Co-expression of Hif1alpha and CAIX is associated with poor prognosis in oral squamous cell carcinoma patients.

BACKGROUND: This study investigates the prognostic impact of the expression of hypoxia-inducible factor 1alpha (Hif1alpha) and carbonic anhydrase IX (CAIX) detected by immunohistochemistry in oral squamous cell carcinoma (OSCC). METHODS: Statistical analysis of immunohistochemical results with clinical parameters including survival outcomes was performed for 80 OSCC patients. RESULTS: Patients with a low expression of both proteins survived on average 54.8 months, whereas those with an increased expression of Hif1alpha in their tumors combined with a low expression of CAIX survived on average only 37.6 months (P = 0.026). In multivariate Cox's regression hazard analysis, again patients with a low expression of Hif1alpha/CAIX had the best prognosis, whereas patients with increased Hif1alpha and low CAIX expression carried a 4.97-fold increased risk of tumor-related death (P = 0.042). CONCLUSION: A co-detection of low Hif1alpha/CAIX expression is significantly correlated with a better prognosis for OSCC patients, which may have implications for therapy options for these patients.

[Prognostic factors for oral squamous cell carcinoma]. / Prognostische Aussagen zum Mundhöhlenkarzinom.

The aim of the present study was to analyze different prognostic factors to calculate the overall survival in oral squamous cell carcinoma (OSCC). Samples retrospectively collected from 99 patients with primary OSCC were analyzed with regard to tumor node metastasis stage, grading, and 5-year survival time and summarized at an SPSS 11.0 databank. Treated were 72 men and 27 women (average age 59 years) due to oral squamous cell carcinoma. A general 5-year survival time of 57.3% was found. Patient survival depended on tumor size and the extent of lymph node metastasis: survival was 80.1% (n=23) for T1 tumors and only 16.2% (n=28) for T4 tumors, 68.7% (n=55) at the N0 stage and 42.8% at >N0 (n=44, chi(2) test P=0.01, Fischer's exact test P=0.014). Highly differentiated carcinomas (n=26) had a survival probability of 78.9% and G2 and G3 tumors of only 48.9% (n=73, chi(2) test P<0.001). Tumor size and lymph node metastases are decisive.

Marfan syndrome: clinical consequences resulting from a medicolegal autopsy of a case of sudden death due to aortic rupture.

To investigate the sudden death of a 31-year-old man, a medicolegal autopsy was performed. Major findings were a dilated aortic root with a longitudinal rupture of the intima and dissection of aorta and right coronary artery and consequent tamponade of the pericardial sac. Moreover, arachnodactyly and other skeletal deformities in combination with the histological finding of a pseudocystic medionecrosis of the aortic wall were noted. By sequencing of the FBN1 gene, a mutation (1622G>A) leading to the diagnosis of Marfan syndrome was found. Genetic counseling was recommended to the relatives who reported that the father of the deceased had died at the same age from aortic rupture. While fortunately the child of the deceased lacked this mutation, it was found in his younger sister. The results of the autopsy thus enabled early diagnosis and beginning of treatment in the sister and thus a considerable statistical increase in lifespan. With this report, we want to show that medicolegal autopsies can also have medical consequences for relatives. We argue that in all sudden and unexpected deaths in young persons up to 35 years an autopsy should be performed, not only to detect unnatural causes of death but also to identify heritable diseases and thus aid the relatives.

Expression of Glut-1 is a prognostic marker for oral squamous cell carcinoma patients.

Oral squamous cell carcinoma (OSCC) is among the tenth most common human cancers worldwide with evidence of an increase in incidence rate and mortality. Despite advances in treatment modalities, the prognosis of this cancer is still very poor and has not changed over the past two decades. This study is based on samples collected from 42 patients with a primary OSCC. Immunohistochemical staining for Glut-1 was carried out and compared with the clinicopathological data. Thirty-two patients showed in their tumors a weak or undetectable Glut-1 expression, whereas in tumors of 10 patients a moderate to strong Glut-1 expression was detected. In multivariate Cox's regression hazard analysis, patients whose tumors had a moderate to strong Glut-1 expression possessed a 4.9-fold increased risk of tumor-related death compared to the other patients. Our results suggest that Glut-1 expression is an independent prognostic marker for routine assessment of OSCC.

[Foreign body reaction to materials implanted as biocompatible for internal fixation]. / Fremdkörperreaktion nach Implantation eines biokompatiblen Osteosynthesesystems.

After implantation of resorbable materials for internal fixation, foreign body reactions are described in 0-47% of cases. Copolymers of poly-l-lactic acid (PLLA) and polyglycolic acid (PGA) seem to offer better biocompatibility than other materials. One of our patients had a midfacial fracture, which we fixed using a resorbable system based on PLLA-PGA (82%-18%); a foreign body reaction developed after 22 months. When resorbable materials are used it is essential to be aware specifically of the risk of foreign body reactions, especially when the facial area is involved. This risk must be discussed with the patient in some detail during the preoperative period.

Bisphosphonate-related jaw necrosis--severe complication in maxillofacial surgery.

Bisphosphonates are used as potent inhibitors in metastatic bone lesions. They can reduce skeletal burden and prevent bony metastases. They are integral in the treatment of some tumours like breast cancer, prostate cancer and multiple myeloma. As a side effect, these drugs also may cause severe jaw necrosis. Twenty-four patients with bisphosphonate-related jaw necrosis were analyzed in a clinical study. These necroses mostly appeared after administration of aminobisphosphonates. Recurrent avascular necroses were found after changing from Pramidronate to Zoledronate. All patients were treated by resection of necrotic bone. Repeated surgical interventions were required with about 25% of the patients. The management of patients with bisphosphonate-related jaw necrosis remains extremely difficult and includes surgical procedures as well as the eradicating of the necrotic bone including antibiotic therapy. The prevention of such complications consists in a minimization of dental surgical interventions and an avoidance of ulcers by dental prosthesis.

[Idiopathic orbital inflammatory syndrome (orbital pseudotumors): diagnosis and therapy]. / Idiopathische entzündliche intraorbitale Fibrosklerose: Diagnostik und therapeutische Möglichkeiten.

BACKGROUND: Pseudotumors of the orbit comprise a group of idiopathic inflammatory processes and are, except for endocrine orbitopathy, the most common reason for exophthalmos in adults. Orbital pseudotumors, also called idiopathic orbital inflammatory syndrome (IOIS), can be determined from orbital involvement in systemic fibrosing diseases. Finding the correct diagnosis can be challenging. Due to the topographic relations of the orbit to neighbouring structures, a multidisciplinary cooperation is highly recommended. CASE REPORT: We report a case of a 42-year-old woman with unilateral exophthalmos. Additionally we found impaired motility of the affected bulbus, ptosis and reduction of visual acuity. Orbital MR imaging demonstrated dense fibrotic masses filling the whole orbita including the extraocular muscles as well as the optic nerve. Tissue specimens were extracted while performing orbital decompression via a lateral orbitotomy. Histological examination revealed a lymphatic infiltration and fibrotically destroyed tissue containing the lacrimal gland. After surgical decompression, oral steroid therapy and immunotherapy, a recovery of the visual loss could be seen. CONCLUSIONS: Intraorbital fibrosclerosing pseudotumors often require a difficult long-term treatment. Therapeutic options are steroid therapy, immunotherapy, radiotherapy and surgery. The diagnostic steps include blood tests, ultrasound, CT and/or MRI as well as histological differentiation. Solid tumors and orbital involvement in diseases of the hematopoetic system have to be excluded. Since intraorbital fibrosis can be accompanied by manifestations in various other organs, a complete investigation of the body and thorough follow up are crucial.

[Bone metastases in the maxilla as first manifestation of renal cell cancer. A case report]. / Die ossäre Metastase im Oberkiefer als Erstmanifestation eines Nierenzellkarzinoms. Ein Fallbericht.

BACKGROUND: Bone metastases in the upper jaw are relatively rare but not unusual in oral and maxillofacial surgery. In many cases finding the primary tumour is difficult because of its occult location. CASE REPORT: We describe a 53-year-old female patient who suffered from a tumor in the oral cavity. The first histological and clinical diagnosis revealed a granuloma pyogenicum. Because of the delayed healing process another biopsy became necessary showing a metastasis of an unknown primary tumor. Diagnostic procedures detected an adenocarcinoma of the left kidney with pelvic metastases. Appropriate surgical intervention and chemotherapy were subsequently initiated. CONCLUSION: The present case report demonstrates how difficult it can be to provide the right pathological diagnosis in biopsy material even regarding obvious malignancy. Therefore thorough diagnostic efforts are indispensable to facilitate the causal treatment of an unknown primary tumor.

[Prolactinoma of the sphenoid sinus. Case report and literature review]. / Prolaktinom der Keilbeinhöhle. Kasuistik und Literaturübersicht.

In this case study, we report on a patient complaining of headache who, after CT and MRI, was found to have a neoplasia of the left sphenoid sinus. After a transnasal biopsy and histological examination, a prolactinoma was diagnosed. Based on this case, we discuss important aspects of tumor biology, diagnostic procedures, histology as well as differential diagnosis. Prolactinoma has to be considered as a differential diagnose in all sphenoid sinus neoplasias with close contact to the pituitary gland.

[Disseminated infection by Histoplasma capsulatum with AIDS]. / Generalisierte Infektion mit Histoplasma capsulatum bei manifester Aids-Erkrankung.

Histoplasmosis is an illness which occurs very rarely in Europe and it is especially rare in Germany. A generalised infection with Histoplasma capulatum, a systemic mycosis of the mononuclear phagocyte system (MPS), occurs only in individuals with weakened immune systems. Within the framework of diagnostics, a pathologist can be confronted with histoplasmosis since there has been an increase in travel to and from endemic regions, as well as an increase in the number of diseases of the immune system. The presented case reports the histological intravital and post-mortem diagnostics of disseminated histoplasmosis in existing HIV-infection in the stage of manifest AIDS.

Detection and enrichment of disseminated renal carcinoma cells from peripheral blood by immunomagnetic cell separation.

We have established an immunomagnetic separation procedure for the detection of circulating tumor cells in the peripheral blood based on the magnetic cell sorting (MACS) technique. In previous in vitro experiments, renal-cell carcinoma (RCC) cells were mixed with peripheral blood. In dilutions of 1:200 to 1:107 tumor cells per mononuclear blood cells, an average recovery rate of 84% of tumor cells was determined. In our study, 104 peripheral blood samples from 59 renal carcinoma patients were analyzed. MACS resulted in significant depletion of leukocytes, permitting a search for tumor cells on just 1 slide. Analyzing 8 ml of peripheral blood per patient, 19/59 RCC patients carried disseminated tumor cells (32%) in the range of 1 to 38 cells (median 8). Interestingly, for the cytokeratin-positive (CK+) patient group, we found a correlation between tumor cell number and grading (G2 vs. G3) and an increased number of CK+ patients with advanced tumor stage. MACS appears to be an efficient technique to detect disseminated tumor cells in peripheral blood.

[Glomus tumor of the nose]. / Glomustumoren der Nase.

Between May 1995 and March 1996 we were able to diagnose and remove glomus tumors of the left nasal cavity from three female patients. Ages of the patients were 9, 36 and 74 years. All patients suffered from a frequent epistaxis and all were extremely sensitive to the slightest nasal touch. One patient reported breathing difficulties due to nasal congestion. Examination revealed a tumor that filled the entire nasal cavity. The method of choice in treatment of these tumors is surgical removal. Hemangiopericytoma, non-chromaffin paraganglioma, hidradenoma, cavernous hemangioma and nevus cell nevi have to be excluded by histology and immunohistochemical techniques. From a clinical perspective the bleeding septal polyp (granuloma telangiectaticum sive pyogenicum sive pediculatum) has to be considered because it often comes from Kieselbachi's plexus, has a mushroom-like appearance and bleeds slightly.