Marion Roessler

Intralesional Endoscopy of Advanced Lymphatic Malformations of the Head and Neck: A New Diagnostic Approach and a Potential Therapeutic Tool

OBJECTIVES To evaluate the morphologic properties of advanced lymphatic malformations of the head and neck and to investigate possible therapeutic interventions by intralesional endoscopy. DESIGN This case study analyzes the outcome of intralesional endoscopy of lymphatic malformations of the head and neck and discusses the results of this approach. SETTING Academic medical center. PATIENTS Endoscopy was performed on 4 patients with cervicofacial lymphatic malformations. INTERVENTIONS Endoscopy of lymphatic malformations. RESULTS The endoscopic inspection and assessment of the lesions revealed detailed information about morphologic aspects like the structure of intralesional septa, internal vascularization, and intercystic correspondence and channel networks. Anatomic landmarks could be followed on their intralesional courses. CONCLUSIONS Intralesional endoscopy of lymphatic malformations provides insight into the morphologic properties of the lesion and is a useful supplementary tool during conventional surgical intervention and for sclerosing therapy. The technique allows a detailed assessment of these lesions and opens a broad spectrum of therapeutic options.

Port-wine stains are more than skin-deep! Expanding the spectrum of extracutaneous manifestations of nevi flammei of the head and neck

UNLABELLED It is well known that port-wine stains of the upper part of the face may herald abnormalities of the brain or eye in the form of Sturge-Weber syndrome. This study focuses on other extracutaneous anomalies in patients with nevi flammei of the head and neck, giving rise to functional complications. PATIENTS AND METHODS A retrospective study was performed on patients with port-wine stains involving the head and neck area. Records were reviewed for demographic parameters, extent of the lesion, clinical complications, diagnostic measures, previous treatments, ultimate therapeutic approach, and outcome. RESULTS Nine patients, mean age 50.4 years, with port-wine stains and clinical symptoms due to extracutaneous involvement, were admitted and treated from 2006 to 2009. Major clinical features included macrocheilia in three cases, gingival bleeding in two, dysphonia with globus sensation, painful parotideal swelling with recurrent otitis, painful lingual swelling, recurrent epistaxis, and nasal obstruction in one case each. Cases with lower lip hypertrophy were treated by conventional surgical approaches. Recurrent epistaxis and nasal obstruction due to affected inferior turbinate were treated by Nd:YAG laser therapy, and globus sensation and dysphonia by speech therapy. Patients with gingival affection and recurrent otitis were treated by local ear care. CONCLUSION Port-wine stains in the head and neck may develop extracutaneous manifestations causing severe problems. A multimodal and interdisciplinary approach is mandatory for an appropriate treatment.

Salvage surgery for head and neck squamous cell carcinoma

modalities for resectable stage III and IV cancers as an alternative to surgical management. this development has led to an increasing role for salvage surgery in cases of recurrent disease. In HNSCC, salvage surgery is, besides aggressive re-irradiation if applicable, often the only curative option in patients with locoregional recurrence [4]. Among patients with advanced HNSCC treated with definitive pr(C)t or adjuvant r(C)t, locoregional recurrence develops in 18–20 % of cases and in 17–33 % of patients treated with definitive rCt for locally advanced, unresectable tumors [5]. locally, recurrent tumors may arise from residual neoplastic cells that survive initial treatment—most likely due to biological factors that provide radioand/or chemoresistance, the existence of cancer stem cells, or insufficiencies in initial treatment parameters such as radiation dose, volume, fractionation and/or treatment duration. Also, secondary tumors following pr(C)t may develop from underlying field cancerization, as a radiationinduced malignancy, or as a de novo process. For patients with resectable disease recurrence, salvage surgery is considered the standard of care and may provide long-term disease control in up to 45 % of patients with advanced and up to 80 % of patients with early recurrent disease [3, 6]. However, recurrence rates after salvage surgery, even when negative margins have been obtained, are high [7]. the rate of recurrence following salvage surgery has been described as 54.9 % in a retrospective analysis of patients with oropharyngeal cancer and cancer of the oral cavity, with an overall five-year survival rate of 32.3 %. In this study, significant prognostic factors in multivariate analysis were recurrent tumor stage (p = 0.049) and disease-free interval (p = 0.045) [8]. roosli et al. [9] showed in a retrospective study of 156 patients with recurrent oropharyngeal tumors that five-year overall survival and disease-specific survival after salvage treatment was 29 and Introduction

CD73 expression in lymph node metastases in patients with head and neck cancer

Abstract Introduction: CD73 is an enzyme crucial in the metabolism of immunosuppressive adenosine. In cancer, it has various functions including tumor growth and metastases. Squamous cell carcinoma of the head and neck has an overall poor prognosis, also due to early spread of metastatic cells. Materials and methods: Tumor and lymph node specimens of 65 patients with HNSCC were subjected to immunohistochemical and H-score analysis of CD73 expression. Demographics, diagnoses, histopathology and subsequent outcome were analyzed. Results: The primary cancer was squamous cell carcinoma in all patients (male/female 55:10) with the following locations: oral cavity n:16, oropharynx n:28, hypopharynx n:11 and larynx n:10. H-score for CD73 expression in the primary lesion and metastatic lymph nodes was significantly higher in advanced compared to early stages with no significant differences among tumor locations. High CD73 expression was associated with reduced overall survival rates at a mean follow-up of 83.4 months (6–204 months). Conclusions: CD73 expression in HNSCC correlated positively with tumor stage and was associated with poor prognosis. Therefore, CD73 expression in primary lesions and regional metastases appears to predict HNSCC patients at high risk of all tumor sites. Therapeutic approaches targeting CD73 might seem promising for this patient population.

Human papilloma virus (HPV) is not implicated in the etiology of Warthin's tumor of the parotid gland

Abstract Conclusion: The lack of human papilloma virus (HPV) sequences as well as potential HPV-activated cells such as cells that would be p16- and Ki-67 positive does not support a role of HPV in the pathogenesis of this lesion. Objective: The exact etiopathogenesis of Warthins tumor of the parotid gland is still unclear. The aim of the present study was to evaluate if HPV could play a role in the development of this parotid lesion. Methods: Tissue samples from 40 Warthins tumors of the parotid gland were investigated by PCR followed by in situ hybridization. The immunohistochemical expression of p16 and the dual immunostaining of p16 and Ki-67 were evaluated in all samples. Results: Strong and diffuse p16 immunoreactivity was found in 7 of the 40 cases (17.5%). In situ hybridization showed a diffuse episomal signal in those samples. However, PCR could not reliably detect the presence of HPV genes. Furthermore, p16-expressing epithelial cells were mostly negative for the proliferation marker Ki-67.

Involvement of LYVE‐1‐positive endothelial cells in the formation of non‐lymphatic vascular malformations

Chih-Ping Han Jeng-Dong Hsu Chung-Chin Yao Ming-Yung Lee Alexandra Ruan Yeu-Sheng Tyan Shun-Fa Yang Hung Chiang Department of Obstetrics and Gynecology, Institute of Medicine, Department of Pathology, School of Medicine, Department of Surgery, Chung-Shan Medical University Hospital, Department of Statistics and Informatics Science, Providence University, Taichung, Taiwan, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA, Department of Medical Imaging and Department of Medical Imaging and Radiological Science, Chung-Shan Medical University and Chung-Shan Medical University Hospital, Taichung, and Taipei Institute of Pathology, Taipei, Taiwan 1. Liao CL, Lee MY, Tyan YS et al. Progesterone receptor does not improve the performance and test effectiveness of the conventional 3-marker panel, consisting of estrogen receptor, vimentin and carcinoembryonic antigen in distinguishing between primary endocervical and endometrial adenocarcinomas in a tissue microarray extension study. J. Transl. Med. 2009; 7; 37. 2. Wolff AC, Hammond ME, Schwartz JN et al., American Society of Clinical Oncology; College of American Pathologists American Society of Clinical Oncology ⁄ College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. J. Clin. Oncol. 2007; 25; 118– 145. 3. Bookman MA, Darcy KM, Clarke-Pearson D et al. Evaluation of monoclonal humanized anti-HER2 antibody, trastuzumab, in patients with recurrent or refractory ovarian or primary peritoneal carcinoma with overexpression of HER2: a phase II trial of the Gynecologic Oncology Group. J. Clin. Oncol. 2003; 21; 283–290. 4. Seidman JD, Kurman RJ, Ronnett BM. Primary and metastatic mucinous adenocarcinomas in the ovaries: incidence in routine practice with a new approach to improve intraoperative diagnosis. Am. J. Surg. Pathol. 2003; 27; 985–993. 5. Seidman JD, Horkayne-Szakaly I, Haiba M et al. The histologic type and stage distribution of ovarian carcinomas of surface epithelial origin. Int. J. Gynecol. Pathol. 2004; 23; 41–44. 6. Köbel M, Kalloger SE, Huntsman DG et al. Differences in tumor type in low-stage versus high-stage ovarian carcinomas. Int. J. Gynecol. Pathol. 2010; 29; 203–211.

Lack of significant estrogen and progesterone receptor expression in nasal telangiectasias in hereditary hemorrhagic telangiectasia: An immunohistochemical analysis

Abstract Conclusion: This immunohistochemical study of estrogen and progesterone receptors could not confirm a significant expression in nasal telangiectasias. Thus, a specific effect of these hormones or anti-hormone therapy on malformed nasal vessels has to be questioned and only offered under strict clinical control. Objective: The efforts to control recurrent epistaxis in hereditary hemorrhagic telangiectasia (HHT) using alternative methods are very intense. Hormone or anti-hormone therapy has frequently been postulated and the reported results are controversial. Therefore it was important to find an explanation regarding a possible impact of hormonal therapies by immunohistochemical evaluation of progesterone and estrogen receptor expression on nasal telangiectasias of affected patients. Methods: Tissue samples of nasal mucosa with evidence of telangiectasias from 14 patients with HHT were analyzed for the expression of progesterone and estrogen receptors on the nuclei of endothelial cells of the malformed vessels using immunohistochemistry. Results: Progesterone receptors were not detected in any of the cases and only two cases showed a weak expression of estrogen receptors with an immunoreactive score of 2/12.

Ectonucleotidase CD39 expression in regional metastases in head and neck cancer

Abstract Introduction: CD39 is the rate-limiting enzyme in the generation of immunosuppressive adenosine and its expression and activity are significant in tumor progression. Squamous cell carcinoma of the head and neck (HNSCC) shows an overall poor prognosis due to high local recurrence rates and early metastatic spread. Material and methods: Primary tumor specimens and lymph node specimens harvested during neck dissection of 65 patients with a diagnosis of HNSCC were subjected to immunohistochemical and H-score analysis of CD39 expression. Demographics, histopathology and subsequent outcome were analyzed. Results: The primary cancer was squamous cell carcinoma in all patients (male/female 55:10). H-score for CD39 expression in the primary lesion and metastatic lymph nodes was significantly higher in advanced compared to early stages with no significant differences among different tumor locations. High intratumoral and intrametastatic CD39 expression was associated with an inferior patients’ overall survival at a mean follow-up of 83.4 months (6–204 months). Conclusion: CD39 expression in HNSCC correlated positively with tumor stage and appears to predict poor prognosis. Therefore, CD39 expression in primary lesions and metastatic lymph nodes seems to identify patients at high risk in HNSCC of all tumor sites. Immunotherapeutic approaches targeting CD39 might be promising for this patient population.

Relevance of level I and IIB neck dissection in laryngeal cancer

OBJECTIVES Dissection of neck levels I and IIB is time-consuming and can cause comorbidity. This study aimed to determine whether level I and IIB neck dissection was necessary in patients with laryngeal cancer and clinically detectable or nondetectable neck nodes. PATIENTS AND METHODS This was a retrospective review of 73 patients with laryngeal cancer. Essential clinical data were obtained and analysed to determine the incidence of neck node metastasis in levels I and IIB. RESULTS Of the 48 patients with no clinically apparent neck nodes, none had level I metastases and only one had level IIB metastases. Of the patients with clinically detectable neck nodes, three of 21 patients had level I metastases and three of 25 patients had level IIB metastases; these six patients also had additional metastases in level IIA. CONCLUSION Dissection of neck levels I and IIB is justifiable in laryngeal cancer patients with clinically detectable neck nodes and suspicious lymph nodes in the respective level or level IIA. However, in patients without clinically detectable neck nodes, preservation of levels I and IIB is oncologically safe, economical and reduces the risk of comorbidity.