Metastatic adenocarcinoma to the cervical lymph node: a significant proportion of cholangiocarcinoma in Thai patients.

OBJECTIVE: To determine distribution of the primary site of metastatic adenocarcinoma to the cervical lymph node in Thai population with histological correlation. MATERIALS AND METHODS: 72 Thai patients with metastatic adenocarcinoma to the cervical lymph node were retrospectively analyzed. Results: Thyroid gland (papillary carcinoma) was the commonest source of tumor (41%), followed by lung (25%), bile duct (17%) and breast (7%). Metastatic cholangiocarcinoma typically produced distinct glandular pattern, and frequently involved the right supraclavicular lymph node. Brush border of the gland-forming tumor cells was a consistent finding in metastatic cholangiocarcinoma, with 100% sensitivity and 97% specificity. CONCLUSIONS: Cholangiocarcinoma represents a significant portion of primary tumor in Thai patients with cervical nodal metastasis. This figure may hold true for countries where bile duct malignancy is endemic, and may be of clinical usefulness in identification of primary cancer.

Line-1 hypomethylation in multistage carcinogenesis of the uterine cervix.

OBJECTIVE: To evaluate characteristics of global hypomethylation in evolution of cervical cancer. MATERIALS AND METHODS: Eight cases of squamous cell carcinoma (SCC) and seven cases of carcinoma in situ (CIS) were studied. Each of the SCC samples contained CIS, and all SCC and CIS samples contained normal ectocervical epithelium. Microdissection was performed to separate normal epithelium, CIS and SCC prior to DNA extraction. Hypomethylation levels of long interspersed nuclear elements (LINE-1 or L1) were measured with a combined bisulfite restriction analysis (COBRA) PCR (polymerase chain reaction) protocol. The percentage of L1 hypomethylation for SCC, CIS and normal epithelium was compared. RESULTS: In the SCC cohort, the L1 hypomethylation level showed progressive increase comparing normal epithelium (59.4 +/- 8.86%) to CIS (64.37 +/- 7.32%) and SCC (66.3 +/- 7.26%) (repeated measurement ANOVA, P = 0.005). A significantly greater L1 hypomethylation level was found in CIS (62.06 +/- 3.44 %) compared to normal epithelium (60.03 +/- 3.69 %) (paired t-Test, P = 0.03). No significant difference in L1 hypomethylation level was noted between CIS of the two sample groups (unpaired t-Test, P = 0.2). CONCLUSIONS: In our study, there was a significant correlation between the degree of hypomethylation and progression from normal ectocervical mucosa to CIS and invasive cancer. Laboratory assessment of biopsies for this molecular event may have clinical significance.