Nobuo Saeki

CD44 expression is related to poor prognosis of hypopharyngeal squamous cell carcinoma

Abstract Conclusions: CD44 expression in hypopharyngeal squamous cell carcinomas (SCCs) is closely associated with poor prognosis for patients. CD44 may serve as a prognostic marker for hypopharyngeal SCCs. Objectives: CD44, an adhesion molecule binding to extracellular matrix, is believed to participate in the progression of malignancies. To clarify the role of CD44 in the progression of hypopharyngeal SCCs, we examined CD44 expression in relation to clinical parameters in hypopharyngeal SCCs. Methods: Biopsy specimens of hypopharyngeal SCCs were collected from 40 untreated patients, and their CD44 expression was examined immunohistochemically. Hypopharyngeal SCCs were classified into two groups: CD44-low SCCs comprising < 50% CD44-positive tumor cells and CD44-high SCCs comprising ≥ 50% CD44-positive tumor cells. The relation between CD44 expression and various parameters (clinical T and N stages, distant metastasis, and pathological T and N stages) was analyzed by Fishers exact test. The relation between CD44 expression and the 5-year disease-free survival (DFS) rate was also analyzed by log rank test. Results: The CD44 expression in hypopharyngeal SCCs was related to pathological N stage, but not to clinical T and N stages and pathological T stage, of the patients. Distant metastasis during the follow-up occurred more frequently in patients with CD44-high SCCs than those with CD44-low SCCs. The 5-year DFS was significantly lower in the former than in the latter.

Clinical features of 5 patients with descending necrotizing mediastinitis originating from deep neck infection.

Descending necrotizing mediastinitis originating from deep neck infection is one of the most serious diseases in the head and neck region. Delayed diagnosis leads to death. We examined 5 cases of descending necrotizing mediastinitis, successfully treated with antibiotics and surgical drainage. Abscess was found in the lower part of the anterior mediastinum in 3 cases and the posterior mediastinum in 2 cases. We first conducted transcervical mediastinal drainage for 3 cases, however, thoracotomy was eventually required in all cases. For cases of abscess in the lower part of the anterior mediastinum, early and aggressive surgical drainage in collaboration with thoracic surgeons is very important and can improve survival.

Utility of real-time diagnosis using contact endoscopy for oral and lingual diseases.

OBJECTIVE In this study, we prospectively investigated the diagnostic accuracy of CE findings in oral and lingual diseases. METHODS Between January 2004 and December 2009, CE was used to examine 66 patients with oral and lingual diseases at Hyogo College of Medicine Hospital. Blood vessel networks and superficial cell layers in the mucosal epithelium of normal and lesion sites were observed after staining with 1% methylene blue. Endoscopic diagnoses (CE diagnosis) were compared with subsequent definitive diagnoses based on pathological findings. The sensitivity and specificity for CE diagnosis were calculated. RESULTS On CE findings, SCC showed the characteristics of absent and tortuous blood vessels, heterogeneous distribution, and increased nucleus/cytoplasm (N/C) ratio. Leukoplakia showed no atypical cells, abundant cornified layers, or cytoplasm without nuclei. Lesions were pathologically classified into three groups: 46 squamous cell carcinomas (SCC), 10 leukoplakias, and 10 other benign lesions (n=66). In 4 patients with SCC, malignancy was underestimated by CE findings. The overall diagnostic rate of the CE was 93.9% (62/66 patients). The sensitivity and specificity of SCC were 0.913 (42/46 patients) and 1.0 (20/20 patients), respectively. CONCLUSION The usefulness of contact endoscopy (CE) as an in vivo real-time diagnostic instrument that can deliver results prior to pathological confirmation was suggested.

Factors Affecting Recurrence of T1 and T2 Tongue Cancer Undergoing Intraoral Resection

1.1. Background: Intraoral resection of early tongue cancer minimally affects the quality of life (QOL) of patients; however, local recurrence of the tumor requires radical resection and negatively affects QOL as well as patient prognosis. The present study was performed to clarify factors affecting recurrence of tongue cancers undergoing intraoral resection. 1.2. Methods: In total, 174 patients (T1: 105 patients and T2: 69 patients) with squamous cell carcinoma of the tongue receiving intraoral resection were enrolled in the study, including 106 male patients and 68 female patients (aged 27-88 years, mean 58 years). Tumor recurrence was observed in 10 of 105 patients with T1 stage cancer (9.5%) and in 6 of 69 patients with T2 stage cancer (8.7%). The clinicopathological factors, including immunohistochemistry for p53, Ki67, and vimentin, were analyzed. 1.3. Results: An infiltration pattern and vimentin expression were associated with tongue cancer recurrence. Specifically, tumors with positive vimentin expression exhibited a higher ratio of endophytic growth, and multivariate analysis revealed that the Ki67 labeling index and vimentin expression were independent factors affecting tumor recurrence. 1.4. Conclusion: The mode of tumor invasion and the epithelial-to-mesenchymal transition, as evidenced by vimentin immunohistochemistry, assisted the identification of high-risk patients with tongue cancer undergoing intraoral resection. Intense follow-up with the aid of multimodal therapies after surgery is necessary in this group of high-risk patients.

S150 – Clinical Study of 13 cases of Olfactory Neuroblastoma

Objectives Olfactory neuroblastoma is a rare neuroendocrine tumor that arises in the upper nasal cavity of the olfactory epithelium. We examined 13 patients with olfactory neuroblastoma and report the findings. Methods The subjects were the primary treated patients of olfactory neuroblastoma at our departments between 1986 and 2008 (age: 29–72). Using the clinical staging proposed by Dulguerov, we examined the treatment methods, the sites of recurrence, and the prognoses in those cases. Results According to Dulguerovs staging, 1 patient was categorized as T1, 3 patients as T2, 8 patients as T3, and 1 patient as T4. Among the 4 cases in T1 and T2, 3 patients underwent radiotherapy as their primary treatment, whereas the remaining 1 patient underwent endoscopic surgery. Eight patients in T3 and T4, whose tumors were resectable, underwent skull base surgery combined with radiotherapy. Among the 13 cases, 4 patients developed primary recurrence, 3 patients developed neck lymph node metastasis, and one patient developed lung metastasis. The overall 10-year survival rate of the 13 cases was 83.3%. The primary tumors could be controlled in all of the 8 patients who underwent skull base surgery and radiotherapy. All of those patients are currently alive without disease. There was 1 patient whose tumor recurred approximately 20 years after the initial treatment. Conclusions The survival rate can be improved performing skull base surgery combined with radiotherapy provided that the tumors are resectable. Long-term clinical follow-up is also significant.

A Case of Malignant Fibrous Histiocytoma of the Right Maxillary Sinus-Associated Ovary Tumor-

Malignant fibrous histiocytoma (MFH) is one of the most common soft tissue sarcomas of the extremities. MFH arising from the maxillary sinus region are extremely rare. We experienced a case of MFH of this region in a 61-year-old female. She was admitted with the chief complaints of right cheek swelling and swelling of the gingiva around the right maxillary molar area. Biopsies of the nasal cavity and maxillary gingiva indicated malignant schwannoma or MFH. Furthermore, a pelvic tumor larger than 10cm was found. We performed excision of the pelvic tumor and total maxillectomy. Histological diagnosis was fibroma of the ovary and MFH of the maxillary sinus. Postoperative radiation therapy (total dose: 50Gy) was performed. No recurrence has been observed for more than 5 years after surgery.