Industrial pollutants and nasopharyngeal cancer: an open question

Introduction and Objectives: Nasopharyngeal Carcinoma represents 0.7% of the total cancer cases in the world with an ASR index of 1.7 and is widely associated with Epstein-Barr virus. It is not common in Italy [ASR index of 0.5] while in China [ASR 1.9], one third of the clinical cases are observed in Guangdong [ASR index 11.3]. It is also quite common in Malaysia and Indonesia. The activation of the cancerogenesis process happens after the exposure to some environmental parameters that epidemiological studies have indicated with various dietary habits, mainly for salted fish consumption. The purpose of this work is to highlight such as exposure to compounds, such as formaldehyde, which is present in the different working conditions of these countries and may lead to the real cause to establish the carcinogenic process

Materials and Methods: The most recent publications regarding the impact of various external factors on Pub Med, Google, TOXLINE, Chem Abstract, were analyzed with the radiological data that were found in Milan hospitals database

Results: The relationship between food consumption and nasopharyngeal cancer are not clear and statistically insignificant in Indonesia. In Malaysia, the preparation of natural rubber for the use of formaldehyde is a dangerous environmental factor. The same exposure is a risk factor in Guangdong, where many workers are employed in the wood panel industry. Incidence of cancer in these Chinese ethnic groups decreases when they migrate to other countries. In the last 5 years, few cases were recorded in Italy, without any apparent change in ethnic environmental factors or HBV infection

Discussion: In the production of natural rubber, a lot of people are exposed to formaldehyde during the various steps of preparation and production such as stripping, drying and coagulation without observing proper environmental hygiene precautions. The same working conditions are present in industrial production of WOOD panels in Guangdong, China. The relationship between exposure to formaldehyde aod nasopharyngeal cancer is demonstrated by the fact thai epidemiological studies on the population of this Chinese district whose immigrant populations were not to these pollutants, the appearance of these decreases. Also an examination of our radiological data in Italy shows that in about one hundred sixty cases of nasopharyngeal cancer none of the patients Indonesian or Chinese

Conclusion: The preliminary results of our study suggest! that EPST-BARR virus could be a risk factor if associated! with exposure to compounds such as formalc which is present in industrial productions of countries! Indonesia, Malaysia, and China

Angiofibroma nasofaríngeo juvenil: estudio de 6 casos en el Hospital Carlos van Buren de Chile / Juvenile nasopharyngeal angiofibroma: study of 6 cases in the Carlos van Buren Hospital in Chile

Introducción: El angiofibroma nasofaríngeo juvenil es una neoplasia vascular benigna y localmente agresiva, que se desarrolla casi exclusivamente en adolescentes de sexo masculino. Sus manifestaciones clínicas habituales son epistaxis y obstrucción nasal. Objetivo: Dar a conocer la experiencia en el Servicio de Otorrinolaringología del Hospital Carlos van Buren de pacientes con angiofibroma operados por vía endoscópica y abierta entre los años 2008 y 2015. Material y método: Estudio descriptivo retrospectivo de pacientes con diagnóstico de angiofibroma nasofaríngeo juvenil que ingresaron al Servicio de Otorrinolaringología del Hospital Carlos van Buren entre los años 2008 y 2015. Resultados: Hubo un total de 6 casos. La edad de los pacientes fluctuó entre los 12 y los 29 años, el 100% fueron pacientes masculinos. Los síntomas de presentación más frecuente fueron epistaxis recurrente y obstrucción nasal, presentes en 5/6 de los pacientes. La totalidad de los casos fueron estudiados con TC, RM y angiografía. El manejo en todos los casos fue con embolización endovascular 48 horas previo a la resección. Conclusión: Los resultados obtenidos se correlacionan con la literatura. El abordaje endoscópico sigue siendo de elección. Este tiene como ventajas menores pérdidas sanguíneas intraoperatorias, una disminución del número días de hospitalización y las tasas de recurrencia.

Introduction: Juvenile nasopharyngeal angiofibroma is a benign vascular neoplasm, locally aggressive that develops almost exclusively in adolescent males. Its usual clinical manifestations are epistaxis and nasal obstruction. Aim: To show the experience in the Department of Otolaryngology Hospital Carlos van Buren of angiofibromas operated by endoscopic and open surgery between the years 2008 and 2015, and review of the literature. Material and Method: Retrospective descriptive study of patients diagnosed with juvenile nasopharyngeal angiofibroma admitted in the Department of Otolaryngology Hospital Carlos van Buren, Valparaiso between 2008 and 2015. Results: A total of 6 cases were identified. The age of patients ranged from 12 to 29 years. The most common presenting symptoms were recurrent epistaxis and nasal obstruction, both present in 5/6 of patients. All the cases were studied with CT, MRI and angiography. All cases had pre-surgical endovascular embolisation48 hours prior to excision. Conclusions: The results correlate with those seen in the literature. The endoscopic approach is the better option, because of its lower intraoperative blood loss, days of hospitalization and recurrence.

Nasoangiofibroma juvenil: nuestra experiencia en los últimos 10 años y revisión de la literatura / Juvenile nasopharyngeal angiofibroma: our experience in the last 10 years and review of the literature

Introducción: El nasoangiofibroma juvenil es un tumor benigno con comportamiento de agresividad local, dadas las importantes epistaxis que provoca, la frecuente recidiva local y la complejidad terapéutica que se presenta ante esta patología; se presenta exclusivamente en hombres adolescentes y corresponde al 0,5 por ciento-0,05 por ciento de todos los tumores de cabeza y cuello. Objetivo: Determinar el manejo y las características del paciente con el diagnóstico de nasoagiofibroma juvenil que acude a nuestro servicio. Evaluar necesidad de transfusión sanguínea. Exponer las complicaciones encontradas. Material y método: Se realizó un trabajo retrospectivo observacional de corte transversal de pacientes con diagnóstico de nasoangiofibroma juvenil (NAJ), confirmado por estudios histológicos en la Cátedra de Otorrinolaringología de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción, desde enero de 1998 hasta septiembre de 2008. Resultados: Con un total de 45, de los cuales 44 recibieron tratamiento quirúrgico. El rango de edad estaba comprendido entre 7 a 34 años, con una mediana de 16 años y un promedio de 17 años, todos de sexo masculino. Se presentaron con mayor frecuencia en estadio Fisch II, rango de evolución sintomática de 1 a 60 meses, con una mediana de 7 meses de evolución de epistaxis recurrente, obstrucción nasal y rinorrea. La mayoría de grupo sanguíneo O Rh+, provenientes del Departamento Central, recibiendo como tratamiento la resección endoscópica. Siete pacientes presentaron recidivas, con una mediana de 7 meses desde el tratamiento. En 58,8 por ciento de los procedimientos quirúrgicos fue necesaria la transfusión de derivados sanguíneos. Conclusión: Los pacientes que acuden al servicio con el diagnóstico de nasoangiofibroma juvenil, son sometidos a tratamiento quirúrgico en la totalidad de los casos. En la mayoría de los casos se requirió algún tipo de transfusión sanguínea. No hubo complicaciones por...

Introduction: The juvenile Nasopharyngeal Angiofibroma is a benign tumor with behavior of local aggressiveness, given the important epistaxis that it provokes, the frequent local recidiva and the therapeutic complexity that one presents before this pathology; he appears exclusively in teen men and corresponds to 0,5 percent-0,05 percent of all the tumors of head and neck. Aim: To determine the managing and the characteristics of the patient with juvenile Nasopharyngeal Angiofibroma diagnosis that comes to our service. To evaluate need of blood transfusion. To expose the opposing complications. Material and method: There realized a retrospective work observacional of patients' transverse court (cut) with diagnosis of juvenile Nasopharyngeal Angiofibroma (NAJ), confirmed by histological studies in the Service of Otolaryngology of the Asuncion's National University, from January, 1998 until September, 2008. Results: With a whole of 45, of which 44 received surgical treatment. The range of age was understood (included) between (among) 7 to 34 years, with a median of 16 years and an average of 17 years, all of masculine sex. Appellants presented with major frequency in estadio Fisch II, range of symptomatic evolution from 1 to 60 months, with a median of 7 months of evolution of epistaxis, nasal obstruction and rinorrea. The majority of blood group O Rh +, from the Central department, receiving as treatment the resection endoscopic. 7 patients presented recidivas, with a median of 7 months from the treatment. In 58,8 percent of the surgical procedures there was necessary the transfusion of blood derivatives. Conclusion: The patients who come to the service with juvenile nasopharyngeal angiofibroma diagnosis, are submitted to surgical treatment in the totality of the cases. In most cases there was needed some type of blood transfusion. There were no complications for the surgical procedure.

Biópsia de nasofaringe em Serviço de Otorrinolaringologia: correlação clínico histopatológico / Nasopharyngeal biosy in an Otorhinolaryngology Service: clinical histopathological correlation

Os tumores de nasofaringe são afecções raras. Devido à grande diversidade de lesões dessa região, todos os pacientes com suspeita de tumor em nasofaringe devem se submeter a exame endoscópico nasal e biópsia...

Nasopharyngeal neoplasm are rare diseases. Due to great diversity of lesions affecting this area, all patients suspected to have a nasopharyngeal neoplasm should be submitted to nasal endoscopy and biopsy...

Prise en charge des cancers naso-sinusiens dans le service d'ORL du CHU de Treicheville (Abidjan)

Introduction : Les cancers des cavites naso-sinusiennes sont peu frequents et se singularisent par leurs varietes histologiques. Les objectifs de ce travail etaient de decrire les caracteristiques epidemiologiques et diagnostiques des cancers des cavites naso-sinusiennes; et d'evaluer leur traitement. Patients et methodes : Cette etude a concerne 8 patients (6 hommes et 2 femmes) operes pour un cancer des cavites naso-sinusiennes durant la periode allant du Ier janvier 1996 a 31 mai 2007. Resultats : Ils avaient un age moyen de 51 ans avec des extremes allant de 28 a 75 ans. Aucun facteur favorisant significatif n'a ete releve. Le diagnostic a ete tardif pour la plupart des cas (T2 : n=5). La voie de rhinotomie paralateronasale a ete utilisee pour l'exerese tumorale associee a un curage ganglionnaire dans un cas. Les suites operatoires ont ete marquees par des troubles neurologiques et oculaires. Trois cas de recidive ont ete observes. Le suivi post operatoire n'ayant pas excede trois mois; l'evolution a long terme et la mortalite n'ont pu etre evaluees. Conclusion : Dans notre service; les caracteristiques epidemiologiques et histologiques des cancers naso-sinusiens ont ete superposables a celles de la litterature. Le traitement essentiellement chirurgical a ete tardif et decevant

Epstein-Barr virus-associated extranodal non-Hodgkin's lymphoma of the sinonasal tract and nasopharynx in Thailand.

Epstein-Barr virus (EBV) infection is highly associated with specific subtypes of malignant lymphoma. In our previous report on nodal malignant lymphoma in Thailand, we found that 64% of classical Hodgkin's lymphoma (cHL), 51% of non-Hodgkin's lymphoma, T-cell (NHL-T), and 13% of non-Hodgkin's lymphoma, B-cell (NHL-B) were EBV-related. In the present research, we conducted a retrospective study of primary extranodal non-Hodgkin's lymphoma of the sinonasal tract (e-NHL-ST) and primary extranodal non-Hodgkin's lymphoma of the nasopharynx (e-NHL-NP) in Southern Thailand, between 1997 and 2004. EBV-encoded RNA (EBER) expression by in situ hybridization was performed in all cases and a T-cell receptor (TCR)-g gene rearrangement study was performed in NHL-T cases. There were 18 cases of e-NHL-ST and 42 cases of e-NHL-NP detected by histologic and immunohistochemistry examinations. The percentages of e-NHL-ST and e-NHL-NP as compared to nodal malignant lymphoma were 3.7% and 6.8%, respectively. Sixteen cases (88.9%) of e-NHL-ST and 7 cases (16.7%) of e-NHL-NP were NHL-T, and the remainder were NHL-B. All of the NHL-T cases in both sites were EBER-positive. Two (5.4%) of the NHL-B cases in the nasopharynx showed EBER positive. Monoclonal bands of the TCR-gamma gene were detected in 71.4% of the extranodal NK/T-cell lymphomas, nasal type, patients; 50.0% of peripheral T-cell lymphoma, unspecified, patients; and one case of angioimmunoblastic T-cell lymphoma. This study indicates a very strong association of NHL-T in the sinonasal tract or nasopharynx with EBV infection, the link apparently being weaker in NHL-B patients. The study also indicates that most cases of extranodal NK/T-cell lymphoma, nasal type, are not the germline configuration of the TCR genes.

Glutathione S-transferase M1 gene polymorphism in Thai nasopharyngeal carcinoma.

Nasopharyngeal carcinoma (NPC) is a serious health problem in Thailand. It is caused by the combined effects of Epstein-Barr virus (EBV), carcinogens and genetic susceptibility. The glutathione S-transferase M1 gene (GSTM1) encodes a phase II enzyme responsible for detoxifying carcinogenic electrophiles. Polymorphic null forms of the gene GSTM1 lack enzyme activity and have been associated with susceptibility to several cancers including NPC. To examine the association between GSTM1 polymorphism and NPC susceptibility in Thais, GSTM1 genotypes (normal and null genotypes) in 78 NPC patients and 145 age-matched healthy controls were determined using PCR assays. Overall, no statistically significant differences were observed in the frequency of GSTM1 genotypes between cases and controls, nor among NPC patients compared on the basis of sex and clinical stage of disease. Carriers with the GSTM1 null genotype had a 2.9-fold increased risk for NPC of WHO type III when compared to those with GSTM1 normal genotype (P < 0.05 with OR =2.9, 95% CI = 1.2-6.8). When cases and controls were categorized into 3 age groups (>40, (>45 and (>50 years), the frequencies of GSTM1 null genotype in cases the (>45 and (>50 age groups were significantly different from controls (P< 0.05). In addition, carriers of the GSTM1 null genotype in age groups (>45 and (>50 years had a 2-fold and 3-fold increased risk for NPC when compared to those with GSTM1 normal genotype (OR = 2.2, 95% CI = 1.1-4.7 and OR = 3.0, 95% CI = 1.2-7.5). We suggest that GSTM1 polymorphism may be associated with NPC susceptibility in Thais, especially for GSTM1 null genotype carriers of age higher than 45 years. The GSTM1 null genotype may be a useful genetic marker for predicting Thai NPC and for screening of early stages of Thai NPC.

Juvenile nasopharyngeal angiofibroma: a single institution study.

BACKGROUND: Juvenile nasopharyngeal angiofibroma (JNA) is a rare tumor of adolescent males and there is a paucity of Indian studies on this subject. AIMS: To present the experience of management of JNA at a single institution. SETTING AND DESIGN: This is a retrospective observational study of patients with JNA who presented at the Tata Memorial Hospital between May 1988 and August 2001. MATERIALS AND METHODS: Thirty-two patients with JNA were treated in the study period. Since the time period was prolonged and diagnostic and therapeutic protocols had undergone many changes, the patients were divided into two groups, namely 1988-1996 and 1997-2001. The age distribution, disease patterns, management approaches and treatment outcomes of patients in the two groups were recorded. Statistical analyses were done using students 't' test and test for proportion. RESULTS: The mean age at presentation was 16 years and more than 90% of the patients had Stage III or IV disease. Preoperative embolization was carried out in 19 patients. The surgical approaches used were median maxillectomy, infratemporal fossa, transpalatal, maxillary swing and craniofacial approach. The recurrence rate, complete resection rate and cure rates were 12.5%, 41% and 63% respectively. CONCLUSION: Surgery is the mainstay of treatment of JNA. Preoperative embolization and newer surgical approaches result in less blood loss and complete resection. Aggressive re-resection should be done for resectable recurrences reserving radiotherapy for unresectable, recurrent/ residual disease.

Nasopharyngeal carcinoma in Indonesia has a low prevalence of the 30-base pair deletion of Epstein-Barr virus latent membrane protein 1.

Epstein-Barr virus (EBV) is associated with nasopharyngeal carcinoma (NPC), one of the highest incidence of tumors in Indonesia. EBV infection is ubiquitous around the world, but NPC occurs with a remarkable geographic distribution. This phenomenon suggests that there are subtypes of EBV, some of which may have greater tumorigenic potential. The latent membrane protein 1 (LMP 1) gene encoded by EBV is tumorigenic due to its ability to transform rodent fibroblast. It was originally shown that the LMP 1 gene from NPC of Chinese patients harbors a deletion of 30-bp in the carboxyl terminal of the gene. However, the deletion is also present in healthy control and in other EBV-positive tumors. We examined the polymorphism of LMP 1 in 56 tumor biopsies of Indonesian patients with NPC and identified low prevalence of the 30-bp deletion of LMP 1. Sequence analysis showed unique mutations of LMP 1 which suggests that strain-specific variations of EBV are found in Indonesia. The low frequency of 30-bp deletion in the country with high prevalence of NPC indicates that the deletion may represent a geographic polymorphism rather than a predisposing factor in the development of NPC.

Risk factors for cancer nasopharynx: a case-control study from Nagaland, India.

BACKGROUND: A high incidence of nasopharyngeal carcinoma has been reported from Nagaland, though it is considered to be a rare neoplasm in India. No case-control study to identify the risk factors of cancer nasopharynx has been conducted in this region. This study was undertaken to identify dietary and environmental risk factors for nasopharyngeal carcinoma relevant to this region. METHODS: A matched case-control study using neighbourhood controls was conducted. For each of the 47 cases identified, 2 apparently healthy neighbourhood controls were matched for age, sex and ethnicity. All information on dietary, environmental, social and demographic factors was collected. Univariate and multivariate logistic regression analysis using maximum likelihood method was used to analyse data. RESULTS: Consumption of smoked meat was found to be the risk factor for nasopharyngeal carcinoma (adjusted odds ratio = 10.8; 95% CI 3.0-39.0). History of using herbal nasal medicine was also found to be associated with nasopharyngeal carcinoma (OR = 21.9, CI = 6.8-71.4). However, exposure to a smoky atmosphere, betel-nut chewing, use of smokeless tobacco products, smoking and drinking habits were not found to be associated with nasopharyngeal carcinoma. CONCLUSION: This study reveals an association of nasopharyngeal carcinoma with consumption of smoked meat in Nagaland. The use of herbal nasal medicine seems to be an additional risk factor for nasopharyngeal carcinoma in Nagaland and needs further assessment.

Epstein-Barr virus in nasopharyngeal carcinoma in Indian patients.

Formalin fixed paraffin embedded tissue blocks from 40 cases of nasopharyngeal carcinoma were investigated for the presence of Epstein-Barr virus (EBV). Heminested polymerase chain reaction was employed to amplify U 2 region of EBV DNA coding for EBNA 2 gene. This is the first study of its kind carried out in India. EBV was detected in 28 out of 40 (70%) nasopharyngeal carcinomas. Type A EBV was identified in 20 cases (71.4%), type B in 7 cases (25%) and coinfection in one case (3.5%). Either type A, or type B EBV, was identified in 22 out of 23 cases (95.7%) of undifferentiated nasopharyngeal carcinoma and 6 out of 15 cases (40%) of non keratinized squamous carcinoma. The higher incidence of EBV in non keratinized squamous carcinoma of nasopharynx assumes importance in view of the contrary reports in other studies. 26 cases were from Western India, of which 15 (57.6%) showed presence of type A EBV and 2 (7.6%) type B EBV. From Eastern Indian particularly Assam, 4 our of 5 cases showed positivity for type B EBV and 1 a coinfection. Whereas, from Bihar 3 out of 4 cases showed presence of type A EBV. From Middle East (Arabs) type A EBV was detected in 3 out of 5 cases of nasopharyngeal carcinomas. Geographically, type A EBV was far more prevalent in Western India, while in Eastern India particularly Assam, all five vases were positive for type B EBV. Thus, a significant variation in the type of EBV infection was observed in nasopharyngeal carcinoma in different ethnic populations in India.

Prevalence of EBV RNA in sinonasal and Waldeyer's ring lymphomas

A high incidence of a T cell phenotype of sinonasal lymphomas in other Asian countries has been associated with a high incidence of Epstein Barr virus (EBV) infection. We analyzed 13 sinonasal and 18 Waldeyer's ring lymphomas for the prevalence of EBV encoded RNA (EBER) using a sensitive and specific in situ hybridization. In addition, we examined the relationship of histologic findings and immunophenotype as well as the location of the lymphomas to the presence of EBV. The EBER was detected in each of 12 sinonasal lymphomas with a T cell immunophenotype. One B cell sinonasal lymphoma was EBER negative. Four of 18 Waldeyer's ring lymphomas were positive for EBER, including two T cell lymphomas. Two of 16 B cell Waldeyer's ring lymphomas were EBER positive. Morphologically, 11 of 20 diffuse large cell lymphomas, 2 diffuse mixed small and large cell lymphomas, 2 of 4 immunoblastic lymphomas and 1 lymphoplasmacytic lymphoma were EBER positive. Four follicular large cell lymphomas were EBER negative. A characteristic angiocentric or angiodestructive pattern was found in most T cell lymphomas and EBER positive cases. These findings indicate that EBV infection is more strongly associated with the T cell immunophenotype, angiocentric pattern and sinonasal location of the lymphoma.

Aspectos epidemiológicos do carcinoma da nasofaringe / Epidemiological aspects of the nasopharyngeal carcinoma

Este estudo apresenta 39 doentes com câncer de nasofaringe (NPC), que foram revisados sob os aspectos epidemiológicos. Todos os casos foram estudados no período de 1979-1989, com uma investigaçäo clínica, neurológica e radiológica e os dados foram analisados, tendo em vista a idade, sexo, origem étnica, primeiros sinais, apresentaçäo clínica, pares cranianos evolvidos, perda de peso, associaçäo com consumo de álcool e fumo e distribuiçäo histológica.

Tumores de la nasofaringe: análisis de casos años 1960-1991 / Nasopharynx tumors: analysis of cases years 1960-1991

Analisis retrospectivo de 20 casos tratados en el Hospital Central de las FFAA. Las adenomegalias fueron universales en el 100 por ciento (20-20). El 80 por ciento (16-20) fueron malignos, y entre estos el 62,50 por ciento epidermoides. Como estadio III se clasificó el 50 por ciento de los casos (8-16). Recibieron radioterapia todos los pacientes, con una tasa de respuesta parcial del 43.75 por ciento (7-16). Recibieron además de la radioterapia, drogas antineoplásicas 6 pacientes con una tasa de respuesta parcial del 50 por ciento (3-6). La sobrevida actuarial a los 5 años fue del 40 por ciento . Se concluye en la necesidad de diagnóstico precoz, buena técnica del tratamiento radiante y manejo interdisciplinario

Estudo epidemiologico, terapeutico e de relaçäo com o virus Epstein e Barr, do cancer da nasofaringe em Säo Paulo, Brasil: estudo epidemiologico do cancer da nasofaringe; parte 2 / Epidemiological therapeutic and relation study with Epstein Barr virus nasopharyngeal cancer in Sao Paulo-Brasil: epidemiological study of nasopharyngeal cancer; part II

No estudo epidemiológico, terapêutico e de relaçäo com o virus Epstein e Barr do câncer da nasofaringe em Säo Paulo-Brasil, säo analisados: a) anatomia do rinofaringe, b) incidência, frequência, distribuiçäo etária e racial, c) etiologia, d) estudo clínico e patológico, e) terapeutica, f) prognostico e resultados, g) instrumental para exame e biopsia e, h) relaçäo com o virus Epstein-Barr