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1.
Sci Rep ; 6: 34081, 2016 Sep 26.
Article in English | MEDLINE | ID: mdl-27665737

ABSTRACT

Squamous cell carcinoma (SCC) is the second most common cancer worldwide and accounts for approximately 30% of all keratinocyte cancers. The vast majority of cutaneous SCCs of the head and neck (cSCCHN) are readily curable with surgery and/or radiotherapy unless high-risk features are present. Perineural invasion (PNI) is recognized as one of these high-risk features. The molecular changes during clinical PNI in cSCCHN have not been previously investigated. In this study, we assessed the global gene expression differences between cSCCHN with or without incidental or clinical PNI. The results of the analysis showed signatures of gene expression representative of activation of p53 in tumors with PNI compared to tumors without, amongst other alterations. Immunohistochemical staining of p53 showed cSCCHN with clinical PNI to be more likely to exhibit a diffuse over-expression pattern, with no tumors showing normal p53 staining. DNA sequencing of cSCCHN samples with clinical PNI showed no difference in mutation number or position with samples without PNI, however a significant difference was observed in regulators of p53 degradation, stability and activity. Our results therefore suggest that cSCCHN with clinical PNI may be more likely to contain alterations in the p53 pathway, compared to cSCCHN without PNI.

2.
Head Neck ; 38(9): 1416-20, 2016 09.
Article in English | MEDLINE | ID: mdl-27043827

ABSTRACT

BACKGROUND: Perineural spread (PNS) of cutaneous squamous cell carcinoma of the head and neck (SCCHN) can be associated with poor outcomes. Disease understanding and awareness is limited leading to delayed diagnosis and treatment. The purpose of this study was to identify epidemiological features of patients with PNS of cutaneous SCCHN. METHODS: Tumor characteristics and demographics of patients with PNS of cutaneous SCCHN managed through a single institution were collected between 1998 and 2013. RESULTS: One hundred twenty patients were included in this study. The majority had a history of skin cancer (85.8%). The median time from primary tumor treatment to PNS symptom onset was 16 months (range, 1-86 months). A total of 34.2% had no perineural invasion (PNI) detected in the primary, and 22.5% had no known primary tumor. Only 5.8% of the patients had nodal involvement at presentation. CONCLUSION: Patients can present with PNS from cutaneous SCCHN with no known primary tumor or with primary tumors without PNI. The majority of patients presented without regional nodal involvement. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1416-1420, 2016.


Subject(s)
Carcinoma, Squamous Cell/epidemiology , Carcinoma, Squamous Cell/pathology , Head and Neck Neoplasms/epidemiology , Head and Neck Neoplasms/pathology , Peripheral Nervous System Neoplasms/epidemiology , Peripheral Nervous System Neoplasms/secondary , Skin Neoplasms/epidemiology , Skin Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/physiopathology , Cohort Studies , Disease-Free Survival , Head and Neck Neoplasms/physiopathology , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/epidemiology , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/physiopathology , Prognosis , Queensland/epidemiology , Retrospective Studies , Risk Assessment , Skin Neoplasms/physiopathology , Squamous Cell Carcinoma of Head and Neck , Survival Analysis , Young Adult
3.
J Neurol Surg B Skull Base ; 77(2): 107-12, 2016 Apr.
Article in English | MEDLINE | ID: mdl-27123386

ABSTRACT

Understanding the natural history of diseases enables the clinician to better diagnose and treat their patients. Perineural spread of head and neck cancers are poorly understood and often diagnosis is delayed resulting in poorer outcomes and more debilitating treatments. This article reviews a large personal series of head and neck malignancy presenting with perineural spread along almost exclusively the trigeminal and/or facial nerves. A detailed analysis of squamous cell carcinoma of cutaneous origin is presented including an analysis of likely primaries, which most often have occurred months to years prior. The importance of early detection is reinforced by the highly significant (p < 0.0001) differences in disease specific survival, which occur, depending on how far along a cranial nerve the disease has been allowed to spread.

4.
Cancer Immunol Immunother ; 65(2): 213-22, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26759008

ABSTRACT

Spread of head and neck cancer along the cranial nerves is often a lethal complication of this tumour. Current treatment options include surgical resection and/or radiotherapy, but recurrence is a frequent event suggesting that our understanding of this tumour and its microenvironment is incomplete. In this study, we have analysed the nature of the perineural tumour microenvironment by immunohistochemistry with particular focus on immune cells and molecules, which might impair anti-tumour immunity. Moderate to marked lymphocyte infiltrates were present in 58.8% of the patient cohort including T cells, B cells and FoxP3-expressing T cells. While human leukocyte antigen (HLA) class I and more variably HLA class II were expressed on the tumour cells, this did not associate with patient survival or recurrence. In contrast, galectin-1 staining within lymphocyte areas of the tumour was significantly associated with a poorer patient outcome. Given the known role of galectin-1 in immune suppression, the data suggest that galectin inhibitors might improve the prognosis of patients with perineural spread of cancer.


Subject(s)
Galectin 1/metabolism , Head and Neck Neoplasms/metabolism , Head and Neck Neoplasms/mortality , Skin Neoplasms/metabolism , Skin Neoplasms/mortality , Aged , Cranial Nerves/pathology , Female , Head and Neck Neoplasms/immunology , Head and Neck Neoplasms/pathology , Histocompatibility Antigens Class I/metabolism , Histocompatibility Antigens Class II/metabolism , Humans , Kaplan-Meier Estimate , Lymphocyte Subsets/immunology , Lymphocyte Subsets/metabolism , Lymphocyte Subsets/pathology , Lymphocytes, Tumor-Infiltrating/immunology , Lymphocytes, Tumor-Infiltrating/metabolism , Lymphocytes, Tumor-Infiltrating/pathology , Male , Middle Aged , Neoplasm Grading , Neoplasm Invasiveness , Neoplasm Recurrence, Local , Patient Outcome Assessment , Prognosis , Skin Neoplasms/immunology , Skin Neoplasms/pathology , Tumor Microenvironment
5.
Head Neck ; 38(6): 824-31, 2016 06.
Article in English | MEDLINE | ID: mdl-25546817

ABSTRACT

BACKGROUND: Queensland, Australia, has the highest rates of cutaneous squamous cell carcinoma (SCC). Perineural invasion (PNI) is associated with reduced local control and survival. METHODS: A retrospective review of a prospective database of patients with clinical PNI from cutaneous SCC of the head and neck (SCCHN) treated with surgery and postoperative radiotherapy (PORT) between 2000 and 2011 and a minimum of 24 months follow-up. Patients were excluded if immunosuppressed, had non-SCC histology, or were treated palliatively. RESULTS: Fifty patients (mean age, 60 years) with median follow-up of 50 months were included in this study. A total of 54.8% of known primary tumors had incidental PNI. Ten percent had nodal disease at presentation. MRI neurogram was positive in 95.8%. Recurrence-free survival (RFS) at 5-years was 62%. Five-year disease-specific survival (DSS) and overall survival (OS) were 75% and 64%, respectively. There were no perioperative deaths. CONCLUSION: This report demonstrates that long-term survival is achievable in patients with clinical PNI from cutaneous SCCHN after surgery and PORT. © 2015 Wiley Periodicals, Inc. Head Neck 38: 824-831, 2016.


Subject(s)
Carcinoma, Squamous Cell/radiotherapy , Carcinoma, Squamous Cell/surgery , Head and Neck Neoplasms/radiotherapy , Head and Neck Neoplasms/surgery , Skin Neoplasms/radiotherapy , Skin Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/mortality , Cranial Nerves , Female , Follow-Up Studies , Head and Neck Neoplasms/mortality , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neoplasm Invasiveness , Prognosis , Retrospective Studies , Skin Neoplasms/mortality , Survival Analysis , Treatment Outcome
6.
Head Neck ; 36(11): 1611-8, 2014 Nov.
Article in English | MEDLINE | ID: mdl-24115192

ABSTRACT

BACKGROUND: Nonmelanoma skin cancer (NMSC) with perineural invasion (PNI) is most commonly seen in cutaneous squamous cell carcinoma of the head and neck (SCCHN). The cranial nerves are a conduit for skin cancer to reach the brainstem. METHODS: The histopathological features of 51 tissue specimens from 49 patients with cutaneous SCCHN and clinical PNI were assessed with consecutive transverse and longitudinal sections. RESULTS: No skip lesions were identified. Tumor spread was contiguous in all specimens. No tumor spread into the perineural space from surrounding or adjacent tumor was seen. Proximal large cranial nerves showed epineural involvement in 3.9% in areas with large tumor bulk, extensive PNI, and intraneural invasion. CONCLUSION: Perineural tumor spread in cutaneous SCCHN was contiguous and no skip lesions were evident in nerve specimens assessed in this series. Spread beyond cranial nerve perineurium was uncommon, reflecting its multilayer barrier function at this level. These findings may have treatment implications.


Subject(s)
Carcinoma, Squamous Cell/secondary , Head and Neck Neoplasms/pathology , Peripheral Nerves/pathology , Peripheral Nervous System Neoplasms/pathology , Skin Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Biopsy, Needle , Carcinoma, Squamous Cell/surgery , Cohort Studies , Cranial Nerves/pathology , Female , Head and Neck Neoplasms/secondary , Head and Neck Neoplasms/surgery , Humans , Immunohistochemistry , Male , Middle Aged , Neoplasm Invasiveness/pathology , Neoplasm Staging , Prognosis , Retrospective Studies , Skin Neoplasms/surgery , Squamous Cell Carcinoma of Head and Neck , Tissue Embedding
8.
J Med Imaging Radiat Oncol ; 56(1): 84-92, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22339750

ABSTRACT

Vascular anomalies encompass a broad spectrum of tumours and malformations as classified by the International Society for the Study of Vascular Anomalies. Despite being one of the most common congenital abnormalities, they are often misunderstood in clinical practice: use of the term 'haemangioma' to denote any vascular anomaly still occurs. They are found frequently in the head and neck, often as complex lesions that require multidisciplinary management which necessitates an accurate diagnosis. Precise radiological assessment is therefore crucial. This pictorial review will briefly discuss the current classification system of vascular anomalies and the optimal radiological tools for their evaluation.


Subject(s)
Head/blood supply , Magnetic Resonance Imaging , Neck/blood supply , Ultrasonography, Doppler , Vascular Malformations/diagnosis , Contrast Media , Humans , Magnetic Resonance Angiography , Vascular Malformations/diagnostic imaging
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