of the mainstays of adjuvant therapy is the administration of intralesional cidofovir (Vistide Ò). Cidofovir is an antiviral agent, registered for the treatment of cytomegalovirus (CMV) retinitis in patients wit

Characterization of the Variability of Epstein-Barr Virus Genes in Nasopharyngeal Biopsies: Potential Predictors for Carcinoma Progression.

Epstein-Barr virus (EBV) infection is a significant factor in the pathogenesis of nasopharyngeal carcinoma, especially in the undifferentiated carcinoma of nasopharyngeal type (UCNT, World Health Organization type III), which is the dominant histopathological type in high-risk areas. The major EBV oncogene is latent membrane protein 1 (LMP1). LMP1 gene shows variability with different tumorigenic and immunogenic potentials. EBV nuclear antigen 1 (EBNA1) regulates progression of EBV-related tumors; however, the influence of EBNA1 sequence variability on tumor pathogenesis is controversial. The aims of this study were to characterize polymorphisms of EBV genes in non-endemic nasopharyngeal carcinoma biopsies and to investigate potential sequence patterns that correlate with the clinical presentation of nasopharyngeal carcinoma. In total, 116 tumor biopsies of undifferentiated carcinoma of nasopharyngeal type (UCNT), collected from 2008 to 2014, were evaluated in this study. The genes EBNA2, LMP1, and EBNA1 were amplified using nested-PCR. EBNA2 genotyping was performed by visualization of PCR products using gel electrophoresis. Investigation of LMP1 and EBNA1 included sequence, phylogenetic, and statistical analyses. The presence of EBV DNA was significantly distributed between TNM stages. LMP1 variability showed six variants, with the detection of the first China1 and North Carolina variants in European nasopharyngeal carcinoma biopsies. Newly discovered variants Srb1 and Srb2 were UCNT-specific LMP1 polymorphisms. The B95-8 and North Carolina variants are possible predictors for favorable TNM stages. In contrast, deletions in LMP1 are possible risk factors for the most disfavorable TNM stage, independent of EBNA2 or EBNA1 variability. A newly discovered EBNA1 subvariant, P-thr-sv-5, could be a potential diagnostic marker, as it represented a UCNT-specific EBNA1 subvariant. A particular combination of EBNA2, LMP1, and EBNA1 polymorphisms, type 1/Med/P-thr was identified as a possible risk factor for TNM stage IVB or progression to the N3 stage

Phylogenetic trees of the C-termini of LMP1 and EBNA1.

<p>(a) Thirty five 506-bp fragments of LMP1 (from coordinates 168719–168213) NPC sequences available in GenBank/EMBL7DDBJ database with accession numbers: JF901794-JF901802, JN971085-JN971091 and KT820429-KT820448 and 13 sequences obtained from GenBank/EMBL7DDBJ database under the following accession numbers: V01555, AY493742, AY493743, AY337721, AY337722, AY493810, AY337723, AY493835, AY337724, AY493799, AY337725, AY337726 and X58140. (b) Forty 329-bp fragments of EBNA1 (from coordinates 109261–109590) NPC sequences available in GenBank/EMBL7DDBJ database with accession numbers KT820449-KT820488 and 10 sequences obtained from GenBank/EMBL7DDBJ database under the following accession numbers: V01555, GU475455, JN986939, AF192742, GU475448, AF192743, GU475431, AF192744, JN986947 and GU475442.</p

Combinations of TNM stages found in UCNT biopsies.

<p>Combinations of TNM stages found in UCNT biopsies.</p

EBNA1 C-terminal nucleotide and amino acid changes found in three subtypes and seven subvariants identified in this study.

<p>EBNA1 C-terminal nucleotide and amino acid changes found in three subtypes and seven subvariants identified in this study.</p

Distribution of three LMP1 characteristics and EBNA1 subtypes in EBV isolates from NPC biopsies.

<p>Distribution of three LMP1 characteristics and EBNA1 subtypes in EBV isolates from NPC biopsies.</p

Alignment of obtained LMP1 sequences isolated from UCNT biopsies.

<p>B95-8* represents aa sequence of the prototype LMP1. Seven characteristic aa positions for variant discrimination, described by Edwards et al. (1999) are underlined. China1 and NC isolates showed additional representative aa changes which were not listed in known classification: China1 (position 322 and 338) and NC (position 338). Of 85 aa substitutions which were identified at additional 58 positions, several were unique for single variant: H→R at 352 for Med-, E→Q at 328 and S at 309 for B95-8, and D→N at 250 for NC.</p