Nikolaos Papadogeorgakis

Evaluation of immunohistochemical expression of p53, p21, p27, cyclin D1, and Ki67 in oral and oropharyngeal squamous cell carcinoma

BACKGROUND The purpose of this study was to evaluate whether the immunohistochemical expression of p53, p21, p27, cyclin D1, and Ki67 can predict therapy response and survival in patients with oral and oropharyngeal squamous cell carcinoma treated with preoperative chemoradiation. METHODS Biomarker expression was evaluated by immunohistochemistry in formalin-fixed, paraffin-embedded pretreatment biopsies of 111 homogenously treated patients. We assessed the association between clinicopathological variables including response to neoadjuvant chemoradiotherapy as well as the survival of the patients and the expression of the biomarkers as both dichotomized (positive vs. negative) and continuous variables. RESULTS Biomarker overexpression on the basis of pre-selected cutoff points was seen in 66 of 111 (59%) cases for p53, in 77 (69%) for p21, in 48 (43%) for p27, in 81 (73%) for cyclin D1, and in 54 (49%) cases for Ki67, respectively. None of the examined biomarkers was able to predict response to neoadjuvant chemoradiotherapy or was associated with survival outcome. Post-treatment pathologic TNM stage (P < 0.001), pathologic response (P < 0.001), and perineural invasion (P < 0.001) were the only factors having a significant effect on recurrence-free survival. Post-treatment pathologic N stage (P = 0.005), post-treatment pathologic TNM stage (P < 0.001), pathologic response (P < 0.001), and perineural invasion (P = 0.001) had a significant impact on overall survival. CONCLUSIONS Our results suggest that the biomarkers p53, p21, p27, cyclin D1, and Ki67 have no impact on treatment response and survival in patients with oral and oropharyngeal cancer treated with preoperative chemoradiation.

Complications after free flap surgery: do we need a standardized classification of surgical complications?

Our main objective was to apply a standard classification to surgical complications after free flap surgery for reconstructions of the head and neck. We used the modified Clavien-Dindo classification in a cohort of 79 patients who were having reconstructions with jejunal free flaps simultaneously with resections of oral and oropharyngeal cancer. The most common minor complication was the need for a blood transfusion, and the most common major complication of a respiratory nature. The medical complications, and those at the recipient site and the donor site were 53/79 (67%), 44/79 (56%), and 9/79 (11%), respectively. The Clavien-Dindo classification is suitable and can easily be used to evaluate postoperative complications after free tissue transfer.

Partial superficial parotidectomy as the method of choice for treating pleomorphic adenomas of the parotid gland.

We present our experience of 156 patients with parotid pleomorphic adenomas who were treated from 1995 to 2009 by partial superficial parotidectomy. In each case the main trunk of the facial nerve was identified and dissected. Only the division of the nerve adjacent to the tumour was dissected, and only the parotid tissue surrounding the tumour was excised. The results were satisfactory, as no patient developed permanent partial or total facial nerve paralysis, and transient paresis was noticed in only 23 patients (15%). Only one tumour recurred, and Frey syndrome developed in only 6 patients (4%). Enucleation was required in 55 patients (35%) because the tumour was so close to the branches of the facial nerve. Partial superficial parotidectomy is a safe treatment for parotid pleomorphic adenomas with relatively few postoperative complications. When it is done by experienced surgeons no permanent deficits are likely, it has low rates of recurrence, and gives excellent aesthetic results.

Acantholytic squamous cell carcinoma of the gingiva: report of a case and review of the literature.

Adenoid squamous cell carcinoma differs from common squamous cell carcinoma in histologic features and its aggressive nature. Microscopically, the tumor shows cystic degeneration of the neoplastic epithelium, producing a prominent alveolar pattern and pseudoglandular structures with acantholytic cells. It occurs most commonly on the lips, rarely intraorally, and it is associated with a poor prognosis. This case concerns a 72-year-old woman who presented with the chief complaint of burning tongue and soreness of the lips. Clinical examination revealed an ulcerated and elevated mass on the edentulous left maxillary ridge, beneath the base of a partial denture. An incisional biopsy rendered the diagnosis of adenoid squamous cell carcinoma. The patient was referred to a specialized maxillofacial surgery center for diagnostic work-up and treatment. She underwent partial maxillectomy and radiotherapy, and 17 months after treatment, she died of uncontrollable recurrence.

Transfusion of allogenic leukocyte-depleted packed red blood cells is associated with postoperative morbidity in patients undergoing oral and oropharyngeal cancer surgery

Evidence indicates that allogenic packed red blood cell transfusion results in the hosts immunomodulation, and is associated with adverse clinical outcomes after surgery. The aim of this study was to test whether allogenic leukocyte-depleted blood transfusion represents a significant risk factor for postoperative morbidity after oral and oropharyngeal cancer surgery. A total of 142 patients, diagnosed for the first time with oral and oropharyngeal squamous cell carcinoma, and receiving neoadjuvant chemoradiotherapy followed by surgery between 2000 and 2008 were retrospectively included in this study. Univariate and multivariate logistic regression models were calculated to identify predictors of postoperative complications. We found a significantly higher complication rate in the group of transfused patients compared to patients not exposed to transfusion (complication rate of 84% and 39%, respectively, p<0.001). On multivariate analysis, the amount of packed red blood cells transfused (for 1-4 units transfused: adjusted OR, 2.59; 95% CI, 1.24-5.39; p=0.011; for more than >4 units transfused: adjusted OR, 5.29; 95% CI, 2.01-13.88; p=0.001) and Charlsons comorbidity score ≥1 (adjusted OR, 2.81; 95% CI, 1.38-5.70; p<0.004) were independently associated with the development of postoperative complications. Allogenic leukocyte-depleted blood transfusion is independently associated with increased postoperative complications in patients undergoing surgery for oral and oropharyngeal cancer. This association follows a dose-response relationship, as patients who received larger amounts of packed red blood cells showed a significant trend toward higher postoperative morbidity.

Use of a porcine dermal collagen graft (Permacol) in parotid surgery

Our aim was to present the results of the use of porcine dermal collagen graft (Permacol) in the prevention of Freys syndrome and face-contouring aesthetic deformities after operations on the parotid. We treated 19 patients with parotid tumours. After resection, a Permacol sheet was applied to the perimeter of the tissue deficit so that it was fully covered, and was sutured firmly. This technique produced satisfactory aesthetic results with good facial contouring in all patients. It also protected the exposed parotid nerve plexus, and none of the patients developed Freys syndrome. Permacol produced good results in both postoperative facial contouring and prevention of Freys syndrome.

Vascular fractal dimension and total vascular area in the study of oral cancer.

Microvessel quantification has been studied extensively as a factor reflecting angiogenesis in various malignant tumors. The aim of our study was to evaluate the vascular fractal dimension and the immunohistochemically positive total vascular area in oral cavity carcinomas in order to assess their potential value as factors reflecting angiogenesis.

A case of successfully treated rhinocerebral mucormycosis: dental implications.

This paper presents a case of rhinocerebral mucormycosis in a 22-year-old female patient with type I diabetes mellitus, who was successfully treated with surgery and long-term antifungal medication. The patient had initially been submitted to extraction of an upper third molar by a general dental practitioner but was referred to our department three days postoperatively because of double vision. Immediately following histopathological confirmation of the infection, the patient was administered Amphotericin B and Posaconazole intravenously. Surgical excision of the affected site was relatively conservative. The patient was free of the disease 15 months after initial admission to the hospital and has recently returned for reconstruction. The aim of this paper is to increase the awareness of general dental practitioners regarding uncommon serious conditions in diabetic patients, which may be confused with periodontal or dental diseases.

A method for extraction of impacted upper third molars

Evangelismos General Hospital, University of Athens, Department of Oral and Maxillofacial Surgery, 41-44 Ipsilantou St., 106 76 Athens, Greece Medical University of Vienna (MUW), Department of Oral and Cranio-Maxillofacial Surgery, Waehringer Guertel 18-20, A-1090 Vienna, Austria Oral and Maxillofacial Surgery, Oral and Maxillofacial Department, St. James Institute of Oncology and Leeds Dental Institute, eeds LS2 9LU, United Kingdom

Metastases to Supramandibular Facial Lymph Nodes in Patients With Squamous Cell Carcinoma of the Oral Cavity

PURPOSE This study evaluated the frequency of metastases to supramandibular facial lymph nodes (SFLNs) in patients with squamous cell carcinoma (SCC) of the oral cavity. PATIENTS AND METHODS SFLNs were identified and removed during neck dissection from 43 patients with oral SCC. All of them were histopathologically and immunohistochemically examined, to detect possible metastases and micrometastases. RESULTS Metastases to SFLNs were present in 6 patients (13.95%). Metastases were much more common among patients with palpable neck nodes, larger size of the primary site, advanced TNM stage, and greater age and those in whom the primary site was located in the mucosa of the alveolar ridge of the mandible. CONCLUSIONS Surgical procedures in the region of the SFLNs must be performed very carefully, because of their close relation with the marginal mandibular nerve. In patients with oral SCC and palpable neck nodes, those with advanced disease, and those in whom the primary site is located in the mucosa of the alveolar ridge of the mandible, removal of SFLNs must be considered.