Prognostic significance of Bcl-2 and p53 expression in advanced laryngeal squamous cell carcinoma.

BACKGROUND: Proteins regulating the cell cycle and cell death are frequently abnormally expressed in cancer. Several of these, particularly p53 and Bcl-2, have been widely suggested as possible prognostic markers in diverse human malignancies. Their role in predicting outcome in squamous cell carcinomas of the head and neck is unclear and may depend on the location, stage, and treatment of the tumor. METHODS: To assess this question specifically for advanced squamous cell carcinoma of the larynx, we studied 69 patients with stage III or IV tumors, all but 6 of whom were treated with surgery plus postoperative irradiation by a single physician. We studied the patients retrospectively to test the association between expression of Bcl-2 and p53, as assessed by immunohistochemistry, with treatment outcome and survival. RESULTS: Twenty of the 69 patients died from their tumor (poor outcome); the rest were alive and tumor free at the last follow-up or died of unrelated causes without clinical tumor recurrence (good outcome). Fourteen tumors had detectable Bcl-2 expression, including 8 scored as overexpressors. Thirty-nine tumors overexpressed p53. Expression of neither Bcl-2 nor p53 was associated with outcome, overall survival, or disease-free survival. Only tumor stage was significantly associated with outcome and disease-free survival. CONCLUSION: These data indicate that assessing expression of p53 or Bcl-2 is unlikely to be prognostically useful for surgically treated advanced laryngeal carcinoma.

Quantification of lymph nodes in selective neck dissection.

OBJECTIVES: Provide reference for surgeon and pathologist regarding expected yield from selective neck dissections. Quantify lymph nodes obtained from cadaver dissection based on current nodal classification and compare with clinical series. STUDY DESIGN: 1. Quantification of lymph nodes at levels I-V harvested from human cadavers and correlation with nodal grouping for supraomohyoid (I-III) and lateral (II-IV) neck dissections. 2. Retrospective review of operative specimens from clinical neck dissections for lymph node quantity. METHODS: 1. Twenty radical neck dissection specimens, harvested from 10 fresh human cadavers without evidence of head and neck cancer, were separated by nodal level for gross and microscopic examination by a pathologist. The quantity of nodes obtained per level for each specimen was tabulated. 2. Charts of patients treated with neck dissection for squamous cell carcinoma were reviewed and tabulated for type of dissection and number of lymph nodes reported. RESULTS: In the 20 cadaver neck dissections, the average number of lymph nodes removed for levels I-V was 24, with 13 for levels I-III and 19 for levels II-IV. In the clinical review, 98 total neck dissections were included. In the six supraomohyoid dissections, an average of 20 lymph nodes (range, 14-26) were found, with an average of 30 (range, 15-43) in the 11 lateral compartment specimens. In 81 radical or modified radical dissections, an average of 31 nodes (range, 19-63) was reported. CONCLUSIONS: The number of lymph nodes removed in selective neck dissection should be comparable to that of the corresponding levels in radical neck dissection, provided that strict adherence to surgical boundaries is maintained. Dissection of normal cadavers provides a reference for the surgeon and the pathologist but may under-represent lymph node quantity in the diseased state.

Nodal size of metastatic squamous cell carcinoma of the neck.

The preoperative use of computed tomographic (CT) scanning continues to be the best diagnostic method for preoperative detection of metastatic neck disease. Current accepted criteria for CT diagnosis of nodal disease are not uniform, although nodal size, nodal grouping, and central necrosis correlate strongly with malignancy. To assess the relationship of nodal size and malignancy, a multicenter study was designed to evaluate the nodes from 100 neck dissections. Sixty-nine positive neck dissections were analyzed, and every node was measured. The relationship of central necrosis was also compared with node size. Our results showed that CT scanning continues to provide a reliable picture of the histologic status of lymph nodes. Using the criterion of central necrosis or node size larger than 1 cm, only 7% of necks had nodal disease that would have been missed by CT interpretation. This study supports the continued use of preoperative CT evaluation for metastatic neck disease.

Benign lymphoepithelial parotid tumors in AIDS patients: CT and MR findings in nine cases.

Benign lymphoepithelial parotid neoplasm with associated cervical adenopathy is a newly described head and neck manifestation of HIV infection, characterized previously as purely cystic masses on both CT and MR evaluations. The CT and MR findings in nine cases of surgically proved benign lymphoepithelial parotid lesions are presented. Five (56%) of the nine cases demonstrated masses that appeared other than cystic, reflecting a greater variety of radiologic appearances than previously reported. The majority of these cystic masses contained solid components and therefore could not be labeled as cysts; instead, they were considered to be benign lymphoepithelial parotid lesions. For patients with parotid gland enlargement, the lack of a characteristic CT/MR appearance of these lesions necessitates an evaluation of clinical history and a determination of whether cervical adenopathy is present in order to determine their underlying origin.