ABSTRACT
Sinonasal teratocarcinosarcoma is an uncommon, aggressive, morphologically heterogenous tumor composed of cells derived from the 3 somatic layers. A histogenetic origin from a multipotential adult somatic stem cell with divergent differentiation has been favored over a germ cell origin. This assumption has been based on the lack of germ cell elements and, until recently, the absence of demonstrable amplification of 12p. We report a case that exhibited foci of yolk sac elements with papillary structures and intracytoplasmic periodic acid-Schiff-positive, diastase-resistant, α-fetoprotein-positive, hyaline globules. An expanded area of undifferentiated cells, likely precursor cells, in the basal layer of the overlying mucosal epithelium transitions into and merges with the immature epithelial, neuroepithelial, and mesenchymal components. These previously unreported histomorphological features support the hypothesis that this tumor is a teratomatous tumor arising from pluripotent embryonic stem cells in the basal layer of the sinonasal epithelium. That notion is further supported by fluorescence in situ hybridization cytogenetic analysis, which showed a distinct subpopulation of the tumor cells with an extra copy of chromosome 12p13.
Subject(s)
Carcinosarcoma/pathology , Chromosomes, Human, Pair 12/genetics , Paranasal Sinus Neoplasms/pathology , Teratoma/pathology , Yolk Sac/pathology , 12E7 Antigen , Antigens, CD/metabolism , Biopsy , Carcinosarcoma/genetics , Carcinosarcoma/metabolism , Carcinosarcoma/surgery , Cell Adhesion Molecules/metabolism , Chromosome Duplication/genetics , Diagnosis, Differential , Female , Germ Cells/pathology , Humans , Hyalin/metabolism , Immunohistochemistry , In Situ Hybridization, Fluorescence , Isochromosomes/genetics , Keratins/metabolism , Middle Aged , Neoplasm Invasiveness , Paranasal Sinus Neoplasms/genetics , Paranasal Sinus Neoplasms/metabolism , Paranasal Sinus Neoplasms/surgery , Paranasal Sinuses/pathology , Periodic Acid-Schiff Reaction , Teratoma/genetics , Teratoma/metabolism , Teratoma/surgery , alpha-Fetoproteins/metabolismABSTRACT
OBJECTIVE: To determine whether return of vocal cord function after treatment of T2b/T3 laryngeal carcinoma is an independent prognostic factor for locoregional recurrence. STUDY DESIGN: A retrospective review of patients treated with radiation +/- chemotherapy between 2000 and 2005 for T2 with vocal cord paresis and T3 laryngeal carcinoma was conducted. METHODS: Only those patients obtained from the tumor registry with pre-and posttreatment video stroboscopies were included. Patients' charts were reviewed for local and regional recurrence after treatment. Fisher's exact test was used to determine significant association between recurrence and possible risk factors. RESULTS: Fourteen patients met the inclusion criterion. Six patients had T2 lesions with vocal cord paresis, and eight patients had T3 lesions. Fifty percent of patients with T2 and 75% of patients with T3 lesions had return of vocal cord function after treatment. Five of 14 patients did not have return of vocal cord function, and of these, 100% had locoregional recurrence. Of the nine patients who had return of vocal cord movement, none of the patients had recurrence. The proportion of recurrence was significantly higher for those whose vocal function did not return compared with the patients whose vocal function returned (100% vs. 0%, P < .01). CONCLUSION: The immobile vocal cord is associated with a worse prognosis and is therefore factored into the American Joint Commission on Cancer staging for laryngeal tumors. We show that vocal cord immobility is an independent prognostic factor of recurrence even after treatment and can predict treatment failure in T2 and T3 lesions of the larynx.
