Janusz Klatka

Tumor angiogenesis in patients with laryngeal cancer.

Abstract Tumor angiogenesis was evaluated in 60 patients with primary laryngeal cancer by quantitating the microvessel density with antibodies against factor VIII. The microvessel density was then correlated with T stage, N stage, histologic grade and patient survival. A direct correlation was found between increased tumor angiogenesis and T stage, histologic grade and a shorter survival rate.

External and middle ear diseases: radiological diagnosis based on clinical signs and symptoms

ObjectivePathology of the external and middle ear is the most frequent reason to prescribe antibiotics and perform surgery in children and young adults. In the majority of cases imaging studies are not performed; the need for imaging comes when complications are suspected or when treatment is not effective. This paper discusses indications for temporal bone imaging studies and presents the most frequent pathological conditions, together with differential diagnosis, clinical symptoms and methods of treatment.Methods and ResultsThis pictorial review describes major external and middle ear diseases, with special regard to clinical findings and appropriate reporting.ConclusionsApprehension of the complete clinical picture, together with imaging clues, narrows differential diagnosis and helps avoid mistakes. Evaluation of temporal bone pathologies requires close cooperation between the clinician and radiologist.

Syndecan-1 expression in laryngeal cancer

Abstract Syndecan-1 is a member of the syndecan family of cell surface heparan sulphate proteoglycans. The aim of this study was the evaluation of syndecan-1 expression in laryngeal cancer. The findings were correlated both with the clinico-pathological parameters of the tumours and with patient survival. Paraffin-embedded samples from 48 patients with laryngeal cancer selected from the files of the ENT Department of the Medical Academy in Lublin were immunostained with anti-syndecan-1 monoclonal antibody. The patients’ mean age was 56 years, and 69% survived for over 3 years . Syndecan-1 immunoreactivity was observed in 48 (100%) of carcinomas. In our study, statistically significant correlations were observed both between syndecan-1 expression and patient survival (Chi-square = 4.364; P<0.05) and between syndecan-1 expression and clinical stage of disease (Chi-square = 4.363; P<0.05). Significant differences in syndecan-1 expression were also observed with various stages of histological differentiation of the carcinomas (Chi-square = 6.588; P<0.05), and also according to the presence or absence of metastatic changes in the regional lymph nodes (Chi-square = 6.289; P<0.05). Our results indicate that syndecan-1 could be used as a prognostic marker in laryngeal cancer.

Prognostic value of the expression of p53 and bcl-2 in patients with laryngeal carcinoma.

Abstract Previous studies have yielded inconsistent results on the prognostic significance of p53 and bcl-2 in head and neck cancer. The aim of this study was the evaluation of p53 and bcl-2 protein expression in laryngeal squamous cell carcinoma and to clarify the relationship between them. All patients with laryngeal carcinoma were treated during the period 1991–1993. In the present study, p53 and bcl-2 expression in paraffin sections from 50 cases of laryngeal squamous cell carcinoma were analysed and correlated with routine clinico-pathological parameters. The expressions of p53 and bcl-2 were examined by immunohistochemical staining. Immunoreactivity for p53 was observed in 45 (90%) of carcinomas and bcl-2 immunoreactivity in 7 (14%). No significant correlation between the p53 or bcl-2 expression and patients’ T- or N-stage, histological grading, or overall survival was found.

Expression of bcl-2 protein in lymphocytes of patients with laryngeal carcinoma.

Abstract The aim of this study was to evaluate the expression of bcl-2 protein in lymphocytes of the peripheral blood of patients with laryngeal carcinoma. The protein product of the proto-oncogene bcl-2 is a physiological inhibitor of apoptosis or programmed cell death. Since we believe that apoptosis is involved in the regulation of an immune response to a cancer process, we tried to show how this mechanism works in laryngeal carcinoma in comparison with normal peripheral blood lymphocytes of healthy controls. To explain the significance of this molecule’s expression, we used flow cytometry to examine the expression of bcl-2 in T lymphocytes from the peripheral blood of 23 patients with laryngeal carcinoma and 20 healthy controls. Our study revealed that the expression of bcl-2 protein in T lymphocytes from the cancer patients was significantly higher than in the controls (P < 0.05). This difference in the expression of bcl-2 protein was found in both CD4 and CD8 subpopulations and was significantly higher than in the control group. In patients with laryngeal carcinoma expression of bcl-2 protein in T lymphocytes was higher in CD4 than in CD8 cells (P < 0.05). These results suggest that bcl-2 protein may interact in the regulation of apoptosis of lymphocytes, taking part in anti-cancer defence.

Recommendations for the diagnosis of human papilloma virus (HPV) high and low risk in the prevention and treatment of diseases of the oral cavity, pharynx and larynx. Guide of experts PTORL and KIDL

The role of human papilloma viruses (HPV) in malignant and nonmalignant ENT diseases and the corresponding epidemiological burden has been widely described. International head and neck oncology community discussed growing evidence that oral HPV infection contributes to the risk of oro-pharyngeal carcinoma (OPC) and recommended HPV testing as a part of the work up for patients with OPC. Polish Society of ENT Head Neck Surgery and National Chamber of Laboratory Diagnosticians have worked together to define the minimum requirements for assigning a diagnosis of HPV-related conditions and testing strategy that include HPV specific tests in our country. This paper briefly frames the literature information concerning low risk (LR) and high risk (HR) HPV, reviews the epidemiology, general guidance on the most appropriate biomarkers for clinical assessment of HPV. The definition of HPV-related cancer was presented. The article is aiming to highlight some of major issues for the clinician dealing with patients with HPV-related morbidities and to introduce the diagnostic algorithm in Poland.

Amyloidosis of the head and neck: a clinicopathological study of cases with long-term follow-up

Extracellular deposits of insoluble proteinaceous material giving a starch-like reaction when treated with iodine and sulphuric acid and accumulating in tissue was for the first time described by Rokitansky in 1842 [1]. It was not until 1851 that Virchow applied the term “amyloidosis” to describe this deposition [2]. An amorphous substance called amyloid (insoluble fibril-forming protein) is deposited in extracellular spaces of organs and tissues. Amyloid deposits, under the electron microscope, appear as non-branching fibrils with a cross-linked, β-pleated sheet conformation. They are eosinophilic after haematoxylin–eosin staining and display apple-green birefringence with polarized light when stained with Congo red. Chronic inflammations of bacterial or non-bacterial origin and immunological immune-competent neoplasm cells are examples of factors that induce amyloid fibril biosynthesis. The organs and tissues where amyloid deposits occur become stiff and plastic, having a hyaline-like appearance that leads to a loss of previous function [3].

Preliminary results of prognostic significance of proliferating cell nuclear antigen expression in advanced primary larynx carcinomas and lymph node metastases

Introduction The aim of this study was to investigate the prognostic significance of proliferating cell nuclear antigen (PCNA) expression in laryngeal carcinoma in relation to clinicopathological features. Special emphasis was placed on examining the relationship of PCNA expression in the primary tumour and PCNA expression in corresponding lymph node metastases obtained from the same patients. Material and methods The study included 60 patients with advanced larynx carcinoma who had received treatment and follow-up for at least 5 years. Sixty laryngeal carcinoma specimens and metastatic lymph nodes from 24 patients were examined for immunohistochemical PCNA expression. Results The percentages of PCNA positive cells were significantly higher in the primary tumours which developed lymph node metastases than in those without metastases. The fraction of PCNA immunolabelled cells in metastatic lymph nodes increased significantly when compared with the PCNA positive cell score in their corresponding primary tumours obtained from the same patient. There was a significant difference in PCNA index score in primary tumours between the group of patients who survived a 5-year period and those who died within 5 years after treatment. Conclusions Our data demonstrate that a high proliferation index in primary larynx tumours is retained and increased in corresponding lymph node metastases. Measurement of the fraction of cancer cells stained for PCNA in primary larynx carcinomas can be helpful in selecting tumours with high aggressiveness potential that are more likely to develop neck metastases and thereby in identifying patients who need elective lymph node dissection or additional treatment.

Head and neck cancer: Value of perfusion CT in depicting primary tumor spread

Summary Background The aim of this study was to assess head and neck squamous cell cancer and surrounding tissue in computed tomography contrast enhanced and perfusion studies, and to examine the role of perfusion imaging in depiction of tissue infiltration. Material/Methods We prospectively evaluated 43 primary malignant head and neck tumors, using standard CT followed by perfusion. Blood flow, blood volume, mean transit time, and permeability values were obtained using regions of interest (ROIs) over lesions and surrounding tissue. Results were compared with histological analysis of resected tissue. Sensitivity, specificity, accuracy, positive and negative predictive values were calculated for both methods. Results We found significant differences between infiltrated and non-infiltrated tissue, especially with regard to muscles. In case of bone and salivary gland infiltration, change in perfusion parameters did not allow proper diagnosis. Conclusions CTP shows promise in depicting malignant infiltration. The combined use of CECT plus CTP results in correct staging of the majority of head and neck tumors.

Molecularly targeted therapies in head and neck cancers.

Head and neck cancers (HNC) are 6th most common malignancies according to the incidence rate. Over 85% of tumors of this region are epithelial tumors, especially squamous cell carcinomas (head and neck squamous cell carcinomas - HNSCC). Surgery, chemotherapy and radiotherapy are still the standard for the treatment of HNC. Despite the great development of the various methods of treatment, survival of patients have not improved significantly over the last 30 years, with the overall, 5-year survival not exceeding 50%. Progress in understanding the biology of cancer leads to personalization of therapy and introduction of drugs with molecular mechanism of action to everyday practice. At present, the effectiveness of monoclonal antibodies against EGFR in the treatment of HNSCC has already been proven. Cetuximab in combination with radiotherapy was found to be effective in patients with advanced and locally advanced HNSCC. There are also some promising results of phase III trials with zalutumumab and panitumumab. Initial efficacy of sorafenib (an inhibitor of the intracellular domain of VEGFR, PDGFR and c-Kit) and afatinib (an irreversible inhibitor of pan-HER tyrosine kinase) have been demonstrated. Great hopes for the future are linked with the potential use of STAT3, EGFRvIII, abnormal proteins K-ras, H-ras and PTEN as well as proteasome as a target for therapy.