Fumihiko Matsumoto

Overexpression of GLUT-1 in the invasion front is associated with depth of oral squamous cell carcinoma and prognosis

OBJECT Malignant cells show increased uptake, which is considered to be facilitated by glucose transporters (GLUTs). Increased GLUT-1 expression has been reported in many human cancers. We hypothesized that a oral squamous cell carcinoma, characterized by high frequency of lymph node metastasis, distant metastasis or local recurrences, was associated with GLUT-1 overexpression in invasion front. METHODS GLUT-1 immunostaining in invasion front was studied on 24 oral squamous cell carcinomas, and revealed the correlation with the clinical characteristics. RESULT The analysis showed that all oral squamous cell carcinoma patients and GLUT-1 expression correlated the depth of the tumors (P = 0.023 < 0.05). Furthermore the survival of patients who had overexpression of invasion front was significant shorter than that of patients with GLUT-1 weakly positive (P = 0.046 < 0.05). No significant association was noted between GLUT-1 immunostaining and either age, gender, subsites, tumor size, or lymph node status. CONCLUSION The present study shows that GLUT-1 served as a marker indicating that tumors with deep invasion tended to result in a worse prognosis in patients due to either lymph node metastasis, a recurrence of the primary lesion or distant metastasis.

Stem cell self-renewal factors Bmi1 and HMGA2 in head and neck squamous cell carcinoma: clues for diagnosis

Head and neck squamous cell carcinoma (HNSCC) includes both morphological and functional cellular heterogeneity, as would be expected if it arose from dysregulated stem or progenitor cells as opposed to the simple clonal expansion of a mutated cell; however, stemness molecule expression levels and distribution in HNSCC remain unclear. To clarify this, stemness molecule expressions were determined in HNSCC, as well as their properties and prognosis. Two proto-oncogenic chromatin regulators, Bmi-1 and high-mobility-group A2 (Hmga2), were identified in 12 pair cases of HNSCC tumor regions by comparison with their non-cancerous background tissues using cDNA microarray. Both Bmi-1 and Hmga2 are known to promote stem cell self-renewal by negatively regulating the expressions of Ink4a and Arf tumor suppressors. Despite similar targets, Bmi-1 protein was expressed in an early cancerous region and HMGA2 protein was expressed in a region showing more progression. Similarly, Bmi1 expression had no significance with regard to overall survival (P=0.67), whereas HMGA2 expression was associated with decreased overall survival (P=0.05). Quantitative real-time reverse transcription polymerase chain reaction analyses also correlated with protein levels. These findings suggest that Bmi-1 is an early detection marker to distinguish cancerous from non-cancerous regions, whereas HMGA2 is presumed to be a tumor prognosis marker. Among our HNSCC analyses, these stemness molecules expressed fewer primitive rare cells in the tumor than all other cells in the tumor. HNSCC cells with high expression of stemness molecules partly behave like stem cells.

Cavernous sinus thrombosis caused by contralateral sphenoid sinusitis: a case report

ObjectiveTo report a rare case of unilateral cavernous sinus thrombosis caused by contralateral sphenoid sinusitis.Case reportA 33-year-old female visited our hospital for severe, right-sided, temporal headache, chemosis, periorbital edema, and proptosis. These signs were associated with congested erythematous nasal mucosa with purulent discharge from the right superior nasal meatus. Contrast enhanced CT showed dilated left superior ophthalmic vein, suggestive of thrombosis, contrast enhancement of the left cavernous sinuses, and dilation of cavernous sinus, indicating cavernous sinus inflammation. The right maxillary, ethmoid and sphenoid sinuses showed mucosal thickening and retention of purulent material. She was diagnosed with cavernous sinus thrombosis caused by contralateral sphenoid sinusitis. All clinical symptoms and signs improved after endoscopic sphenoidotomy and appropriate medical treatment.ConclusionsSphenoiditis can cause contralateral cavernous sinus thrombosis. Early surgical sphenoidotomy and aggressive medical treatment are the cornerstones of successful management of this life-threatening complication.

A case report of metastasizing myoepithelial carcinoma of the parotid gland arising in a recurrent pleomorphic adenoma

Myoepithelial carcinoma, arising in a recurrent or in a pre-existing pleomorphic adenoma of the parotid gland is an extremely rare cancer. We herein report the case of myoepithelial carcinoma occurring in a recurrent pleomorphic adenoma, which showed a high metastatic potential. A 53-year-old male, who had undergone a superficial parotidectomy of the pleomorphic adenoma 2 years previously, presented with recurrent parotid swelling and with multiple coin lesions in the lung. A total parotidectomy and a thoracoscopic biopsy of the lung lesion revealed both lesions to be myoepithelial carcinoma. The patient died about 12 months later despite undergoing intensive chemotherapy.

Endoscopy-assisted transoral resection of the styloid process in Eagle's syndrome. Case report

Eagles syndrome is often associated with elongated styloid process or ossified stylohyoid or stylomandibular ligament. Patients with this syndrome present with recurrent cervicofacial pain. Surgical removal of the elongated styloid process is a standard treatment and can be accomplished through either a transoral or extraoral approach. Both approaches have advantages and disadvantages, and the best surgical approach remains controversial. In our case, the elongated styloid process was removed by transoral approach assisted by endoscopy. Endoscopy provides clear surgical view thus lessen the chance of neurovascular injury and other intraoperative complications. Endoscopy-assisted transoral resection is an optional alternative surgical procedure for Eagles syndrome.

Relationship between insulin-like growth factor-1 receptor and human papillomavirus in patients with oropharyngeal cancer

Human papillomavirus (HPV)‐positive oropharyngeal squamous cell carcinoma (SCC) is associated with better prognosis than HPV‐negative oropharyngeal SCC. The purpose of this study was to assess the expression of insulin‐like growth factor‐1 receptor (IGF‐1R) in patients with oropharyngeal SCC, its relationship to HPV status and various clinical parameters, and its relationship with clinical outcome.

A randomized prospective study of oral levofloxacin vs intravenous flomoxef prophylaxis in postoperative infection after endoscopic sinus surgery

OBJECTIVE The clinical efficacy and cost effectiveness of oral antimicrobial prophylaxis with levofloxacin (LVFX) on endoscopic sinus surgery (ESS) was evaluated. MATERIALS AND METHODS Ninety-three patients undergoing ESS were prospectively enrolled in the present study. The patients were randomly divided into 2 groups, LVFX and flomoxef (FMOX). Two hundred milligrams of LVFX was orally given 2 hours before the start of surgery and 6 hours after the end of surgery, which was followed by the administration of 200 mg every 12 hours for 2 days. One gram of FMOX was dissolved in 100 ml of physiological saline and given intravenously at the induction of anesthesia and 6 hours after the end of surgery, followed by infusion twice daily for 2 days. RESULTS There were no statistically significant differences between 2 groups in terms of age, sex, systemic complications, surgical procedures, the duration of the operation, the length of hospitalization, the amount of blood loss, body temperature, or the number of white blood cells or C-reactive protein. Although no statistical significance was observed in the bacterial resistance between the two antibiotics, LVFX seems to show a low rate of resistance pattern change as compared to FMOX. The present study demonstrated that no patients treated with LVFX or FMOX were afflicted with postsurgical infection. CONCLUSION Oral administration of LVFX is a simple, cost-effective and safe alternative to intravenous prophylaxis in ESS based on clinical efficacy and bacteriological study.

Biopsy of cervical lymph node

OBJECTIVE This report examines 60 non-cancer patients who underwent a cervical lymph node biopsy, and discusses the value of the cervical lymph node biopsy as a diagnostic tool. METHODS Sixty patients with cervical lymph node enlargement who had lymph node biopsies at the Juntendo University between 2004 and 2007 were examined. The clinical parameters including age, size of the lymph node, white blood cell (WBC), C reactive protein (CRP), lactate dehydrase (LDH), soluble interleukin-2 receptor (sIL-2r) were measured at initial examination. Fine needle aspiration cytology was carried out in all patients. The patients were divided into 2 groups, including the malignant lymphoma (ML) group and the benign disease group. These groups were compared based on the patients clinical parameters. RESULTS Serum levels of LDH, sIL-2r, age and lymph node size in the ML group were significantly higher than in the benign group. WBC and CRP showed no significant differences. Simple regression analysis showed that there are correlation between the size of enlargement lymph node and serum levels of LDH and sIL-2r in ML group. CONCLUSION The results of this study suggest that a biopsy should be considered early to patients with an advanced age, large swollen lymph nodes or high levels of serum sIL-2r or LDH.

Significance of delayed primary excision in localized nonmetastatic adult head and neck rhabdomyosarcoma

Adult rhabdomyosarcoma (RMS) is a highly aggressive tumor. Multidisciplinary treatment is important. However, the role of surgery is controversial. The purpose of this study was to reveal the role of a delayed primary excision (DPE) after induction chemotherapy (IC) in localized nonmetastatic adult head and neck RMS. We retrospectively reviewed 24 adult head and neck RMS. Treatment was classified into the following two groups: the DPE group, who received IC followed by surgery, postoperative radiotherapy, and adjuvant chemotherapy (17 patients); the chemoradiotherapy (CRT) group, who received IC followed by chemoradiotherapy (seven patients). We analyzed the efficacy of IC, local control rate (LCR), and overall survival (OS). In the DPE group, 10 patients (59%) underwent complete surgical resection. In the evaluation of the surgical specimens, 14 patients (82%) had residual viable tumors after IC. The response to IC was significantly associated with the 3‐year LCR (CR/PR vs. SD/PD: 100% vs. 33%, P = 0.0014). In patients with good response to chemotherapy, the DPE group had a significantly better 3‐year LCR compared with that of the CRT group (DPE group vs. CRT group, 100% vs. 44%, P = 0.018). However, the treatment modalities were not associated with OS (DPE group vs. CRT group, 65% vs. 57%: P = 0.98). The recurrence patterns differed according to treatments, and distant metastases were more frequent in the DPE group. DPE may impact local control of localized nonmetastatic adult head and neck RMS. Poor response to IC is a risk factor for local recurrence.

Embryonal rhabdomyosarcoma of the head and neck in an adult.

OBJECTIVE This report describes an exceedingly rare case of adult embryonal rhabdomyosarcoma arising in the head and neck, which was initially diagnosed as a primary unknown cancer. METHOD The patient underwent a radical neck dissection with the total excision of the tumor, which was diagnosed as embryonal rhabdomyosarcoma. RESULT The patient received intensive adjuvant chemotherapy, and is still alive with no signs of recurrence or metastasis. CONCLUSION This case report demonstrates not only the rarity of this neoplasm but the importance of the differential diagnosis for planning the therapeutic strategy.