Joon Kyoo Lee

KITENIN increases invasion and migration of mouse squamous cancer cells and promotes pulmonary metastasis in a mouse squamous tumor model

KAI1 C‐terminal interacting tetraspanin (KITENIN) is reported to promote metastasis in mouse colon cancer models. We investigated the role of KITENIN on the progression of squamous cell carcinoma (SCC). In a preliminary clinical study using resected tissues from head and neck SCC patients, KITENIN was highly expressed in tumors and metastatic lymph nodes, while KAI1 was more increased in adjacent mucosa than in tumor. KITENIN‐transfected mouse squamous cancer (SCC VII/KITENIN) cells showed significantly higher invasion, migration, and proliferation than empty vector‐transfected cells. In syngeneic mouse squamous tumor models, more increased tumor volume and enhanced lung metastasis were found in SCC VII/KITENIN cells‐injected mice. Thus, KITENIN increases invasion and migration of squamous cancer cells and thereby promotes distant metastasis in mouse squamous tumor models.

Invasive Fungal Sinusitis of the Sphenoid Sinus

Objective This study was conducted to present the clinical outcome of invasive fungal sinusitis of the sphenoid sinus and to analyze clinical factors influencing patient survival. Methods A retrospective review of 12 cases of invasive fungal sphenoiditis was conducted. Results Cases were divided into acute fulminant invasive fungal spheonoidits (n=4) and chronic invasive fungal sphenoiditis (n=8). The most common underlying disease was diabetes mellitus (n=9). The most common presenting symptoms and signs included visual disturbance (100%). Intracranial extension was observed in 8 patients. Endoscopic debridement and intravenous antifungals were given to all patients. Fatal aneurysmal rupture of the internal carotid artery occurred suddenly in two patients. The mortality rate was 100% for patients with acute fulminant invasive fungal sphenoiditis and 25% for patients with chronic invasive fungal sphenoiditis. In survival analysis, intracranial extension was evaluated as a statistically significant factor (P=0.027). Conclusion The survival rate of chronic invasive fungal sphenoiditis was 75%. However, the prognosis of acute fulminant invasive fungal sphenoiditis was extremely poor despite the application of aggressive treatment, thus, a high index of suspicion should be required and new diagnostic markers need to be developed for early diagnosis of invasive fungal sinusitis of the sphenoid sinus.

Vascular Leiomyoma in the Head and Neck Region: 11 Years Experience in One Institution

Objectives Vascular leiomyoma is an uncommon benign tumor of smooth muscle origin that arises from the muscularis layer of blood vessel walls. We report our experiences with the clinical manifestations, pathologic characteristics, and management of vascular leiomyoma in the head and neck. Methods The clinical records of 12 patients with vascular leiomyoma of the head and neck in the 11-year period were reviewed retrospectively. Results The 12 patients included nine men and three women. The locations of the tumors were variable, including nasal cavity, auricle, hard palate, upper lip, upper eyelid, and supraclavicular space. All but three patients reported an asymptomatic spherical mass; the other three patients complained of intermittent epistaxis or unilateral nasal obstruction resulting from the tumor originating in the nasal cavity. All tumors were painless. Computed tomography consistently revealed a well-defined, intensely enhanced small mass on the mucosa. No case was dignosed corretly as vascular leiomyoma before surgical excision. All patients underwent localized surgical excision of the tumor without recurrence. Five of 12 tumors (42%) were of solid type, four (33%) were of venous type, and three (25%) were of cavernous in histological classification. The histologic type was not related to gender, site of occurrence, and presence of pain. Conclusion Vascular leiomyoma presents as a small, painless mass in various locations of the head and neck region. Localized surgical excision is the only way to make the diagnosis and yields excellent results.

KITENIN represents a more aggressive phenotype in a murine model of oral cavity squamous carcinoma.

Objective: To investigate the tumor invasiveness and early lung metastasis associated with KITENIN in a murine model of oral cavity squamous carcinoma. Study Design: Cross-sectional study with planned data collection. Setting: Department of Otolaryngology–Head and Neck Surgery, Medical Research Center for Gene Regulation, and Pathology, Chonnam National University Medical School and Hwasun Hospital. Subjects and Methods: The cDNA of KITENIN and vector only were transfected into the SCC VII (murine squamous cell line) cells. The suspension of 5 × 105/mL viable KITENIN- or vector-transfected SCC VII cells was injected into the floor of the mouth of C3H/HeJ syngeneic mice, deep into the mylohyoid muscle via the intraoral approach. From the first to the sixth week after injection, tumor, lung, liver, and brain tissues were obtained. Results: For all groups, the tumor invaded the superficial musculature of the floor of the mouth, the deep musculature of the floor of the mouth, the salivary glands, perineural tissue, bone, and skin, sequentially. Lung metastases developed multiple focal nodular patterns at first and then became more extensive. Earlier and more aggressive tumor invasion into the deep floor of the mouth musculature, salivary glands, perineural tissue, bone, and skin was observed in the KITENIN-transfected group compared to the vector-only group. An earlier and more extensive lung metastasis was observed in the KITENIN group. Conclusion: An antisense KITENIN strategy might inhibit distant metastasis and the progression of head and neck squamous cell carcinoma.

Clinical utility of the inferior turbinate flaps in the reconstruction of the nasal septum and skull base.

Purpose The inferior turbinate flaps (ITFs) include the anterior pedicle inferior turbinate flap (APITF) and the posterior pedicle inferior turbinate flap (PPITF). The APITF has been used for the repair of the septal perforation, and the PPITF has been used for the reconstruction of the skull base. Because of the technical difficulties of endoscopic preparation of the ITF, clinical studies on endoscopic management with the ITFs have been sporadic. Methods We retrospectively reviewed 11 patients who underwent endoscopic reconstruction with the ITFs at our institutions from 2006 to 2010. The APITF had been used for the repair of the septal perforation and reconstruction of mucosal defect following excision of a septal tumor, and the PPITF had been used for the reconstruction of the skull base. Clinical data included characteristics of septal perforation and skull base defect, including defect size, types of the ITFs, repair techniques, and complications. Results Pathology included septal perforation (n = 4), pleomorphic adenoma (n = 2), ethmoid teratocarcinosarcoma (n = 1), and pituitary adenoma (n = 4). The 6 septal lesions were reconstructed with the APITF. The size of the septal mucosal defects ranged from 5 to 18 mm, and the success rate of APITF septal defect repair was 83.3% (5/6 patients). A patient with a tiny residual septal perforation was symptom-free. There was no full-thickness necrosis of the flap. Postoperatively, there was no excessive crusting or empty nose syndrome. The 5 skull base defects following endoscopic skull base surgery were repaired with the PPITF, where the nasoseptal flap was not available because of surgical loss of the nasal septum, operative injury to the posterior nasoseptal artery, or previous use of the nasoseptal flap. The sites of skull base reconstruction included the sellar floor (n = 3), clivus (n = 1), and posterior ethmoid (n = 1). Flap necrosis was noted in 2 patients who underwent surgery in the early period of this series, and the success rate of the PPITF was 60%. However, after acquisition of surgical skills, improved viability of the flap became evident. Conclusions Inferior turbinate flaps could be a feasible alternative in the repair of the nasal septum and skull base. Although endoscopic application of ITFs requires a considerable learning curve, increased familiarity with these flaps would improve flap survival and treatment outcome of reconstruction of the nasal septum and skull base.

Concurrent chemoradiotherapy with cisplatin and fluorouracil for locally advanced hypopharyngeal carcinoma

Conclusions. The concurrent administration of cisplatin and fluorouracil (CCRT) during radiotherapy after induction chemotherapy had better results than induction chemotherapy followed by radiotherapy alone (CT+RT) for overall survival, laryngeal preservation, and locoregional control in patients with locally advanced hyopharyngeal cancer. Objectives. To report treatment results comparing CCRT with CT+RT in locally advanced hypopharyngeal cancer. Patients and methods. Sixty-six consecutive patients treated with curative intent were analyzed retrospectively. Thirty-eight patients were treated with induction chemotherapy followed by definitive RT, and 28 patients with induction chemotherapy followed by concurrent chemoradiotherapy. All patients had more than three cycles of continuous infusion of cisplatin and 5-fluorouracil every 3 weeks. The median dose of irradiation was 70 Gy in the CT+RT group and 68.4 Gy in the CCRT group, respectively. Results. The overall 5-year survival rates were 24% for the CT+RT group and 42% for the CCRT group (p=0.031). The 3-year pharyngolaryngectomy-free survival rates were 32% for the CT+RT group and 63% for the CCRT group (p=0.032). The 3-year locoregional control rate for CCRT was significantly better than that for the CT+RT (52% vs 23%, p=0.004). Acute hematologic toxicity appeared in 39% of the CT+RT patients and 75% of the CCRT patients.

Expression of KITENIN and its association with tumor progression in oral squamous cell carcinoma

OBJECTIVE KAI1 COOH-terminal interacting tetraspanin (KITENIN) contributes to tumor invasion and metastasis in various cancers. The aim of this study was to investigate expression of KITENIN in patients with oral cavity squamous cell carcinoma (SCC) and to determine whether KITENIN affects tumor cell behavior in oral cavity SCC cell line. METHODS Western blotting and immunohistochemistry was used to assess alteration of KITENIN expression in human oral cavity SCC and normal oral cavity mucosa. To evaluate the impact of KITENIN knockdown, the cell invasion assay and cell migration assay using small-interfering RNA were performed. RESULTS KITENIN protein expression was significantly increased in human oral cavity SCC tissues than in normal oral cavity mucosa by Western blotting. KITENIN immunoreactivity was strongly identified in human oral cavity SCC relative to adjacent normal tissue. Knockdown of KITENIN resulted in significantly reduced cell invasion in human oral cavity SCC cells (p=0.001). Cell migration showed a marked decrease in KITENIN knockdown oral cavity SCC cells compared to the negative control oral cavity SCC cells (p=0.01). CONCLUSION KITENIN is associated with tumor invasiveness and metastasis in human oral cavity SCC.

Laryngeal involvement in Madelung disease.

Madelung disease is a rare condition characterized by the presence of bilateral symmetric unencapsulated lipomatous tissues in the neck, shoulders, and upper thorax. Some patients present with dyspnea and dysphonia caused by extrinsic compression or compression of the recurrent laryngeal nerve by infiltration of fat. Laryngeal involvement in Madelung disease is extremely rare, with only 7 cases reported in the medical literature. Among these 7 patients, only 2 had laryngeal surgical treatment. Herein, a third case with laryngeal involvement of Madelung disease treated by surgery is reported.

Clinical utility of fine needle aspiration cytology in pediatric parotid tumors

OBJECTIVE The purpose of this study was to evaluate the usefulness and accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of pediatric parotid tumors. METHODS From June 2002 to June 2012, 22 patients ≤18-years-of-age with parotid mass were treated at Chonnam National University Hospital. Included in the study were 21 cases with preoperative FNAC. A retrospective chart review analyzed the results of FNAC and compared them with the corresponding histopathological diagnosis. RESULTS Twenty-one of the 22 patients had undergone preoperative FNAC, which diagnosed pleomorphic adenoma in 13 patients. The remaining eight patients were diagnosed with benign tumor (n = 6), malignant tumor (n = 1) or Kimura disease (n = 1). All 21 patients underwent parotid tumor removal. FNAC had a diagnostic sensitivity of 92.3%, positive-predictive value of 92.3% and accuracy of 90.5% for diagnosing pleomorphic adenoma of pediatric parotid tumor. FNAC had a diagnostic sensitivity of 100%, a positive-predictive value of 85% and accuracy of 85.7% for diagnosing benign parotid tumor. CONCLUSIONS Preoperative FNAC is a useful and accurate adjunct for preoperative evaluation of pediatric parotid tumors. We recommend that preoperative FNAC should be part of the initial evaluation of pediatric patients with parotid masses.

KAI1 COOH-terminal interacting tetraspanin (KITENIN) expression in early and advanced laryngeal cancer.

To investigate the expression of KAI1 COOH‐terminal interacting tetraspanin (KITENIN) in patients with laryngeal cancers and to examine the correlation between its expression and various clinical and pathological variables.