Chung-Feng Hwang

Kikuchi's disease: A review and analysis of 61 cases

OBJECTIVE Kikuchis disease (KD), or histiocytic necrotizing lymphadenitis, is a rare self-limiting disorder that typically affects the cervical lymph nodes. It has occasionally been misdiagnosed as malignant lymphoma or another serious diseases; hence, clinicians should be made more aware of this disease. METHODS From January 1986 to January 2001, a series of 61 patients who underwent a biopsy of a cervical lymph node and proved histologically to have KD were enrolled in this study. We retrospectively reviewed the clinical records and pathologic parameters of each patient. The patients were followed up from 6 months to 14.3 years (mean, 6.9 years). RESULTS There were 34 women and 27 men (1.26:1 ratio; age range, 6 to 46 years; mean age, 21 years). The affected cervical lymph nodes were commonly located in the posterior cervical triangle (54 of 61, or 88.5%). Unilateral and bilateral cervical lymph nodes were affected in 54 and 7 patients, respectively. The dimensions of affected lymph nodes were commonly in the range of 0.5 to 4 cm (57 of 61, or 93.4%). In 2 patients, the size of the enlarged lymph nodes was greater than 6 cm. Leukopenia was observed in 14 patients (23%); fever, in 18 patients (29.5%). Five patients had a past history of tuberculosis. Two patients developed systemic lupus erythematosus, 1 month and 5 years later, respectively. The cervical lymphadenopathy usually resolved without any medical treatment within 6 months after definite diagnosis was made. In 3 patients, the enlarged lymph nodes eventually disappeared after more than 1 year. No recurrence has since been noted. CONCLUSION The results of this study support the theory that KD is a self-limiting disorder that does not require any specific management. The female predominance was not as striking as in the studies performed in Western countries. We suggest that the patients with KD require a systemic survey and regular follow-up for several years; 2 of our patients developed systemic lupus erythematosus. An effective communication between the otolaryngologist and pathologist is needed because the clinical and pathologic characteristics of KD are essential in making an accurate diagnosis.

A new Transnasal approach to endoscopic marsupialization of the Nasolabial cyst

Objective: Nasolabial cyst is a mucus‐secreting, nonodontogenic cyst in the nasofacial area. It is usually situated behind the ala nasi, extending backward beneath the nasal floor into the inferior meatus and forward into the labio‐gingival sulcus behind the upper lip. Patients with nasolabial cysts generally undergo surgical removal of the cyst via a transoral sublabial approach. This article reports a simple, less invasive surgical procedure for the treatment of nasolabial cysts. Study Design: A transnasal endoscopic marsupialization method was designed to treat patients with nasolabial cysts. From 1996 through 1998, 16 consecutive patients underwent this new surgical procedure. Methods: With patients under local anesthesia, the roof of the cyst, which was firmly attached to the mucous membrane of the anterior nasal floor, was removed transnasally with a sickle knife and scissors. Under the guidance of a nasoendoscope, the opening of the cyst was widened with bite forceps. Meanwhile, the cut edges of the nasal mucosa and the epithelium lining of the cyst were adequately matched. The nose was then loosely packed. Results: All but 1 of the 15 patients were successfully treated with this technique, and the whole surgical procedure was usually completed within 15 to 20 minutes. Postoperative endoscopic and radiological findings revealed that the cyst was replaced by an air‐containing sinus with a persistent opening at the anterior or anterolateral nasal floor. There has been no evidence of mucus accumulation in the newly created sinus or recurrence of the cyst during a mean follow‐up of 16 months. Conclusions: Transnasal endoscopic marsupialization is a simple and effective surgical procedure for treatment of nasolabial cysts.

Schwannoma (neurilemmoma) of the tongue

Conclusion. Schwannoma of the tongue always presents as a painless mass on the lingual surface and exhibits no gender preference. A schwannoma on the base of tongue is usually larger at presentation than one on the tongue itself, since it is asymptomatic initially. Complete resection is achievable and recurrence is uncommon. Objectives. To describe the patient demographics, presenting signs and symptoms, tumor location, imaging studies, management, and therapeutic outcomes of schwannoma of the tongue, an uncommon tumor of neuroectodermal origin that may arise from any myelinated nerve fiber. Patients and methods. In this retrospective study, records of 10 patients who underwent surgical removal of schwannomas of the tongue or base of the tongue between January 1988 and June 2005 were reviewed and summarized. Results. The records of five men and five women with ages ranging from 9 to 45 years (mean 27.4 years) were reviewed. The locations of the schwannomas were as follows: four on the lateral border of the tongue, two on the tongue tip, one on the ventral side of the tongue, and three on the base of the tongue. The major clinical sign was a painless mass on the lingual surface. For all patients, no tumor recurrence or complication was noted after tumor extirpation.

Enhancer of zeste homolog 2 overexpression in nasopharyngeal carcinoma: an independent poor prognosticator that enhances cell growth.

PURPOSE As a key component of polycomb-repressive complex 2, enhancer of zeste homolog 2 (EZH2) represses target genes through histone methylation and is frequently overexpressed and associated with poor prognosis in common carcinomas. For the first time, we reported EZH2 expression and its biological and clinical significance in nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS In NPC cell lines and specimens, endogenous expression of EZH2 mRNA and protein was determined by semiquantitative reverse transcription-polymerase chain reaction and immunoblotting, respectively. To analyze the effect on cell growth, stable silencing of EZH2 was established in EZH2-expressing TW02 NPC cells with RNA interference. EZH2 immunolabeling was assessable for 89 primary NPC biopsy samples and correlated with clinicopathological variables, disease-specific survival (DSS), and overall survival (OS). RESULTS Growth activity of TW02 cells was significantly suppressed (p < 0.001) with stable EZH2 silencing. Compared with normal nasopharyngeal tissue, expression levels of EZH2 transcript and protein were apparently upregulated in NPC specimens. As a continuous variable, higher EZH2 expression preferentially occurred in NPCs of T3 to T4 stages (p = 0.03) and significantly predicted inferior DSS (p = 0.0010) and OS (p = 0.004). The prognostic implications for DSS (p = 0.010) and OS (p = 0.006) still remained valid when using the median (≥ 60%) of EZH2 immunolabeling index to dichotomize the cohort. In the multivariate model, higher EZH2 expression was an independent adverse factor of both DSS (p = 0.012) and OS (p = 0.011), along with American Joint Committee on Cancer Stages III to IV (p = 0.024 for DSS, p = 0.017 for OS). CONCLUSION At least partly through promoting cell growth, EZH2 implicates disease progression, confers tumor aggressiveness, and represents an independent adverse prognosticator in patients with NPC.

Zinc in the treatment of idiopathic sudden sensorineural hearing loss

The objective of this study was to investigate whether zinc supplementation can enhance the recovery of idiopathic sudden sensorineural hearing loss (SSNHL).

Small cell carcinoma of the nasopharynx

Small cell carcinoma is predominantly found in the lung and only about 5% of small cell carcinoma cases have been noted to be extrapulmonary; these are commonly found in the esophagus, pancreas, skin, uterus, and breast. A head and neck origin for small cell carcinoma is extremely rare. Both pulmonary and extrapulmonary small cell carcinomas usually have a good response to chemotherapy initially, but a poor prognosis finally. We report here a case of small cell carcinoma of the nasopharynx. The patient underwent chemotherapy and irradiation for the disease, but died of lung metastasis 38 months later.

Microdebrider-assisted endoscopic marsupialization for the nasolabial cyst : Comparisons between sublabial and transnasal approaches

Background The incidence of nasolabial cysts is very low. Simple excision through a sublabial approach is the treatment of choice. The aim of this study was to evaluate the microdebrider as a tool in transnasal endoscopic marsupialization for nasolabial cysts and compare it with conventional instruments and a sublabial approach for cyst removal. Methods Retrospective chart review of 30 patients (31 cysts) with a mean age of 46.9 years received surgical treatments for nasolabial cysts. We performed three types of surgical procedures including the sublabial approach (10 cysts), conventional transnasal marsupialization (13 cysts), and microdebrider-assisted marsupialization (8 cysts). Results Patients that received surgery with the sublabial approach experienced significant increases in operation time, blood loss, and hospitalized time compared with those treated with transnasal marsupialization. However, the number of postoperative stoma stenoses was higher for conventional transnasal marsupialization (two cases). No recurrences or other postoperative complications were found during the follow-up. Conclusion The transnasal marsupialization of nasolabial cysts has remarkable benefits compared with sublabial cyst excision during operation. Microdebriders can be used safely and effectively in endoscopic marsupialization without stoma stenosis.

Overexpression of cyclin E messenger ribonucleic acid in nasopharyngeal carcinoma correlates with poor prognosis

AIMS S-phase kinase-associated protein 2 is required for the degradation of p27 protein, which is a negative regulator of cyclin E/cyclin-dependent kinase 2 complex. The present study examined the expression of cyclin E, S-phase kinase-associated protein 2 and p27 protein in nasopharyngeal carcinoma. METHODS Tissue from 35 cases of nasopharyngeal carcinoma and 10 normal nasopharyngeal tissue samples underwent reverse polymerase chain reaction to detect messenger ribonucleic acid. Immunohistochemical analysis was performed on 29 nasopharyngeal tissue samples in order to detect protein expression. RESULTS Messenger ribonucleic acid expression in the nasopharyngeal carcinoma tissue samples analysed indicated a 1.75-fold change in the amount of S-phase kinase-associated protein 2, a 0.34-fold change in the amount of cyclin E and a 0.31-fold change in the amount of p27 protein, compared with positive controls. High levels of cyclin E significantly correlated with late-stage nasopharyngeal carcinoma (p = 0.009) and a poor overall survival (p = 0.010). Immunohistochemical analysis indicated positive expression of S-phase kinase-associated protein 2 in 16/29 nasopharyngeal tissue samples (55 per cent), of cyclin E in 13/29 samples (45 per cent) and of p27 protein in 17/29 (59 per cent) samples. CONCLUSIONS Overexpression of cyclin E messenger ribonucleic acid showed an adverse prognostic significance, correlating with an advanced stage of nasopharyngeal carcinoma and a low overall survival rate.

Human papillomavirus infection in oral papillary and verrucous lesions is a prognostic indicator of malignant transformation

BACKGROUND Recent studies have demonstrated an increase in the incidence of HPV-associated oral squamous cell carcinoma. The aim of this study was to investigate the presentation of HPV in verrucous and papillary lesions of the oral mucosa and the relationship with the prognosis of the patients. METHODS Fifty-three biopsy specimens from 31 patients were investigated by polymerase chain reaction using a consensus primer directed to the HPV L1 gene; this was followed by a confirmatory in situ hybridization to identify the HPV types. RESULT Fifteen tumor biopsies (28.3%) were positive for the HPV L1 gene, but only 8 specimens (15.1%) were found to be positive using in situ hybridization. The positive rates of HPV L1 gene were 58.8% and 13.9% in malignant and benign verrucous lesions, respectively. HPV infection is independently associated with malignant transformation and disease-specific survival. CONCLUSION The presence of HPV infection is relatively low; however, the clinical outcome of patients with HPV-positive papillary and verrucous lesions was poor.

Ethanolic Extracts of Pluchea indica Induce Apoptosis and Antiproliferation Effects in Human Nasopharyngeal Carcinoma Cells

Pluchea indica is used in traditional medicine for the treatment of lumbago, ulcer, tuberculosis and inflammation. The anti-cancer activities and the underlying molecular mechanisms of the ethanolic extracts of P. indica root (PIRE) were characterized in the present study. PIRE strongly inhibited the viability of the human nasopharyngeal carcinoma cells (NPC-TW 01 and NPC-TW 04) in a time- and dose-dependent manner. Migration of cancer cells was also suppressed by PIRE. In addition, PIRE significantly increased the occurrence of the cells in sub-G1 phase and the extent of DNA fragmentation in a dose-dependent manner, which indicates that PIRE significantly increased apoptosis in NPC cells. The apoptotic process triggered by PIRE involved up-regulation of pro-apoptotic Bax protein and down-regulation of anti-apoptotic Bcl-2 protein, consequently increasing the ratios of Bax/Bcl-2 protein levels. Moreover, the p53 protein was up-regulated by PIRE in a concentration-dependent manner. Therefore, PIRE could induce the apoptosis-signaling pathway in NPC cells by activation of p53 and by regulation of apoptosis-related proteins.