R?sum? Les m?tastases du cancer du sein au niveau du tractus gastro-intestinal sont rares. Le carcinome lobulaire infiltrant est le type histologique le plus incrimin?. Nous rapportons l?observation d?une femme ?g?e de 55 ans suivie pour un carcinome mammaire gauche et qui a pr?sent? apr?s 8 ans une ?volution m?tastatique gastrique, colique et p?riton?ale.

The ultrastructural localization of chitin in the cyst walls of Euplotes muscicola was determined by labelling with WGA-gold complex. , La localisation de la chitine dans la paroi kystique de Euplotes muscicola a été déterminée par marquage ultrastructural par le complexe WGA-BSA-Au.

IntroductionLes malformations adenomatoides kystiques pulmonaires (MAKP) sont des lesions kystiques rares du poumon. Elles correspondent a un defaut de developpement des alveoles associe a une proliferation anormale des bronchioles terminales, donnant ainsi naissance a des kystes de taille variable.ButIl s'agit d'une etude retrospective ayant interesse 3 enfants presentant une MAKP. Nous avons analyse les manifestations cliniques, radiologiques ainsi que les resultats histologiques afin d'apprecier l'evolution apres le traitement chirurgical.Patients et MethodesNous rapportons 3 observations de MAKP : 2 filles et un garcon. La moyenne d'age de nos patients etait de 56 mois. Dans aucun cas un diagnostic antenatal n'a ete etabli. Tous nos patients avaient un score d'Apgar normal a la naissan...

... the mouth. The tonsils are part of the immune system and help fight infections. Eustachian tube The adenoids ... mouth. The adenoids are also part of the immune system and help fight infections. The uvula is also ...

... a much better prognosis than high-grade ones. Adenoid cystic carcinoma Adenoid cystic carcinoma is usually slow growing and often appears to ... of because it tends to spread along nerves. Adenoid cystic carcinomas tend to come back after treatment (generally surgery ...

Abstract A new fluorescent platinum(II) compound containing the N,N?-bis-(anthracen-9-ylmethyl)propane-1,3-diamine as a carrier ligand has been designed, synthesized and characterized. High cytotoxic activity of cis-[Pt(bapda)Cl2] is observed in A2780 and A2780R cells (human ovarian carcinom...

Adenoid basal hyperplasia is an underrecognized cervical lesion, resembling adenoid basal carcinoma, except the absence of deep invasion into the stroma. We report a series of 10 cases, all extending less than 1 mm from the basement membrane. Our results support the hypothesis that adenoid basal hyperplasia arises from reserve cells of the cervix. Lesions were found close to the squamocolumnar junction, in continuity with the nearby subcolumnar reserve cells. They shared the same morphology and immunoprofile using a panel of 4 antibodies (keratin 5/6, keratin 14, keratin 7 and p63) designed to differentiate reserve cells from mature squamous cells and endocervical columnar cells. We detected no human papillomavirus infection by in situ hybridization targeting high-risk human papillomavirus, which was concordant with the absence of immunohistochemical p16 expression. We demonstrated human papillomavirus infection in 4 (80%) of 5 adenoid basal carcinoma, which is in the same range as previous studies (88%). Thus, adenoid basal hyperplasia should be distinguished from adenoid basal carcinoma because they imply different risk of human papillomavirus infection and of subsequent association with high-grade invasive carcinoma. In our series, the most reliable morphological parameters to differentiate adenoid basal hyperplasia from adenoid basal carcinoma were the depth of the lesion and the size of the lesion nests. Furthermore, squamous differentiation was rare in adenoid basal hyperplasia and constant in adenoid basal carcinoma. Finally, any mitotic activity and/or an increase of Ki67 labeling index should raise the hypothesis of adenoid basal carcinoma. PMID:22809729

RéSUMé: Le carcinome épidermoïde de l'urètre masculin est une tumeur rare, les tumeurs de l'urètre tous types confondus représentant moins de 1 % des tumeurs de l'appareil urinaire. Le pronostic reste défavorable malgré un traitement chirurgical énergique. La radiochimiothérapie semble être un traitement prometteur, mais son rôle doit être défini par d'autres études.Nous rapportons un cas rare de carcinome épidermoïde de l'urètre bulbo-membraneux découvert à un stade localement avancé après observation d'une rupture urétrale transtumorale chez un homme âgé de 70 ans. Le patient a été traité, après drainage vésical, par une irradiation externe associée à une chimiothérapie par cisplatine, et est décédé après progression de la maladie sur un an.La rupture spontanée de l'urètre transtumorale est un mode de découverte exceptionnel témoignant d'une évolution locale défavorable, ce qui rend ces tumeurs difficilement opérables. Cependant, l'espoir actuel réside dans des protocoles thérapeutiques associant radiothérapie et chimiothérapie. PMID:21672490

ResumeLacetabuloplastie est un traitement palliatif utilise chez certains patients souffrant de maladies metastatiques douloureuses du bassin. Nous examinons le cas dune femme de 45 ans souffrant dobesite morbide et dun carcinome mammaire techniquement difficile a traiter par guidage radioscopique en raison de la mauvaise visualisation attribuable a lhabitus. Une ablation par radiofrequence et une acetabuloplastie ont pu etre realisees en utilisant la tomodensitometrie a faisceaux coniques comme technique de guidage.

Adenoid cystic/basal cell carcinoma (ACBCC) is a rare neoplasm in the prostate. Definitive treatment is warranted, as among 19 patients previously reported by us, 5 had extraprostatic extension and 4 were metastatic. The HER?2/neu (c?erbB?2) gene has been reportedly overexpressed in adenoid cystic c...

Adenoid cystic carcinoma is a malignant neoplasm most commonly originating in salivary glands of head and neck region. Here we present a case report of a 50 year old male who was diagnosed with adenoid cystic carcinoma of the right buccal mucosa. The peculiarity of the lesion and the approach we mad...

Adenoid cystic carcinoma rarely occurs within the subglottic larynx. In this study, a case of subglottic adenoid cystic carcinoma was reported. A 54 year-old Chinese woman developed a sudden onset of chest distress and cough worsening after physical exertion, and was diagnosed with, and treated as, ...

Primary adenoid cystic carcinoma in the lung is very rare, so its clinicopathologic characteristics have usually been extrapolated from the salivary disease. However, the clinical courses of pulmonary adenoid cystic carcinomas may be different from those of salivary disease, and individual differenc...

A case of adenoid cystic carcinoma of the oesophagus occurring in a patient who had previously been treated for craniopharyngioma is presented. This is the thirteenth reported case of adenoid cystic carcinoma of the oesophagus and the first in association with craniopharyngioma. The previously descr...

The distribution of fibronectin and laminin was examined by immunohistochemistry in 11 adenoid cystic breast carcinomas, six adenoid cystic carcinomas of mouth and salivary gland, and six cribriform ductal breast carcinomas. Both proteins were present lining cystic lumina and around tumour islands i...

SummaryObjectives Concordance between sinusitis and otitis media with effusion (OME) has been reported in 5-60% of patients. Since nasal diseases induce edema and lymphoid tissue hyperplasia in the nasopharyngeal mucosa, especially the adenoids, chronic infection of the adenoids has been reported to induce otitis media. In addition, deterioration in the mucosal barrier of the adenoids makes the latter vulnerable to bacterial infections, resulting in OME or sinusitis. We therefore evaluated adenoid local immunity and Eustachian tube function by sinusitis and the concordance between sinusitis and OME. Materials and methods We examined PNS series and tympanometry of 520 patients who had undergone adenotonsillectomies. In addition, local adenoidal immunity was evaluated in 10 children with OME...

Background: There are several methods of evaluating adenoidal size pre-operatively. Plain nasopharyngeal radiography is a common investigative modality: it has been advocated, and also condemned. Aim: This study was intended to assess nasopharyngeal airway obstruction by the adenoids using plain X-rays; and also to find correlation if any, with the symptomatology. Methods: This is a retrospective study carried out between January and December 2008. The case notes and plain X-rays of the nasopharynx of 34 paediatric patients with clinical features of obstructive adenoids were analyzed. Results: A total of 34 children were studied, 22 (64.7%) were males and 12 (35.3%) were females. Their ages ranged between 7 months and 10 years: mean age was 3.55 years, standard deviation 2.723. Majority (67.6%) of the children were in the age group 0-4 years. The lowest symptomatology assessment score was 0 and the highest was 3. Children 4 years and below had the highest symptomatology scores. The minimum adenoidal-nasopharyngeal ratio was 0.35 and the maximum was 0.94. There was no significant difference in the mean adenoidal-nasopharyngeal ratio of males and females (t = 0.407; p = 0.692). Many (75.0%) of the children with moderate to severe nasopharyngeal airway obstruction by the adenoids were in the age bracket 0-4 years. The lowest adenoidal-nasopharyngeal ratio score was 0 and the highest was 3. Children 4 years and below had the highest adenoidal-nasopharyngeal ratio scores. There was a very weak nonsignificant correlation between the symptomatology assessment score and the radiological assessment score (r = 0.168; p = 0.375). Conclusion: The adenoidal-nasopharyngeal ratio is reliable in assessing the nasopharyngeal airway in children with obstructive adenoids.

The presence of calcification in a pulmonary nodule is usually a sign of benignity. However, infrequently calcification can occur in a malignant lesion. Adenoid cystic carcinoma of the lung is a type of bronchial adenoma, and a rare disease. We recently experienced a case of adenoid cystic carcinoma with diffuse and homogenous calcification involving the right middle lobe associated with regional lymph node metastasis. CT examination revealed the mass to have high Hounsfield unit of 193, which is unusual for a malignant tumor which usually has a Hounsfield unit lower than 165. From this case, it is learned that adenoid cystic carcinoma has high Hounsfield unit when it is calcified.

Adenoid cystic carcinoma is an epithelial tumour of the major and minor salivary glands, accounting for about 1% of all malignant tumours of the oral and maxillofacial region. Surgical excision with wide margins is the treatment of choice for adenoid cystic carcinoma, but the tendency of this tumour to recur locally and to develop distant metastasis is correlated with an ultimately poor prognosis. Spontaneous remission of cancer, especially in the sinonasal tract, is a rare biological event. Here, we present a case of recurred adenoid cystic carcinoma of the nasal cavity that regressed spontaneously after an intranasal biopsy. We also present a brief review of the literature. PMID:23104530

Objective To evaluate the accuracy of clinical assessment of adenoidal obstruction based on a standardized score of the degree of mouth breathing and speech hyponasality (nasal obstruction index [NOI]) in comparison to nasal fiberoptic endoscopy. Study Design Cross-sectional study with planned data collection. Setting Outpatient clinics of the Departments of Maternal and Pediatric Sciences and Specialized Surgical Sciences, University of Milan, Italy. Subjects and Methods Children aged three to 12 years with adenoidal obstruction suspected on the grounds of persistent/recurrent otitis media or perceived obstructive nasal breathing were eligible. Ear, nose, and throat examination, allergy testing, NOI measurement, and nasal fiberoptic endoscopy to assess the degree of adenoidal hypertrophy ...

Adenoid cystic carcinoma is a rare malignant tumour of the breast. It usually presents as a painful, apparently benign lump near the nipple. The tumour has an interesting histology, natural history and mammographic appearance. Mastectomy is usually curative.

... States each year on treatment of head and neck cancers. (2010 numbers) More information on rare forms of oral cancers including Oral Malignant Melanoma, Mucoepidermoid Carcinoma, Adenoid Cystic Carcinoma . See US Government ...

... taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), warfarin (Coumadin), and other drugs like these. Ask your ... and adenoids. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics . 19th ...

A 51-year-old man with adenoid cystic carcinoma in the main stem bronchus was treated by a left lower lobectomy. A 44-year-old man with adenoid cystic carcinoma in the peripheral small bronchi underwent a right sleeve upper lobectomy with tracheobronchoplasty and neo-carina reconstruction; because of positive tumor margins, radiotherapy was administered postoperatively. Both patients were alive without any signs of tumor after 30 and 24 months of follow-up, respectively. PMID:23087312

SummaryIntroductionAllergic sensitization of the airways occurs not only in the mucosa of the shock organ, but also in the lymphatic stations draining these structures. The lymphatic structure closest to the nasal mucosa in humans is the adenoid. Many researches show that in part of children allergic rhinitis can be a risk factor for adenoid hypertrophy.Materials and methodsWe used acoustic rhinometry and endoscopy to evaluate the influence of the birch pollination on the adenoid size in 67 children between 5 and 12 years old.Four separate groups of children were examined. The study group consisted of 28 children hypersensitive to tree pollen with seasonal allergic rhinitis (interview, positive skin prick test results, presence of sIgE in the serum and positive nasal provocation test with ...

The specific function of putative cut2 protein (or CFP25), encoded by the Rv2301 gene from Mycobacterium tuberculosis H37Rv, has not been identified yet. The aim of this study was to assess some of CFP25 characteristics and its possible biological role in Mycobacterium tuberculosis H37Rv invasion process to target cells. Molecular assays indicated that the gene encoding Rv2301 is present and transcribed in M. tuberculosis complex strains. The presence of Rv2301 protein over the bacilli surface was confirmed by Western blot and immunoelectron microscopy analyses, using goats sera inoculated with synthetic peptides derived from Rv2301 protein. Receptor?ligand binding assays with carcinomic human alveolar basal epithelial cells (A549) and macrophages derived from human histolytic lymphoma mon...

Resume Le lymphome primitif de la prostate est une affection maligne rare. Les patients pr?sentent initialement des signes urinaires locaux et des signes g?n?raux. Plusieurs traitements ont ?t? utilis?s comme la prostatectomie radicale, la radioth?rapie ou des associations de chimioth?rapie et de radioth?rapie. Une revue de la litt?rature fait ?tat du mauvais pronostic du lymphome de la prostate, le diagnostic se faisant souvent ? un stade tardif. Nous rapportons le cas d?un patient ?g? de 73 ans pr?sentant une r?tention aigu? d?urines dans un contexte de constipation opini?tre avec amaigrissement s?v?re. Il ?tait diab?tique, aux ant?c?dents de carcinome uroth?lial de stade pT1 et de grade G3, trait? par r?section transur?trale et BCG th?rapie. L?examen clinique a r?v?l? une prostate tr?s ...

Background:Patients enrolled in clinical trials of advanced hepatocellular carcinoma (HCC) are usually required to have good liver reserve and organ function. However, their outcomes are still highly variable. We aimed to examine whether current staging systems can predict the survival of these highly selected patients.Methods:Patients from clinical trials involving first-line anti-angiogenic therapy were assigned to different stage groups using the American Joint Committee on Cancer (AJCC), Barcelona Clinic Liver Cancer (BCLC), China integrated score, Cancer of the Liver Italian Program (CLIP) score, Chinese University Prognostic Index (CUPI), Groupe d’Etude et de Traitement du Carcinome Hepatocellulaire (GETCH), Japan Integrated Staging (JIS) score, Okuda, Tokyo score, and a new st...

R?sum? Pr?-requis Le carcinome ?pidermo?de primitif de la v?sicule biliaire est tr?s rare. Il repr?sente moins de 2 % de toutes les tumeurs malignes de la v?sicule. A notre connaissance, trente cas ont ?t? rapport?s dans la litt?rature [1]. Il s?agit d?une forme histologique agressive d??volution rapide avec des m?tastases visc?rales pr?coces. L?histogen?se est toujours controvers?e. Son pronostic est sombre avec une survie ne d?passant pas six mois. Objectif A travers une observation et une revue de la litt?rature, notre objectif est de discuter les aspects anatomocliniques, l?histog?n?se ainsi que les modalit?s th?rapeutiques de cette entit? rare. Observation Une femme de 44 ans, ?tait hospitalis?e pour prise en charge de douleur de l?hypochondre droit associ?e ? une alt?ration de l??tat...

Adenoid cystic carcinoma arising from the peripheral lung is rare. Here, we describe adenoid cystic carcinoma that developed in the peripherally in S9 of the right lower lobe of an 84-year-old woman. Cell blocks prepared from the bronchial wash specimens exhibited the cribriform formation. An immunohistochemical examination of the surgically resected tumor revealed positive thyroid transcription factor-1 and c-kit staining. Exons 9 and 11 of c-kit in tumor cells were not mutated. We compared the clinical features of this patient with those of 10 others described in the English-language literature.   

Summary New chemotherapeutic strategy should be investigated to enhance clinical management in salivary gland adenoid cystic carcinoma (ACC). Recently, sulforaphane (SFN), as a natural compound from cruciferous vegetables exhibits a potent anti-cancer activity in various tumor cells, but remains uncertain in ACC cells. The present study examined whether SFN suppresses proliferation and in ACC cells, if so, the possible molecular targets would be further investigated. Cell survives, apoptosis, cell cycle progression and molecular targets were identified by multiple detecting techniques, including trypan blue dye exclusion assay, electron microscopy, AO/EB staining, flow cytometry and immunoblotting in human lung high metastasis cell line of salivary gland adenoid cystic carcinoma (ACC-M). T...

Primary adenoid carcinoma are rare skin tumors. We present a 75-year-old female with this primary cutaneous tumor of the scalp with additional bone involvement. Wide scalp excision with bone enclosure, latissimus-dorsi-free-flap defect overage, and subsequent radiation slowed down the disease but co...

We analyzed 41 oral salivary gland carcinomas from consecutive 290 salivary gland carcinoma database (14%) with emphasis on the histological spectrum and clinical outcome of adenoid cystic carcinoma (ACC) and polymorphous low-grade adenocarcinoma (PLGA). The cohort included 14 ACCs, 14 mucoepidermoi...

In order to find common genetic abnormalities that may identify loci of genes involved in the development of adenoid cystic carcinoma (ACC), we investigated DNA copy number changes in 24 of these tumors by comparative genomic hybridization (CGH). Our results indicate that unlike many carcinomas, ACC...

A 23 year old man presented with a tumour mass in the lung. Subsequent investigation showed ectopic secretion of adrenocorticotrophic hormone (ACTH) and growth hormone releasing hormone (GHRH) from an adenoid cystic carcinoma. The patient progressed to show the clinical effects of long term exposure...

Adenoid cystic carcinoma is a frequently occurring malignant salivary gland neoplasm. We studied the induction of protease activity by the laminin-derived peptide, SIKVAV, in cells (CAC2) derived from this neoplasm. Laminin ?1 and matrix metalloproteinases (MMPs) 2 and 9 were immunolocalized in aden...

Adenoid cystic carcinoma (ACC) is a slowly growing tumor with a particular tendency to infiltrate the surrounding tissue by perineural spread. The clinical diagnosis may prove difficult due to the submucons extension of the tumor, especially at the skull base. This article outlines the clinical char...

Primary malignant tumors of the trachea are rare, the most prevalent histologies beeing squamous cell and adenoid cystic carcinoma. A review of the literature revealed only ten cases of primary tracheal or bronchial non-Hodgkin's lymphoma. We describe a case in which tracheal involvement of bronchus-associated lymphoid tissue lymphoma, a subtype of non-Hodgkin's lymphoma, occurred.

The role of metastasectomy for recurrent disease in patients with adenoid cystic carcinoma (ACC) is not defined clearly yet. A 52-year-old woman found two hepatic metastatic nodules 3 years after the completion of treatment for primary ACC of the trachea. After confirming the absence of other lesion...

Adenoid cystic carcinoma (ACC) is a relatively rare epithelial tumor of the salivary glands. We present a 64-year-old gentleman with ACC of the tongue who following resection and radiotherapy, presented 10 years later with a lung metastasis and underwent operative intervention and further radiothera...

We report the case of a patient who presented with a painful breast lump that turned out to be an adenoid cystic carcinoma of the breast. The literature is reviewed, highlighting the good prognosis associated with this rare condition and the current preferred treatment modalities. PMID:22613278

Primary cutaneous adenoid-cystic carcinoma (PCACC) is a rare slow-growing neoplasm of disputed histogenesis characterized by a cribriform pattern at histology and local aggressive behaviour. Up to date about 60 cases of PCACC have been reported in the literature. This tumour is most common in the sc...

Adenoid cystic carcinoma of the parotid gland is a rare and slowly growing, but highly malignant tumor. Surgical resection of a malignant parotid tumor should include resection of the facial nerve when the nerve is involved in the tumor. Facial nerve reconstruction is required after nerve resection....

The aim of this study is presentation of 2 cases primary adenoid cystic carcinoma in subglottic part larynx and upper part trachea. Both were treated by surgical resection with following radiotherapy. Observation period in one case without any recurrens signs and neoplasmatic dissemination is 16 years. (author) 11 refs, 1 fig

We report an extremely rare case of primary adenoid cystic carcinoma (ACC) trachea presenting as midline swelling neck and mimicking thyroid tumor. A 44-year-old female presented with painless midline swelling neck without any respiratory complaints, hoarseness of voice or dysphagia etc. Fine needle...

Purpose: To assess the magnetic resonance imaging (MRI) findings of pathologically confirmed palatal tumors. Methods: Nine cases of palatal tumor were studied. Clinical data, MRI findings, and pathological diagnoses were evaluated. Results: Five cases were tumors of the hard palate and four of the soft palate. Signal intensity on T1-weighted images varied, and hyperintensity was observed on T2-weighted images. Adenoid cystic carcinoma and diffuse large B cell lymphoma showed homogenous signal intensity. Other tumors showed heterogeneous signal intensities. On dynamic contrast analysis, malignant pleomorphic adenoma, adenoid cystic carcinoma, diffuse large B cell lymphoma, and peripheral T cell lymphoma showed early enhancement. On post-contrast T1-weighted images, hard palate pleomorphic adenoma, malignant pleomorphic adenoma, adenoid cystic carcinoma, diffuse large B cell lymphoma, and peripheral T cell lymphoma showed strong enhancement. Although the borders of the tumors were classified as clear in 6 cases treated surgically, macroscopic and microscopic borders of the tumors were unclear. Adenoid cystic carcinoma and hard palate diffuse large B cell lymphoma invaded the maxillary bone. Conclusion: Magnetic resonance findings of palatal tumor varied in different histologies. Even with a small palpable portion, malignant tumors could directly infiltrate surrounding structures, which demonstrated well on MRI.   

Adenoid cystic carcinoma (ACC) of the breast is a rare neoplasm accounting for 0.1% of all breast carcinomas, and presenting most commonly as a painful breast mass. In contrast to the aggressive nature of ACC at other sites, ACC of the breast has a favorable prognosis, lymph node involvement or dist...

The authors present a case of unusually aggressive adenoid cystic carcinoma of the head and neck. The patient presented with sciatica one year after initial diagnosis. She was otherwise asymptomatic. Complete work-up for bone involvement, included bone scan and MRI. The patient had painful osteolyti...

AIM: To investigate the role of human papillomavirus (HPV) in adenoid cystic carcinoma of the uterine cervix. METHODS: Eleven archival, paraffin wax embedded specimens were analysed by non-isotopic in situ hybridisation (NISH) for HPV types 6, 11, 16, 18, 31, and 33 using digoxigenin labelled probes...

Thymic carcinomas are rare malignant neoplasms. We present a case of adenoid cystic carcinoma of thymus in a 65-year-old woman that was initially misdiagnosed and was treated as non-small cell carcinoma of the lung. We describe the clinical and pathologic features of this extremely rare thymic epithelial tumor, with survival at 2 years and 6 months of follow-up.

Adenoid cystic carcinoma (ACC) is common in the salivary glands but rare in the esophagus. Routine esophagogastroscopy performed in a 54-year-old woman as part of a medical check-up revealed a submucosal tumor (1.5×1.0 cm) at the mid-esophagus. Endoscopic ultrasonography revealed a lesion with mixed...

This report deals with a basal cell epithelioma, partially adenoid and partially morphea-like in structure, which despite intensive X-ray treatment relapsed constantly and which finally developed into an ulcus terebrans. Approximately 13 years after the primary tumor had developed (located on the left wing of the nose) both a lymphogenic and a hematogenic formation of metastases occurred with a subsequent exitus letalis 4 months later. Besides the metastases of the skin, there were multiple metastases in the lymph nodes, vertebral column, ribs, spleen, liver, stomach, pleura, and peritoneum as well as in the myocard of both ventricles and in the perimysium of the skeletal muscles. Their histological structure was similar to a partly adenoid, partily morphea-like basal cell epithelioma. The possible influence of X-ray treatment on the tumor tissue in way of benignity or malignancy is discussed in view of relevant literature on this topic. The alteration of basal cell epitheliomas into the socalled transitional epitheliomas is also analyzed.

To report on the diagnostic challenge of an adenoid cystic carcinoma arising from the eyelid. A 77-year-old male was referred to our center with a clinical diagnosis of upper eyelid chalazion for a lesion that had appeared 2 years before. A loss of cilia was observed over the cutaneous area of induration, but there was no reddening or ulceration. Incisional biopsy was performed and the specimen was submitted in formalin for histopathological examination. On light microscopy, the lesion was composed of basaloid epithelial and myoepithelial cells that were arranged in strands or nests and associated with cystic spaces that contained a deeply eosinophilic secretory substance and an Alcian blue-positive material, characteristic of adenoid cystic carcinoma. After histological diagnosis, tumor r...

Adenoid cystic carcinoma of the breast is a rare neoplasm, accounting for only 0.1% of all malignant breast tumours. It is more common in women in the sixth decade of their lives and often in the sub areolar area. The clinical criteria is not specific and the radiographic examination showed a benign-appearing tumour. The preoperative diagnosis is possible with fine-needle aspiration cytology. The diagnosis is made by histological examination, presented a difficult differential diagnosis with cribriform carcinoma; so it is necessary to use histochemical or immunohistochemical techniques. The treatment is not well established. It consists of lumpectomy with radiation or mastectomy. Compared to other locations, adenoid cystic carcinoma of the breast has a favorable prognosis. Lymph node involvement or distant metastases seldom occur. The aim of our study is to describe the epidemiological, clinico pathological characteristics, the treatment and the prognosis of this rare type of breast tumour. (authors)

Adenoid cystic carcinoma is a malignant salivary gland tumor with typical histologic patterns. The majority of the se tumors occurs in the minor salivary glands, especially mucosa of the hard palate. The authors experienced the patients, who complained the tumor-like soft tissue masses on the palatal and mouth floor area. After careful analysis of clinical, radiological and histopathological findings, we diagnosed them as adenoid cystic carcinomas in the minor salivary glands, obtained results were as follows : 1. Main clinical symptoms were a slow growing soft tissue mass with normal intact mucosa on the palatal area, and soft tissue mass with mild pain on the mouth floor area. 2. In the radiographic examinations, soft tissue masses were observed with invasion to adjacent structures, and moderate defined, heterogeneous soft tissue mass with enhanced margin, respectively. 3. In the histopathologic examinations, dark-stained, small uniform ballad's cells in the hyaline or fibrous stroma were observed as solid and cribriform patterns, respectively.

Marques Y M F S, Giudice F S, Freitas V M, Abreu e Lima M d C C, Hunter K D, Speight P M & Machado de Sousa S C O -(2012) Histopathology60, 609-616-Oestrogen receptor in adenoid cystic carcinoma of salivary glands Aims:- This study aimed to describe the expression of oestrogen receptor (ER), ER and aromatase in salivary gland adenoid cystic carcinoma (ACC). Methods and results:- ER, ER and aromatase expression was analysed by immunohistochemistry in tissue microarray blocks from 38 cases of ACC and seven normal salivary glands. The intracellular localization and amount of total protein expression were investigated by immunofluorescence and western blotting in an ACC cell line. Western blotting analysis showed overexpression of ER, ER and aromatase in the ACC cell line; however, with immuno...

Autophagy is the endogenous cellular pathway that facilitates cellular survival by maintaining energy homeostasis and macromolecular synthesis during cellular stress and nutrient deprivation. Endoplasmic reticulum (ER) stress is the process in which disruption of these physiological functions leads to an accumulation of unfolded proteins and induces the unfolded protein response (UPR). ER stress and autophagy are involved in human cancer. We investigated the expression of autophagic proteins (LC3 and beclin 1) and ER stress-related protein (GRP78) in head and neck adenoid cystic carcinoma tissue. Tissue samples from 79 cases of head and neck adenoid cystic carcinoma tissue were utilized for immunohistochemistry. LC3 expression was significantly correlated with lymph node involvement (P=.01...

The authors report a rare case of primary mucinous carcinoma of the skin initially diagnosed as a metastatic adenocarcinoma. The tumor occurred in the right axilla in a 75-year-old man. Initial pathological diagnosis was metastatic adenocarcinoma. However, no primary focus was found in the body. The revised diagnosis by the authors was primary cutaneous mucinous carcinoma. The tumor (1.5 cm) was characterized by proliferation of atypical epithelial cells arranged in cell nests with many pseudolumens resembling adenoid cystic carcinoma. It was also characterized by much mucinous stroma or pool around tumor cells. No apparent eccrine or apocrine differentiation was noted histologically and immunohistochemically. The present case suggests that primary cutaneous mucinous carcinoma may be misdiagnosed as metastatic adenocarcinoma, and that it may resemble adenoid cystic carcinoma.   

Costa A F, Tasso M G, Mariano F V, Soares A B, Chone C T, Crespo A N, Fresno M F, Llorente J L, Surez C, de Arajo V C, Hermsen M & Altemani A -(2012) Histopathology60, 816-837 Levels and patterns of expression of hypoxia-inducible factor-1, vascular endothelial growth factor, glucose transporter-1 and CD105 in adenoid cystic carcinomas with high-grade transformation Aims:- To compare the expression of proteins regulated by hypoxia between adenoid cystic carcinoma (ACC) with and without high-grade transformation (HGT). Methods and results:- In eight ACC-HGT and 18 ACC without HGT, expression of hypoxia-inducible factor-1 (HIF-1), vascular endothelial growth factor (VEGF), glucose transporter-1 (GLUT-1) and microvascular density (MVD) by CD105 (a hypoxia-inducible protein expressed in angiog...

Adenoid cystic carcinoma (ACC) of salivary glands is a slow-growing malignant tumor, characterized by wide local infiltration, perineural spread, a propensity to local recurrence and late distant metastasis. Although ACC is the second most common malignant salivary gland neoplasm and constitutes approximately one-third of all salivary gland malignancies, it is relatively rare in parotid gland. Here, we present a case report of a cribriform type of ACC involving parotid salivary gland in a 66-year-old female. PMID:3864098

Nine patients with an adenoid-cystic carcinoma of the trachea are described. It is a rare tumour which grows relatively slowly; it has a tendency for early invasion of neighbouring tissues, but late distant metastases. A correct diagnosis can be made by the radiologist. The trachea should be visible on every film of the thorax and should be inspected. In particular, a diagnosis of therapy-resistent asthma should direct the attention of the radiologist to the trachea.

Childhood rhinosinusitis is a frequent motive for consulting a physician. Given its recurrent character, the patient should be assessed for intrinsic as well as environmental factors. Intrinsic factors to search for include adenoid hypertrophy, allergies, gastroesophageal reflux, diabetes, immunity deficiency, a ciliary disorder, and cystic fibrosis. Among the environmental factors, passive smoking should be discouraged; community living, repeated viral infections, and pollution have also been implicated.

Abstract Objective: To test the validity of four different types of lateral cephalometric radiograph (LCR) measurements as a diagnostic test of adenoid hypertrophy in different age groups of mouth-breathing children. Materials and Methods: Eighty-six mouth-breathing children (male 54.65%, mean age 7.0 ± 2.2 years) were randomly selected from a hospital population. Adenoid obstruction of the nasopharynx was evaluated by subjective, linear, ratio, and area LCR measurements. Each measurement was compared with flexible fiberoptic endoscopy diagnosis. Results: Kendall correlation coefficients for agreement between tests were ? 0.67 and kappa scores were substantial (? 0.64). Higher correlation coefficients and agreement values were found in older age groups. When the sample was stratified by age, the 3- to 5-year-old age group showed lower correlation coefficients and agreement strength for subjective, linear, and ratio measurements. The sensitivity of LCR varied from 71% (ratio) to 84% (linear). The specificity varied from 83% (linear) to 97% (ratio). The positive predictive value varied from 88% (linear) to 97% (ratio). The negative predictive value varied from 70% (ratio) to 78% (linear). The validity of each measure was different among the age groups. Conclusions: LCR is a valid method for measuring adenoid hypertrophy in children from 6 to 12 years old. The diagnosis of adenoid hypertrophy, based on LCR measurements, in children with primary dentition (3-5 years old) should be made with caution. The combination of linear and ratio LCR measurements is a reliable screening tool to determine the need for an ear, nose, and throat evaluation. PMID:22428943

It is often difficult to exactly grasp the malignancy of salivary gland tumor because of inadaptability of percutaneous biopsy. The purpose of this study is to discuss whether Ga-67 scintigraphy on patient with salivary gland tumor can provide useful information for differential diagnosis. We studied retrospectivelly the case records of twenty patients with parotid or submandibular gland tumors admitted to the Nippon Dental University, School of Dentistry at Niigata, between January 1984 and December 1991. The final diagnoses of these twenty patients were pleomorphic adenoma in 11, adenocarcinoma in 3, adenoid cystic carcinoma in 3, Warthin's tumor in 1, oncocytoma in 1, and carcinoma in pleomorphic adenoma in 1. The scintigraphic patterns of the twenty patients were classified as negative (-), weakly positive (+), moderate positive (++), strongly positive (+++). Malignant tumors showed increased activity in Ga-67 images except those in three patients with adenoid cystic carcinomas. We concluded that Ga-67 scintigraphy may be useful to distinguish benign salivary gland tumors from adenocarcinoma or carcinoma in pleomorphic adenoma, but not be useful in detection of adenoid cystic carcinoma. (author).

Between 1949-1977, 74 patients with adenoid-cystic carcinoma of various head and neck sites were treated by radiation therapy at Memorial Sloan-Kettering Cancer Center. Radiation therapy alone was employed in 49 patients for recurrent, unresectable disease, and in 25 patients it was given as an adjunct to surgical resection. Among the 49 patients treated with radiation therapy alone, tumor regression was seen in 47 (96%). However, 44 of the 47 (93.5%) subsequently relapsed locally. Relapse occurred within 18 months in one-half of the patients and within 5 years in all of them. Of the 25 patients who received adjunctive radiation therapy about one-half relapsed locally within five years. There were 9 patients in this group, however, whose field size exceeded 8x8 cm and the dose of radiation also exceeded 4500 rad: 88% of these patients remained relapse-free at 5 years, compared with only 22% of the other 16 whose dose, or field size, or both, were inadequate by comparison. These data suggest that when irradiation is employed for advanced, inoperable adenoid-cystic carcinoma, it offers useful palliation but is rarely, if ever, curative. Postoperative irradiation, on the other hand, might improve the local control and the survival in patients with operable adenoid-cystic carcinoma who are at high risk for relapse, but only if the field size and the dose are adequate.

Cytotoxin-associated gene A (cagA) of Helicobacter pylori (H. pylori) encodes a highly immunogenic and virulence-associated protein. The presence of cagA+ H. pylori strains in tonsil and adenoid tissues may affect clinical outcome. The aim of the present study was to determine the presence of H. pylori cagA gene in tonsil and adenoid tissues and to establish the potential association of cagA+ H. pylori in recurrent adenotonsillitis (RAT) and adenotonsillar hypertrophy (ATH). For this aim, a total of 118 tissue samples (71 tonsil and 47 adenoid tissues) were collected from a total of 71 children: 28 cases with RAT and 43 cases with ATH. The samples were analyzed for glmM gene to detect the infection with H. pylori by polymerase chain reaction (PCR). H. pylori-positive samples were further analyzed for the presence of the cagA gene. The PCR analysis showed that 29 samples (24.6%) were positive for H. pylori. Seventeen out of these 29 samples (58.6%) were found positive for cagA; the cagA gene was detected in 12 samples of ATH and 5 samples of RAT. The presence rate of cagA gene was significantly higher (p < 0.05) in ATH patients than that found in RAT patients. These results suggest that presence of cagA+ H. pylori may be associated with development of ATH.   

Cell sub-populations surviving to high radiation doses were selected. The KBm survival part was obtained by exposure to a mutagenic agent and irradiation, FaDum results of a progressive irradiation of FaDu. A semi-quantitative RT-PCR analysis revealed a significant overexpression of GST-? and p53 genes for KBm and FaDum cell lines that remained stable for 18 months. The SF2, ?, ?, and MID parameters, determined by clonogenic assays, show no modifications of radiosensitivity. The variations of expression observed are not correlated to a radiosensitivity variation. The overexpression of GST-? and p53 does not seem to be a radiosensitivity marker. Nous avons isolé des sous-populations de 2 lignées cellulaires humaines (KB et FaDu) de carcinomes des voies aéro-digestives supérieures survivant à de fortes doses d'irradiation. La fraction survivante KBm a été obtenu après exposition à un agent mutagène et à une irradiation, FaDum résulte de l'irradiation progressive de FaDu. Une analyse par RT-PCR semi-quantitative nous a permis de mettre en évidence une surexpression significative des gènes GST-? et p53 pour les souches KBm et FaDum analysées après 18 mois de culture. Les paramètres, ?, ?, SF2, MID, déterminés par essais clonogéniques, n'indiquent pas de modification de la radiosensibilité. Les variations d'expression observées ne sont donc pas corrélées à une variation de radiosensibilité. La surexpression des gènes GST-? et p53 ne semble pas constituer un marqueur de radiosensibilité.

Abstract in spanish Introducción: El clearance mucociliar normal es el mecanismo de defensa básico de las vías respiratorias. Sin embargo, los mecanismos de control ciliar aún se desconocen. Con el fin de entenderlo mejor, se han desarrollado diferentes técnicas de cultivo de células ciliadas. Objetivos: Desarrollar un modelo experimental a partir de cultivos primarios de tejido adenoideo y cornete medio. Caracterizarla respuesta a adenosin trifosfato (ATP), agonista conocido de la fre (more) cuencia de batido ciliar (FBC). Material y método: Cultivos primarios a partir de explantes de epitelio adenoideo y cornete medio humano. Medición de FBC, con técnica de microfotodensitometría, en condición basal y en respuesta a ATP a diferentes concentraciones. Resultados: La FBC basal (promedio (X) ±desv estándar (DE)) para los cultivos de cornete medio fue 11,9 ±1,5 Hz y para tejido adenoideo fue 10,9 ±1,9 (p >0,05). Se observó un aumento en la FBC en respuesta a ATP, dosis dependiente. No hubo diferencia significativa en la FBC basal ni en la respuesta a ATP entre cultivos de cornete medio y adenoides. Conclusión: El cultivo primario de células ciliadas nasales a partir de explantes de adenoides, es un modelo experimental reproducible, en el que es posible observar actividad ciliary una respuesta funcional concordante con lo descrito en la literatura Abstract in english Introduction. Mucociliary clearance constitutes the main defense mechanism of the airway, but the mechanisms of ciliary control are still unknown. With the aim of a better understanding of this process, many ciliated cells culture techniques have been developed. Aims. 1. To develop an experimental model based on primary cultures from adenoid and middle turbinate tissue. 2. To characterize in this model the response to ATP, a known agonist of ciliary beat frequency (CBF). (more) Material and Method. Primary cultures derived from human adenoid tissue and middle turbinate epithelial explants were obtained. CFB was measured by microphotodensitometry, both in basal conditions and in response to ATP at different concentrations. Results. Basal CFB (average (X) +- standard deviation (SD)) for middle turbinate cultures was 11.9 +-1.5 Hz, and for adenoid tissue was 10.9 +-1.9 Hz (p

Abstract in portuguese O carcinoma adenóide quístico é uma neoplasia epitelial maligna de origem glandular, ocorrendo nas glândulas mamárias, salivares e raramente no pulmão, onde é responsável por 0,2% dos tumores. Embora raro, é o tumor de ?tipo glândula salivar? mais comum ao nível do tracto respiratório. Estes tumores apresentam um crescimento lento e curso clínico prolongado, caracterizando-se pela natureza infiltrativa, com tendência para a recorrência local tardia. Os au (more) tores apresentam o caso de uma mulher com carcinoma adenóide quístico do pulmão diagnosticado na sequência de investigação de nódulo do pulmão submetida a ressecção cirúrgica com intuito curativo, cujo follow-up documentou recidiva local tardia 9 anos após a ressecção. O presente caso vem realçar a necessidade de vigilância prolongada, dado o potencial de recidiva local tardia deste tipo de tumor. O artigo revê aspectos clínicos e patológicos do carcinoma adenóide quístico do pulmão e discute opções terapêuticas, nomeadamente de prevenção da recidiva, à luz dos conhecimentos actuais. Abstract in english The adenoid cystic carcinoma is a malignant epithelial glandular type neoplasia, occurring frequently in the salivary and mammary glands, and rarely in the lung, and is responsible for 0.2% of lung tumours. These tumours present a slow growth and prolonged clinical course, and are characterised by their infiltrative nature and tendency towards late local recurrence. The authors present a case of a woman with adenoid cystic lung carcinoma diagnosed after investigation of a (more) lung nodule, submitted to surgical resection with curative intention, whose follow -up identified late recurrence, 9 years after surgery. The present case emphasises the need for a prolonged surveillance, due to the potential late recurrence of this kind of tumour. The article reviews clinical and pathological features of lung adenoid cystic carcinoma, as well as therapeutic options, namely for prevention of recurrence.

The specific function of putative cut2 protein (or CFP25), encoded by the Rv2301 gene from Mycobacterium tuberculosis H37Rv, has not been identified yet. The aim of this study was to assess some of CFP25 characteristics and its possible biological role in Mycobacterium tuberculosis H37Rv invasion process to target cells. Molecular assays indicated that the gene encoding Rv2301 is present and transcribed in M. tuberculosis complex strains. The presence of Rv2301 protein over the bacilli surface was confirmed by Western blot and immunoelectron microscopy analyses, using goats sera inoculated with synthetic peptides derived from Rv2301 protein. Receptor-ligand binding assays with carcinomic human alveolar basal epithelial cells (A549) and macrophages derived from human histolytic lymphoma monocytes (U937) allowed us to identify five high activity binding peptides (HABPs) in both cell lines, and two additional HABPs only in A549 cells. U937 HABPs binding interactions were characterized by saturation assays, finding dissociation constants (Kd) within the nanomolar range and positive cooperativity (nH>1). Inhibition assays were performed to assess the possible biological role of Rv2301 identified HABPs, finding that some of them were able to inhibit invasion at a 5 ?M concentration, compared with the cytochalasin control. On the other hand, HABPs, and especially HABP 36507 located at the N-terminus of the protein, facilitated the internalization of fluorescent latex beads into A549 cells. These findings are of vital importance for the rational selection of Rv2301 HABPs, to be included as components of an antituberculosis vaccine. PMID:21594640

A pictorial review of nasal cavity neoplasms is provided for the reader to gain or refresh information about these neoplasms. The images provided are to help aid in recognition of the lesions. Retrospective case review of pathologically and clinically proven nasal cavity neoplasms are shown with multiple modalities including computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT) to illustrate the findings and complement a succinct review of this category of disease. Examples include squamous cell cancer, adenoid cystic cancer, esthesioneuroblastoma, inverted papilloma, juvenile nasal angiofibroma, melanoma, lymphoma, sarcoma, and benign nasal histiocytoma. PMID:20113866

A case of a 56 year-old man with adenoid cystic carcinoma in the middle and the lower trachea which was successful treated by multidisciplinary treatment is reported. The trachea stenosis was improved from 90 % to 60 % by endoscopic Nd-YAG laser irradiation (total: 20,000 joules). Then bronchial arterial infusion therapy with 15 million units of interferon ..beta.., intratumor injection therapy with 2 million units of interferon ..beta.. through a bronchofiberscope, and 660 cGy. of fast neutron irradiation were performed. The tumor disappeared entirely macroscopically, following these multidisciplinary modalities and the patient has been well for four years since treatment started.

A 62-year-old Japanese male patient presented with right oculomotor, abducens, and trigeminal nerve disturbances. Neuroimaging revealed a right middle cranial fossa mass lesion with the characteristics of trigeminal schwannoma. The patient underwent a right temporal craniotomy for gross total resection. Histological examination confirmed a metastasis of adenoid cystic carcinoma (ACC). After the operation, no evidence of the primary lesion could be found. The patient was treated with radiation therapy. ACC can be difficult to identify before histological confirmation. The incidence of intracranial invasion of ACC is 4-22%, but in this case no evidence of the primary lesion was found.   

Two cases of severe tracheal stenosis due to advanced nonresectable adenoid cystic carcinoma of the trachea were reported. Case 1 was a 38-year-old male who underwent emergency {sup 60}Co irradiation following endoscopic YAG laser irradiation. This approach was quite effective. Proton irradiation was effective against tumor recurrence. Case 2 was a 28-year-old female in whom emergency treatment for tracheal obstruction due to edema after laser therapy necessitated transient tracheal intubation. The tracheal stenosis due to recurrent tumor after {sup 60}Co irradiation was improved by insertion of an intraluminal permanent stent. (author).

Adenoid cystic carcinoma (ACC) is a rare malignant neoplasm, arising from glandular tissues, found mainly in the head and neck. Generally, it presents insidiously but can behave aggressively making its course unpredictable. Surgery and adjuvant radiotherapy continue to be the cornerstone for its treatment. ACC remains extremely difficult to treat. The authors report a case of a 37-year-old woman with bloody rhinorrhea for 6 months. She was diagnosed with a left nasal cavity lesion that was biopsied, and the anatomopathological result showed ACC. The patient was submitted to a left extended maxillectomy, microsurgical reconstruction and radiotherapy. PMID:22914229

J Oral Pathol Med (2012) 41: 621-629 Background:- Although autophagy is universally involved in tumorigenesis and tumor progression, the roles of autophagy and autophagy-regulating genes in salivary gland adenoid cystic carcinoma (ACC) remain unknown. In this study, we investigated the expression of the autophagy-regulating genes Beclin-1, death-associated protein kinase-1, ultraviolet radiation resistance-associated gene, and phosphatase and tensin homolog in salivary gland ACC samples. Methods:- Immunohistochemistry and real-time polymerase chain reaction were used to analyze the expression of these genes in 89 ACC samples and normal salivary gland tissue samples. The relationship of their expression with clinicopathological features was analyzed. Results:- The data showed significantly ...

First bite syndrome is a well-described sequelae of parapharyngeal space surgery, thought to result from sympathetic denervation of the parotid gland. We describe a case of first bite syndrome caused by an adenoid cystic carcinoma of the submandibular gland. The tumor was not clinically or radiographically apparent until 18 months after initial presentation despite repeated imaging. In patients with first bite syndrome and no surgical history, there must be high suspicion for a malignancy, which may be occult on presentation. The submandibular gland should be considered as a possible site of a lesion. PMID:22991297

ObjectivesTo correlate sleep apnea with craniofacial characteristics and facial patterns according to gender. MethodsIn this prospective survey we studied 77 male and female children (3-12years old) with an upper airway obstruction due to tonsil and adenoid enlargement. Children with lung problems, neurological disorders and syndromes, obstructive septal deviation, previous orthodontic treatment, orthodontic surgeries or oral surgeries, or obesity were excluded. Patients were subjected to physical examinations, nasal fiberoptic endoscopy, teleradiography for cephalometric analysis, and polysomnography. Cephalometric analysis included the following skeletal craniofacial measurements: facial axis (FA), facial depth (FD), mandibular plane angle (MP), lower facial height (LFH), mandibular arch...

Abstract in spanish El estroma juega un rol importante en los procesos tumorales de invasión y metástasis. Las fibras de colágeno tipo I son el principal componente estructural del estroma en distintos tumores. Sin embargo, hay muy pocos estudios en los tumores de glándulas salivales. Basándonos en estos antecedentes el objetivo de la presente comunicación fue estudiar las características del colágeno con Picrosirius red/polarización en tumores benignos y malignos de glándulas sali (more) vales para evaluar su posible rol en los mecanismos de progresión tumoral. Cortes histológicos de adenoma pleomórfico, carcinoma adenoide quístico y carcinoma epitelial mioepitelial se colorearon con H/E y Picrosirius red y se examinaron con microscopio de polarización. La birrefringencia del colágeno con Picrosirius/polarización resultó diferente en el estroma de los tumores malignos (carcinoma adenoide quístico y carcinoma epitelial mioepitelial), con predominio de colágeno I, en comparación con el tumor benigno (adenoma pleomórfico), con predominio de colágeno III. El diferente perfil de coloración en las fibras colágenas producidas en el estroma de los tumores analizados podría relacionarse con diferentes mecanismos de expansión tumoral, los que fueron poco estudiados en los tumores de glándulas salivales. Más estudios son necesarios para obtener resultados más concluyentes que contribuyan al diagnóstico, pronóstico y tratamiento. Abstract in english The stroma plays an important rol in tumoral invasion and metastasis. Type I collagen is the main structural component of the stroma in several tumors. However, there are few studies on salivary gland tumors. Based on this background the objective of the present communication was to study collagen characteristics with picrosirius red/polarization on malignant and benign tumors of salivary glands to evaluate its posible rol in the tumoral progression mechanism. Histologica (more) l sections of pleomorphic adenoma, adenoid cystic carcinoma and epithelial/myoepithelial carcinoma were stained with H/E and picrosirius red and were studied with polarization microscope. Collagen birefringence with Picrosirius/polarization was different in the malignant tumor stroma (adenoid cystic carcinoma and epithelialmyoepithelial carcinoma), with predominance of type I collagen, compared with a benign tumor (pleomorphic adenoma), with predominance of type III collagen. The different staining profile in collagen fibers produced in the benign and malignant stroma tumors analized could be related with different tumoral expansion mechanism, which were scarce studied on the salivary glands tumors. More studies are needed to obtain more conclusive results to contribute to diagnosis, prognosis and treatment.

The volume of the pneumatised portion of the ear was determined by computed tomography in 235 patients. Amongst the 470 ears examined, 320 had no disease in the ear, nose or throat. Normal pneumatisation of the ear can be quantified by CT and strict correlation has been demonstrated between the air content and age from ten to 17 years. Chronic inflammatory processes of the middle ear occurring during childhood interfere with pneumatisation on one or both sides. The most severe failure of pneumatisation occurs with congenital abnormalities of the ear, most cases never showing significant pneumatisation. Chronic infection of the tonsils or adenoids causes much less interference with pneumatisation.

The lacrimal fossa can be involved by a wide spectrum of orbital pathology. The correct diagnosis is important to avoid unnecessary procedure and to do appropriate management. 14 patients with mass lesions in the lacrimal fossa were evaluated with computed tomography (CT) and clinical findings. The results were as follows: 1. Final diagnosis of 14 cases with lacrimal fossa tumors was pleomorphic adenoma in 3 cases, adenoid cystic carcinoma in 1 case, pseudotumor in 5 cases, lymphoma in 2 cases, neurofibroma in 1 case, chloroma in 1 case and metastatic adenocarcinoma in 1 case. 2. The duration of symptoms of pleomorphic adenoma was more than 1 year and characteristic CT findings were globular masses with pressure erosion of the adjacent bone. Patient with adenoid cystic carcinoma had a short history of symptoms. CT showed a fusiform mass but intracranial extension with frank destruction of sphenoid bone. 3. Patients with pseudotumor and lymphoma had symptoms for less than 1 year. The CT findings were ill-defined infiltrative patterns with scleral thickening and the differential diagnosis of them was difficult. 4. The margins of neurofibroma and chloroma were well defined while that of the metastic adenocarcinoma was ill-defined. 5. The degree and the extent of the contrast enhancement gave no benefit in the differential diagnosis of each disease entities and even of the benign and malignant lesions.

Surgery after proper imaging (MRI or CT scan) is the main stay of treatment for salivary gland tumors. Although excision margins should be ?5 mm for malignant tumors in cases of parotid gland carcinoma, the facial nerve should be preserved whenever it is not infiltrated. Adjuvant external radiation is indicated for malignant tumors with high-risk features such as close (or invaded) margins, perineural speed, lymphatic and/or vascular invasion, lymph-node involvement and high-grade histology. A Phase II trial testing adjuvant concomitant cisplatin plus radiation therapy versus adjuvant radiation therapy alone after surgery is currently under investigation for high-risk salivary gland cancer. For inoperable cancers, photons combined with proton boost seem to be a valuable option. Even if protons or carbon ions are promising, access to the latter is limited for usual treatment. For recurrent and/or metastatic cancer, polychemotherapy (cisplatin based) gives a 25% response rate in adenoid cystic carcinoma and should be used when the disease is overtly in progression. Targeted therapies with anti-EGF receptor molecules, antiangiogenic agents and tyrosine kinase inhibitors are ongoing, but more trials are needed to establish their efficacy, as is the use of bortezomib followed by doxorubicin. The products of fusion oncogenes, which have a pathogenic role in some adenoid cystic carcinoma and mucoepidermoid carcinomas, are of interest as potential therapeutic targets. PMID:23098116

Purpose: To examine the efficacy of fast neutron radiotherapy in the treatment of locally advanced adenoid cystic carcinoma (ACC) of the trachea and to compare outcomes with and without high-dose-rate (HDR) endobronchial brachytherapy boost. Methods and Materials: Between 1989 and 2005, a total of 20 patients with ACC of the trachea were treated with fast neutron radiotherapy at University of Washington. Of these 20 patients, 19 were treated with curative intent. Neutron doses ranged from 10.7 to 19.95 Gy (median, 19.2 Gy). Six of these patients received an endobronchial brachytherapy boost using an HDR {sup 192}Ir source (3.5 Gy x 2 fractions). Median duration of follow-up was 46 months (range, 10-121 months). Results: The 5-year actuarial overall survival rate and median overall survival for the entire cohort were 89.4%, and 97 months, respectively. Overall survival was not statistically different among those patients receiving an endobronchial boost compared with those receiving neutron radiotherapy alone (100% vs. 68%, p = 0.36). The 5-year actuarial locoregional control rate for the entire cohort was 54.1%. The locoregional control rate was not statistically different among patients who received an endobronchial boost compared with those who received neutron radiotherapy alone (40% vs. 58%, p 0.94). There were no cases of Grade {>=}3 acute toxicity. There were 2 cases of Grade 3/4 chronic toxicity. Conclusions: Fast neutron radiotherapy is an effective treatment for locally advanced adenoid cystic carcinoma of the trachea, with acceptable treatment-related toxicity.

Biological Behavior and treatment results of 33 patients with Adenoid Cystic Carcinoma (ACC) in the Head and Neck at Yonsei Cancer Center for 10 years between 1971 and 1980 were retrospectively analyzed. Most common, primary site was minor salivary glands such as maxillary sinus, nasal cavity and base of tongue. The typical biological behavior of these tumors was very slowly in growth with long rime of duration (mean 19 months) from I month to 10 years and more frequent of nerve invasion but rare invasion of neck nodes. Local control and failure pattern in the results of treatment, 16 of 17 patients with irradiation alone were seen complete or partial response but 5 cases of loco regional recurrence, 2 cases of failure of neck node and 4 cases of distant metastasis as lung and brain. On the other hand, among 10 cases of surgery and postoperative irradiation, 2 cases of locoreginal failure and 3 cases of distant metastasis as lung and bone. 2 of 4 cases with surgery alone were recurred within primary site. Actuarial overall NED survival at 5 and 10 years were 52.6% and 42.8%, respectively. Survival rate of 10 patients with surgery and postoperative irradiation was more high than 17 patients of radiation alone. Therefore, we have known that surgery with postoperative adjunctive irradiation is most effective treatment modality of adenoid cystic carcinoma in the head and neck. Primary site, treatment modality and with or without nerve and bone invasion have influenced on prognosis.

Mucositis; Oral Complications of Chemotherapy; Oral Complications of Radiation Therapy; Recurrent Adenoid Cystic Carcinoma of the Oral Cavity; Recurrent Basal Cell Carcinoma of the Lip; Recurrent Lymphoepithelioma of the Nasopharynx; Recurrent Lymphoepithelioma of the Oropharynx; Recurrent Mucoepidermoid Carcinoma of the Oral Cavity; Recurrent Salivary Gland Cancer; Recurrent Squamous Cell Carcinoma of the Hypopharynx; Recurrent Squamous Cell Carcinoma of the Larynx; Recurrent Squamous Cell Carcinoma of the Lip and Oral Cavity; Recurrent Squamous Cell Carcinoma of the Nasopharynx; Recurrent Squamous Cell Carcinoma of the Oropharynx; Recurrent Verrucous Carcinoma of the Larynx; Recurrent Verrucous Carcinoma of the Oral Cavity; Stage I Adenoid Cystic Carcinoma of the Oral Cavity; Stage I Basal Cell Carcinoma of the Lip; Stage I Lymphoepithelioma of the Nasopharynx; Stage I Lymphoepithelioma of the Oropharynx; Stage I Mucoepidermoid Carcinoma of the Oral Cavity; Stage I Salivary Gland Cancer; Stage I Squamous Cell Carcinoma of the Hypopharynx; Stage I Squamous Cell Carcinoma of the Larynx; Stage I Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage I Squamous Cell Carcinoma of the Nasopharynx; Stage I Squamous Cell Carcinoma of the Oropharynx; Stage I Verrucous Carcinoma of the Larynx; Stage I Verrucous Carcinoma of the Oral Cavity; Stage II Adenoid Cystic Carcinoma of the Oral Cavity; Stage II Basal Cell Carcinoma of the Lip; Stage II Lymphoepithelioma of the Nasopharynx; Stage II Lymphoepithelioma of the Oropharynx; Stage II Mucoepidermoid Carcinoma of the Oral Cavity; Stage II Salivary Gland Cancer; Stage II Squamous Cell Carcinoma of the Hypopharynx; Stage II Squamous Cell Carcinoma of the Larynx; Stage II Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage II Squamous Cell Carcinoma of the Nasopharynx; Stage II Squamous Cell Carcinoma of the Oropharynx; Stage II Verrucous Carcinoma of the Larynx; Stage II Verrucous Carcinoma of the Oral Cavity; Stage III Adenoid Cystic Carcinoma of the Oral Cavity; Stage III Basal Cell Carcinoma of the Lip; Stage III Lymphoepithelioma of the Nasopharynx; Stage III Lymphoepithelioma of the Oropharynx; Stage III Mucoepidermoid Carcinoma of the Oral Cavity; Stage III Salivary Gland Cancer; Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage III Squamous Cell Carcinoma of the Nasopharynx; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage III Verrucous Carcinoma of the Larynx; Stage III Verrucous Carcinoma of the Oral Cavity; Stage IV Adenoid Cystic Carcinoma of the Oral Cavity; Stage IV Basal Cell Carcinoma of the Lip; Stage IV Lymphoepithelioma of the Nasopharynx; Stage IV Lymphoepithelioma of the Oropharynx; Stage IV Mucoepidermoid Carcinoma of the Oral Cavity; Stage IV Salivary Gland Cancer; Stage IV Squamous Cell Carcinoma of the Hypopharynx; Stage IV Squamous Cell Carcinoma of the Larynx; Stage IV Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage IV Squamous Cell Carcinoma of the Nasopharynx; Stage IV Squamous Cell Carcinoma of the Oropharynx; Stage IV Verrucous Carcinoma of the Larynx; Stage IV Verrucous Carcinoma of the Oral Cavity

Abstract in portuguese OBJETIVO: Verificar a aceitação da videonasofaringoscopia por crianças, no ambiente escolar, para avaliação de vegetações adenoideanas e determinar a sua prevalência nessa população MÉTODO: Estudo transversal realizado em amostra proporcional (n = 368) de escolares da primeira série do ensino fundamental de Aracaju (SE), com idades entre 6 e 13 anos, submetidos a videonasofaringoscopia flexível. Todas se submeteram à mesma rotina de exame, feito na própria (more) escola, sem a necessidade de contenção ou qualquer tipo de sedação. RESULTADOS: As crianças que foram submetidas a avaliação nasofibroscópica aceitaram bem o procedimento, permitindo a adequada avaliação das cavidades do nariz e nasofaringe. A prevalência de hipertrofia adenoideana grau I foi de 50,6%, a de grau II foi de 35,1% e a de grau III foi de 14,3%. As hipertrofias adenoideanas graus II e III apresentam maior número de sintomas obstrutivos. CONCLUSÃO: A videonasofaringoscopia flexível pode ser realizada, com excelente aceitação, fora do ambiente hospitalar ou consultório, como mostra este estudo realizado em ambiente escolar, indicando que sua utilização pode ser mais ampla, tornando-a mais acessível a um maior número de pessoas. A prevalência dos três graus de hipertrofia adenoideana encontrada em Aracaju difere de alguns estudos por ter sido realizada em crianças não triadas para sintomas respiratórios. Abstract in english OBJECTIVE: To verify children's acceptance of nasal fiber optic examination in a school setting and to evaluate hypertrophy of adenoid vegetation and to determine its prevalence in this population. METHODS: A survey was performed of a representative (n = 368) sample of school age children at elementary school (aged 6 to 13 years old) who had been subjected to fiber optic examination, in Aracaju (SE), Brazil. All students were subjected to the same study protocol, carried (more) out at school and with no need for sedation or restraint. RESULTS: All of the children tolerated the nasal fiber optic examination well, making possible a good evaluation of pharynx and nasal cavities. The prevalence of adenoid hypertrophy grade I was 50.6%, of grade II 35.1% and of grade III 14.3%. Grades II and III hypertrophy were related to an increase in obstructive symptoms. CONCLUSION: As this study performed in a school setting demonstrates, nasal fiber optic examination can be performed with excellent tolerance in settings other than hospitals and outpatient clinics, indicating that its usage could be increased and made available for an extended range of populations. The prevalence of adenoid hypertrophy in Aracaju is not comparable with prevalence rates observed in earlier studies because it this was a study of children without respiratory symptoms.

AbstractObjectives/Hypothesis: To review our favorable experience with a minimally invasive transfrontal sinus approach to tumors of the subfrontal region. Study Design: Retrospective review in a tertiary care referral practice. Methods: Patients undergoing anterior skull base surgery by the senior author (Y.D.) were reviewed and transfrontal sinus approach patients selected for review. All cases of transfrontal sinus approaches to the base of the anterior cranial fossa from 2007 to 2011 were reviewed in a retrospective fashion. Results: A total of 14 cases were noted. Male to female ratio was 10 to 4 with an average age of 58.2 years. The pathologies included: meningioma (n = 6), esthesioneuroblastoma (n = 3), squamous cell carcinoma (n = 3), adenocarcinoma (n = 1), and adenoid cystic car...

Retraction of the lower eyelid can be consequence of medical and surgical conditions. Various kinds of allotransplants and biomaterial have been used to correct it; we report on the surgical correction of lower lid retraction with a decellularized porcine derived membrane (Tarsys). A 49-year-old patient with a history of adenoid cystic carcinoma in the pterygo-palatine fossa, requiring extensive surgery and repeated radiotherapy, presented with 6 mm lagophthalmus and exposure keratopathy secondary to facial nerve palsy. The lower lid malposition was corrected with a Tarsys implant. Three months after surgery no lagophthalmos was present and substantial relief of signs and symptoms of ocular surface disease and good symmetry between right and left eye was achieved. If general condition or m...

Objectives: To review the published literature on the diagnosis and management of adenoid cystic carcinoma (ACC) of the breast. Materials and Methods: Papers were identified by searching PubMed using the terms > and >. Additional papers were identified by reviewing references of relevant articles. Results: ACC of the breast is a rare tumour comprising less than 0.1% of breast malignancies. Its cellular origin in the breast remains unclear. The histological characteristics of ACC in the breast are similar to those of ACC of the salivary glands. However the prognosis of ACC of the breast is better than that of other localizations with prolonged survival. Breast-conserving treatment including postoperative radiotherapy seems to be equivalent to mastecto...

Adenoid cystic carcinoma (ACC) is the most common malignant tumor of the minor salivary glands. The sinonasal tract is a common site of ACC occurrence, second only to the oral cavity. Of all cases of sinonasal ACC, a minority (22 to 35%) arise in the nasal cavity. Three histologic patterns of ACC have been described: cribriform, tubular, and solid. Compared with the cribriform and tubular forms, predominantly solid-type ACCs have been associated with higher rates of perineural invasion, higher S-phase fractions, and a higher incidence of aneuploidy. The histologic differentiation of solid-pattern ACC from other sinonasal malignancies typically requires the identification of one or both of the other ACC patterns in the same specimen. We present the case of a 39-year-old man with solid-pattern ACC arising in the nasal cavity. The tumor was resected endoscopically. We also discuss the relevant literature regarding the histologic diagnosis, prognosis, and treatment options for solid-pattern ACC. PMID:22711397

Adenoid cystic carcinoma (ACC) of the uterine cervix is a rare primary neoplasm of the uterus that occurs in post-menopausal women; its radiological findings have not been described previously. We present the MR findings of a case of ACC. The mass exhibited homogeneous low-signal intensity on T1-weighted images. On T2-weighted images, the mass showed high-signal intensity with a lobulated contour and multiple septum-like internal architectures. It also contained spots of very high-signal intensity, which would represent the mucin in the glandular lumen. The multiple septum-like internal architectures probably represented interglandular fibrous stroma. These MRI findings may be helpful for future diagnoses of ACC of the uterine cervix. (orig.)

The usefulness of {sup 67}Ga-citrate and {sup 99m}Tc-MDP scintigraphy were investigated using 81 patients with head and neck malignant tumor. The detection rate for primary and metastatic lesions was defined as the true-positive rate (TPr). In salivary gland tumor, TPr of {sup 67}Ga citrate scintigraphy were higher than squamous cell carcinoma. In squamous cell carcinoma, TPr of {sup 67}Ga citrate scintigraphy correlated with the tumor size of primary lesions. In squamous cell carcinoma, TPr of the tongue and floor of the mouth were lower than any other site. In the metastatic lesions of adenoid cystic carcinoma, significant difference of TPr of {sup 67}Ga citrate scintigraphy appeared among the cases. {sup 99m}Tc-MDP scintigraphy provided very useful information for evaluating the presence of tumor invasion to bone in the primary region and bone metastatic region. (author)

The recrods of 71 patients with adenoid cystic carcinoma of the salivary glands were reviewed to determine the dose response relationships for this aggressive tumor. Local control after treament was determined for all patients and analyzed with respect to extent of surgery and dose of radiation. Of 70 patients who were available for evaluation of local control, 28 (40%) had a local recurrence and 42 (60%) did not. The highest control rates were found in patients who underwent both radiation therapy and surgery. Patients who received a dose equal to or greater than 6,000 rad (60 Gy) in addition to surgery had significantly higher local control rates than those who received less than 6,000 rad (60 Gy). Distant metastases developed in 50% of patients regardless of local control, with the following distribution: 39% lung, 19% bone, and 10% disseminated soft-tissue metastases.

AbstractBACKGROUND: The scientific literature to date lacks population-based studies on the demographics, clinical features, and survival of patients with adenoid cystic carcinoma (ACC) of different anatomic sites. METHODS: The authors identified 5349 patients who had ACC of the major salivary glands (N = 1850), minor salivary glands (N = 2077), breast (N = 696), skin (N = 291), lung and bronchus (N = 203), female genital system (N = 132), and eye and orbit (N = 100) from the Surveillance, Epidemiology, and End Results (SEER) registry. Differences in demographics, clinical features, and survival of patients were assessed. RESULTS: ACC of the eye and orbit was associated with younger age at presentation (mean age,49.9 years). ACC of the skin or breast tended to present with less aggressive ...

A case of a 37-year-old woman with radiation optic neuropathy was reported. She had undergone subtotal removal of the right orbital tumor (adenoid cystic carcinoma) by frontal craniotomy, followed by radiation therapy (64 Gy). She had been quite well until she noticed a gradual loss of vision in her right eye 18 months later. Her visual acuity was 0.2 in the right eye and 1.5 in the left eye with right relative afferent pupillary defect and dense central scotoma. Funduscopy revealed optic disc swelling with surrounding retinal edema and small hemorrhage in the right eye. Fluorescein angiography revealed a hypoperfusion area and obstruction of the small retinal vessels in the posterior pole, but this was not large enough to explain the dense central scotoma. Although prednisolone therapy gave temporary improvement, the visual function gradually deteriorated. (author).

158 patients with advanced malignancies of the head and neck area were treated by a combined hyperthermia/radiotherapy since 1972. 16 were adenoid cystic carcinoma (ACC). Their treatment results are compared with 28 ACC after radiotherapy alone. All 16 patients with hyperthermia achieved a complete remission. CR in 28 ACC-patients with hyperthermia-treated squamous cell carcinomas had a comparatively low CR-rate of 49%. Five-year-survival on the other hand was 50% for ACC after hyperthermia, 57% after a planned postoperative radiation without hyperthermia and 37,5% after a radiotherapy alone in cases of inoperability. The combination of hyperthermia and radiotherapy is indicated in cases of advanced inoperable ACC and leads to a high percentage of local tumour control.

Circumferential airway resection with primary anastomosis has been widely adopted as a treatment for adenoid cystic carcinoma (ACC) of the trachea. However, carinal resection is a complicated procedure with high mortality and morbidity rates. We describe a technique of non-circumferential tracheal resection performed to treat ACC arising from the lower membranous trachea adjacent to the carina. The tumor was resected while preserving the tracheo-carinal cartilage. A silicone Y-stent was placed at the bifurcation to ensure airway patency before closing the defect. The airway defect, measuring 4 × 2.5 cm, was closed using an autologous pericardial patch and pedicled latissimus dorsi muscle flap. These procedures were technically easy, and no postoperative airway complication occurred. PMID:22614530

Objective Adenoid cystic carcinoma of the salivary glands has a propensity for perineural invasion, which could favor spread along the major cranial nerves, sometimes to the skull base and through the foramina to the brain parenchyma. This study evaluated the relationship between neural spread and relapse in the skull base. Study Design During surgery, we performed multiple biopsies with extemporaneous examination of the major nerves close to the tumor to guide the surgical resection. Results The percentage of actuarial local control at 5 years for patients with a positive named nerve and skull base infiltration was 12.5%, compared with 90.0% in patients who were named nerve–negative and without infiltration of the skull base (P = .001). Conclusions Our study shows that local contro...

Six different brain tumors in middle cranial fossa are presented which are studied by CT and proved pathologically. The authors experienced rare tumors in middle cranial fossa such as cavernous hemangioma, cystic meningioma, Schwannoma, Masson's vegetant intravascular hemangioendothelioma and other tumors (arteriovenous malformation and metastatic adenoid cystic carcinoma) whose CT findings were atypical. The results are as follows; 1. In case of tumors in middle cranial fossa, basal and coronal sections are necessary for further evaluation of the relations with dura and adjancent bone change. 2. In suspicion of metastasis, bone setting should be done to find out bone involvement. 3. Internal carotid angiography gave little help in the differential diagnosis of tumors in middle cranial fossa.

Adenoid cystic carcinoma (ACC) has a 5-year survival rate of 90%. The 15-year survival rate drops to 10% due to recurrence and invasion. ACC has three subtypes: cribriform, tubular, and solid. The cribriform subtype has the best prognosis and the solid subtype has the worst prognosis. By immunohistochemistry of tissue sections, we showed that the solid form expresses ?v?6 integrin and tenascin-C, which are known promoters of epithelial-to-mesenchymal transition (EMT). We also defined two ACC cell lines with the characteristics of the cribriform and solid subtype. The SACC83 cells grow in basaloid-like clusters and express high levels of E-cadherin. In contrast, the ACCh cells are more myoepithelial-like and express high levels of vimentin and of ?v?6 integrin. The ACCh cells are highly invasive and this behavior is dependent upon the ?v?6 integrin function. Our results suggest that the transition from the cribriform to solid form may occur through EMT. PMID:22993306

Triple-negative breast cancers (TNBC) are a heterogeneous group of breast cancers defined by their lack of expression of oestrogen and progesterone receptors as well as human epidermal growth factor receptor 2 amplification, and therefore, are resistant to hormonal and Trastuzumab therapy. TNBC accounts for 15% of all breast cancers, and are more common in African-American women than in Whites. Also, BRCA-1 associated tumours are usually TNBC. Since the majority of TNBC fall into the basal-like breast cancer category by molecular studies, they are generally regarded as tumours of poor prognosis. However, some TNBC, such as adenoid cystic carcinoma and medullary carcinomas have excellent prognosis. Others, like metaplastic carcinoma have a prognosis that is comparable to infiltrating ductal...

Purpose: To investigate the prognostic role of radical lymph node dissection in treatment for pulmonary Low Grade Malignant Tumors (LGMTs); specifically, on the extent of nodal removal and its impact on long-term survival. Methods: A total of 93 LGMTs cases underwent surgical resection and were histopathologically confirmed. Overall survival rates and disease-free survival were respectively calculated according to the extent of lymph node resection and histopathological grades of tumors. Risk factors of nodal involvement and survival predictors were calculated via multivariate analysis. Life table, Kaplan-Meier, and Cox regression models were used for the statistical analysis. Results: Thirty-eight cases of carcinoid, 17 adenoid cystic carcinomas, and 38 mucoepidermoid carcinomas were incl...

Adenoid cystic carcinoma (ACC) of the head and neck region is an uncommon epithelial tumor of the major and minor salivary glands. In the oral region, although ACC arising from the minor salivary glands is the second most commonly found tumor in the tongue base, its occurrence in the anterior part of the tongue is rare. Histopathologically, ACC is categorized into three growth patterns (tubular, cribriform, and solid types) and three histologic grades (I?III) that are based on the proportions of these patterns. According to this classification, tubular- and cribriform-type ACCs are considered to be lower grade lesions, while solid-type ACCs are considered to be higher grade lesions. A fourth histopathological type has recently been reported by some authors, namely, dedifferentiation or hig...

AbstractBACKGROUND: Adenoid cystic carcinoma (ACC) is characterized by slow growth, frequent local recurrences, and distant metastasis (DM). However, these findings frequently are reported in patients with advanced-stage tumors, but the outcomes of early-stage tumors are poorly defined. We sought to evaluate the risk factors for the development of DM in early-stage ACC. METHODS: We retrospectively reviewed the charts of 60 patients who were diagnosed with clinical early-stage (T1-2/N0) ACC to determine the risk factors for development of DM and survival of these patients. RESULTS: DM was detected in 12 (20%) of the patients, with a median latency of 31.5 months after diagnosis. Univariate analysis revealed that DM was associated with age -45 years, pathologically positive lymph nodes, extr...

A 48-year-old man presented with an enlarging mass of the right upper eyelid over a 1-month period. Nine years prior, the patient was diagnosed with adenoid cystic carcinoma (ACC) of the right maxillary sinus and underwent a total maxillectomy followed by local radiotherapy. Over the previous year, the patient had been treated with chemotherapy and radiotherapy for multiple organ metastases, including the spine, chest, and oral cavity. Ophthalmic examination revealed a white, round mass on the tarsal conjunctiva of the right upper eyelid, measuring approximately 1 × 1 cm, and 2 palpable subcutaneous masses near the inferior orbital rim. Excisional biopsies of the masses were performed, and the histopathological findings were consistent with ACC with solid and cribriform patterns. Herein, the authors describe a case of metastatic ACC of the eyelid, which has not been described in the literature to their knowledge. PMID:22366665

Adenoid cystic carcinoma (ACC), commonly from salivary glands, is known for its insidious local growth and usually protracted clinical course. ACC developing from non-salivary glands (i.e., non-salivary ACC) is heterogeneous, and its clinicopathological features remain poorly defined. Patients treated for ACC in a single institution between 1995 and 2007 were included in this study. Immunohistochemical evaluation of Ki-67, E-cadherin, p16, and cyclinD1 was performed. The prognostic significance of clinical and immunophenotypic markers was evaluated. 83 cases of salivary ACC and 24 cases of non-salivary ACC were included. The expression levels of Ki-67 (54.8%), E-cadherin (90.4%), p16 (32.9%), and cyclinD1 (19.2%) between ACCs present at various sites were not different. Sinonasal, lacrimal...

The most frequent malignant salivary gland tumours are the mucoepidermoid tumour, adenoid cystic carcinoma and adenocarcinoma. The major salivary glands and the minor glands of the mouth and upper respiratory tract may potentially develop any of these malignant lesions. Malignant lesions most frequently present as a palpable mass and tend to enlarge more rapidly than benign neoplasms. Pain, paresthesia, muscle paralysis and fixation to surrounding tissue are all ominous signs and symptoms. The only reliable means of differential diagnosis of these lesions is biopsy and histologic analysis. Therapy involves surgery or a combination of surgery and radiation therapy. The ultimate prognosis is governed by the intrinsic biologic behaviour of the neoplasms, the extent of disease and adequate clinical therapy.

Purpose: The purpose of the study was to evaluate the treatment results of adenoid cystic carcinoma (ACC) of the airway at a single institution during a 30-year period. Materials and methods: All cases of ACC of the airway over a 30-year period at one tertiary care institution were reviewed retrospectively. The demographics, treatment modalities, pathologic characteristics, and outcomes were evaluated. Results: Eleven patients were treated for ACC of the airway with an age range of 25 to 72 years (median, 48 years). Six patients presented with ACC in the larynx, and 5 patients had ACC of the trachea. All patients underwent surgical excision and radiation; 9 of 11 patients had postoperative external beam radiation, 1 patient had preoperative external beam radiation, and the remaining patien...

Seventy patients with salivary gland carcinoma (63% major gland and 37% minor gland) are reviewed. Histologies included adenoid cystic (54%), mucoepidermoid (16%), and adenocarcinoma (14%). Patients were analyzed according to extent of surgery and whether or not adjuvant postoperative radiotherapy was given. There is no difference in survival in patients who had complete excision of gross tumor with or without adjuvant radiotherapy. Patients who did not undergo radiotherapy had a 62% actuarial risk of locoregional failure at 5 years, with a 20% risk in the adjuvantly irradiated group (P less than 0.001). A failure analysis demonstrates that among the 44% of patients with recurrence 71% (22/31) failed locoregionally and 69% (21/31) had distant metastases. Twenty-seven percent (19/70) died of disease, with 31% (6/19) dying of locoregional disease and 26% (5/19) of distant disease. Implications for management are discussed.

Primary sinonasal tract carcinoma ex-pleomorphic adenoma (CEPA) is very uncommon, with adenoid cystic carcinoma (ACC) CEPA exceptional. These tumors are often misclassified. This is a retrospective study. Nine cases of ACC CEPA included 7 females and 2 males, aged 39???64 years (mean, 51.1 years). Patients presented most frequently with obstructive symptoms (n = 5), epistaxis (n = 3), nerve changes or pain (n = 3), present for a mean of 25 months (men: 9.5 versus women: 29.4 months; p = 0.264). The tumors involved the nasal cavity alone (n = 5), nasopharynx (n = 2), or a combination of locations (n = 2) with a mean size of 2.9 cm (females: 3.3; males: 1.7; p = 0.064). Most patients presented at a low clinical stage (n = 7, stage I), with one patient each in stage II ...

Tian Z, Hu Y, Wang L, Li L, Zhang C & Li J -(2012) Histopathology61, 921-929 An unusual cribriform variant of salivary basal cell tumours: a clinicopathological study of 22 cases Aims:- To clarify the clinicopathological characteristics of salivary basal cell tumours exhibiting cribriform architecture, and to discuss the differential diagnosis of these tumours with regard to adenoid cystic carcinoma (AdCC). Methods and results:- Eighteen basal cell adenomas (BCAs) and four basal cell adenocarcinomas (BcACs) with at least a 10% area of cribriform morphology were collected, and the histological and immunohistochemical features were evaluated. The majority of tumours showed the typical histological patterns of basal cell tumours, in addition to cribriform architecture. In some areas, the peri...

This is a retrospective review of all patients who underwent endoscopic endonasal surgical resection of tumors involving the orbital apex within a single year at the Hospital of the University of Pennsylvania. Endoscopic approaches to tumors involving the orbit only but that did not include the orbital apex were not included in this series. Five patients were identified. Two patients had fibrous dysplasia; one patient had a schwannoma; one patient had a multiply recurrent adenoid cystic carcinoma; and one patient had an intraconal cavernous hemangioma. Tumors that did not invade the periorbita could be resected and/or decompressed with minimal morbidity through the endoscopic approach alone. Tumors that involved the periorbita and tumors that were located intraconal required additional ope...

AbstractObjectives/Hypothesis: The most common cause of pediatric obstructive sleep apnea (OSA) is adenotonsillar hypertrophy (ATH). In cleft palate patients, however, the obstructive effects of ATH are more severe due to narrow airways. The aim of this study was to assess the effectiveness of tonsillectomy and/or partial adenoidectomy on OSA in cleft palate patients. Study design: Case series. Methods: Tonsillectomy and/or partial adenoidectomy was performed in 17 repaired cleft palate patients with tonsillar and/or adenoid hypertrophy and OSA. Apnea/hypopnea (A/H) index and minimum O2 saturation were measured before and after surgery. In addition, because these patients are vulnerable to speech impairment after pharyngeal surgery, auditory perceptual assessment (APA) and nasometric asses...

The present study examined the possible use of autologous human plasma (AHP) to improve the in vitro culture for cytogenetics of benign and malignant oral tumor cells. The effect of AHP on the growth of a variety of benign and malignant head and neck tumor cells was studied by inverted microscope and cytogenetic analysis. Minced tumor biopsies of cases of hemangioma (HM), lipoma (LP), central giant cell granuloma (GC), pleomorphic adenoma (PA), schwannoma (SW), oral squamous cell carcinoma (SCC), Ewing sarcoma (ES), Merkel cell carcinoma (MCC) and adenoid cystic carcinoma (ACC), were cultured in medium supplemented with either AHP, allogeneic pooled human plasma (PHP), or fetal calf serum (FCS). More fibroblasts were seen in the FCS supplemented cultures, while in HP or PHP culture medium,...

A retrospective study was performed on 47 patients with primary malignant neoplasms of the parotid gland treated in our department between 1982 and 1999. Most of the patients were male and over age 40, and 23 patients were of stage IV in clinical classification. The most frequently observed histological type was adenocarcinoma (12 patients), and the next was adenoid cystic carcinoma (11 patients). A radical parotidectomy with postoperative radiation therapy was administered in 38 patients, and palliative treatment in 9. The global survival rate was 74.1% at 5 years, and 89.4% in the patients treated with the radical procedure. Radical operative treatment and subsequent over 50-Gy of irradiation supposed to be the important factor to improve the prognosis. (author)

Twenty-one patients with the diagnosis of mucopolysaccharidosis or mucolipidosis and a history of respiratory complaints or thorough respiratory evaluation were studied retrospectively. Anatomic factors affecting respiratory status included: (i) upper airway narrowing by hypertrophied tongue, tonsils, adenoids, and mucous membranes; (ii) lower airway narrowing by glycosaminoglycan deposition within the tracheobronchial mucosa; (iii) decreased thoracic dimensions due to scoliosis and thoracic hyperkyphosis; and (iv) decreased abdominal dimensions due to lumbar hyperlordosis, gibbus formation and hepatosplenomegaly. Cardiac and neurologic involvement, while present, did not play primary roles in the development of respiratory disease. The functional consequences of these findings included increased risk of developing: (i) respiratory tract infections; (ii) airway compromise during or after anesthesia or sedation; (iii) dyspnea on exertion; (iv) obstructive lung disease; (v) obstructive sleep apnea; and (vi) cor pulmonale. A management approach is presented which can reduce the morbidity and mortality experienced by these patients. PMID:3134589

Abstract Objective: The purpose of this study was to evaluate the role of photodynamic therapy (PDT) in primary tracheal carcinomas. Methods: Data were obtained from patients treated with Photofrin® PDT for primary tracheal carcinoma at the Ohio State University. Demographic data as well as survival and response were collected. Results: Ten patients 47?79 years of age with primary tracheal carcinoma (three adenoid cystic, seven squamous histology) were treated with PDT. Treatment was part of curative-intent therapy in three patients, one of whom underwent surgery. The other seven patients received palliative PDT. Five patients received sequential radiation and two received concurrent chemotherapy. All 10 patients had improvement in obstructive symptoms within 1 month. Eight patients had ob...

J Oral Pathol Med (2010) Background:? In several cancer types, osteopontin (OPN) expression has been correlated with tumor progression and prognosis. Two earlier studies have examined OPN expression in salivary gland carcinomas with contradictory results. Methods:? One hundred and seventy-five patients with a primary salivary gland carcinoma diagnosed from January 1, 1990 to December 31, 2005 were identified in the local pathology register, Odense University Hospital. Criteria as documented by Allred et al. were used to assess OPN immunostaining that was performed on surgical specimens. Results:? Osteopontin was expressed in all salivary gland carcinomas. Adenoid cystic carcinomas had the highest mean sum score (7.3) and a significantly higher proportion of carcinomas with high OPN sum score than both mucoepidermoid carcinoma and acinic cell carcinoma. Correlation of OPN expression with known prognostic factors in salivary gland carcinomas was insignificant. Conclusions:? Salivary gland carcinomas express OPN. The expression does not correlate with known prognostic factors.

Abstract We report on a father and his 4-year-old son sharing a characteristic dysmorphic facial phenotype (including hyperteleroism, prominent forehead, and wide nasal bridge), macrocephaly, hearing loss, palatal clefting, developmental delay, hypotonia and bony abnormalities including marked cranial sclerosis and sclerosis of the ribs and long bones, which evolved in severity in the son between the ages of 2 and 4 years. The father's radiographs also showed prominent coarse striations, patchy metaphyseal sclerotic plaques, markedly increased bone density and cortical thickening of long bones, and significant degenerative changes in the thoracic spine. The son has an additional history of sleep apnea resulting from multi-level airway obstruction that includes adenoid hypertrophy, lingual ...

Abstract Adenoid cystic carcinoma (ACC) of the head and neck is a malignant tumor with poor long-term prognosis. Besides the recently identified MYB-NFIB fusion oncogene generated by a t(6;9) translocation, little is known about other genetic alterations in ACC. Using high-resolution, array-based comparative genomic hybridization, and massively paired-end sequencing, we explored genomic alterations in 40 frozen ACCs. Eighty-six percent of the tumors expressed MYB-NFIB fusion transcripts and 97% overexpressed MYB mRNA, indicating that MYB activation is a hallmark of ACC. Thirty-five recurrent copy number alterations (CNAs) were detected, including losses involving 12q, 6q, 9p, 11q, 14q, 1p, and 5q and gains involving 1q, 9p, and 22q. Grade III tumors had on average a significantly higher nu...

Purpose: To analyze the recent experience of patients with adenoid cystic carcinoma treated with radiation therapy at Memorial Sloan-Kettering Cancer Center. Methods and Materials: From 1990 to 2004, a total of 59 patients with a diagnosis of primary adenoid cystic carcinoma of the head and neck received radiation therapy at our institution. The subsite distribution was oral cavity, 28% (n = 17); paranasal sinuses, 22% (n = 13); parotid, 14% (n = 8); submandibular, 14% (n = 8); oropharynx, 10% (n = 6); sublingual, 3% (n = 2); nasopharynx, 3% (n = 2); and other, 5% (n = 3). T Stage distribution was T1, 34% (n = 20); T2, 19% (n = 11); T3, 14% (n = 8); and T4, 34% (n = 20). Twenty-nine percent of patients (n = 17) were treated with intensity-modulated radiation therapy; 25% (n =15), with three-dimensional conformal therapy, and the remainder, with conventional techniques. Ninety percent (n = 53) of patients received treatment including the base of skull. Results: Median follow-up for surviving patients was 5.9 years. Five-year and 10-year rates of local control and distant metastases-free survival were 91%/81% and 81%/49%, respectively. Five-year and 10-year rates of disease-free and overall survival were 76%/40% and 87%/65%, respectively. On univariate analysis, stage T4 (p = 0.004) and gross/clinical nerve involvement (p = 0.002) were associated with decreased progression free survival, whereas stage T4 and lymph node involvement were associated with decreased overall survival (p = 0.046 and p < 0.001, respectively). Conclusions: Radiation therapy in combination with surgery produces excellent rates of local control, although distant metastases account for a high proportion of failures. Routine treatment to the base of skull reduces the significance of histologic perineural invasion, but major nerve involvement remains an adverse prognostic factor.

The authors retrospectively assessed the usefulness of postoperative radiation therapy after local resection of adenoid cystic carcinoma, with emphasis on organ-conserving treatment and the cosmetic results. Between 1985 and 1995, 32 patients underwent local resection followed by postoperative radiation therapy with curative and organ-conserving intent. None of patients received any form of chemotherapy as part of their initial treatment. Radiation therapy was carried out by techniques that were appropriate for the site and extension of each tumor. The 5-year local control, disease-free, and overall survival rates of all patients were 76%, 68%, and 86%, respectively. The 5-year local control rate and disease-free survival rate of patients with microscopically positive margins were 89% and 75%, respectively, and higher than in patients with macroscopically residual disease, but no significant difference in 5-year overall survival rate was observed. The postoperative cosmetic results in 29 patients with head and neck lesions were evaluated. No difference was documented between the cosmetic results postoperatively setting and after postoperative radiotherapy, and no significant differences in cosmetic results were observed according to radiation dose. The combination of local resection with organ-conserving intent and postoperative radiation therapy provided good cosmetic results in patients with T1 or T2 lesions. Postoperative radiation therapy with smaller fractions is useful, because good local control can be achieved in patients with adenoid cystic carcinoma having microscopically positive margins without inducing any late adverse reactions. However, the number of patients was too small and the follow-up period was too short to draw any definite conclusion in regard to fraction size. A much longer follow-up study with a larger number patients will be required to accurately determine the optimal treatment intensity and duration of treatment. (K.H.)

Abstract in spanish OBJETIVO: El carcinoma adenoideo quístico de la mama es inusual se presenta con una frecuencia menor al 1 %. La presentación de este caso está relacionada con la rareza del mismo, incidencia de 0,1 %. MÉTODOS: Paciente femenina 56 años de edad, menarquía: 15 años. IIIG, IP, IC, IA. Menopausia: 2002. No recibe terapia hormonal. No antecedentes personales y/o familiares de patología mamaria. Consulta a nuestra unidad por control, examen físico:normal. Mamografía:m (more) amascon moderadacantidad de tejido fibroglandular, evidencia opacidad nodular en unión de cuadrantes inferiores mama derecha. Eco mamario: imagen aspecto sólido bordes regulares, ubicada en cuadrantes inferiores de mama derecha de 6,1 mm x 7,1 mm x 7,0 mm, se corresponde con opacidad nodular mamográfica. DISCUSIÓN: Evaluación mastológica clase IV. Se recomienda evaluación histológica de la lesión a través de técnica de biopsia ecoguiada. Anatomía patológica: carcinoma adenoideo quístico. Grado nuclear II, actividad mitótica atípica presente. Desmoplasia estromal severa. Estudio de inmunohistoquímica: CK7+ (célulassecretoras),CK7/CK14+(célulasadenoescamosas), colágeno tipo IV. Se realizamastectomía parcial oncológica derecha, previa localización y confirmación por imagen márgenes por corte congelado más ganglio centinela. Anatomía patológica: carcinoma adenoideo quístico de 0,7 cm. Grado nuclear I. Actividad mitótica atípica presente. Bordes de resección quirúrgica, margen adicional libres de lesión. Patología mamaria adicional: ectasia ductal y condición fibroquística. Ganglio linfático centinela uno sin evidencia de neoplasia. En marzo de 2009, paciente acude a control, donde se realiza evaluación mastológica concluyéndose clase IIRF. Abstract in english OBJECTIVE: Adenoid cystic breast carcinoma is rare variant occurring less than 1 %. The presentation of this case is related to the rarity of it, because the incidence of this tumor in the breast is 0.1 %. METHOD: Female patient, 56 years old, menarche: 15 years. III pregnancy: IB, IP, IA. Menopause: 2002. Not receiving substitutive hormone therapy. No personal and family history of breast pathology. She came in August, 2007 for breast evaluation, physicalexamination:Norm (more) al. Mammography:Breastwith moderate amount of fibroglandular tissue, nodular opacity in union of lower quadrants right breast. Breast ultrasound: Solid image, with regular edges, located at junction of lower quadrants right breast, measuring 6.1 mm x 7.1 mm x 7.0 mm, which corresponds with nodular mammographic opacity. DISCUSSION: Mast logical evaluation class IV. Histological evaluation of lesion, using the technique of microbiopsia ecoguide. Pathology report: Adenoid cystic carcinoma, nuclear grade II. This atypical mitotic activity, stromal desmoplasia severe. Immunohistochemistry: CK7 + (secretory cells), CK7/CK14 + (Adenosquamous cell), type IV collagen. Partial mastectomy was performed in oncology right after echolocate confirmation by imaging, margins cut more frozen sentinel node. With pathology report: Adenoid cystic carcinoma of 0.7 cm. nuclear grade I, atypical mitotic activity, edge of surgical resection and additional margin free of injury. Additional mammary pathology: Fibrocystic status, ductal ectasia. A sentinel lymph node without evidence of malignancy; March 2009, the patient comes to control,where assessment is completed mast logical class IIRF.

Abstract in portuguese OBJETIVO: Apresentar a experiência do tratamento de 4 pacientes com tumores primários de traquéia, não operados, submetidos à braquiterapia endobrônquica de alta taxa de dose. PACIENTES E MÉTODOS: Dois casos de carcinoma espinocelular, uma recidiva de carcinoma adenóide cístico e uma recidiva de plasmocitoma primário da traquéia. Todos receberam braquiterapia endobrônquica, exclusiva ou como reforço de dose da radioterapia externa. Foram administradas 3 ou 4 (more) frações de 7,5 Gy cada, calculados a 1 cm de profundidade. O seguimento foi considerado a partir do término da braquiterapia. RESULTADOS: Em todos os casos houve resposta completa. Dois pacientes com carcinoma espinocelular evoluíram a óbito em 6 e 33 meses após a braquiterapia, o primeiro, sem evidência de doença e o outro por recidiva local, respectivamente. As outras 2 pacientes encontravam-se vivas após 64 e 110 meses de seguimento, sem evidência de doença. Esses 2 casos apresentaram estenose traqueal em 22 e 69 meses após a braquiterapia, sendo necessária a colocação de prótese traqueal apenas na paciente com carcinoma adenóide cístico. CONCLUSÕES: A braquiterapia endobrônquica de alta taxa de dose pode ser utilizada tanto como reforço de dose da irradiação externa quanto em recidivas. O controle local obtido em 3 de 4 pacientes indica que casos individuais podem se beneficiar desse procedimento. Sobrevida a longo prazo pode ser observada, principalmente nos casos de histologia adenóide cística. Abstract in english PURPOSE: To present experience with high dose-rate endobronchial brachytherapy in the treatment of primary tracheal tumors. PATIENTS AND METHODS: Four patients with nonresected primary tracheal tumors are presented: 2 cases of squamous cell carcinoma of the trachea, 1 of recurrent adenoid cystic carcinoma, and 1 with recurrent plasmacytoma. All received brachytherapy, alone or as a boost for primary irradiation, in 3 or 4 fractions of 7.5 Gy, calculated at a depth of 1 cm (more) . Follow-up was considered to start from the end of brachytherapy. RESULTS: Local control was achieved in all cases at the time of first bronchoscopic evaluation. Two patients with squamous cell carcinoma died at 6th and 33rd months after brachytherapy, respectively. The first had no evidence of disease, and the latter had local recurrence. The other 2 patients were alive after 64 and 110 months of follow-up, respectively, both with no evidence of disease. Tracheal stenosis developed in these 2 cases, 22 and 69 months after brachytherapy. Tracheal stent placement was needed only for the patient with an adenoid cystic carcinoma. CONCLUSIONS: Endobronchial high dose-rate brachytherapy may be used for tracheal tumors, even as a boost for external beam irradiation, or in recurrences. Local control in 3 out of 4 patients indicates that individual cases may benefit from the treatment. Long-term survival may also be expected, mainly for tumors with adenoid cystic histology.

Abstract in portuguese Crianças com tonsilas e adenoides hipertróficas podem apresentar efeitos desfavoráveis na oclusão dentária, que tendem a agravar no período de crescimento, tornando imprescindível seu diagnóstico e tratamento precoce. OBJETIVO: Este estudo clínico prospectivo comparou medidas cefalométricas dos incisivos antes e após a adenotonsilectomia, em respiradores orais. MATERIAL E MÉTODO: A amostra foi de 38 pacientes de ambos os gêneros, entre 7 e 11 anos, dividida e (more) m: grupo oral, com 18 pacientes com hipertrofia obstrutiva da tonsila faríngea e/ou palatinas grau 3 ou 4; grupo controle, com 20 pacientes com respiração nasal. Medidas dentárias angulares e lineares foram comparadas entre os grupos, antes e após adenotonsilectomia, em um intervalo de 14 meses. A análise estatística utilizou os testes t-Student e Wilcoxon para amostras não pareadas, ao nível de significância de 5%. RESULTADOS: A inclinação axial e a posição sagital dos incisivos inferiores aumentaram significativamente no grupo com respiração oral; o posicionamento sagital dos incisivos superiores aumentou significativamente no grupo oral, que ainda obteve aumento significativo de sobremordida. CONCLUSÃO: A adenoamigdalectomia se mostrou bastante eficaz na melhora de algumas medidas dentárias, com benefícios aos pacientes em crescimento, prevenindo que más oclusões dentárias tenham difícil tratamento ou se tornem definitivas. Abstract in english Children with hypertrophic tonsils and adenoids may have adverse effects on dental occlusion, which tend to worsen during the growth period. Diagnosis and early treatment is essential. AIM: Prospective clinical study to compare the cephalometric measurements before and after adenotonsillectomy in mouth breathing patients. MATERIAL AND METHOD: We had 38 patients of both genders, aged between 7 and 11 years in our sample, broken down into: oral group, 18 patients with obstr (more) uctive hypertrophy of pharyngeal tonsil and/or palate grade 3 or 4; control group, 20 patients with normal breathing. Angular and linear dental measurements were compared between the groups in a 14 months interval. We used the "t" Student and Wilcoxon tests for unpaired samples, at 5% significance, for statistical purposes. RESULTS: The sagittal position and axial angle of the lower incisors increased significantly in the group with oral breathing, the sagittal position of the upper incisors increased significantly in the oral group, which still had a significant increase in overbite. CONCLUSION: Adenotonsillectomy was very effective in improving some dental measurements, with benefits to growing patients preventing malocclusions from becoming difficult to treat or permanent.

ABSTRACT: BACKGROUND: Allergic rhinitis is one of the commonest atopic diseases which contribute to significant morbidity world wide while its epidemiology in Tanzania remains sparse. There was paucity of information regarding allergic rhinitis in our setting; therefore it was important to conduct this study to describe our experience on allergic rhinitis, associated co-morbidities and treatment outcome in patients attending Bugando Medical Centre. METHODS: This was descriptive cross-sectional study involving all patients with a clinical diagnosis of allergic rhinitis at Bugando Medical Centre over a three-month period between June 2011 and August 2011. Data was collected using a pre-tested coded questionnaire and analyzed using SPSS statistical computer software version 17.0. RESULTS: A total of 190 patients were studied giving the prevalence of allergic rhinitis 14.7%. The median age of the patients was 8.5 years. The male to female ratio was 1:1. Adenoid hypertrophy, tonsillitis, hypertrophy of inferior turbinate, nasal polyps, otitis media and sinusitis were the most common co-morbidities affecting 92.6% of cases and were the major reason for attending hospital services. Sleep disturbance was common in children with adenoids hypertrophy (chi2 = 28.691, P = 0.000). Allergic conjunctivitis was found in 51.9%. The most common identified triggers were dust, strong perfume odors and cold weather (P < 0.05). Strong perfume odors affect female than males (chi2 = 4.583, P = 0.032). In this study family history of allergic rhinitis was not a significant risk factor (P =0.423). The majority of patients (68.8%) were treated surgically for allergic rhinitis co morbidities. Post operative complication and mortality rates were 2.9% and 1.6% respectively. The overall median duration of hospital stay of in-patients was 3 days (2 -- 28 days). Most patients (98.4%) had satisfactory results at discharge. CONCLUSION: The study shows that allergic rhinitis is common in our settings representing 14.7% of all otorhinolaryngology and commonly affecting children and adolescent. Sufferers seek medical services due to co-morbidities of which combination of surgical and medical treatment was needed. High index of suspicions in diagnosing allergic rhinitis and early treatment is recommended. PMID:23136895

High-risk human papillomavirus (HPV) is an established cause of head and neck carcinomas arising in the oropharynx. The presence of HPV has also been reported in some carcinomas arising in the sinonasal tract, but little is known about their overall incidence or their clinicopathologic profile. The surgical pathology archives of The Johns Hopkins Hospital were searched for all carcinomas arising in the sinonasal tract from 1995 to 2011, and tissue microarrays were constructed. p16 immunohistochemical analysis and DNA in situ hybridization for high-risk types of HPV were performed. Demographic and clinical outcome data were extracted from patient medical records. Of 161 sinonasal carcinomas, 34 (21%) were positive for high-risk HPV DNA, including type 16 (82%), type 31/33 (12%), and type 18 (6%). HPV-positive carcinomas consisted of 28 squamous cell carcinomas and variants (15 nonkeratinizing or partially keratinizing, 4 papillary, 5 adenosquamous, 4 basaloid), 1 small cell carcinoma, 1 sinonasal undifferentiated carcinoma, and 4 carcinomas that were difficult to classify but exhibited adenoid cystic carcinoma-like features. Immunohistochemistry for p16 was positive in 59/161 (37%) cases, and p16 expression strongly correlated with the presence of HPV DNA: 33 of 34 (97%) HPV-positive tumors exhibited high p16 expression, whereas only 26 of 127 (20%) HPV-negative tumors were p16 positive (P<0.0001). The HPV-related carcinomas occurred in 19 men and 15 women ranging in age from 33 to 87 years (mean, 54 y). A trend toward improved survival was observed in the HPV-positive group (hazard ratio=0.58, 95% confidence interval [0.26, 1.28]). The presence of high-risk HPV in 21% of sinonasal carcinomas confirms HPV as an important oncologic agent of carcinomas arising in the sinonasal tract. Although nonkeratinizing squamous cell carcinoma is the most common histologic type, there is a wide morphologic spectrum of HPV-related disease that includes a variant that resembles adenoid cystic carcinoma. The distinctiveness of these HPV-related carcinomas of the sinonasal tract with respect to risk factors, clinical behavior, and response to therapy remains to be clarified. PMID:23095507

To present a new classification based on the CT and MR imaging findings of buccal space lesions, and to propose guidelines for their radiologic differentiation. Sixty-two histopathologically confirmed or clinically diagnosed buccal space lesions were classified on the basis of their morphologic appearance and extension to adjacent space as either (1) a mass with a distinct margin, confined to the buccal space; (2) a mass with surrounding infiltration, confined to the buccal space; or (3) a multi-space occupying mass. Type 1 included pleomorphic adenoma, ex-pleomorphic adenoma, carcinoma, B-cell lymphoma, acinic cell carcinoma, rhabdomyosarcoma, glomus tumor and ameloblastoma, and differentiation between malignant and benign neoplasms was not possible. Type 2 included adenoid cystic carcinoma, abscess, complicated dermoid cyst, and Kimura disease. T-cell lymphoma, neurofibroma, vascular malformation, inflammation, and foreign body granuloma pertained to type 3, and each type-3 entity showed different imaging characteristics. This new classification based on CT and MR imaging characteristics may provide useful guide-lines for predicting the differential diagnosis of buccal space lesions.

To compare computed tomography (CT) images and bronchoscopic findings of local tumor recurrence at the bronchial stump site in post-operative non-small cell lung cancer (NSCLC) patients. A retrospective study was conducted to review the CT images of 9 lung cancer cases that recurred at the bronchial stump site on 576 resected primary non-small cell lung cancers over a 9-year period. The CT images of the bronchial stump site recurrence were classified as: bronchial wall thickening, nodular or endobronchial polypoid lesion, multiplicity, and enhancement patterns. We classified the bronchoscopic findings based on the revised classification by the Japan Lung Cancer Society. The histologic types of the 9 cases of lung cancer that recurred, included 7 squamous cell carcinomas, 1 adenocarcinoma, and 1 adenoid cystic carcinoma. The CT findings included bronchial wall thickening with nodules (n = 6) and endobronchial polypoid nodules (n = 3) with heterogeneous enhancement. The CT findings were further classified as nodular infiltrating type (n = 5), polypoid type (n = 3) and superficial infiltrating type (n = 1) on bronchoscopy. Both a bronchoscopy and CT can be used as a complementary or alternative tool in evaluating bronchial stump site recurrences.

ObjectiveThis study reviews the published outcomes related to sinonasal adenoid cystic carcinoma (SNACC). Clinical presentation, radiographic diagnosis, pathology, treatment, and management outcomes of this uncommon disease are reported.Data SourcesPubMed database.MethodsA systematic review of studies for SNACC from 1960 to 2012 was conducted. A PubMed search for articles related to SNACC, along with bibliographies of those articles, was performed. Articles were examined for both individual patient data (IPD) and aggregate patient data (APD) that reported survivability. Demographics, disease site and spread, treatment strategies, follow-up, outcome, and survival were described for IPD, and a meta-analysis for survival rates was performed for APD.ResultsA total of 55 journal articles were included. Individual patient data were reported in 39 journal articles, comprising a total of 88 cases of SNACC. Sixteen articles, totaling 366 patients that reported aggregate 5-year survivorship pertaining to SNACC, were also included. Average follow-up in the IPD was 51.2 months (range, 1-198 months), and 5-year survivorship was 63.5%. In the studies reviewed, surgery followed by postoperative radiotherapy was the most common therapy used and resulted in the highest percentage of survivors. Aggregate patient data meta-analysis revealed a 5-year survival rate of 62.5%.ConclusionThis study contains the largest pool of SNACC patients to date. The data suggest that SNACC has a poor overall prognosis. It also suggests that surgery with postoperative radiotherapy is the most commonly used and may possibly be the most effective therapy. PMID:23064210

BACKGROUND: Adenoid cystic carcinoma (ACC) is a malignant tumor commonly occurring in the major salivary glands. ACC of the nasal septum is exceeding rare. METHODS: The case of a 42-year-old woman with ACC of the nasal septum is presented. Her chief complaint was nasal obstruction and dysosmia for two month. CT and MRI demonstrated a massive mass occupying the nasal septum infiltrating the palate, vomeronasal, anterior skull base, and dura mater. Combined anterior cranial surgery, endoscopic intranasal surgery, and transpalatal surgery were selected due to the size and location of the tumor. A negative surgical margin was achieved without cosmetic deformity or functional disorder. RESULTS: She had postoperative radiotherapy with no recurrence or distant metastasis during the follow-up period. CONCLUSION: The tumor location and the perineural spread pattern should be considered to determine the treatment plan for septum ACC. Post operative radiation is now generally recommended. ACC has a high incidence of local recurrence and distant metastasis rate; therefore, long-term follow-up is necessary. PMID:22664355

Primary cancers of the external auditory canal (EAC) are rare and most are squamous cell carcinomas. We report the case of a 78-year-old man who visited our institution with a 5-month history of right-side intermittent otalgia and ear fullness. Otoscopic examination showed a bulging mass arising from the superior and posterior aspects of the right EAC, and incision biopsy confirmed the lesion as adenoid cystic carcinoma (ACC). Lateral temporal bone resection in conjunction with total parotidectomy and neck dissection was subsequently performed. Postoperative adjuvant radiotherapy was administered and no recurrence was noted at a 26-month follow-up. We review the medical literature on the topic and suggest that early diagnosis is still the best option for successful treatment of this neoplasm. ACC arising in the EAC must be removed using radical procedures to increase the chance of local control. Subsequent metastasis that tends to develop in the lungs and regional lymph nodes is best evaluated regularly using computed tomography examination. PMID:22721626

Intracranial involvement by adenoid cystic carcinoma (ACC) is very rare and there is no report of intracranial extension from the palate ACC in Korea. Intracranial involvement can occur in one of three ways: direct extension, perineural spread, and hematogenous spread. A case report of a 35-year-old woman with intracranial ACC is presented. Initially she had ACC of the right palate and was treated by surgery and postoperative radiation therapy. Three years and 10 months later, the paresthesia in the distribution of ophthalmic and maxillary branch of right trigeminal nerve developed without evidence of recurrence in CT scan. Ptosis and total ophthalmoplegia developed sequentially and the second operation was performed. It was suggested that the tumor was spread perineurally along the trigeminal nerve into the Gasserian ganglion and then cavernous sinus and orbit. Seven years and 6 months after the first operation, direct intracranial extension into the right temporal lobe developed via sphenoid bone, sphenoid sinus and temporal bone and the third operation was done. And then Jung metastasis was diagnosed. She is alive for 9 years 5 months after first operation.

To evaluate imaging characteristics of metastatic renal tumors in CT and US. Renal metastases were diagnosed in 25 patients by surgery (n = 2), US-guided biopsy (n = 15), or follow-up CT (n = 8). The primary tumors metastasized to kidney were lung cancer (n = 11), adenoid cystic carcinoma (n = 3), stomach cancer (n = 2), and choriocarcinoma (n = 2). Twelve cases involved one kidney and 13 involved both kidneys. CT was performed in all 25 patients while US was done in 14. We analysed CT findings in respect to number, size, shape, exophytic degree, margin, and degree and homogeneity of the contrast enhancement of the lesion; US findings in regand to echogenicity and homogeneity of the lesion. The average number of the lesions per patient seen on CT was three; average diameter of the lesion was 3.6 cm; and 75% (57/76) of all tumors had exophytic degree of 0%. The characteristic CT findings of metastatic renal tumors were round shape (52/76), ill-defined margin (54/76), and poor (76/76) and inhomogeneous (45/76) contrast enhancement. The echogenicity of the tumors were homogeneous (11/18) and isoechoic (10/18) on US. Metastatic renal tumors had a tendency of multiple, small, ill-marginated, and less-exophytic nature on CT, and homogeneous, isoechoic appearance on US. The familiarity with the constellation of CT and US findings of renal metastasis described may be helpful in making a correct diagnosis.

Adenoid cystic carcinoma (ACC) is an infrequent malignant neoplasm that originates most commonly in the major and minor salivary glands of the head and neck region. This study provides new information on head and neck ACC with cervical lymph node metastasis. Of 616 patients who underwent primary tumour resection from 1995 to 2008 in the authors' hospital, 62 cases with cervical lymph node metastasis were analyzed. The general incidence of cervical lymph node metastasis in ACC was approximately 10%. The base of tongue, mobile tongue and mouth floor were the most frequent sites of lymph nodes metastasis, with incidences of 19.2%, 17.6% and 15.3%, respectively. Most cases occurred via a classic 'tunnel-style' metastasis and the level Ib and II regions were the most frequently involved. Primary site and lymphovascular invasion were significantly associated with lymph node metastasis. High patient mortality was significantly correlated with lymph node positive cases. The tongue-mouth floor complex has a high propensity for cervical lymph node metastasis, which occurs through a classic 'tunnel-style' metastasis. Peritumoral lymphovascular invasion could be taken as strong predictor for lymph node metastasis, which ultimately leads to poor prognosis of ACC patient. Selective neck dissection should be considered in such cases. PMID:22647764

CT findings of histologically proven malignant tumors of maxillary sinus in 36 patients were retrospectively analyzed. A variety of malignant tumors were included; 27 cases of squamous cell carcinoma, 3 malignant lymphomas, 2 malignant melanomas, 2 rhabdomyosarcomas, and chondrosarcoma, adenoid cystic carcinoma, and malignant ameloblastoma. CT staging was T4 in 19 cases, T3 in 16 cases and T2 in 1 case. The most common involved area beyond maxillary antrum was nasal cavity (25 cases), followed by ethmoid sinus (20 cases), orbit (19 cases), infratemporal fossa (17 cases), check skin (13 cases), pterygopalatine fossa (10 cases), and nasopharynx (6 cases). Skeletal destruction was seen in medial wall of antrum (31 cases), posterior wall of antrum (25 cases), anterior wall of antrum (23 cases), roof of antrum (19 cases), lamina papyracea (6 cases), and lateral wall of orbit (5 cases) in that order of frequency. Lymph node metastases were found in 2 cases of malignant melanoma, 2 cases of malignant lymphoma, and chondrosarcoma, squamous cell carcinoma, and malignant ameloblastoma. Predilection site of lymph node involvement was submandibular (3 cases), internal jugular (2 cases), parotid (2 cases), and retropharyngeal node (1 case)

The aim of the present study was to compare the expression of ?2?1, ?3?1, and ?5?1 integrins between 28 pleomorphic adenomas (PAs) and 10 adenoid cystic carcinomas (ACCs), and investigate differences in the expression of these integrins according to histologic subtypes of ACCs. It was taken into consideration the presence or absence, distribution, and localization of integrin immunoexpression. There was immunoreactivity in the intercellular contacts of the strands, nests, and solid sheets of PAs, as well as in the luminal and nonluminal cells of the duct-like structures, with a predominant immunoexpression in the luminal cells. The immunoexpression in ACCs varied with histologic subtype of the tumor. It was verified for a tendency of absence and/or reduced expression of all integrins in the solid subtype of ACCs. In general, PAs revealed a more diffuse and remarkable immunoexpression of all studied integrins than ACCs. The reduced integrins expression in ACC may be related to a lesser degree of cell differentiation in this neoplasm. Moreover, the absence and/or reduced expression of the studied integrins in solid ACC suggest a possible role in pathogenesis and more aggressive biological behavior of this histologic subtype. PMID:22914615

AIM To investigate the treatment status and prognosis of space-occupying lacrimal gland lesions at one tertiary eye center in China. METHODS A retrospective clinical study was performed on 95 patients with space-occupying lesions of the lacrimal gland surgically treated at the Eye & ENT Hospital of Fudan University from 2003 to 2007. The reviewed clinical data included age, gender, side of the lesion, duration of signs and symptoms, histopathological diagnosis, treatment modality, recurrence (local, regional, and distant metastasis) and survival. RESULTS Of the 95 cases (99 eyes), pleomorphic adenomas were the most common lesions (43 cases), followed by lymphoid disorders (14), inflammatory pseudotumors (11), carcinoma ex-pleomorphic adenomas (11), and adenoid cystic carcinomas (ACC, 6). There were 8 patients with relapsed pleomorphic adenomas. Five of these 8 cases had malignant pathological changes. All patients with ACC had metastasis and three of them died during their follow-up. CONCLUSION Our study indicated that the most common lacrimal gland lesions were pleomorphic adenomas. Multiple recurrence and surgical procedures may increase the risk of tumor progression. ACC had a high incidence of tumor metastasis and a poor prognosis. PMID:18171416

Abstract in spanish Se realiza una investigación aplicada descriptiva longitudinal con todos los pacientes portadores de tumores de glándulas salivales que necesitaron tratamiento quirúrgico en el Servicio de Cirugía Maxilofacial del Hospital Universitario Clinicoquirúrgico "Dr. Gustavo Aldereguía" de Cienfuegos, durante el período de enero de 1990 a diciembre de 1999. Se observó un predominio del sexo femenino, así como del grupo etario de mayores de 60. La glándula más afectada (more) fue la parótida, dentro de los adenomas, el pleomorfo fue el de mayor frecuencia, mientras que el carcinoma adenoideo quístico lo fue en el grupo de los carcinomas. La cirugía fue la principal arma terapéutica, seguida de la combinación quirúrgicaradiante. Además se analizan algunos esquemas de quimioterapia. Abstract in english An applied descriptive and longitudinal investigation was made with all the patients carriers of salivary gland tumors that needed surgical treatment at the Maxillofacial Surgery Service of "Dr. Gustavo Aldereguía" Clinical and Surgical Teaching Hospital, in Cienfuegos, from January, 1990, to December, 1999. It was observed a predominance of females as well as of the age group over 60. The parotid gland was the most affected, whereas the pleomorphic salivary adenoma was (more) the commonest. The adenoid cystic carcinoma was the most frequent in the group of carcinomas. Surgery was the main treatment used, followed by the surgical-radiant combination. Some drug therapy schemes were also analyzed.

MRI findings of 13 patients with proven salivary gland tumors, including 7 cases of parotid gland tumors, 2 cases of submandibular gland tumors, and 4 cases of minor salivary gland tumors, were reviewed. All examinations were carried out on a 1.5-T MRI system (General Electric, SIGNA Performance plus and SIMAZU, SMT-150X) with spin echo sequence. T1 and T2 weighted images and Gd-DTPA enhanced T1 weighted images were obtained. The results were as follows: All tumors demonstrated low to intermediate signal intensity on T1 weighted images and intermediate to high signal intensity on T2 weighted images. The differences between malignant and benign tumors were not detected by means of the signal intensity of the tumors. Tumor margins were clear except for 2 cases, including inflamed pleomorphic adenoma of the submandibular gland and adenoid cystic carcinoma of the parotid gland. Except for the case of adenolymphoma, internal structures of the tumor are inhomogenous, especially on T2 weighted images. Although the intraparotid facial nerve is not detected directly, whether the tumor is located on superficial or deep lobe could be detected by drawing a line between the lateral surface of the posterior belly of the digastric muscle and the lateral posterior border of the mandible except for one case and using the retromandibular vein except for two cases. (author).

The aim of this retrospective study of 56 patients with minor salivary gland tumours (MSGTs) of the upper aerodigestive tract is to present demographic features, distribution of tumours as well as methods and results of treatment performed in our institution over a 10-year period. Of 221 patients with salivary gland tumours, 56 patients with MSGT were selected. There were 36 female and 20 male patients aged from 8 to 81 years. Male-to-female ratio was 1?:?2 in the group of benign MSGT and 1?:?1.7 in the group of malignant tumours. The palate was the most frequent site of MSGT (45.6%), followed by buccal mucosa (19.3%). Of all MSGTs 63.2% were malignant, and 36.8% were benign. Adenoid cystic carcinoma was the most common neoplasm (31.6%), followed by pleomorphic adenoma (29.8%). Surgery was the method of choice in the treatment of patients with MSGT. Postoperative defects were reconstructed by prosthetic obturators, local flaps, and free radial forearm flap. Relative survival for patients with malignant MSGT was 88% at three years and 71.5% at five years. MSGTs are more frequent in females and predominantly affect the palate. Malignant MSGTs are more common than benign.

A 57-year male patient suffered severe tracheal stenosis due to adenoid cystic carcinoma. A 5 mm diameter bronchoscope could not be passed through the trachea. Surgical resection was very difficult, because the CT scan showed that the length of stenosis was at least 5 cm. After the patient received 40 Gy external beam irradiation, a 5 mm diameter catheter could be passed through his trachea for intraluminal radiotherapy. A cobalt-60 source was fed into the catheter by a remote afterloader. A dose of 3 Gy at 1 cm from the source was delivered weekly for 7 weeks. After intraluminal radiotherapy, his trachea opened still more. Intraluminal radiotherapy involves no danger to the spinal cord or vital mediastinal structures, because the dose decreases remarkably at a short distance from the source. And further, the patient received 20.8 Gy external beam irradiation. The combination of external and intraluminal radiotherapy produced an 80 % opening of the trachea with few side effects. Intraluminal radiotherapy can be useful method to boost the total tumor dose in unresectable tracheal tumors.

We used a mobile positron emission tomography (PET) scanner positioned within the proton therapy treatment room to study the feasibility of proton range verification with an in-room, stand-alone PET system, and compared with off-line equivalent studies. Two subjects with adenoid cystic carcinoma were enrolled into a pilot study in which in-room PET scans were acquired in list-mode after a routine fractionated treatment session. The list-mode PET data were reconstructed with different time schemes to generate in-room short, in-room long and off-line equivalent (by skipping coincidences from the first 15 min during the list-mode reconstruction) PET images for comparison in activity distribution patterns. A phantom study was followed to evaluate the accuracy of range verification for different reconstruction time schemes quantitatively. The in-room PET has a higher sensitivity compared to the off-line modality so that the PET acquisition time can be greatly reduced from 30 to <5 min. Features in deep-site, soft-tissue regions were better retained with in-room short PET acquisitions because of the collection of 15O component and lower biological washout. For soft tissue-equivalent material, the distal fall-off edge of an in-room short acquisition is deeper compared to an off-line equivalent scan, indicating a better coverage of the high-dose end of the beam. In-room PET is a promising low cost, high sensitivity modality for the in vivo verification of proton therapy. Better accuracy in Monte Carlo predictions, especially for biological decay modeling, is necessary.

Abstract in portuguese Os autores descrevem o caso de uma paciente de 54 anos de idade com carcinoma adenóide cístico de traquéia ao nível da cricóide, na qual foi realizada ressecção extensa, incluindo a laringe, parte da traquéia e esôfago. A reconstrução do trato digestivo foi através do tubo gástrico e a via aérea pela construção de uma traqueostomia mediastinal. Cinco anos mais tarde foi removida uma recorrência tumoral cutânea no pescoço. Sete anos depois do procediment (more) o original, foi notada nova recorrência no mediastino, que respondeu à irradiação. A paciente encontra-se muito bem atualmente, oito anos e cinco meses após o procedimento. Abstract in english The authors describe the case of a 54 year-old female with adenoid cystic carcinoma of the trachea at the cricoid level upon whom extensive surgical resection was performed, including the larynx, part of the trachea and esophagus. Reconstruction of the digestive tract was done by means of a gastric tube and the airway with a mediastinal tracheostomy. Five years after the original procedure there was a local cutaneous recurrence which was removed. Seven years later the dis (more) ease recurred in the mediastinum, which responded to irradiation. The patient is alive and well eight years and five months after the operation.

BackgroundSonoelastography has been used to differentiate malignant from benign lesions in numerous types of tissues including breast, prostate, liver, blood vessels, thyroid, musculoskeletal structures, and salivary glands.PurposeTo evaluate the efficacy and application of real-time qualitative sonoelastography in the differentiation of benign and malignant focal parotid gland lesions.Material and MethodsA total of 75 patients (36 boys/men, 39 girls/women; age range, 10-83 years) with 81 lesions were evaluated prospectively by sonoelastography performed and interpreted by two expert radiologists. The results of these experts classification and scoring of lesions according to relative stiffness of the mass were compared with each other and with histopathological findings. The interpretation of sonoelastography scores of 1-4 were as follows: 1, soft; 2, mostly soft; 3, mostly stiff; and 4, stiff.ResultsThe kappa statistic of 0.508 (P adenoid cystic carcinoma, and high-grade tumors was low, whereas the diagnostic rates for low-grade tumors such as mucoepidermoid carcinoma, acinic cell carcinoma, and metastases of basal cell carcinoma were better with sonoelastography.ConclusionAlthough sonoelastography seems to be promising in the differentiating of low-grade malignancies, the primary role of radiology is currently limited to determination of localization, size, and morphology of parotid tumors. PMID:23091238

Purpose: To review a single-institution experience with the management of salivary gland cancers treated by radiation alone. Methods and Materials: Between 1960 and 2004, 45 patients with newly diagnosed salivary gland carcinomas were treated with definitive radiation to a median dose of 66 Gy (range, 57-74 Gy). Distribution of T-stage was: 24% T1, 18% T2, 31% T3, and 27% T4. Histology was: 14 mucoepidermoid (31%), 10 adenocarcinoma (22%), 8 adenoid cystic (18%), 4 undifferentiated (9%), 4 acinic (9%), 2 malignant mixed (4%), 2 squamous (4%), and 1 salivary duct carcinoma (2%). No patient had clinical or pathologic evidence of lymph node disease. Median follow-up was 101 months (range, 3-285 months). Results: The 5-year and 10-year rate estimates of local control were 70% and 57%, respectively. A Cox proportional hazard model identified T3-4 disease (p = 0.004) and radiation dose lower than 66 Gy (p = 0.001) as independent predictors of local recurrence. The 10-year overall survival and distant metastasis-free rates were 46% and 67%, respectively. Conclusion: Radiation therapy alone is a reasonable alternative to surgery in the definitive management of salivary gland cancers and results in long-term survival in a significant proportion of patients. Radiation dose in excess of 66 Gy is recommended.

Specificity protein 1 (Sp1) is often overexpressed in cancer cells. Its binding sites are known to exist in the phosphatase and tension homolog deleted on chromosome 10 (PTEN) promoter. In this study, we hypothesized that Sp1 negatively regulates PTEN expression. We used several cell lines to determine the effects of Sp1. The results showed that Sp1 overexpression inhibited the expression and promoter activity of PTEN and correspondingly upregulated AKT phosphorylation, whereas Sp1 knockdown upregulated the expression and promoter ability of PTEN and downregulated AKT phosphorylation. Moreover, a series of deletion and site-directed mutations of the PTEN promoter indicated that Sp1 can inhibit PTEN promoter activity through a specific Sp1-binding site at the PTEN core promoter in vivo. Meanwhile, non-acetylated Sp1, with its loss of DNA binding activity, failed to inhibit the expression and promoter activity of PTEN. Histone deacetylase 1 was necessary for Sp1 to inhibit PTEN expression. The inverse expression of Sp1 and PTEN was found in tongue cancer cells and salivary adenoid cystic cancer (SACC)-LM cells (possessing higher potential for lung metastasis than SACC-83) as compared with that in adjacent normal tissue and SACC-83 cells, respectively. Sp1 knockdown decreased the migration and invasion of SACC-LM cells, whereas Sp1 overexpression increased the migration and invasion of SACC-83 cells. Overall, these results suggest that Sp1 is involved in the development and invasiveness of cancer through inhibition of PTEN. PMID:23104175

The purpose of this study was to clarify the relationship between lip seal and malocclusion in Japanese children. Fifty-three patients aged 7 to 14 years (mean 10.24±1.93) were selected randomly, and compared with 20 subjects with normal occlusion aged 7 to 14 years (mean 10.50±2.56). The subjects were divided into a good lip seal group and poor lip seal group by observing the distance between the upper and lower lip at rest. The variables that were analyzed for morphological evaluation included model analysis and cephalometric analysis. Noted for functional evaluation were tongue position, the size of the tonsils and adenoids and the oral muscle force measured by button pulling. In the evaluation of the degree of lip seal, there was no statistical difference between subjects with malocclusion and those with normal occlusion. Within the group with malocclusions, however, there were significant differences in overbite (p<0.01), overjet (p<0.01), and oral muscle force by button pulling (p<0.05) between the good lip seal and poor lip seal groups. These results suggest that there is a need not only to correct malocclusion but also to be aware of lip sealing so that it may be improved in Japanese children.   

Carbon-ion radiotherapy (C-ion RT) possesses physical and biological advantages. It was started at NIRS in 1994 using the Heavy Ion Medical Accelerator in Chiba (HIMAC); since then more than 50 protocol studies have been conducted on almost 4000 patients with a variety of tumors. Clinical experiences have demonstrated that C-ion RT is effective in such regions as the head and neck, skull base, lung, liver, prostate, bone and soft tissues, and pelvic recurrence of rectal cancer, as well as for histological types including adenocarcinoma, adenoid cystic carcinoma, malignant melanoma and various types of sarcomas, against which photon therapy could be less effective. Furthermore, when compared with photon and proton RT, a significant reduction of overall treatment time and fractions has been accomplished without enhancing toxicities. Currently, the number of irradiation sessions per patient averages 13 fractions spread over approximately three weeks. This means that in a carbon therapy facility a larger number of patients than is possible with other modalities can be treated over the same period of time.

The Rare Cancer Network (RCN), founded in 1993, performs research involving rare tumors that are not common enough to be the focus of prospective study. Over 55 studies have either been completed or are in progress.The aim of the paper is to present an overview of the 30 studies done through the RCN to date, organized by disease site. Five studies focus on breast pathology, including sarcoma, lymphoma, phyllodes tumor, adenoid cystic carcinoma, and ductal carcinoma in situ in young women. Three studies on prostate cancer address prostatic small cell carcinoma and adenocarcinoma of young and elderly patients. Six studies on head and neck cancers include orbital and intraocular lymphoma, mucosal melanoma, pediatric nasopharyngeal carcinoma, olfactory neuroblastoma, and mucosa-associated lymphoid tissue lymphoma of the salivary glands. There were 4 central nervous system studies on patients with cerebellar glioblastoma multiforme, atypical and malignant meningioma, spinal epidural lymphoma and myxopapillary ependymoma. Outside of these disease sites, there is a wide variety of other studies on tumors ranging from uterine leiomyosarcoma to giant cell tumors of the bone. The studies done by the RCN represent a wide range of rare pathologies that were previously only studied in small series or case reports. With further growth of the RCN and collaboration between members our ability to analyze rare tumors will increase and result in better understanding of their behavior and ultimately help direct research that may improve patient outcomes. PMID:23087791

Salivary gland tumors are relatively uncommon and there exists a considerable diagnostic difficulty owing to their diverse histological features in individual lesions and the presence of a number of types and variants, in addition to overlapping histological patterns similar to those observed in different tumor entities. The classification is complex, but is closely relevant to the prognostic and therapeutic aspects. Although hematoxylin-eosin staining is still the gold standard method used for the diagnosis, immunohistochemistry (IHC) can enhance the accuracy and be a helpful tool when in cases to investigate the subjects that cannot be assessed by histological examination, such as the cell nature and differentiation status, cell proliferation, and tumor protein expression. This review depicts on the practical diagnostic utility of IHC in salivary gland tumor pathology under the following issues: assessment of cell differentiation, focusing on neoplastic myoepithelial cells; discrimination of histologically mimic tumor groups; diagnosis of specific tumor types, e.g., pleomorphic adenoma, adenoid cystic carcinoma, and salivary duct carcinoma; and evaluation of malignancy and prognostic factors. IHC plays a limited, even though important, role in the diagnosis of salivary gland tumors, but is often useful to support the histological assessment. However, unfortunately few tumor type-specific markers are still currently available. For these reasons, IHC should be considered a method that can be used to assist the final diagnosis, and its results themselves do not directly indicate a definitive diagnosis.   

Abstract in portuguese OBJETIVO: Analisar os aspectos tomográficos dos tumores malignos da cavidade nasal. MATERIAIS E MÉTODOS: Foram estudados 18 pacientes - dez homens e oito mulheres - com tumor da cavidade nasal, os quais realizaram tomografia computadorizada da face. RESULTADOS: Dos tumores, seis eram casos de carcinoma epidermóide, três melanomas, dois carcinomas adenóides císticos, um adenocarcinoma polimórfico de baixo grau, um carcinoma indiferenciado, um carcinoma neuroendócri (more) no, um linfoma não-Hodgkin, um rabdomiossarcoma alveolar, um sarcoma fusocelular grau II e um estesioneuroblastoma. As lesões foram mais freqüentes (p > 0,05) no lado esquerdo e no andar médio. CONCLUSÃO: Os carcinomas epidermóides apresentam grau de destruição correspondente ao seu volume, semelhante aos tumores epidermóides de outros sítios. O septo nasal foi acometido de maneira diferente, de acordo com os tipos histológicos. Abstract in english OBJECTIVE: To review the computed tomography findings in patients with nasal cavity tumors. MATERIALS AND METHODS: Eighteen patients - ten male and eight female - with nasal cavity tumors were studied using computed tomography. RESULTS: Histological types of the tumors included six epidermoid carcinoma, three malignant melanoma, two adenoid cystic carcinoma, and one case of each of the following: adenocarcinoma, undifferentiated carcinoma, neuroendocrine carcinoma, non-Ho (more) dgkin lymphoma, rhabdomyosarcoma, fusiform cell sarcoma, and stesioneuroblastoma. The lesions were more frequent on the left side and middle level of the nasal cavity (p > 0.05). CONCLUSION: Epidermoid carcimomas showed a close relationship between the lesion volume and the degree of destruction of adjacent structures. Septum involvement was different depending on the histological type of the lesion.

Abstract in portuguese Os tumores primários da traqueia são raros, representando apenas 0,3% de todos os tumores. A incidência destes tumores é inferior a 0,2 por 100 000 habitantes e 180 vezes menos frequente do que os tumores do pulmão. O porquê da sua raridade permanece por explicar. Possivelmente o fluxo turbulento na traqueia protege a mucosa do depósito de carcinogénios inalatórios. Os autores apresentam um caso clínico de um tumor adenóide cístico da traqueia em mulher de 23 (more) anos, não fumadora, e com quadro agudo de estridor inspiratório onde a utilização do laser Nd-Yag foi de primordial importância, permitindo uma exérese parcial alargada e segura da massa tumoral que fazia obstrução de 80% do lúmen da traqueia, conseguindo a repermeabilização rápida da via aérea principal, evitando um quadro asfíxico iminente, enquanto a doente aguardava cirurgia. Abstract in english Tracheal tumours are rare, accounting for only about 0.3% of all bodily tumours. Their incidence is less than 0.2 per 100 000 inhabitants and 180 times less frequent than lung cancer. The reason for their rarity is not so clear. It is possible that turbulent airflow in the trachea protects its mucosa from inhaled carcinogen deposits. The authors report a case of adenoid cystic carcinoma in a 23 year-old woman, non-smoker, with acute clinical inspiratory stridor, where Nd- (more) Yag laser use was extremely important to tracheal permeability as the tumor occupied over 80% of the tracheal lumen and could have led to imminent patient asphyxia.

Failure of antibiotics to eradicate the microbial pathogens primarily responsible for otorhinolaryngological diseases has led to the hypothesis that these microorganisms may be structured in a biolfilm. Aim of the study was to evaluate the ability to produce biofilm among bacteria isolated from tonsils and/or adenoids and nasopharynx. Biopsies and swabs were collected during surgery and after 3 and 6 months in 32 children undergoing adenoidectomy and/or tonsillectomy. Production of biofilm by Staphylococcus aureus, Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae was evaluated in vitro by means of spectrophotometry after growth in microplates and staining with crystalviolet. Of the isolates from intraoperative samples, 44.7% were either moderate or strong biofilm producers compared with 27% of isolates at 6 months after surgery. A decrease in biofilm production was observed for H. influenzae and S. aureus. In conclusion, the rate of isolation and ability to form biofilm decreased in bacteria isolated subsequent to adenoidectomy and/or tonsillectomy. This suggests a role for biofilm in pathogenesis of recurrent and chronic pharyngeal diseases and rhinopharingitis. PMID:22515296

Prostate, pancreatic, and head and neck carcinomas have a high propensity to invade nerves. Surgical resection is a treatment modality for these patients, but it may incur significant deficits. The development of an imaging method able to detect neural invasion (NI) by cancer cells may guide surgical resection and facilitate preservation of normal nerves. We describe an imaging method for the detection of NI using a herpes simplex virus, NV1066, carrying tyrosine kinase and enhanced green fluorescent protein (eGFP). Infection of pancreatic (MiaPaCa2), prostate (PC3 and DU145), and adenoid cystic carcinoma (ACC3) cell lines with NV1066 induced a high expression of eGFP in vitro. An in vivo murine model of NI was established by implanting tumors into the sciatic nerves of nude mice. Nerves were then injected with NV1066, and infection was confirmed by polymerase chain reaction. Positron emission tomography with [18F]-2?-fluoro-2?-deoxyarabinofuranosyl-5-ethyluracil performed showed significantly higher uptake in NI than in control animals. Intraoperative fluorescent stereoscopic imaging revealed eGFP signal in NI treated with NV1066. These findings show that NV1066 may be an imaging method to enhance the detection of nerves infiltrated by cancer cells. This method may improve the diagnosis and treatment of patients with neurotrophic cancers by reducing injury to normal nerves and facilitating identification of infiltrated nerves requiring resection.

Pathological lesions of the parotid gland were examined comparatively with different examination sequences both plain and with the contrast medium Gd-DTPA. There were 36 benign lesions (parotitis, Sjoegren's syndrome, adenoma, etc.) and 24 malignant tumours (squamous cell carcinoma, adenocarcinoma, adenoid cystic carcinoma etc.) Examinations were carried out at 1.0 T with long and short spin echo sequences in transverse and frontal layer orientation before and after application of Gd-DTPA as contrast medium. In the patients suffering from parotitis the best results were obtained with plain T{sub 1} and T{sub 2} sequences; the contrast medium Gd-DTPA bemained without superior diagnostic relevance. However, in Sjoegren's syndrome (myoepithelial sialadenitis) administration of the contrast medium alwys yielded a characteristic honeycomblike pattern. In benign and malignant space-occupying growths MRI supplied additional diagnostic information with Gd-DTPA in respect of defining the tumour borderlines and paths of infiltration. MRI is now a significant diagnostic tool in inflammatory and tumorous lesions of the parotid gland. (orig.).

The new technique of non-invasive magnetic resonance (MR) sialography was evaluated for normal and various pathologic conditions of the parotid gland. Ten volunteers and 15 patients with various symptomatic diseases of the parotid gland were tested in the present study. Diseases included pleomorphic adenoma, cystadenolymphoma, carcinoma ex pleomorphic adenoma, ductal carcinoma, adenoid cystic carcinoma, lymphoepithelial carcinoma, non-Hodgkin's lymphoma, sialolithiasis, sialadenitis, Heerfordt's syndrome and congenital duct ectasies. In addition to the usually performed T1 and T2 cross-sectional sequences a heavily weighted T2 sequence (TR 3600, TE 800) was performed and allowed depiction of a fluid-filled parotid duct. Results showed that the main parotid and primary branching ducts were depicted reliably in all normal cases and all patients, except one with sicca syndrome. Pathological conditions such as duct dilatations, duct strictures, obstructing duct calculus and irregular shapes and courses of the ductal system were demonstrable. While X-ray sialography obtained a higher resolution, only MR sialography was able to depict dilated ducts proximal from a complete obstruction, as well as all ductal cysts. Our findings show that MR sialography can be applied successfully to investigations of the parotid gland system. There have been no contraindications or complications to date because MR sialography is non-invasive. The technique will also allow the salivary ducts and lesions to be differentiated from the course of the facial nerve. PMID:9539054

To assess outcomes, toxicity and quality-of-life (QoL) of patients with parotid gland adenoid cystic carcinoma (PGACC) treated by surgery and postoperative radiotherapy. Between 1995 and 2010, 46 patients with PGACC were treated with parotidectomy±neck dissection followed by radiotherapy. Endpoints were loco-regional control (LRC), distant metastasis-free (DMFS), disease-free (DFS), cause-specific (CSS), and overall survival (OS), late toxicity, and QoL. After a median follow-up of 58 months (range 4-171), the 5-year Kaplan-Meier estimates of LRC, DMFS, DFS, CSS, and OS were 88%, 78%, 75%, 80%, and 67%, respectively and the 8-year rates were 88%, 75%, 72%, 77%, and 64%, respectively. On multivariate analysis, T-stage, N-stage, tumor grade, and perineural invasion correlate significantly with DMFS and DFS. The overall 5-year cumulative incidence of grade ?2 late toxicity was 9%. QoL-scores deteriorate during and shortly after treatment but returned in all scales to almost baseline levels within 6 months. Excellent LRC rates were achieved in patients with PGACC treated by surgery and postoperative radiotherapy with low rate of late side-effects and preservation of good QoL. Despite the effective local therapy, 9 of 46 patients (20%) failed distantly. Because effective treatment strategies for this problem are lacking, prospective trials are needed to determine the role of adjuvant systemic or targeted therapy in patients at high risk of DM. PMID:22093375

Thirty-one patients with malignant tumors of the middle ear and external auditory canal (EAC) were observed at the University of Virginia Hospital from 1956 through 1980. Of 27 patients with carcinoma, 21 had squamous cell carcinoma, 4 had basal cell carcinoma and 2 had adenoid cystic carcinoma. The 27 patients with carcinoma are reviewed with regard to clinical presentation, treatment modality, results and complications. The majority (67%) of patients had a history of chronic ear drainage, 22% had a previous mastoidectomy or polypectomy and 7% had an associated cholesteatoma. Eighty percent of patients with carcinoma limited to EAC were alive and well at 5 years, compared to 43% of patients with involvement of the middle ear. Fifty-six percent of patients without invasion of the petrous bone were alive at 5 years compared to only 20% of patients with petrous bone involvement. The data strongly suggest that survival depends on the extent of disease. The corrected disease free 5 year survival rates were 14% for patients who had surgery alone and 50% for those who had surgery and radiotherapy. Of the three patients with advanced disease who received radiotherapy alone, none survived five years.

Altered microsatellite DNA in the blood of cancer patients may provide a novel means for tumor detection. Such alterations are a major characteristic of many types of tumor especially those associated with head or neck cancer. Moreover, recent evidence suggests that senescent tumor cells release DNA into the circulation, which is subsequently carried by the blood and thus enriched in the serum and plasma. We tested 10 head and neck cancer patients (5 with malignant melanomas (MM) and 5 with adenoid cystic carcinomas (ACC)) by polymerase chain reaction (PCR)-based microsatellite analysis of DNA from white blood cells and paired plasma samples. Our goal was to amplify two microsatellite markers, D1S243 and D19S246, which sometimes show microsatellite alterations in head and neck cancer patients. However amplification of fragments from three loci in the plasma samples proved impossible, probably due to the small amounts of DNA isolated. We used multiple displacement amplification (MDA) to amplify genomic DNA from the plasma samples. Two microsatellite fragments were amplified from whole genome amplified DNA. Among 5 heterozygote samples, 3 showed the same pattern in DNA samples from both blood cells and plasma but 2 showed loss of heterozygosity (LOH). Although further study is necessary to confirm whether the LOH found in this study reflects alteration in circulating tumor cell DNA, application of whole genome amplification may allow DNA analysis from limited amounts of such DNA and provide a minimally invasive diagnostic procedure and useful aid in therapy.   

Due to progressively expanded indications of endoscopic transnasal surgery, having different reconstructive options in the armamentarium becomes of paramount importance. We herein report our experience with the use of the temporo-parietal fascial flap after extended endoscopic procedures for malignancies of the clival and nasopharyngeal regions. We focus our report on the surgical anatomy of this flap and the technique for its intranasal transposition through an infratemporal corridor. The main steps of the procedure and anatomic landmarks were highlighted, thanks to previous cadaver dissection. Five patients underwent an extended endoscopic resection for malignant tumors: one with persistent clival chordoma, three with recurrent nasopharyngeal carcinomas, and 1 recurrent nasopharyngeal adenoid cystic carcinoma. In all patients a temporo-parietal fascial flap was harvested to protect critical structures or irradiated denuded bone. The Mean harvesting and hospitalization time were 120 min and 5 days, respectively. No major or minor complications were observed. Whenever local flaps are not available for oncologic reasons or previous surgery, the temporo-parietal fascial flap is a safe and relatively easy option to protect the residual skull base and critical structures such as the internal carotid artery and dura of the posterior cranial fossa, after extended endoscopic resections. PMID:22996083

Cephalometry is useful as a screening test for anatomical abnormalities in patients with obstructive sleep apnoea syndrome (OSAS). To evaluate comprehensively the cephalo metric features of children with OSAS, with or without adenotonsillar hypertrophy, and to elucidate the relationship between cephalometric variables and apnoea-hypopnoea index (AHI) severity. The study population consisted of 39 children, aged 4-12 years, with OSAS. Cephalometry was analysed using 11 measurements of the bony structures, their relationships and the size of the airways. Additionally, adenoid and tonsillar hypertrophy were graded. Cranial base angles (BaSN and BaSPNS) were found to correlate with increasing levels of AHI scores (P<0.001). Protrusion of the maxilla (SNA) and mandible (SNB) did not correlate with AHI scores (P>0.05). The length of the mandibular plane (GnGo) and the minimal posterior airway space (MPAS) were inversely correlated with AHI scores (P<0.001). There was positive correlation between MPAS and GnGo (r=0.740, P<0.001), and negative correlation between MPAS and gonial angle (ArGoGn) (r=-0.541, P<0.001). There was significant correlation between cephalometric data and adenotonsillar hypertrophy concerning BaSN, BaSPNS, ArGoGn, GnGoH, BaN-GnGo, MPAS, GnGO and MPH. (orig.)

We report on a father and his 4-year-old son sharing a characteristic dysmorphic facial phenotype (including hyperteleroism, prominent forehead, and wide nasal bridge), macrocephaly, hearing loss, palatal clefting, developmental delay, hypotonia and bony abnormalities including marked cranial sclerosis and sclerosis of the ribs and long bones, which evolved in severity in the son between the ages of 2 and 4 years. The father's radiographs also showed prominent coarse striations, patchy metaphyseal sclerotic plaques, markedly increased bone density and cortical thickening of long bones, and significant degenerative changes in the thoracic spine. The son has an additional history of sleep apnea resulting from multi-level airway obstruction that includes adenoid hypertrophy, lingual tonsil hypertrophy, subglottic stenosis, and supra-arytenoid tissue consistent with laryngomalacia and tracheomalacia. The clinical, radiographic, and genetic findings in father and son are consistent with a sclerosing skeletal dysplasia syndrome with similarities to mixed sclerosing bone dysplasia (MSBD) including metaphyseal plaques, osteopathia striata, and cranial sclerosis (OS-CS). This family may represent one of the first descriptions of familial inheritance and evolving phenotype in MSBD. The evidence for male-male transmission would support the existence of an autosomal mechanism of inheritance for a novel form of MSBD with characteristic syndromic features. PMID:22821701

Abstract in spanish Antecedentes: Los tumores adenomatoides (TA) son poco frecuentes. Se encuentran principalmente en el aparato reproductor femenino y especialmente en el útero. No existen reportes a nivel nacional sobre estos. Objetivos: Describir las características histológicas e inmunohistoquímicas de los TA uterinos. Método: Estudio descriptivo de 32 muestras ingresadas al Servicio de Anatomía Patológica de Clínica Las Condes. Las muestras estudiadas fueron recopiladas entre no (more) viembre de 1999 y noviembre de 2008. Resultados: El diagnóstico de TA fue realizado en 21 histerectomías y 11 miomectomías. En 14 casos se diagnosticaron como lesiones nodulares únicas (43,8%) y en 18 junto a leiomiomas (56,2%). El tamaño promedio de las lesiones únicas fue 2,6 cm, significativamente mayor que aquellas asociadas a leiomiomas. El patrón histológico predominante más frecuente correspondió al tipo angiomatoide (81,3%), seguido por los patrones adenoide (9,4%), sólido (6,3%) y mixto (3%), no se encontraron TA quísticos. El estudio inmunohistoquími-co fue positivo en el 100% de los casos para citoqueratina AE1/AE3, calrretinina, vimentina y D2-40. Fue negativo para CD31 y CEA. Sólo un 6,3% (2 casos) fue positivo para citoqueratina 5/6. Conclusiones: Los TA corresponden a tumores benignos de origen mesotelial. Generalmente su diagnóstico es un hallazgo. Al presentarse en el útero, se confunden generalmente con leiomiomas o se presentan en conjunto con estos. En base a lo anterior el tratamiento de estas lesiones debe ser conservador, bastando con la resección del tumor. Abstract in english Background: The adenomatoid tumors (AT) are rare. They are found mainly in the female reproductive system and especially in the uterus. There is not national reporting on these. Objective: To describe the his-tological and immunohistochemical features of uterine AT. Method: Descriptive study of 32 patients admitíed to the Pathology Department of Clinica Las Condes. The cases studied were collected between November 1999 and November 2008. Results: The diagnosis of AT was (more) performed in 21 hysterectomies and 11 myomectomies. In 14 patients were diagnosed as nodular single lesions (43.8%) and in 18 cases associated with leiomyomas (56.2%), the average size of single lesions was 2.6 cm, significantly greaterthan those associated with leiomyomas. The predominant histologic type most often correspond to angiomatoid (81.3%), followed by adenoid patterns (9.4%), solid (6.3%) and mixed (3%), the cystic pattern was not observed. The immunohistochemical study of ST was positive in 100% for cytokeratin AE1/AE3, calrretinin, vimentin and D2-40. It was negative for CD31 and CEA. Only 6.3% (2 cases) were positive for cytokeratin 5/6. Conclusio-ns: The AT is a benign tumor of mesothelial origin. Usually the diagnosis is a finding. In the uterus they are generally mistaken with leiomyomas or it is in associated with them. Based on the foregoing the treatment of AT should be conservative, only with resection.

Since its recognition about 150 years ago, there has been much progress in the understanding of the pathogenesis, prevention, early detection and management of carcinoma of the uterine cervix. Important historical landmarks include the (1) recognition of pre-invasive and pre-clinical lesions, and the devise of various systems for reporting these lesions, (2) improvements in diagnostic techniques particularly colposcopy, (3) advent of therapeutic procedures (electrocoagulation, cryotherapy, laser therapy and loop electrosurgical excision), and (4) recognition of the aetiological relationship between the human papillomavirus and cervical neoplasia. The susceptibility of the cervical transformation zone to malignant change is now well recognised. The WHO classification system remains the one most commonly utilised for histological reporting of cervical cancers. In the recent 1994 update, cervical carcinoma is divided into 3 main categories: squamous cell carcinoma, adenocarcinoma and other epithelial tumours. Squamous cell carcinoma (60-80%) predominates among invasive cervical carcinoma. Recognised variants include verrucous, warty (condylomatous), papillary squamous (transitional) and lymphoepithelioma-like carcinoma. Adenocarcinoma (5-15% of invasive carcinomas) shows an increasing trend in young females. Like its squamous counterpart, preinvasive and microinvasive versions are known. Variants such as mucinous, endometrioid, clear cell, mesonephric, serous, villoglandular and minimal deviation carcinoma are now defined. Adenosquamous carcinoma (5-25%), adenoid-cystic, adenoid-basal, neuroendocrine and undifferentiated carcinomas constitute other epithelial tumours of the cervix. The management of invasive cervical carcinoma remains heavily dependent on its stage. The FIGO staging system remains the most widely used. The 1995 update provides more definite criteria in subdividing stage IA tumours by delimiting stromal invasion of stage IA1 lesions to a maximum depth of 3 mm and a horizontal axis of 7 mm. In Malaysia, an appreciation of the cervical carcinoma problem has to take into consideration the population at risk, its multi-ethnicity, its socio-economic and geographical diversities and the constraints of the health care system. Females form 48.9% of the Malaysian population. 52.9% of them are in the sexually active age group of 15-50 years, indicating a significant population at risk for cervical carcinoma. Cervical carcinoma was the third most common cause of death due to solid tumours among Malaysian females in 1995 following carcinoma of the breast and respiratory tract. East Malaysia is predominantly rural with many communities having limited modern facilities. Such areas imply a lower educational and socio-economic status, raising the worry of a population at higher risk for developing cervical carcinoma. The population: doctor for Malaysia of 2153:1 compares poorly with nearby Singapore. Besides a shortage of doctors, there is also an uneven distribution of doctors, resulting in a ratio in East Malaysia of > 4000:1. Although Malaysia does not have a national cervical cancer-screening programme, many action plans and cancer awareness campaigns have been launched throughout the years, which appear to have made an impact as evidenced by the decreasing mortality rates from cervical carcinoma. Another interesting feature of cervical carcinoma in Malaysia relates to its multiethnic population. In Malaysian Chinese and Malay females, the prevalence of cervical carcinoma ranks second to breast cancer whereas the pattern is reversed in Malaysian Indian females. Studies into its aetiology and pathogenesis are being undertaken and may shed more light on this matter. PMID:10879274

Abstract in portuguese OBJETIVO: Descrever e analisar as características de uma série de casos de portadores de neoplasias epiteliais primárias da glândula lacrimal, o tratamento cirúrgico, assim como os achados histopatológicos. MÉTODOS: Avaliação retrospectiva dos arquivos de pacientes com neoplasias epiteliais primárias da glândula lacrimal, no período de 1997 até 2007. Todos os pacientes com tumores epiteliais primários da glândula lacrimal foram incluídos neste estudo. Fora (more) m analisados os dados sobre sexo, idade, características clínicas, tratamento cirúrgico, achados histopatológicos e seguimento dos pacientes. As lâminas com secções histológicas dos tumores foram revisadas pelo mesmo patologista. RESULTADOS: No período do estudo, foram encontrados 12 pacientes, sendo 5 (41,7%) portadores de tumores benignos, todos adenomas pleomórficos (tumor benigno misto), e 7 (58,3%) com neoplasias malignas, assim distribuídos: quatro casos de carcinoma adenóide cístico, dois de carcinoma mucoepidermóide e um de carcinoma ex-adenoma pleomórfico. Analisando-se de modo global, a idade média dos portadores foi de 54,1 anos (variando de 14 a 70 anos); com média de idade de 52,4 anos (variando de 14 a 65 anos) para neoplasias benignas, e 55,3 para neoplasias malignas (variando de 26 a 70 anos). Informações do seguimento, variando de 2 a 10 anos, estavam disponíveis para todos os pacientes. Três pacientes desenvolveram metástases distantes e morreram devido à doença. CONCLUSÕES: A maioria das neoplasias epiteliais primárias da glândula lacrimal foi o adenoma pleomórfico e o carcinoma adenóide cístico no período de estudo. Os tumores malignos foram mais frequentes que os benignos. O diagnóstico histopatológico e o estadiamento inicial da doença podem desempenhar uma papel significante na sobrevida do paciente. Abstract in english PURPOSE: To describe and analyze the features of a cases series of patients with primary epithelial neoplasms of the lacrimal gland, its surgical treatment, and histopathological findings. METHODS: Retrospective evaluation of files from patients with primary epithelial neoplasms of the lacrimal gland in the period from 1997 to 2007. All patients with primary epithelial tumors of the lacrimal gland were included in this study. Data on gender, age, clinical features, surgic (more) al treatment, histopathological findings and follow-up were collected. The slides with histological sections of the tumors were reviewed by the same pathologist. RESULTS: During the study period, there were 12 patients, 5 (41.7%) with benign tumors, all pleomorphic adenomas (benign mixed tumor) and 7 (58.3%) with malignant neoplasms, thus distributed: four cases of adenoid cystic carcinoma, two of mucoepidermoid carcinoma and one carcinoma expleomorphic adenoma. Globally, patients mean age was 54.1 years-old (ranging from 14 to 70 years-old), with mean age of 52.4 years-old (ranging from 14 to 65 years-old) for benign neoplasms, and 55.3years-old for malignant neoplasms (ranging from 26 to 70 years-old). Clinical follow-up information, ranging from 2 to 10 years-old, was available for all patients. Three patients developed distant metastasis and died of disease. CONCLUSIONS: The most frequent primary epithelial neoplasms of the lacrimal gland were pleomorphic adenoma and adenoid cystic carcinoma during the study period. Malignant tumors were more frequent than benign tumors. The histopathological diagnosis and the disease initial stage can play a significant role in patient's survival.

Abstract in portuguese OBJETIVO: Revisar evidências sobre fatores de risco modificáveis para otite média aguda recorrente. FONTE DOS DADOS: MEDLINE sem restrição de linguagem de janeiro de 1966 até julho de 2005, utilizando descritores "acute otitis media/risk factors". Obtiveram-se 257 artigos. Desses, incluíram-se ensaios clínicos randomizados, coortes, estudos de caso-controle e transversais que tiveram análise dos fatores de risco modificáveis para desenvolvimento de otite média (more) aguda recorrente como objetivo principal e com amostras de indivíduos de até 18 anos. Excluíram-se, exceto quando relevantes, revisões não-sistemáticas, relatos de casos e série de casos, além de diretrizes de sociedades médicas. SÍNTESE DOS DADOS: Identificaram-se nove fatores de risco ligados ao hospedeiro e oito ligados ao ambiente. Do primeiro grupo, classificaram-se como modificáveis alergia, anormalidades craniofaciais, refluxo gastroesofágico e presença de adenóides. Na segunda categoria, incluíram-se infecção de vias aéreas superiores, cuidados em creches, presença de irmãos/tamanho da família, fumo passivo, aleitamento materno e uso de chupetas. Posteriormente, classificaram-se os fatores de risco de acordo com níveis de evidência. CONCLUSÕES: Os fatores de risco estabelecidos para otite média aguda recorrente e passíveis de intervenção foram uso de chupetas e cuidados em creche. Os fatores de risco prováveis foram privação do leite materno, presença de irmãos, anormalidades craniofaciais, fumo passivo e presença de adenóides. Nenhum fator modificável foi classificado como pouco provável. Entre os que precisam ser melhor estudados estão alergia, refluxo gastroesofágico e fumo passivo na gestação. Abstract in english OBJECTIVE: Review evidence about modifiable risk factors for recurrent acute otitis media. SOURCE OF DATA: MEDLINE with no language restriction, from January 1966 to July 2005, using descriptors "acute otitis media/risk factors". Two hundred and fifty-seven articles were obtained. These included randomized clinical trials, cohorts, case-control and cross-sectional studies that contained analyses of modifiable risk factors for the development of recurrent acute otitis medi (more) a as the main objective and with samples of individuals up to the age of 18 years. Except when relevant, the following were excluded: non-systematic reviews, reports of cases, series of cases, and medical society guidelines. SUMMARY OF DATA: Nine risk factors linked to the host and eight linked to the environment were identified. Of the first group, allergy, craniofacial abnormalities, gastroesophageal reflux and the presence of adenoids were classified as modifiable. In the second category, upper airway infections, day care center attendance, presence of siblings/family size, passive smoking, breastfeeding and use of pacifiers were included. Afterwards, the risk factors were classified in accordance with levels of evidence. CONCLUSIONS: The risk factors established for recurrent acute otitis media and capable of being modified were the use of pacifiers and care in daycare centers. The probable risk factors were privation of mother's milk, presence of siblings, craniofacial abnormalities, passive smoking and presence of adenoids. No modifiable factor was classified as unlikely. Among those that need further study are allergy, gastroesophageal reflux and passive smoking during gestation.

Metabolic imaging with F-18-FDG has diagnostic potential to detect residual malignancy as well as the involvement of lymph node after or during the treatment, but it is not widely available because of high cost of PET operation. The alternative method to use F-18-FDG has been developed the coincident PET (CoDe PET) using gamma camera. Purpose is to evaluate the clinical usefulness of the F-18-FDG CoDe PET using gamma camera in differentiating residual/recurrent disease from post-therapy changes in patients with head and neck cancer. 55 cases F-18-FDG CoDe PET studies in 32 patients (Age : 25-79, mean : 50 13, M/F : 23/9) after therapy with various head and neck cancers were performed (11 undifferentiated carcinoma, 10 squamous cell carcinoma, 9 malignant lymphoma, 1 adenoid cystic cancer, 1 Ewing sarcoma). All patients were in the fasting stage for 6-12 hours and injected 3-10mCi of F-18-FDG 1 hour before the imaging. Images were obtained for 30 min (3 min per one rotation) with 20% photopeak window and 20% compton scatter window and reconstructed after filtered with METS filter. Attenuation correction was not done. Any visually detectable FDG uptake in the head and neck except the physiologic uptake were considered positive. All findings were validated either by biopsy or by clinical follow-up and compared with corresponding CT/MRI findings. Ten of eleven cases with residual disease and 41 of 44 cases which remained relapse free were correctly identified by CoDe PET. CoDe PET assessed nine more relapse free cases, in which CT/MRI were specificity (93%). FDG CoDe PET was especially helpful in patients with residual abnormalities noted on radiological imaging. F-18-FDG CoDe PET is a useful method for follow-up after the initial therapy in patients with head and neck cancers.

A pilot study of heavy charged particles with heavy ion medical accelerator in Chiba (HIMAC) for advanced H and N cancer has been carried out from June 1994 at National Institute of Radiological Sciences (NIRS). As of the beginning of August 1994, three patients were treated by 290 MeV carbon ions. The patients had adenocarcinoma of the cheek mucosa, squamous cell carcinoma of the ethmoid sinus and adenoid cystic carcinoma of the sublingual gland. Patients were immobilized by individual head coach and thermosplint facial shell. Individual collimators and bolus were also prepared for each ports. Dose fractionation for the initial pilot study group was 16.2 GyE/18 fractions/6 weeks, which would be equivalent to standard fractionation of 60.0 Gy/30 fractions/6 weeks with photons. This dose fractionation was considered to be 20% lesser than 75 GyE/37.5 fractions/7.5 weeks, which is estimated to be maximum tolerance dose for advanced H and N cancers. HIMAC worked well and there was no major trouble causing any treatment delay. Acute skin reactions of 3 patients were 2 cases of bright erythema with patchy moist desquamation and one of dull erythema, which were evaluated as equivalent reaction with irradiated dose. Acute mucosa reactions appeared to have lesser reaction than predicted mucositis. Tumor reactions of three patients were partial reaction (PR) at the end of treatment and nearly complete remission (CR) after 6 months of treatment. From October 1994, we started to treat patients with advanced H and N cancer with 10% high dose than previous dose. And new candidates of pilot study with non small cell lung cancer, brain tumor and carcinoma of the tongue were entered into pilot study. At the end of February 1995, a total of 21 patients were treated by carbon ions. (J.P.N.).

Purpose: Carcinoma of the nasal cavity and septum has historically been associated with a poor prognosis. This report updates the long-term outcomes for radiotherapy (RT) of this disease site at University of Texas M.D. Anderson Cancer Center. Methods and Materials: A retrospective analysis was performed on the data from 68 patients diagnosed with histologically proven carcinoma of the nasal cavity or septum treated with RT for curative intent between 1969 and 2000. The disease histologic type was as follows: 45 (66%) had squamous cell carcinoma, 12 (18%) had adenoid cystic carcinoma, 8 (12%) had adenocarcinoma, and 3 (4%) had poorly/undifferentiated carcinoma. Of the 68 patients, 32 (47%) had received definitive RT. Of these, 23 had received external beam RT and 9 brachytherapy. Of the remaining 36 patients, 3 (4%) underwent preoperative external beam RT and 33 (49%) postoperative external beam RT. Of the 68 patients, 13 (19%) received neck RT. The median dose for patients receiving definitive and postoperative RT was 65 and 58.2 Gy, respectively. The median follow-up for the entire cohort was 11 years (range, 2.4-30.1 years). Results: Of the 68 patients, 19 (28%) developed a locoregional relapse, 14 (21%) locally and 5 (7%) regionally. The local control rate at 5 and 10 years was 86% and 76%, respectively. The disease-specific survival rate was 86% and 78%, and the overall survival rate was 82% and 62% at 5 and 10 years, respectively. Conclusion: This extended follow-up of our institutional experience has demonstrated that RT can provide durable long-term locoregional control and survival outcomes for patients with carcinoma of the nasal cavity and septum.

Carbon ion radiotherapy for head and neck malignancies, which has been performed since April of 1997, was analyzed preliminarily. Of 101 head and neck patients who were treated till August 2000, 37 cases with adenocarcinomas were analyzed. They consisted of 13 cases of adenocarcinoma (AC), 16 cases of adenoid cystic carcinoma (ACC), and 8 cases with papillary adenocarcinoma (PAC) of the thyroid. There were 11 males and 2 females in AC, 6 males and 10 females in ACC, and 4 males and 4 females in PAC. Age ranged from 45 to 75 (average, 60 years old) in AC, from 39 to 79 (52) in ACC, and from 39 to 78 (69) in PAC. Target volume ranged from 31 to 484 cc (average of 206 cc) in AC, from 58 to 530 cc (210 cc) in ACC, and from 108 to 407 (253 cc) in PAC. Thirty-five cases were treated with 57.6 GyE/16 fractions/4 weeks, and 2 cases were treated with 64.0 GyE/16 fractions/4 weeks. There was no acute reaction more than grade 3 (PTOG/EORTC) in normal tissues, and all of the patients completed their scheduled irradiations. The three-year local control rate (LCR) of AC was 91%, and the three-year survival rate (SR) was 74% by the Kaplan-Meier method. In ACC, the three-year LCR was 100% and the three-year SR was 54%. In PAC, the three-year LCR was 83%, and the three-year SR was 38%. There were 2 cases of lymph node metastases, and 3 cases with distant metastases, in AC. Also, there were 2 cases with lymph node metastases, 2 cases with meningeal spread, and 6 cases with distant metastases, in ACC. In PAC, there were 3 cases with lymph node metastases. These metastases were the main causes of death of the patients. (author)

The purpose of this study is to report the outcome of using expandable metallic stent in the management of malignant tracheobronchial stenosis with dyspnea. Under fluoroscopic and bronchoscopic guidance, seven patients with malignant airway stenosis were treated with ten expandable metallic stents. The cause of stenosis was metastasis from esophageal cancer in five patients, recurrent adenoid cystic carcinoma of the trachea in one, and primary lung cancer in one. The major sites of obstruction were the trachea in four patients, the left main bronchus in one, the trachea and left main bronchus in one, and the trachea and both bronchi in one. Chest radiography (n=7), bronchoscopy (n=5), pulmonary function test (PFT)(n=3), and spirometry(n=1) were performed before and after stent placement. In all seven patients, the stent was successfully placed at the lesion sites and dyspnea began to improve immediately. After the procedure, chest radiography and bronchoscopy showed an increase in airway diameter. After the procedure, chest radiography and bronchoscopy showed an increase in airway diameter. After stent placement, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) improved 53% and 56%, respectively. Peak flow velocity also changed from 46 L/min to 200 L/min. During median follow-up of 67 (41-1565) days, one stent migration occurred. In one patient, proximal tumor overgrowth occurred, and in one, tumor ingrowth was treated with balloon dilatation. For in the palliative treatment of malignant tracheobronchial stenosis with dyspnea, placement of expandable metal stents is safe and effective. (author). 21 refs., 1 tabs., 3 figs.

Between 1969-1985, 45 patients with carcinomas of the nasal cavity proper received curative treatment. Of these, 30 had squamous cell carcinoma, 1 un-differentiated carcinoma, 9 adenocarcinoma and 5 adenoid cystic carcinoma. 18 Patients were treated with definitive radiotherapy (interstitial brachy-therapy in 5 patients and external beam therapy in 13 patients), 27 received surgery and radiotherapy. Median length of follow-up was 11 years (range 2.8-16.8 years). 36 Patients had no evidence of disease at the last follow-up visit. All 14 patients with carcinoma of nasal septum had the disease controlled. 9/31 Patients with lesions of lateral wall and floor died of the disease, 5 of uncontrolled local disease, 2 of distant metastases, 2 of both. Disease specific survival rates at 5 and 10 years were 83 and 80%, the corresponding overall survival rates were 75 and 60%. Blindness occurred in 4 patients, 2 due to orbital exenteration and 2 to radiation injury to the cornea and optic pathway. Other infrequent side effects were bone necrosis, dental decay, nasal stenosis and septal perforation. This study indicated that prognosis of patients with nasal cavity carcinoma was better than that of patients with maxillary sinus cancer treated during the same era. In addition, the study showed that carcinoma of the nasal septum were smaller than those of lateral wall and floor at diagnosis, so that excellent control could be achieved by definitive radiotherapy; when accessible, interstitial brachytherapy might be the treatment of choice in such patients. (author). 18 refs.; 4 figs.; 2 tabs.

Hepatobiliary scintigraphy with /sup 99m/Tc-N-pyridoxyl-5-methyltryptophan (/sup 99m/Tc-PMT) was carried out on 48 patients with intrahepatic masses, 44 with hepatocellular carcinoma and one each of hepatocellular adenoma, focal nodular hyperplasia, cholangiocellular carcinoma, and adenoid cystic carcinoma. Scans were performed twice, early scan (30 min post i.v.) and delayed scan (2.5 h post i.v.), and the delayed scan was used for assessing the accumulation of /sup 99m/Tc-PMT in the intrahepatic masses. In the hepatocellular carcinoma group, based on individual patients, 17 out of 44 (38.6%) showed accumulation of /sup 99m/Tc-PMT in various degrees; and based on individual masses, accumulation was noted in 21 out of 55 masses (38.2%). However, only the cases which had not received transarterial infusion of anti-cancer drugs (TAI) and/or blocking agents (TAE) were taken into consideration, 9 out of 18 patients (50%) and 12 out of 25 masses (48.0%) were found capable of picking up /sup 99m/Tc-PMT. A case of hepatocellular adenoma showed a strong accumulation of /sup 99m/Tc-PMT in the mass which was depicted as a defect on the /sup 99m/Tc-colloid scan and did not slow a significant accumulation of /sup 67/Ga. In a case of focal nodular hyperplasia, there were two space-occupying lesions (SOLs), one of which showed a clearcut defect on the /sup 99m/Tc-colloid scan and the other which showed only a distorted uptake pattern. However, both masses were strongly positive with /sup 99m/Tc-PMT. /sup 99m/Tc-PMT scintigraphy is useful in connection with /sup 99m/Tc-colloid scan and sometimes with /sup 67/Ga-citrate in the diagnosis of intrahepatic masses originating from hepatocytes. (author).

Salivary gland cancers (SGCs) frequently metastasize to cervical lymph nodes and distant organs. Currently, the mechanisms responsible for the metastatic behavior of SGC cells are not fully understood. We previously demonstrated that the stromal cell-derived factor-1 (SDF-1; also known as CXCL12)/CXCR4 system is involved in the establishment of metastasis in oral squamous cell carcinoma. In the present study, we investigated the role of CXCR4 in the metastatic behavior of SGCs. We examined the expression of CXCR4 mRNA and protein in human SGC cell lines by quantitative RT-PCR and western blotting, respectively. The expression of CXCR4 mRNA and protein were frequently upregulated in 5 out of 6 SGC cell lines. Functional CXCR4 expression was demonstrated by the ability of these SGC cell lines to migrate toward an SDF-1 gradient. SDF-1 rapidly activated extracellular signal-regulated kinase (ERK)1/2 in SGC cell lines. Immunohistochemical analysis revealed that CXCR4 protein expression was detected in either the nucleus or cytoplasm of cancer cells in 16 out of 20 tissues of adenoid cystic carcinoma (ACC) and in 4 out of 6 tissues of mucoepidermoid carcinoma, which are representative of SGC. Furthermore, ACC cell lines exhibited dramatic metastasis to the lung following intravenous inoculation, whereas AMD3100, a CXCR4 antagonist, significantly inhibited lung metastasis of the cells, ameliorated body weight loss and improved the survival rate of tumor-bearing nude mice. These results indicate that CXCR4 expression contributes to the metastatic potential of SGCs. PMID:22847686

J Oral Pathol Med (2012) Background:? The carcinogenesis mechanism of adenoid cystic carcinoma (ACC) of the salivary gland is poorly understood. MicroRNA155 (miRNA155) has been involved in the carcinogenesis of many malignant tumors. The present study aims to examine the role of miRNA155 in tumor growth and invasion of ACC. Methods:? MiRNA155 expression was determined in ACC specimens along with normal salivary glands by quantitative PCR. Using ACC-2 cells as a model for ACC, cell proliferation was examined by MTT assay after knocking down miRNA155 expression, and cell cycle analysis was performed. Invasive capacity of ACC-2 cells was examined by a Transwell culture assay. The effect of miRNA155 on tumor growth was also examined in vivo using mouse models. The effect of miRNA155 on epidermal growth factor receptor (EGFR)/NF-?B was studied by quantitative PCR and electrophoretic mobility shift assay. Results:? MiRNA155 was over-expressed in ACC. Proliferation of ACC-2 cells was markedly inhibited by knocking down miRNA155, resulting from a blockade of cell cycle in the G1 phase. Inhibition of miRNA155 significantly suppressed the invasive capacity of ACC-2 cells. In vivo growth of ACC-2 cell-derived tumors was significantly slower by inhibition of miRNA155. Inhibition of miRNA155 also resulted in decreased expression of EGFR and RelA (NF-?B). Conclusion:? The results suggest that miRNA155 facilitates cell cycle progression and promotes invasion in ACC and that the EGFR/NF-?B pathway might participate in mediating the effects of miRNA155. This study has provided insights into the carcinogenic mechanisms of ACC and identified new targets for intervention of salivary ACC. PMID:22823535

Adenoid cystic carcinoma (ACC) of the head and neck is a malignant tumor with poor long-term prognosis. Besides the recently identified MYB-NFIB fusion oncogene generated by a t(6;9) translocation, little is known about other genetic alterations in ACC. Using high-resolution, array-based comparative genomic hybridization, and massively paired-end sequencing, we explored genomic alterations in 40 frozen ACCs. Eighty-six percent of the tumors expressed MYB-NFIB fusion transcripts and 97% overexpressed MYB mRNA, indicating that MYB activation is a hallmark of ACC. Thirty-five recurrent copy number alterations (CNAs) were detected, including losses involving 12q, 6q, 9p, 11q, 14q, 1p, and 5q and gains involving 1q, 9p, and 22q. Grade III tumors had on average a significantly higher number of CNAs/tumor compared to Grade I and II tumors (P = 0.007). Losses of 1p, 6q, and 15q were associated with high-grade tumors, whereas losses of 14q were exclusively seen in Grade I tumors. The t(6;9) rearrangements were associated with a complex pattern of breakpoints, deletions, insertions, inversions, and for 9p also gains. Analyses of fusion-negative ACCs using high-resolution arrays and massively paired-end sequencing revealed that MYB may also be deregulated by other mechanisms in addition to gene fusion. Our studies also identified several down-regulated candidate tumor suppressor genes (CTNNBIP1, CASP9, PRDM2, and SFN) in 1p36.33-p35.3 that may be of clinical significance in high-grade tumors. Further, studies of these and other potential target genes may lead to the identification of novel driver genes in ACC. PMID:22505352

We evaluated {sup 18}F-FDG PET/CT findings in initially diagnosed adenoid cystic carcinoma (ACC) of the head and neck in association with pathological subtype, staging, uptake comparison with squamous cell carcinoma (SqCC) and prognosis. The subjects were 16 patients with initially diagnosed ACC of head and neck who underwent pretreatment {sup 18}F-FDG PET/CT. Histological subtype (solid pattern vs. tubular/cribriform pattern), SUV{sub max} of size-matched SqCC of the head and neck as control group, disease-free survival (DFS) were compared with the SUV{sub max} of ACC of the head and neck. Of total 16 patients, 6 had solid pattern and the remaining 10 had tubular/cribriform pattern. The SUV{sub max} were significantly higher in solid pattern group than in tubular/cribriform pattern group (6.7{+-}3.2 vs. 4.2{+-}0.9, p=0.03). PET/CT found unexpected distant metastasis in 18.7% of patients (3/16) and changed the therapeutic plan in those patients. The SUV{sub max} of ACC was significantly lower than that of size-matched SqCC (5.1{+-}2.4 vs. 13.6{+-}6.0, p<0.001). DFS was not significantly different according to the histological subtype. In contrast, patients with high {sup 18}F-FDG uptake (SUV{sub max} {>=}6.0) had significantly shorter DFS than those with low {sup 18}F-FDG uptake (SUV{sub max} <6.0). {sup 18}F-FDG uptake of ACC of the head and neck is significantly associated with histological subtype and DFS. {sup 18}F-FDG PET/CT may be useful for detecting unexpected metastasis. Since {sup 18}F-FDG uptake of tubular/cribriform ACC compared with SqCC is relatively low, it is necessary to interpret PET images carefully in patients without alleged ACC.

Forty eight patients with adenoid cystic carcinoma(ACC) in the head and beck treated between 1979 and 1990 were reviewed according to treatment modalities and clinical courses. The common site of origin was minor salivary gland (69%), mostly had palate and maxillary sinus. 11 patients received radiation therapy(RT) alone and 37 patients received combined surgery and radiation therapy. The follow-up period of the survivors ranged from 4 to 118 months (median 49.5 months). The 5 year local control rate was 69.3%, 67.3% and 83.9% in RT alone, conservative operation(OP)+RT and radical OP+RT group, respectively(p>0.05). The control of local disease was best achieved with radical OP+RT. In postoperative RT, high dose ({>=}60 Gy) and generous field size (>64cm{sup 2}) yielded a better local control rate. Actuarial overall survival rate was 79.0%, at 5 years and 19.2% at 10 years. Distant metastases (DM) developed in 40% of patients, mostly in the lung. Disease-free(NED) survival rate was 45.8%, at 5 years and significant differences did not exist according to primary sites and treatment options. Survival rate after the onset of DM was 19.5% at 5 years. Occurrence of DM tends to lower survival significantly. In an effort to find the role of RT in the treatment of ACC, our data suggest that a well-planned postoperative RT employing a high dose and generous field size can produce high local control rate and remaining urgent problem of distant metastasis demands more effective chemotherapy for the purpose of improving survival of ACC patients.

Background: Tumor doses > 70 Gy are needed for local control in adenoid cystic carcinomas. These tumor doses cannot be delivered if the tolerance doses to neighboring organs at risk (OAR) are respected. This treatment planning study investigates the physical advantage of combined photon intensity-modulated radiation therapy (IMRT) plus carbon ion boost compared to photon IMRT alone. Patients and Methods: For nine patients, treatment plans were generated using a) photon IMRT alone (integrated boost concept), and b) sum plans consisting of a photon IMRT plan and a carbon ion boost plan. 54 Gy were prescribed to the planning target volume 1 (PTV1), the boost volume (PTV2) received 72 Gy. The tolerance doses of the delineated OAR were strictly adhered to. Plan quality of IMRT plans and sum plans was compared using adequate physical parameters. Results: Both therapy techniques lead to highly conformal dose distributions that allow the prescription of the desired target doses. Target conformality and heterogeneity as well as target coverage for PTV1 are comparable for both techniques. The target coverage for PTV2 can be significantly improved using carbon ion beams (median 95% coverage 93.7% vs 87%; p = 0.039). Furthermore, the mean doses to the OAR can be reduced by 8.3% (median % reduction of mean doses to OAR; p = 0.00001) using carbon ions. Conclusions: The combination of photon IMRT with carbon ions improves the target coverage for the boost volume and offers better sparing of OAR close to the PTV2 (gross tumor volume) in comparison with photon IMRT alone. A clinical study has been initiated to evaluate whether these potential advantages translate into clinical benefit. (orig.)

Abstract in portuguese Vários estudos mostram que a perda da função do gene TP53 desempenha um importante papel na gênese de diversas neoplasias, incluindo as neoplasias de glândula salivar. Assim, o objetivo deste estudo foi avaliar a presença de mutações no gene TP53 em neoplasias de glândula salivar. Para isso, DNA genômico foi extraído de casos de adenoma pleomórfico (AP), carcinoma em adenoma pleomórfico (CAP), carcinoma mucoepidermóide (CME), carcinoma adenóide cístico (CA (more) C) e adenocarcinoma polimorfo de baixo grau de malignidade (APBG) emblocados em parafina. Foi realizada amplificação pela técnica da PCR dos exons 5 a 8 e em seguida a SSCP (análise de conformação de fita simples). Foi observada alteração na mobilidade das bandas em 9 das 18 neoplasias estudadas, principalmente nos exons 5 e 8. Esses achados sugerem que mutações no gene TP53 estão relacionadas à patogênese das neoplasias de glândula salivar e que os exons 5 e 8 estão mais freqüentemente envolvidos. Abstract in english Many studies have demonstrated that loss of TP53 gene function has an important role in the genesis of many neoplasms, including salivary gland neoplasms. The purpose of this study was to examine the mutation profile of the TP53 gene in salivary gland neoplasms. Genomic DNA was extracted from paraffin-embedded tissues of pleomorphic adenoma, carcinoma in pleomorphic adenoma, mucoepidermoid carcinoma, adenoid cystic carcinoma and polymorphous low grade adenocarcinoma. Exon (more) s 5 to 8 of the TP53 gene were amplified by polymerase chain reaction (PCR) to perform single-stranded conformational polymorphism (SSCP) analysis. Band shifting was observed in exons 5, 6 and 8 in 9 out of 18 neoplasms. The results of this study suggest that mutations in TP53 gene are related to salivary gland neoplasms pathogenesis and that exons 5 and 8 are most frequently involved.

Two major antibody classes operate in saliva: secretory IgA (SIgA) and IgG. The former is synthesized as dimeric IgA by plasma cells (PCs) in salivary glands and is exported by the polymeric Ig receptor (pIgR). Most IgG in saliva is derived from serum (mainly via gingival crevices), although some is locally produced. Gut-associated lymphoid tissue (GALT) and nasopharynx-associated lymphoid tissue (NALT) do not contribute equally to mucosal PCs throughout the body. Thus, enteric immunostimulation is an inadequate mode of stimulating salivary IgA antibodies, which are poorly associated with the intestinal SIgA response, for instance after enteric cholera vaccination. Nevertheless, the IgA response in submandibular/sublingual glands is better related to B cell induction in GALT than the parotid response. Such disparity is suggested by the elevated levels of IgA in submandibular secretions of AIDS patients, paralleling their highly upregulated intestinal IgA system. Moreover, in patients with active celiac disease, IgA antibodies to disease-precipitating gliadin are reliably represented in whole saliva but not in parotid secretion. Parotid SIgA may be more consistently linked to immune induction in palatine tonsils and adenoids (human NALT), as supported by the homing molecule profile of NALT-derived B cell blasts. Also several other variables influence the levels of antibodies in oral secretions. These include difficulties with reproducibility and standardization of immunoassays, the impact of flow rate, acute or chronic stress, protein loss during sample handling, and uncontrolled admixture of serum-derived IgG and monomeric IgA. Despite such problems, saliva remains an interesting biological fluid with great scientific and clinical potentials. PMID:17435136

Leprechaunism (Donohue syndrome) is the most severe type of insulin receptor (INSR) gene anomaly with the majority of patients surviving for only 2 years. We report a surviving 2 -year-old male with leprechaunism, bearing novel compound heterozygous mutations in the INSR. The patient is a Japanese boy with acanthosis nigricans, lack of subcutaneous fat, hirsutism, thick lips, gum hypertrophy and extremely high insulin levels (6702 mU/mL). He was as having identified novel compound heterozygous mutations in INSR (p.T910M and p. E1047K). At 24 day-old, recombinant human insulin-like growth factor 1 (rh-IGF1) treatment was started because of poor weight gain. At 2 years old, the patient’s serum glucose level and HbA1C value had worsened, and both a bolus of rh-IGF-1 and a subcutaneous injection of a rapid-acting insulin analog after meals, in addition to ?-glycosidase inhibitor, were initiated from 2 years onward. Oxygen administration and biphasic positive airway pressure treatment were also initiated from 2 years old due to upper airway obstruction with adenoidal hypertrophy. In the experiments conducted using COS7 cells homozygously transfected with the INSR mutation, T910M INSR failed to process the proreceptor and decreased insulin-stimulated tyrosine phosphorylation. E1047K INSR resulted in a complete absence of insulin-stimulated tyrosine phosphorylation. These findings suggest the near absence of INSR in this patient. We consider that the rhIGF1 treatment contributed to his long survival, but it was not able to prevent his diabetic condition. Our report provides important insights into the function of INSR, and for the treatment of leprechaunism.   

Plain chest films are the most useful modality in diagnosis of primary lung cancer, but it is difficult to interpret the radiologic findings by histological types. Authors reviewed chest films of 324 cases of histologically confirmed primary lung cancer from January 1974 to April 1982 at Seoul National University. The results are as follows; 1. Incidence was most common in the 6th decade as 34.4%. Male to female sex radio was 3.8 : 1 and there was no sex difference in Adenocarcinoma. 2. Distribution of histologic types of primary lung cancers as follows; Squamous cell carcinoma 50.6%, Small cell carcinoma 22.5%, Large cell carcinoma 9.3%, Bronchogenic adeno carcinoma 10.5%, Bronchioloalveolar cell carcinoma 1.9%, Adenosquamous carcinoma 0.6%, Carcinoid tumor 0.3%, Adenoid cystic carcinoma 0.3%. 3. Radiologic findings by histologic types are follows; a) Squamous cell carcinoma commonly present as collapse (51.8%), peripheral mass (40.8%), pneumonitis (37.2%), hilar involvement (34.8%), and in single abnormality, peripheral mass (44.4%). b) Small cell carcinoma commonly present as hilar involvement (78.1%), mediastinal widening or mass (53.4%) and in single abnormality, hilar involvement (58.3%). c) Large cell carcinoma commonly present as hilar involvement (50%), pneumonia (46.7%), collapse (40%), peripheral mass (36.7%) and in single abnormality, large peripheral mass (33.3%). d) Bronchogenic adenocarcinoma commonly present as peripheral mass (44.1%), collapse (41.2%), pleural effusion (35.2%) and in single abnormality, peripheral mass (50%). e) Solitary peripheral mass commonly present as lobulation (48%) and spiculated margin (51%), but no specific findings by histologic types. Cavitary formation was most common in Squamous cell carcinoma.

The aim of this study was to determine the expression of human epidermal growth factor receptor type 2 (HER2), epidermal growth factor receptor (EGFR), peroxisome proliferator-activated receptor ? (PPAR?), CD44 and androgen receptor (AR) in adenoid cystic carcinomas (ACC), carcinoma ex pleomorphic adenomas (CXPA) and mucoepidermoid carcinomas (MEC) of the salivary glands, to investigate their molecular difference and to estimate the availability of molecular-targeted and hormonal therapy in salivary-gland tumors. Forthy patients with a salivary gland tumor, diagnosed and treated at our hospital, were studied. On the basis of histopathology, 10, 19 and 11 patients were identified with ACC, CXPA and MEC, respectively. The associations between histological types were evaluated by the chi-square test. Differences were considered statistically significant at P < 0.05. HER2-positive expression was observed in 10% of ACC, 84% of CXPA and 18% of MEC. EGFR-positive expression was observed in 40% of ACC, 68% of CXPA and 91% of MEC. CD44-positive expression was observed in 40% of ACC, 47% of CXPA and 91% of MEC. PPAR?-positive expression was observed in 10% of ACC, 53% of CXPA and 18% of MEC. AR-positive expression was observed in 20% of ACC, 32% of CXPA and 9% of MEC. Compared with other histological types, CXPA demonstrated significant HER2 and PPAR? staining and MEC demonstrated significant EGFR and CD44 staining. The differences in expression of markers between histological types in our study suggests the possibility that HER2- and PPAR?-targeted therapy may be effective in CXPA, and that EGFR-target therapy may be effective in MEC of the salivary glands.   

OBJECTIVE To use information about prevalence, cost, and variation in resource utilization to prioritize comparative effectiveness research topics in hospital pediatrics. DESIGN Retrospective analysis of administrative and billing data for hospital encounters. SETTING Thirty-eight freestanding US children's hospitals from January 1, 2004, through December 31, 2009. PARTICIPANTS Children hospitalized with conditions that accounted for either 80% of all encounters or 80% of all charges. MAIN OUTCOME MEASURES Condition-specific prevalence, total standardized cost, and interhospital variation in mean standardized cost per encounter, measured in 2 ways: (1) intraclass correlation coefficient, which represents the fraction of total variation in standardized costs per encounter due to variation between hospitals; and (2) number of outlier hospitals, defined as having more than 30% of encounters with standardized costs in either the lowest or highest quintile across all encounters. RESULTS Among 495 conditions accounting for 80% of all charges, the 10 most expensive conditions accounted for 36% of all standardized costs. Among the 50 most prevalent and 50 most costly conditions (77 in total), 26 had intraclass correlation coefficients higher than 0.10 and 5 had intraclass correlation coefficients higher than 0.30. For 10 conditions, more than half of the hospitals met outlier hospital criteria. Surgical procedures for hypertrophy of tonsils and adenoids, otitis media, and acute appendicitis without peritonitis were high cost, were high prevalence, and displayed significant variation in interhospital cost per encounter. CONCLUSIONS Detailed administrative and billing data can be used to standardize hospital costs and identify high-priority conditions for comparative effectiveness research-those that are high cost, are high prevalence, and demonstrate high variation in resource utilization. PMID:23027409

The sodium iodide symporter (hNIS), an intrinsic transmembrance protein that mediates active transport of iodine in the thyroid gland, has also been demonstrated in lactating mammary gland. We investigated the expression of hNIS mRNA in primary breast tumors and its correlation with the uptake of Tc-99m-pertechnetate (TcO4). Thirty-two consecutive patients (28 ductal, 1 papillary, 1 adenoid cystic and 1 medullary carcinoma, and 1 lactating adenoma ) underwent mammogrpahy and TcO4 scintigraphy of the breast before surgery. Both lateral images in prone position and anterior image in supine position were obtained 30 min after injection of 370 MBq of TcO4. The scintigraphy was considered to be positive when there was focal uptake that was higher than upper thoracic wall and adjacent normal breast activity. We measured the expression levels of hNIS mRNA in 32 breast tumor tissues and 14 normal tissues by noncompetitive reverse transcription-polymerase chain reaction (RT-PCR), RT-PCR values were quantified by measuring the optical density of electrophoresis bands and normalized to the GAPDH values. TcO4 scintigrpahy revealed positive uptake in 4 (2 invasive ductal, 1 papillary, and 1 lactating adenoma) out of 32 patients. There was a wide range distribution of normalized hNIS mRNA levels of breast tumors (n=32, 0.85{+-}0.88, range 0.10-4.97) and normal breast tissue (n=14, 0.95{+-}1.25, range 0.21-4.48 )without significant difference. However, mRNA expression of hNIS was higher in tumors with positive uptake on the scintigraphy (n=4, median 0.95, range 0.69-1.27) than that in negative uptake tumors (n=28, median 0.52, range 0.10-4.97, p<0.05). TcO4 uptake was correlated with the hNIS mRNA expressions in the breast tumor suggesting that TcO4 scintigraphy may predict hNIS mRNA expression in human breast tumor tissue.

Abstract in portuguese A hipertrofia obstrutiva das tonsilas palatinas e faríngeas está associada à respiração oral e pode levar a desequilíbrios faciais. A adenotonsilectomia parece ser insuficiente para o tratamento quando ocorreram alterações anatômicas. Técnicas ortopédicas faciais auxiliam no restabelecimento morfofuncional. Estudo clínico longitudinal prospectivo objetivou observar alterações craniofaciais após adenotonsilectomia e verificar a importância de associar ortop (more) edia ao tratamento. MATERIAL E MÉTODO: Cinquenta e três crianças de ambos os gêneros, entre 6 e 12 anos, divididas em: Grupo 1, 20 crianças com respiração nasal; Grupo 2, 33 crianças com hipertrofia obstrutiva das tonsilas faríngeas e/ou palatinas, submetidas à adenotonsilectomia. Após a cirurgia, este grupo foi subdividido: Grupo 2A, 16 pacientes não tratados com expansão rápida da maxila; Grupo 2B, 17 pacientes tratados com disjunção maxilar. Foram realizadas medidas cefalométricas em norma frontal e lateral anteriores à cirurgia e após 14 meses. Foram utilizados os testes Kruskal-Wallis e Wilcoxon, com nível de significância de 5%. RESULTADOS: A adenotonsilectomia equilibrou o crescimento transversal, sagital e vertical em ambos os grupos, sendo mais efetiva no grupo submetido ao tratamento combinado. CONCLUSÕES: A adenotonsilectomia favoreceu o crescimento facial das crianças com hipertrofia obstrutiva, sendo mais evidente quando associada à expansão maxilar. Abstract in english Obstructive hypertrophy of the tonsils and/or adenoids is associated with mouth breathing and can lead to facial imbalances. Adenotonsillectomy is not enough to treat the anatomic changes. Facial orthopedic techniques aid in morphological and functional recovery. This prospective longitudinal clinical study aimed to observe craniofacial changes after adenotonsillectomy and to verify the importance of linking rapid maxillary expansion to treatment. METHOD: Fifty-three chil (more) dren of both genders, aged 6 to 12 years, were allocated to: Group 1, 20 children with nasal breathing; and group 2, 33 children with obstructive hypertrophy of pharyngeal and/or palate undergoing adenotonsillectomy. After surgery, this group was subdivided into Group 2A, 16 patients not treated with rapid maxillary expansion; and Group 2B, 17 patients treated with maxillary rapid expansion. Frontal and lateral cephalometric measurements were made prior to surgery and after 14 months. Statistical analysis used the Kruskal-Wallis and Wilcoxon tests - significance level of 5%. RESULTS: Adenotonsillectomy balanced transversal, sagittal and vertical growth in both groups, and was more effective in the group undergoing combined treatment. CONCLUSIONS: Adenotonsillectomy improved the facial growth of children with obstructive hypertrophy, which was more evident when associated with rapid maxillary expansion.

Abstract in portuguese OBJETIVO: este trabalho tem por objetivo determinar a freqüência relativa e a distribuição das neoplasias epiteliais benignas e malignas de glândulas salivares. FORMA DE ESTUDO: Coorte histórica. MATERIAL E MÉTODO: registradas no Laboratório de Patologia e Citologia, em Aracaju-SE, no período de janeiro de 1980 a dezembro de 1999, considerando-se as variáveis sexo, idade, tipo racial, localização anatômica e diagnóstico histopatológico. RESULTADO: Dos 162.3 (more) 12 casos registrados, 245 (0,15%) foram de neoplasias epiteliais de glândulas salivares, sendo 187 de natureza benigna (76,33%) e 58 (23,67%) malignas. O adenoma pleomórfico foi o tumor benigno mais identificado (89,94%) e o carcinoma adenóide cístico foi o representante maligno mais prevalente (22,41%). As neoplasias benignas ocorreram principalmente entre as 2º e 3º décadas de vida, exibindo predileção pelo sexo feminino, enquanto as malignas foram diagnosticadas entre as 6º e 7º décadas de vida, sendo as mulheres o principal alvo. CONCLUSÃO: Constatou-se que o padrão epidemiológico das neoplasias estudadas está em consonância com a maioria da literatura pesquisada. Abstract in english AIM: The aim of the present study is to establish the relative frequency and distribution of benign and malignant epithelial neoplasms of salivary glands in the Pathology and Cytology Laboratory, STUDY DESIGN: Historic cohort. MATERIAL AND METHOD: in the state of Sergipe, during the period 1980-1999. The neoplasms were individualized by gender, age, race of the patients, anatomic localization of the lesions and histopathological diagnosis. RESULTS: Out of 162,312 register (more) ed cases, 245 were salivary gland epithelial neoplasms and 187 (76.33%) were benign and 58 (23.67%) were malignant. Pleomorphic adenoma was the most frequent benign neoplasm (89.94%) and adenoid cystic carcinoma represented the most prevalent malignant neoplasm (22.41%). The benign neoplasms occurred mainly between the second and third decades of life and showed preference for female, while malignant neoplasms were diagnosed between the sixth and seventh decades of life and in women. CONCLUSION: The data demonstrated that epidemiology profile of the studied neoplasms corroborated most of the studied literature.

HIBMC is the world's first facility to be able to use both proton (PRT) and carbon-ion radiotherapy (CiRT). The medically dedicated synchrotron can accelerate protons up to 230 MeV and carbon ions up to 320 MeV. From April 2001 to March 2010, the facility treated 3275 patients, with 2487 patients treated using PRT and 788 using CiRT. Particle radiotherapy was delivered to patients suffering from malignant tumors originating in the head and neck (502 patients), lungs (330), liver (539), prostate (1283), and the bone and soft tissue (130). The clinical results are as follows: (1) H and N tumors: The 2-year overall survival (OS) rates of patients with olfactory neuroblastoma, mucoepidermoid cancer, adenoid cystic cancer, adenocarcinoma, squamous cell carcinoma, and malignant melanoma was 100%, 86%, 78%, 78%, 66%, and 62%, respectively. (2) Lung cancer: For all 80 patients, the 3-year OS rate was 75%(Stage IA: 74%; Stage IB: 76%) and local control (LC) rate was 82%(IA: 87%; IB: 77%). Grade 3 pulmonary toxicity was observed in only 1 patient. These results are comparable to those obtained by surgery, and indicate proton therapy and carbon-ion therapy are safe and effective for stage I lung cancer. (3) Liver cancer: The 5-year LC rate for 429 tumor patient was 90%, and the 5-year OS rate for 364 patients was 38%. These results seem equivalent to those obtained by surgery or radio-frequency ablation. (4) Prostate cancer: In 290 patients treated by proton radiotherapy, five patients died from other disease in the median follow-up period of 62 months. Biochemical disease-free survival and OS rate at 5 years was 88.2% and 96.5%, respectively. Our proton radiotherapy showed excellent OS and biochemical disease-free survival rates with minimum late morbidities. PRT VS CiRT: From our retrospective analysis, it seems that there is no significant difference in the LC and OS rate in H and N, lung and liver cancer between PRT and CiRT.

Abstract in spanish Objetivo: Presentamos dos casos con diagnóstico histológico de carcinoma adenoideo quístico de la próstata, tumor de presentación extremadamente raro. Métodos: Evaluamos a dos pacientes con edad de presentación, manifestación clínica, diagnóstico, tratamiento y evolución distintos. Resultados: La edad varia de 41 y 59 años, con dolor perineal y sintomatología urinaria baja, tacto rectal masa tumoral redondeada y dura o normal respectivamente. El antígeno pro (more) stático específico y la fosfatasa ácida prostática son normales, el ultrasonido transrectal puede ser normal o aportar con el hallazgo de nódulo hipoecoico, se realizó tratamiento quirúrgico con prostatectomía radical e inmunoterapia adyuvante en el primero que a los 6 años evoluciona a metastasis pulmonar y muere, el otro cistoprostatectomía radical con derivación urinaria ortotópica con buena evolución a los dos años. Conclusiones: La clínica es inespecífica, generalmente el diagnóstico es mediante resección transuretral o biopsia transrectal ante la sospecha por tacto rectal o ultrasonido, es inmunoreactivo para p53 y citoqueratinas 7 y 34 beta E12 y el tratamiento de elección es la cistoprostatectomía radical debido a que es una neoplasia potencialmente agresiva y puede añadirse tratamiento adyuvante. Abstract in english Objective: We report two cases with the pathologic diagnosis of cystic adenoid carcinoma of the prostate, an extremely rare tumor. Methods: We evaluate two patients with different age, clinical presentation, diagnosis, treatment and outcome. Results: The ages were 41 and 59, the symptoms perineal pain and lower urinary tract symptoms, on digital rectal examination a round hard tumor mass and normal exam, respectively. PSA and prostatic acid phosphatase were normal; Transr (more) ectal ultrasound may be normal or find a hypoechoic node. The first patient underwent radical prostatectomy and adjuvant immunotherapy; six years after surgery he developed lung metastasis and died. The second patient underwent radical cystoprostatectomy with orthotopic urinary diversion with good outcome after two years of follow-up. Conclusions: The clinical presentation is non specific, with the diagnosis generally obtained by transurethral resection or transrectal biopsy after the suspicion of an abnormal digital rectal examination or ultrasound. The tumor is immunoreactive to p53 and citokeratins 7 and 34 Beta E12, and the treatment of choice is radical cystoprostatectomy because it is a potentially aggressive neoplasia; adjuvant treatment may be added.

Abstract in portuguese OBJETIVO: Revisão dos achados clinicopatológicos dos tumores de glândulas salivares diagnosticados no período de 1980 a 1997 no Departamento de Patologia da Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM/Unifesp). MÉTODO: Foi realizado estudo retrospectivo de 205.967 diagnósticos anatomopatológicos e encontrados 119 casos de neoplasias de glândulas salivares, sendo 93 (78%) neoplasias benignas e 26 (22%) malignas. RESULTADOS: A idade variou (more) de 6 a 74 anos (média de 40 anos), sendo 71 (60%) pacientes do sexo feminino e 48 (40%) do sexo masculino. Com relação à topografia, 84 (70,6%) casos foram de parótida, 23 (19,3%) de glândula submandibular, 11 (9,24%) de glândulas salivares menores e um (0,86%) de glândula sublingual. Quanto ao tipo histológico, os tumores corresponderam a 59,7% de adenomas pleomórficos, 10% de cistoadenomas papilíferos linfomatosos (tumor de Warthin), 9,3% de carcinomas adenóides císticos e 8,4 % de carcinomas mucoepidermóides. CONCLUSÃO: O padrão de distribuição dos tumores de glândulas salivares foi semelhante ao encontrado em outras séries. A análise desta distribuição permite identificar variáveis como localização e padrão histológico, subsídios importantes que devem ser considerados no tratamento e em estudos de marcadores prognósticos. Abstract in english BACKGROUND: The purpose of this study was to review clinicopathological aspects of salivary glands tumours from 1980 through 1997 at Departament of Pathology of Paulista School of Medicine - Federal University of São Paulo - Unifesp. METHODS: We retrospectively evaluated 205.967 pathological reports and we found 119 salivary gland tumours, 93 benign neoplasms (78%) and 26 malignant tumours (22%). RESULTS: The age range was 6-74 years (mean age 40 years), 71 cases were in (more) female (60%) and 48 cases were in male (40 %). The distribution of tumours in various sites were 84 cases of parotid tumours (70.6%), 23 cases of submandibular (19.3%), 11 cases of minor (oropharyngeal) glands (9.24%) and just one case of sublingual gland tumour (0.86%) . Pleomorphic adenoma forming 59.7% of the total salivary gland tumours, Warthin's tumour forming 10% of the series, adenoid cystic carcinoma forming 9.3% and mucoepidermoid carcinoma forming 8.4%. CONCLUSIONS: Some aspects like distribution of tumour in relation to the site and histopathological pattern are very important to considered in the treatment of the disease and prognosis.

Abstract in spanish Introducción: Secreciones sinonasales patológicas y elevados niveles de factor de necrosis tumoral alfa (TNF?) se han encontrado en mucosa sin usal de pacientes con sinusitis crónica. Las células ciliadas respiratorias tienen una reserva funcional que les permite autorregular su frecuencia de batido ciliar (FBC) en respuesta a cambios en la viscosidad, modificando los niveles de calcio intraacelular [Ca+²]ic. Objetivo: Nuestro objetivo es determinóar si TNF^ (more) 5; afecta el mecanismo de autorregulación y la homeostasis del calcio intraacelular frente a cambios en la viscosidad. Material y método: Cultivos primarios de explantes de tejido adenoideo. Registro de FBC mediante microfotodensitometría. Cultivos tratados con TNF? (10 ng/ml) o control durante 24 y 48 horas. Se in crementó la viscosidad agregando dextrano 500 al 10% y 20%. Se midió [Ca+²]ic en células cargadas con Fura 2AM. Resultados: El tratamiento con TNF? por 48 horas produjo una significativa disminución de la FBC a baja viscosidad, aumento significativo de [Ca+²]ic y caída mayor de FBC en cultivos tratados con tapsigargina (bloqueador bomba calcio-ATPasa retículo). in o se encontró diferencia a alta viscosidad. Conclusión: Después de 48 horas de exposición a TNF? se observa un efecto negativo en el mecanismo de adaptación de las células ciliadas a un medio con baja viscosidad, probablemente secundario a cambios en la homeostasis del [Ca+²]ic. Abstract in english Introduction: Pathologic sin onasal secretions and elevated levels of tumor necrosis factor alpha (TNF?) have been in oted in sin us mucosa ofpatients with chronic sinusitis. Respiratory ciliated cells have a functional reserve that allows them to autoregulate their ciliary beat in response to the changesin viscosity, modify in g intraacellular calcium levels [Ca+²]ic. Aim: Our goal was to determinate if TNF? affect this autoregulation to viscosity and calcium (more) homeostasis. Material and Method: Primary cultures from adenoid tissue expiants. Ciliary beat frequency (CBF) was recorded usin g microphotodensitometry Cultures viere treated with TNF? (10 ng/ml) or control during 24 and 48 hours. Viscosity wasincreased by add in g dextran 500 10% and 20%. [Ca+²]ic was determined in cells loaded with Fura-2AM. Results: 48 hours treatment with TNF? produced a significant decrease in CBF at low viscosity significant increase in [Ca+²]ic and greater decrese in CBF in cultures treated with thapsigargin (endoplasmic calcium-ATPase pump blocker). Conclusions: After 48 hours ofexposure to TNF? a negative effect in the adaptation mechanism to a low viscous media is observed in ciliated cells, probably secondary to changesin homeostasis of [Ca+²]ic.

Abstract in spanish Introducción: El cáncer laríngeo en 95% de los casos corresponde a carcinomas escamosos, siendo el porcentaje restante de diversos tipos histológicos. Objetivo: Determinar la frecuencia de cáncer laríngeo de histología inhabitual en nuestro centro. Material y método: Estudio retrospectivo, revisión de fichas clínicas de pacientes con diagnóstico histopatológico de cáncer laríngeo evaluados en el Servicio Otorrinolaringología Hospital San Juan de Dios, entre (more) años 2000-2008. Se describen sexo, edad, tipo histológico, hábito tabáquico y localización tumoral, realizándose un análisis descriptivo de los datos. Resultados: Se incluyeron 85 pacientes; 74 casos (87,1%) de sexo masculino; promedio edad 64 años; se encontraron 5 casos de tumores de histología inhabitual (5,9%); un caso respectivamente de: condrosarcoma, tumor carcinoide, carcinoma adenoideo-quístico, carcinoma sarcomatoide y carcinoma verrucoso. Discusión: Se podría sospechar histología inhabitual con base estadística ante un paciente menor de 60 años y con un tumor de localización subglótica. Además, sexo femenino, no fumador y más de una toma de muestra para biopsia. Conclusión: Los tumores de histología inhabitual se encontraron en 5,9%> de los casos, similar a lo reportado en la literatura. Abstract in english Introduction: The laryngeal cancer in 95%> of the cases corresponds to squamous cell carcinomas, being the remaining percentage several histological different types. Aim: To determine the frequency of laryngeal cancer of unusual histology in our center. Material and method: Retrospective study review of clinical data of patients with histophatological diagnosis of laryngeal cancer evaluated in Otolaryngology Department ofSan Juan de Dios's Hospital between years 2000-2008 (more) . Sex, age, histological type, tobacco smoking and tumor location are described, being carried outa descriptive analysis ofthe data. Results: 85 patients were included; 74 cases (87,1 %>) ofmasculine sex; mean age 64 years; there were 5 cases of unusual histology tumors (5,9 %>); a case respectively of: chondrosarcoma, carcinoid tumor, adenoid-cystic carcinoma, sarcomatoid carcinoma and verrucous carcinoma. Discussion: It might suspect unusual histology with statistical base in patient younger than 60 years and tumor of subglotic location. Also, in feminine patient, not smoking and more than one capture ofsample forbiopsy Conclusion: The tumors of unusual histology viere found in a 5.9% of the cases, similar to the reponed in the literature.

Abstract in portuguese INTRODUÇÃO: Mutações no gene TP53 têm sido identificadas em várias neoplasias, incluindo as de glândulas salivares (NGS). Entretanto não existe consenso sobre o significado biológico da expressão de p53 nessas lesões. OBJETIVOS: Avaliar a marcação imuno-histoquímica do antígeno p53 em NGS, investigando possíveis diferenças entre lesões benignas e malignas, entre diferentes tipos histológicos e entre tumores malignos que: 1) não desenvolveram metástase (more) s; 2) emitiram metástases; e 3) metástases de NGS. MATERIAL E MÉTODO: Foram avaliados 16 casos de adenomas pleomórficos (AP), 17 lesões malignas que não apresentaram metástase durante a proservação (sete carcinomas adenóides císticos [CAC] e dez mucoepidermóides [CM]), 13 tumores malignos que emitiram metástases (nove CAC e quatro CM) e, ainda, 12 metástases regionais ou distantes (cinco CAC e sete CM). Por marcação imuno-histoquímica (estreptavidina-biotina-peroxidase), índices médios de localização do antígeno p53 foram estabelecidos para cada tumor. Para análise, utilizaram-se testes de Mann-Whitney e Kruskal-Wallis, com nível de significância de 5%. RESULTADOS: Foram observadas diferenças estatisticamente significantes nos índices médios de imunomarcação de p53 entre lesões benignas e malignas (p = 0,03) e entre os diferentes tipos histológicos, notadamente entre o AP e o CM (p = 0,02). Todavia houve marcada sobreposição dos intervalos de índices de expressão entre os grupos testados. Nenhuma diferença de expressão foi observada entre as neoplasias malignas quanto ao seu comportamento metastático. CONCLUSÃO: Embora a expressão de p53 tenha sido detectada em todos os subtipos de NGS, a marcação imuno-histoquímica deste antígeno não permitiu discriminar os tumores malignos quanto ao seu comportamento biológico. Abstract in english BACKGROUND: Mutations in the tumor suppressor gene TP53 have been found in many tumors, including salivary gland neoplasms (SGN). However, there is not consensus about the influence of p53 protein expression on the biological behavior of SGN. OBJECTIVES: To compare the expression of p53 between benign and malignant neoplasms, among histologic subtypes of those tumors, and among (1) tumors that did not metastasize; (2) primary lesions that emitted metastasis; and (3) metas (more) tasis of SGN, by immunohistochemistry. MATERIAL AND METHOD: It was evaluated 16 cases of pleomorphic adenoma (PA), 17 samples of primary malignant tumors that did not metastasize throughout preservation (seven adenoid cystic carcinoma [ACC] and ten mucoepidermoid carcinomas [MC]), 13 malignant neoplasms that emitted metastasis (nine ACC and four MC) and 12 regional or distant metastasis (five ACC and seven MC) by immunohistochemical detection of p53 antigen (streptavidin-biotin-peroxidase method). Statistical analyses were performed by Mann-Whitney and Kruskal-Wallis tests. p value below 0.05 was considered significant. RESULTS: A significant difference between benign and malignant lesions (p = 0.03) and among different histological types (p = 0.02) was observed, notably between PA and MC. Malignant lesions with distinct biological behavior did not differ according to this analysis.

Abstract in portuguese INTRODUÇÃO: Recentemente, tem-se relacionado respiração oral a insucessos no desempenho escolar. Esta é uma das queixas mais freqüentes na idade pré-escolar e é causada, principalmente, pelos processos alérgicos e o aumento de amígdalas e adenóide. OBJETIVO: Comparar o processo de aquisição da linguagem escrita e problemas disciplinares entre crianças com e sem distúrbios respiratórios. MÉTODO: Realizado levantamento de prontuários de 152 pré-escolares (more) de escola particular na cidade de São Paulo em 2002, sobre desempenho escolar. Foi investigado o quadro de respiração oral e os professores classificaram o nível de aquisição da linguagem escrita de acordo com Emília Ferreiro. Foram avaliados, ainda, os aspectos disciplinares e encaminhamento ao reforço escolar. Problemas emocionais, visuais ou auditivos, também foram levantados e agrupados sob a denominação de dificuldades. RESULTADOS: Houve um predomínio de meninos no grupo com respiração oral. Há maior número de crianças com respiração oral dentre as que participam do reforço escolar e encontram-se nos níveis de aquisição da linguagem não adequados para esta faixa etária. Não houve relação com o grupo descrito como dificuldades. Houve relação entre problemas de disciplina e respiração oral. CONCLUSÃO: Há relação entre respiração oral e problemas disciplinares e de aprendizado. É de grande importância a orientação e o conhecimento dos profissionais da educação sobre a relação da respiração oral, roncos, distúrbios respiratórios do sono e o desempenho escolar e aprendizado, a fim de reconhecer as crianças e orientar os pais na busca de um tratamento específico, contribuindo para uma melhora da evolução do aprendizado das crianças. Abstract in english INTRODUCTION: Recently, mouth breathing has been related to poor school performance. This is one of the most common complains in childhood and may be caused by allergies or tonsil and adenoid enlargement. OBJECTIVE: Compare the process of written language acquisition and behavior problems in children with and without mouth breathing. METHOD: This is a retrospective study of school folders from 152 pre-school students from a particular school in São Paulo, during 2002. Te (more) achers classified the level of written language acquisition according to Emília Ferreiro. We evaluated also behavior aspects and reinforcement classes referral. Visual and hearing disabilities and emotional problems were also evaluated and constituted a group called difficulties. RESULTS: There were more boys than girls in the mouth breathing children group. The number of children with mouth breathing was higher among those referred to reinforcement classes and they were classified in the earlier stages of written language learning. There was no correlation between "difficulties" and mouth breathing or learning. Behavior problems were found to be related to mouth breathing, too. CONCLUSION: There is a correlation between mouth breathing and learning and behavior problems. So, it is very important that education professions be aware of breathing disorders in their students. Thereby, they can identify and refer them to search for treatment and improve learning.

Abstract in portuguese OBJETIVO: Analisar fatores que influenciam a ocorrência de metástase linfática cervical e a sobrevida nos tumores malignos epiteliais da glândula parótida. MÉTODO: Analisamos retrospectivamente os prontuários de 150 pacientes tratados em nossa instituição de 1974 a 1998. Vinte e quatro pacientes foram excluídos do estudo por não terem sido tratados primariamente por cirurgia. O 126 pacientes restantes foram submetidos a parotidectomia e incluídos neste estudo. (more) Setenta e quatro pacientes tiveram sua cirurgia complementada por radioterapia pós-operatória. Trinta e quatro pacientes foram submetidos ao esvaziamento cervical associado a parotidectomia. A idade média foi de 49 anos. Todos os pacientes foram estadiados pela Classificação TNM da UICC de 1997, sendo 49 pacientes estágio I, 27 estágio II, 22 estágio III, and 28 estágio IV. A influência dos fatores analisados na ocorrência de metástase cervical foi estabelecida pelo teste do chi quadrado e por análise multivariada. A influência de fatores prognósticos na sobrevida específica de doença (SED) em 5 e 10 anos foi estabelecida pelo método de Kaplan-Meier e pelo teste log-rank. RESULTADOS: O tipo histopatológico de 40 pacientes foi o carcinoma mucoepidermóide, de 18 pacientes o adenocarcinoma (SOE), de 18 pacientes o carcinoma de células acinares, de 15 pacientes o carcinoma adenóide cístico, de 11 pacientes o carcinoma exadenoma pleomórfico, de 11 pacientes o carcinoma de ducto salivares, e de 13 pacientes outras histopatologias. Vinte e cinco pacientes apresentaram recidivas, 17 recidivas locais, quatro recidivas regionais, e quatro recidivas loco-regionais. A incidência geral de metástase linfática cervical foi de 17,5%. Metástases linfáticas cervicais ocultas ocorreram em cinco pacientes daqueles submetidos a esvaziamento cervical profilático. A presença de paralisia facial no diagnóstico, a idade, o estágio T, e o grau de malignidade foram relacionados a ocorrência de metástase linfática cervical na análise multivariada. Cinco fatores influenciaram negativamente o prognóstico, estágio T3-T4, alto grau de malignidade, presença de metástase cervical, paralisia facial no diagnóstico, e idade acima de 50 anos. A SED em 10 anos foi de 97% para o estágio I, 81% para o estágio II, 56% para o estágio III, e 20% para estágio IV. CONCLUSÕES: O grau de malignidade e o estágio foram os fatores prognósticos mais importantes. Apesar de ser um estudo retrospectivo e não randomizado, nossos dados sugerem que o esvaziamento cervical profilático deve ser considerado em casos de tumores de alto grau de malignidade, estágio T3-T4, e na presença de paralisia facial no diagnóstico. Abstract in english BACKGROUND: Factors influencing the occurrence of neck metastasis and survival in patients with parotid malignant epithelial tumors are analyzed. METHODS: One hundred fifty patients treated at our institution from 1974 to 1998 were retrospectively reviewed. Twenty four patients were not treated by surgery and were excluded from this study. The remaining 126 patients were operated on and 74 patients had postoperative radiotherapy. Thirty four patients were treated with par (more) otidectomy plus neck dissection. The mean age was 49 years old. According to the UICC/1997 TNM Classification 49 patients were Stage I, 27 were Stage II, 22 were Stage III, and 28 were Stage IV. The influence of selected factors on 10 years disease-specific survival was analyzed using Kaplan-Meier actuarial method and log-rank test. RESULTS: Forty patients had mucoepidermoid carcinoma, 18 patients adenocarcinoma, 18 patients acinic cell carcinoma, 15 patients adenoid cystic carcinoma, 11 patients carcinoma ex pleomorphic adenoma, 11 patients salivary duct carcinoma, and 13 patients other pathology. Recurrences occurred on 27 patients, 17 local, 4 had neck recurrences, and 4 loco-regional recurrences. Overall incidence of neck metastasis was 17.5%. Occult neck metastasis occurred in 5 patients who underwent elective neck dissection. Facial nerve dysfunction, age, T stage, grade, and histology were related to the recurrence of neck metastasis in univariate analysis. Prognoses were negatively influenced by five factors: T3- T4 stage, high malignancy grade, presence of cervical metastases, facial nerve palsy at first presentation and age higher then 50 years old. Ten years disease-specific survival was 97% for stage I, 81% for stage II, 56% for stage II, and 20% for stage IV. CONCLUSION: Tumor grade and stage were the most important prognostic factors. In spite of lack of prospective randomized published studies, recommendations to do elective neck dissections in high grade tumors, T3- T4 stage tumors, and facial nerve palsy at presentation should be considered.