Kazuyuki Kainuma

Differences in the expression of genes between normal tissue and squamous cell carcinomas of head and neck using cancer-related gene cDNA microarray

Conclusion. This study clearly showed the molecular characteristics of head and neck squamous cell carcinoma (HNSCC) on the basis of gene expression patterns. Objective. cDNA microarray has recently been shown to have the ability to represent the expression patterns of large numbers of genes from a small amount of tissue, potentially enabling definition of groups of patients with similar biological behavior of cancer. Although gene expression profiling using this technique has proven helpful for predicting the prognosis in various cancers, little is known regarding HNSCC. The aim of this study was to investigate the differences in the expression of various genes between normal tissue and cancers of patients with HNSCC by cDNA microarray. Patients and methods. We extracted mRNA from 17 HNSCC patients and used cDNA microarray analysis to investigate the gene expression patterns. The present study was not designed to perform an inclusive search for genes but rather to focus on cancer-related genes. Results. Seven independent genes were found to be up-regulated in cancer tissues: matrix metalloproteinase-1, -3, and -10, interleukin-8, cadherin 3, hexabrachion, and interferon gamma-inducible protein 10. Hyaluronic acid-binding protein 2, keratin 4, and keratin 13 were categorized as down-regulated. The hierarchical clustering and dendrogram for 17 cancer samples and 425 genes could be grouped into three clusters.

Chondrosarcoma of the nasal septum: A case report

Chondrosarcoma make up only 10-20% of malignant primary bone tumors, with 5-10% located in the head and neck (Downey TJ, Clark SK, Moore DW. Chondrosarcoma of the nasal septum. Otolaryngol Head Neck Surg 2001;125:98-100), and nasal septal chondrosarcoma is extremely rare. Surgical excision is the only curative treatment and radiation and chemotherapy have a limited role for palliation. We used a navigation system in endoscopic surgery without complications for a case of chondrosarcoma of the nasal septum by means of a midfacial degloving approach at primary operation and an external incision approach at salvage operation for local recurrence. To our knowledge, this is the first report of the use of such a system for this surgical approach along with a salvage operation. We discuss the clinical presentation, diagnosis, and treatment of this case as well as present a review of the literature.

Inverted papilloma of the middle ear: A case report and review of the literature

Abstract Papilloma of the middle ear is extremely rare; to our knowledge there have been only 9 reports (13 cases) in the literature. Aggressive surgical excision is the only curative treatment and radiation therapy is necessary if there is evidence of focal squamous cell carcinoma. We describe a case of a 65-year-old male with inverted papilloma of the middle ear. The tumor was surgically resected by radical tympanomastoidectomy, and we provided postoperative radiation therapy. There has been no evidence of recurrence to date. We discuss the clinical presentation, diagnosis, and treatment of this case and present a review of the literature.

Hybrid carcinoma of the parotid gland: Report of a case (epithelial-myoepithelial carcinoma and salivary duct carcinoma) and review of the literature

Hybrid tumors of salivary glands are rare neoplasms. We describe a case of a 74-year-old male with a hybrid carcinoma composed of epithelial-myoepithelial and salivary duct carcinomas of the right parotid gland. The presence of two components was verified by differential immunohistochemical staining. The tumor was surgically resected. There has been no evidence of recurrence to date. To our knowledge, this is the first report of a hybrid carcinoma composed of epithelial-myoepithelial and salivary duct carcinomas of the parotid gland in Japan.

Guanine nucleotide-binding protein 1 is one of the key molecules contributing to cancer cell radioresistance

Standard fractionated radiotherapy for the treatment of cancer consists of daily irradiation of 2‐Gy X‐rays, 5 days a week for 5–8 weeks. To understand the characteristics of radioresistant cancer cells and to develop more effective radiotherapy, we established a series of novel, clinically relevant radioresistant (CRR) cells that continue to proliferate with 2‐Gy X‐ray exposure every 24 h for more than 30 days in vitro. We studied three human and one murine cell line, and their CRR derivatives. Guanine nucleotide‐binding protein 1 (GBP1) gene expression was higher in all CRR cells than their corresponding parental cells. GBP1 knockdown by siRNA cancelled radioresistance of CRR cells in vitro and in xenotransplanted tumor tissues in nude mice. The clinical relevance of GBP1 was immunohistochemically assessed in 45 cases of head and neck cancer tissues. Patients with GBP1‐positive cancer tended to show poorer response to radiotherapy. We recently reported that low dose long‐term fractionated radiation concentrates cancer stem cells (CSCs). Immunofluorescence staining of GBP1 was stronger in CRR cells than in corresponding parental cells. The frequency of Oct4‐positive CSCs was higher in CRR cells than in parental cells, however, was not as common as GBP1‐positive cells. GBP1‐positive cells were radioresistant, but radioresistant cells were not necessarily CSCs. We concluded that GBP1 overexpression is necessary for the radioresistant phenotype in CRR cells, and that targeting GBP1‐positive cancer cells is a more efficient method in conquering cancer than targeting CSCs.

Leiomyosarcoma of the larynx : emergency tracheostomy

Leiomyosarcoma of the larynx is extremely rare. Histological diagnosis for excluding other tumours remains extremely difficult. A rare case of leiomyosarcoma of the larynx, treated by surgery and radiotherapy, is reported. We discuss the clinical presentation, diagnosis, and treatment of leiomysarcoma with a review of the literature.

The first report of bilateral retropharyngeal lymph node metastasis from papillary thyroid carcinoma and review of the literature

Abstract The sites of lymph node metastasis of papillary thyroid carcinomas are typically the paratracheal and jugular lymph nodes. On the other hand, metastasis to the retropharyngeal or parapharyngeal nodes from papillary thyroid carcinomas is very rare. During the last two decades, limited to cases with a histologically definite diagnosis by surgery, only 39 cases have been reported. All reported cases were unilateral retropharyngeal or parapharyngeal node metastasis except one metachronous bilateral case, and there were no reports of simultaneous bilateral cases within our literature review. We report three cases of retropharyngeal node metastasis from thyroid papillary carcinoma, including a case of bilateral nodal metastasis. Retropharyngeal node metastasis was successfully resected in all three patients by the transcervical approach. As pointed out in past reports, this report also suggests that prior neck dissection and/or metastasis to cervical lymph nodes might alter the direction of lymphatic drainage to the retrograde fashion, resulting in the unusual metastasis to the retropharyngeal lymph nodes, and there is a possibility of a bilateral pattern. Also, it is necessary to consider the possibility of metastasis from a papillary thyroid carcinoma in the differential diagnosis of lymph node swelling in the parapharyngeal space.

Prevalence of level V metastasis in head and neck squamous cell carcinoma.

Abstract Conclusion: The results of this study accord with those of past reports about the prevalence of level V metastasis in head and neck squamous cell carcinoma (HNSCC) cases. Because of the low rate of level V metastasis, and from the viewpoint of standard postoperative radiotherapy, selective neck dissection without level V dissection may be possible in cases without clinical evidence of level V metastasis on both the ipsilateral and contralateral sides. In addition, degree of pathological differentiation and pN stage >N2b are suggested risk factors for level V metastasis. Objectives: The most frequent complication of any type of neck dissection in HNSCC cases with level V metastasis is shoulder dysfunction secondary to traction or ischemic injury to the spinal accessory nerve (SAN). The purpose of this study was to examine procedures to preserve the SAN and avoid level V dissection and shoulder dysfunction due to SAN injury. This study investigated the prevalence of level V metastasis and its associated risk factors at various primary sites in patients with HNSCC. Methods: Clinical and pathological data were retrospectively reviewed for 162 patients with HNSCC, including those with clinically negative neck (cN0) and clinically positive neck (cN+) in whom level V neck dissection was performed. The prevalence of pathological metastasis to level V lymph nodes on both the ipsilateral and contralateral sides was investigated. Several potentially predictive risk factors for level V metastasis, such as age, sex, primary site, T stage, N stage, degree of pathological differentiation, and lymph node status of levels I–IV, were also evaluated. Statistical analysis was performed using Fishers exact test. Results: In total, 301 neck dissections (ipsilateral side, n = 162; contralateral side, n = 139) were performed in this study. The most common primary site was the oral cavity (n = 51), followed by the larynx (n = 48), hypopharynx (n = 39), and oropharynx (n = 24). On the ipsilateral side, the overall incidence of pathologically positive neck (pN+) was 63.6% (103/162). The overall prevalence of level V metastasis was 7.4% (12/162), 6.8% (11/162) on the ipsilateral side, and 1.4% (2/139) on the contralateral side. Isolated level V metastasis and bilateral level V metastasis was observed in three patients and one patient, respectively. Metastasis to level V and other levels was observed in eight patients (8/96, 8.3%), and level V involvement on the ipsilateral side alone was observed only in three patients (3/66, 4.5%). There were two cases in which level V was involved when the other levels were also involved (2/22, 9.1%), and there was no case in which the other levels were not involved on the contralateral side. A statistically significant association was found between level V metastasis and pN stage >N2b (p = 0.0035), degree of pathological differentiation (p = 0.0305) on the ipsilateral side, status of neck levels I–IV (p = 0.001), and the number of positive neck levels (p < 0.0001) on the contralateral side.