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1.
Port J Card Thorac Vasc Surg ; 31(1): 59-62, 2024 May 13.
Article in English | MEDLINE | ID: mdl-38743514

ABSTRACT

INTRODUCTION: Purulent pericarditis secondary to esophago-pericardial fistula is a serious complication that has been previously reported in patients with esophageal cancer treated with radio/chemotherapy and esophageal stenting. However, the presence of esophago-pericardial fistula as the first manifestation of advanced carcinoma of the esophagus is exceedingly infrequent. We report the case of a 61-year-old male who presented with sepsis, cardiac tamponade and septic shock who was found to have an esophago-pericardial fistula secondary to squamous carcinoma of the esophagus. Emergency pericardiocentesis was performed with subsequent hemodynamic improvement. The drained pericardial fluid was purulent in nature and cultures were positive for Streptococcus anginosus. A CT scan followed by upper gastrointestinal endoscopy with tissue biopsy confirmed the diagnosis of squamous cell carcinoma of the esophagus. A self-expanding covered stent was endoscopically placed to exclude the fistula and restore the esophageal lumen. In this report, we discuss some aspects related to the diagnosis and management of this serious clinical entity.


Subject(s)
Carcinoma, Squamous Cell , Esophageal Fistula , Esophageal Neoplasms , Pericarditis , Humans , Male , Middle Aged , Esophageal Neoplasms/pathology , Esophageal Neoplasms/complications , Pericarditis/microbiology , Pericarditis/etiology , Pericarditis/therapy , Pericarditis/diagnosis , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/diagnosis , Esophageal Fistula/etiology , Esophageal Fistula/diagnosis , Streptococcal Infections/complications , Streptococcal Infections/diagnosis , Streptococcus anginosus/isolation & purification , Pericardiocentesis , Stents , Tomography, X-Ray Computed , Cardiac Tamponade/etiology
2.
Acta Dermatovenerol Alp Pannonica Adriat ; 33(3): actaapa.2024.14, 2024 05 29.
Article in English | MEDLINE | ID: mdl-38808531

ABSTRACT

Recessive dystrophic epidermolysis bullosa (RDEB) is a rare genetic skin disease caused by mutations in the type VII collagen gene (COL7A1; 3p21.31). Mutations in this gene lead to an alteration in function or reduced amounts of collagen VII. This alteration of collagen VII leads to skin fragility and lesions at minor injuries with difficult healing. Cutaneous squamous cell carcinoma (cSCC) is more frequent in patients with RDEB than in the general population because of chronic wound formation; it constitutes a major cause of morbidity and is often cited as a cause of death for these patients. There is little experience with the treatment of cSCC in patients with RDEB. We report the case of a 19-year-old female patient with RDBE and inoperable locally advanced cSCC of the left arm. Because of the lack of therapy options, therapy with cemiplimab was started at a dose of 350 mg administered intravenously every 3 weeks. A confirmed clinical response was observed after the second cycle of treatment with no toxicity. During follow-up, the patient had a notable clinical response with no auto-immune adverse reactions. This shows that cemiplimab has a good safety profile for cSCC in patients with RDEB and is a valuable therapy option.


Subject(s)
Antibodies, Monoclonal, Humanized , Carcinoma, Squamous Cell , Epidermolysis Bullosa Dystrophica , Skin Neoplasms , Humans , Epidermolysis Bullosa Dystrophica/drug therapy , Epidermolysis Bullosa Dystrophica/complications , Female , Skin Neoplasms/drug therapy , Skin Neoplasms/complications , Skin Neoplasms/pathology , Carcinoma, Squamous Cell/drug therapy , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/pathology , Antibodies, Monoclonal, Humanized/therapeutic use , Young Adult , Treatment Outcome , Antineoplastic Agents, Immunological/therapeutic use
3.
Sci Rep ; 14(1): 12025, 2024 05 26.
Article in English | MEDLINE | ID: mdl-38797769

ABSTRACT

Sarcopenia has been associated with higher toxicity induced by anti-cancer treatments and shorter survival in patients with squamous cell lung carcinoma (SqCLC). Over the past few decades, immune checkpoint inhibitors (ICIs) significantly improves the prognosis. However, few clinical studies explored the effectiveness of immunotherapy in the elderly population. Here, we performed a retrospective analysis to determine the prognostic role of sarcopenia in older patients with SqCLC receiving ICIs. We retrospectively assessed SqCLC patients who were treated with PD-1 inhibitors and all patients were at least 70 years old. Pre-treatment sarcopenic status was determined by analyzing L3 skeletal muscle index (SMI) with chest CT. Progression-free survival (PFS), disease-specific survival (DSS) and overall survival (OS) were estimated using the Kaplan-Meier method, and the differences in survival were compared using the log-rank test. Among 130 male SqCLC patients, 93 had sarcopenia. Patients with sarcopenia were older and had a lower body mass index (BMI). Over an average follow-up of 20.8 months, 92 patients died. For all 130 patients, the mean OS was 13.3 months. Patients with sarcopenia had a significantly shorter OS and PFS than those without sarcopenia (OS, 12.4 ± 5.2 months vs. 15.5 ± 10.5 months, P = 0.028; PFS, 6.4 ± 2.9 months vs. 7.7 ± 4.2 months; P = 0.035). Multivariable analysis showed that sarcopenia was an independent prognostic factor for shorter OS and PFS. CT-determined sarcopenia is an independent prognostic factor for older patients with SqCLC receiving ICIs.


Subject(s)
Immune Checkpoint Inhibitors , Lung Neoplasms , Sarcopenia , Tomography, X-Ray Computed , Humans , Sarcopenia/diagnostic imaging , Sarcopenia/etiology , Aged , Male , Female , Lung Neoplasms/drug therapy , Lung Neoplasms/complications , Lung Neoplasms/mortality , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/pathology , Prognosis , Tomography, X-Ray Computed/methods , Aged, 80 and over , Immune Checkpoint Inhibitors/therapeutic use , Immune Checkpoint Inhibitors/adverse effects , Retrospective Studies , Carcinoma, Squamous Cell/drug therapy , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/diagnostic imaging , Kaplan-Meier Estimate
4.
BMC Pulm Med ; 24(1): 192, 2024 Apr 22.
Article in English | MEDLINE | ID: mdl-38644505

ABSTRACT

BACKGROUND: Stenosis and obliteration of the pulmonary vein can be developed by multiple diseases and might cause hemoptysis. Traditional therapy including surgical procedure and conservative treatments might be inappropriate choices to manage massive hemoptysis. CASE PRESENTATION: A 64-year-old man, diagnosed with advanced stage IVA lung squamous cell carcinoma, presented with dyspnea and recurrent, massive hemoptysis. An initial contrast-enhanced computed tomography revealed a giant tumor in the left lung hilus and occlusion of the left superior pulmonary vein. Despite immediate selective bronchial artery embolization and simultaneous embolization of an anomalous branch of the internal thoracic artery, the massive hemoptysis continued. Subsequently, embolization of the left superior pulmonary artery was performed, achieving functional pulmonary lobectomy, which successfully treated the hemoptysis without relapse during a six-month follow-up. The patient continues to undergo cancer therapy and remains stable. CONCLUSIONS: This case successfully managed massive hemoptysis associated with lung cancer invasion into the pulmonary vein through functional pulmonary lobectomy via embolization of the corresponding pulmonary artery.


Subject(s)
Carcinoma, Squamous Cell , Embolization, Therapeutic , Hemoptysis , Lung Neoplasms , Pulmonary Artery , Tomography, X-Ray Computed , Humans , Hemoptysis/therapy , Hemoptysis/etiology , Male , Middle Aged , Embolization, Therapeutic/methods , Lung Neoplasms/complications , Lung Neoplasms/therapy , Pulmonary Artery/diagnostic imaging , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/therapy , Pulmonary Veins/abnormalities , Pulmonary Veins/diagnostic imaging , Pneumonectomy
5.
J Low Genit Tract Dis ; 28(2): 153-159, 2024 Apr 01.
Article in English | MEDLINE | ID: mdl-38518213

ABSTRACT

OBJECTIVES: Human papillomavirus (HPV)-independent vulvar intraepithelial neoplasia (VIN) is a rare yet aggressive precursor lesion of vulvar cancer. Our objectives were to estimate its long-term incidence, the risk of recurrent disease and progression to vulvar cancer, and risk factors thereof. MATERIALS AND METHODS: Patients with HPV-independent VIN between 1991 and 2019 in a selected region were identified from the Dutch Nationwide Pathology Databank (Palga). Data were collected from the pathology reports. Crude and European age-standardized incidence rates were calculated for 10-year periods. Kaplan-Meier analyses were performed to determine the cumulative recurrence and cancer incidence, followed by Cox regression analyses to identify associated risk factors. RESULTS: A total of 114 patients were diagnosed with solitary HPV-independent VIN without prior or concurrent vulvar cancer. The European age-standardized incidence rate increased from 0.09 to 0.69 per 100,000 women-years between 1991-2010 and 2011-2019. A cumulative recurrence and cancer incidence of 29% and 46% were found after 8 and 13 years of follow-up, respectively. Nonradical surgery was identified as the only independent risk factor for recurrent HPV-independent VIN. Risk factors associated with progression to cancer were increasing age and a mutant p53 immunohistochemical staining pattern. CONCLUSIONS: The incidence of detected HPV-independent VIN has substantially increased the last decade and the subsequent recurrence and vulvar cancer risks are high. Although HPV-independent VIN may present as a wide morphologic spectrum, surgical treatment should aim for negative resection margins followed by close surveillance, especially for p53 mutant lesions.


Subject(s)
Carcinoma in Situ , Carcinoma, Squamous Cell , Papillomavirus Infections , Vulvar Neoplasms , Humans , Female , Infant , Vulvar Neoplasms/pathology , Incidence , Human Papillomavirus Viruses , Papillomavirus Infections/complications , Papillomavirus Infections/epidemiology , Papillomavirus Infections/diagnosis , Tumor Suppressor Protein p53 , Carcinoma in Situ/pathology , Risk Factors , Carcinoma, Squamous Cell/complications , Papillomaviridae
6.
J Dtsch Dermatol Ges ; 22(4): 513-519, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38483049

ABSTRACT

BACKGROUND AND OBJECTIVES: Previous work has demonstrated that hydrochlorothiazide (HCTZ) is a risk factor for squamous cell carcinomas (SCC) and basal cell carcinomas (BCC) due to pro-photocarcinogenic effects. Atypical fibroxanthoma (AFX) and pleomorphic sarcoma (PDS), both ultraviolet-induced cancers, display a rare but rising cutaneous tumor entity. This study aimed to evaluate if the use of HCTZ is higher in patients with AFX/PDS than in patients with SCC/BCC and subsequently may be a risk factor for AFX/PDS-development. PATIENTS AND METHODS: In a retrospective study of four German skin cancer centers, AFX/PDS cases and SCC/BCC controls were sex and age matched (1:3) over a time-period of 7 years (2013-2019) to evaluate the use of HCTZ, immunosuppressive medication, second malignancies, and presence of diabetes mellitus. RESULTS: Overall, 146 AFX/PDS and 438 controls (SCC/BCC) were included in the study. The use of HCTZ was significantly higher in patients with AFX/PDS (44.5%) compared to patients with SCC/BCC (25.3%). Additionally, the presence of diabetes mellitus was significantly higher in AFX/PDS patients. CONCLUSIONS: This study demonstrates a significantly higher use of HCTZ in patients with AFX/PDS compared to SCC/BCC. This result suggests that HCTZ may be a risk factor for AFX/PDS. Additionally, diabetes mellitus or its comorbidities may be associated with an increased risk for AFX/PDS.


Subject(s)
Carcinoma, Basal Cell , Carcinoma, Squamous Cell , Diabetes Mellitus , Histiocytoma, Malignant Fibrous , Sarcoma , Skin Neoplasms , Humans , Hydrochlorothiazide/adverse effects , Retrospective Studies , Skin Neoplasms/chemically induced , Skin Neoplasms/epidemiology , Skin Neoplasms/complications , Sarcoma/epidemiology , Sarcoma/pathology , Carcinoma, Basal Cell/chemically induced , Carcinoma, Basal Cell/epidemiology , Carcinoma, Squamous Cell/complications
7.
Urogynecology (Phila) ; 30(3): 309-313, 2024 03 01.
Article in English | MEDLINE | ID: mdl-38484247

ABSTRACT

ABSTRACT: Concurrent cervical cancer with advanced pelvic organ prolapse is rare: there are no well-established treatment recommendations. It is hypothesized that chronic irritation, as with long-standing pelvic organ prolapse, may lead to dysplasia and human papillomavirus-independent carcinoma, which represents only 5% of cervical cancers. Two patients with complete uterine procidentia were referred to gynecologic oncology with cervical squamous cell carcinoma; both were clinically staged as International Federation of Gynaecology and Obstetrics IB3. Treatment planning was complicated by procidentia in both cases. Standard definitive treatment of locally advanced cervical cancer is radiation therapy and concurrent chemotherapy; however, the mobility and externalization of the target lesion raised concerns regarding anatomic reproducibility during radiation treatment. After multidisciplinary team discussion (gynecologic oncology, urogynecology, radiation oncology), surgical resection and co-management with gynecologic oncology and urogynecology were successfully performed for definitive management for both patients. Although rare, this case study demonstrates the importance of multidisciplinary coordination in these complex clinical scenarios.


Subject(s)
Carcinoma, Squamous Cell , Genital Neoplasms, Female , Pelvic Organ Prolapse , Uterine Cervical Neoplasms , Humans , Female , Uterine Cervical Neoplasms/complications , Cisplatin , Carcinoma, Squamous Cell/complications , Genital Neoplasms, Female/drug therapy , Reproducibility of Results , Pelvic Organ Prolapse/complications
8.
Int J Cancer ; 154(11): 1920-1929, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38339891

ABSTRACT

Esophageal cancer (EC), which includes squamous cell carcinoma (ESCC) and adenocarcinoma (EAC), is an important cancer with poor prognosis and high mortality rate. Several occupational exposures have been associated with EC. We aim to investigate the association between occupational asbestos exposure and EC risk, considering types of asbestos and histology of the disease. We included studies mentioned in the list of references in previous reviews and pooled analyses, and we conducted an independent search in PubMed and Scopus. Forest plots of relative risks (RR) were constructed based on the association between occupational asbestos and EC risk. Random-effects models were used to address heterogeneity between 48 independent cohort and case-control studies. We found an association between occupational asbestos exposure and EC (meta-relative risk [RR] = 1.20, 95% confidence interval [CI] = 1.09-1.32; I2 = 58.8%, p-heterogeneity [het] <.001). The results of stratification by job (p-het = .20) indicate an increased RR among asbestos product workers (RR = 1.39, 95% CI = 1.07-1.81), asbestos applicators (RR = 1.41, 95% CI = 1.20-1.67), and construction workers (RR = 1.12, 95% CI = 1.02-1.24). There was no heterogeneity in meta-RR according to outcome (p = .29), geographic region (p = .69), year of publication (p = .59), quality score (p = .73), asbestos type (p = .93), study design (p = .87), and gender (p = .88), control for potential confounders (p = .20), year of first employment (p = .94) and exposure level (p = .43). The stratification analysis by histology type found an increased RR for both ESCC 1.33(1.03-1.71) and EAC 1.45(1.03-2.04) (p-het = .68). We didn't find evidence of publication bias (p = .07). The results of our study suggest that occupational asbestos exposure is associated with an increased risk of EC in both histology types.


Subject(s)
Adenocarcinoma , Asbestos , Carcinoma, Squamous Cell , Esophageal Neoplasms , Occupational Diseases , Occupational Exposure , Humans , Occupational Exposure/adverse effects , Asbestos/toxicity , Esophageal Neoplasms/etiology , Esophageal Neoplasms/chemically induced , Adenocarcinoma/etiology , Carcinoma, Squamous Cell/complications , Occupational Diseases/epidemiology , Occupational Diseases/etiology
9.
West Afr J Med ; 41(1): 97-99, 2024 Jan 31.
Article in English | MEDLINE | ID: mdl-38412544

ABSTRACT

Hoarseness is a well-known condition in primary care offices, with over 1% of primary care visits secondary to this ailment.1 The most common causes are acute laryngitis (40%), functional dysphonia (30%), benign and malignant tumors (2.2 to 30%), neurogenic factors such as vocal cord paralysis (8%), physiological aging (2%), and psychogenic factors (2.2%). Most of these cases are secondary to viral infections and do not require antibiotics on most occasions. These viral infections subside after 1 to 2 weeks, and in the case of persistent hoarseness (above 4 weeks) the American Academy of Otolaryngology recommends direct visualization with a laryngoscopy before treatment with proton pump inhibitors, antibiotics, or steroids. Our patient presented with prolonged hoarseness (greater than eight weeks) but had a quick turn around time interval between primary care visit and laryngoscopy evaluation (less than 2 weeks). This led to her diagnosis and treatment with chemo and radiation therapy within three months of diagnosis with Squamous Cell Carcinoma of the Supraglottis. The Primary care physician serves as the number one point of visitation by sufferers of hoarseness. It is important that they are knowledgeable and up to date with recommendations and guidelines for managing this condition, as unwarranted delay can affect overall outcome on the part of the patient. This is especially important in patients such as ours with high risk factors including Nicotine dependence, alcohol use, asbestos exposure, and HPV infection.


La voix rauque est une condition bien connue dans les cabinets de soins primaires, avec plus de 1 % des visites en soins primaires dues à ce problème. Les causes les plus courantes sont la laryngite aiguë (40%), la dysphonie fonctionnelle (30 %), les tumeurs bénignes et malignes (2,2 à 30 %), les facteurs neurogènes tels que la paralysie des cordes vocales (8 %), le vieillissement physiologique (2 %) et les facteurs psychogènes (2,2 %). La plupart de ces cas sont dus à des infections virales et ne nécessitent pas d'antibiotiques dans la plupart des cas. Ces infections virales disparaissent après 1 à 2 semaines, et en cas de voix rauque persistante (plus de 4 semaines), l'American Academy of Otolaryngology recommande une visualisation directe avec une laryngoscopie avant le traitement par inhibiteurs de la pompe à protons, antibiotiques ou stéroïdes. Notre patiente présentait une voix rauque prolongée (plus de huit semaines), mais a bénéficié d'un délai rapide entre la visite en soins primaires et l'évaluation par laryngoscopie (moins de 2 semaines). Cela a conduit à son diagnostic et à son traitement par chimiothérapie et radiothérapie dans les trois mois suivant le diagnostic de carcinome épidermoïde du supraglotte. Le médecin de soins primaires est le premier point de visite pour les personnes souffrant de voix rauque. Il est important qu'ils soient informés et à jour des recommandations et des lignes directrices pour la prise en charge de cette condition, car un retard non justifié peut affecter le résultat global pour le patient. Ceci est particulièrement important chez les patients comme le nôtre présentant des facteurs de risque élevés, y compris la dépendance à la nicotine, la consommation d'alcool, l'exposition à l'amiante. MOTS-CLÉS: Laryngoscopie, Supraglotte, Larynx, Enrouement.


Subject(s)
Carcinoma, Squamous Cell , Dysphonia , Virus Diseases , Female , Humans , Hoarseness/diagnosis , Hoarseness/etiology , Hoarseness/therapy , Dysphonia/diagnosis , Dysphonia/etiology , Dysphonia/therapy , Anti-Bacterial Agents , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/therapy , Virus Diseases/complications
10.
BMJ Case Rep ; 17(2)2024 Feb 20.
Article in English | MEDLINE | ID: mdl-38378591

ABSTRACT

Patients on dialysis have limited treatment options for advanced lung cancer because some chemotherapeutic agents are unavailable due to renal dysfunction. A man in his 70s on peritoneal dialysis presented with persistent fever refractory to antibiotics for 2 weeks. Subsequent whole-body CT showed a 5 cm diameter mass in the right lower lobe of the lung with right-sided pleural effusion and osteolytic metastasis of the right iliac bone. The patient was diagnosed with squamous cell carcinoma (cT3N2M1b, stage IVB) harbouring the p.Gly719Ala point mutation on exon 18 of the epidermal growth factor receptor. The patient developed severe respiratory failure due to malignant lymphangitis after a bronchoscopy. He received 30 mg/day of afatinib, resulting in tumour shrinkage and recovery from respiratory failure. We advocate for aggressive screening of driver oncogenes in patients with lung cancer on dialysis, including those with squamous cell lung cancer.


Subject(s)
Carcinoma, Squamous Cell , Lung Neoplasms , Lymphangitis , Respiratory Insufficiency , Male , Humans , Afatinib/therapeutic use , Lymphangitis/drug therapy , Lymphangitis/etiology , Renal Dialysis , Lung Neoplasms/complications , Lung Neoplasms/drug therapy , Lung Neoplasms/genetics , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/drug therapy , Respiratory Insufficiency/therapy , Respiratory Insufficiency/drug therapy , Lung/pathology , Mutation
11.
J Wound Care ; 33(2): 102-117, 2024 Feb 02.
Article in English | MEDLINE | ID: mdl-38329829

ABSTRACT

OBJECTIVE: Malignant wounds develop when neoplastic cells invade the skin either locally or by lymphatic and haematogenous spread. They can present as hard-to-heal wounds and underlying causes include: primary skin cancer; metastasis of extracutaneous primary malignancy; malignant transformation of a hard-to-heal wound; iatrogenic injury; and cutaneous forms of cancers of non-skin origin. High clinical suspicion for a malignant wound should be confirmed with skin biopsy. The aim of this case series is to highlight a combination of both clinically clear cutaneous malignancies and not-so-obvious wounds caused by malignancy. METHOD: This case series examines patients with malignant wounds of varying aetiology and appearance. For each case, we explain the pathophysiology, atypical features, diagnostic approach and treatment. We also discuss types of wound biopsy and general wound management principles. RESULTS: Among the 11 cases analysed using descriptive statistics, median wound duration before presentation at our clinic was one year, while median age at presentation was 65 years. Our case series included the following diagnoses: cutaneous metastasis of invasive ductal carcinoma of the breast (n=2); cutaneous metastasis of colorectal adenocarcinoma (n=1); Marjolin's ulcer (n=1), basal cell carcinoma (BCC) (n=2), primary cutaneous squamous cell carcinoma (SCC) (n=1), metastatic malignant melanoma (n=1), cutaneous T-cell lymphoma (n=1), cutaneous angiosarcoma (n=1), Kaposi sarcoma (n=1) and recurrent tonsillar SCC with osteoradionecrosis (n=1); one case had both BCC and SCC. CONCLUSION: Punch and excisional biopsies were the most frequently used diagnostic techniques. Local wound therapy addressed bleeding, malodour, exudate, pain and infection. However, wound healing is usually achieved once the underlying malignancy is treated. In advanced or metastatic disease, palliative wound care aims to prevent exacerbation of existing wounds and focuses on patient comfort.


Subject(s)
Carcinoma, Squamous Cell , Melanoma , Skin Neoplasms , Aged , Humans , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/therapy , Carcinoma, Squamous Cell/complications , Melanoma/diagnosis , Melanoma/therapy , Neoplasm Recurrence, Local , Skin/pathology , Skin Neoplasms/diagnosis , Skin Neoplasms/therapy
12.
PLoS Negl Trop Dis ; 18(2): e0011911, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38329944

ABSTRACT

The concurrent diagnoses of Buruli ulcer (BU) and cutaneous squamous cell carcinoma (SCC) is a phenomenon not previously described, despite the fact that both conditions are highly prevalent in Australia. This report presents an intriguing case of concurrent diagnoses, with clues alluding to more than one skin condition being present. The case involves a 73-year-old man with BU diagnosed on the scalp, an atypical location, which led to the consideration of malignancy, ultimately revealing concurrent SCC. This case highlights the importance of considering both conditions in patients with epidemiological risk factors, necessitating multiple lines of investigation for accurate diagnosis. Medical practitioners must remain vigilant and incorporate this possibility into their diagnostic algorithms for suspicious skin lesions to optimize treatment and outcomes. This is the first recorded instance of simultaneous diagnosis, underlining the need for enhanced awareness and attention to these unique cases.


Subject(s)
Buruli Ulcer , Carcinoma, Squamous Cell , Skin Neoplasms , Male , Humans , Aged , Buruli Ulcer/therapy , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/pathology , Skin Neoplasms/complications , Skin Neoplasms/diagnosis , Health Personnel , Australia
13.
Medicine (Baltimore) ; 103(6): e36448, 2024 Feb 09.
Article in English | MEDLINE | ID: mdl-38335428

ABSTRACT

Squamous cell carcinoma of the head and neck (SCCHN) is a commonly detected cancer worldwide. Human papillomavirus (HPV) is emerging as an important risk factor affecting SCCHN prognosis. Therefore, identification of HPV status is essential for effective therapies in SCCHN. The aim of this study was to investigate the prognostic value of HPV-associated RNA biomarkers for SCCHN. The clinical data, survival data, and RNA-seq data of SCCHN were downloaded from The Cancer Genome Atlas database. Before the differential expression analysis, the heterogeneity between the 2 groups (HPV+ vs HPV-) of samples was analyzed using principal component analysis. The differentially expressed genes (DEGs) between HPV+ and HPV- SCCHN samples were analyzed using the R edgeR package. The Gene Ontology functional annotations, including biological process, molecular function and cellular component (CC), and Kyoto Encyclopedia of Genes And Genomes pathways enriched by the DEGs were analyzed using DAVID. The obtained matrix was analyzed by weighed gene coexpression network analysis. A total of 350 significant DEGs were identified through differential analysis, and these DEGs were significantly enriched in functions associated with keratinization, and the pathway of neuroactive ligand-receptor interaction. Moreover, 72 hub genes were identified through weighed gene coexpression network analysis. After the hub genes and DEGs were combined, we obtained 422 union genes, including 65 survival-associated genes. After regression analysis, a HPV-related prognostic model was established, which consisted of 8 genes, including Clorf105, CGA, CHRNA2, CRIP3, CTAG2, ENPP6, NEFH, and RNF212. The obtained regression model could be expressed by an equation as follows: risk score = 0.065 × Clorf105 + 0.012 × CGA + 0.01 × CHRNA2 + 0.047 × CRIP3 + 0.043 × CTAG2-0.034 × ENPP6 - 0.003 × NEFH - 0.068 × RNF212. CGA interacted with 3 drugs, and CHRNA2 interacted with 11 drugs. We have identified an 8 HPV-RNA signature associated with the prognosis of SCCHN patients. Such prognostic model might serve as possible candidate biomarker and therapeutic target for SCCHN.


Subject(s)
Carcinoma, Squamous Cell , Head and Neck Neoplasms , Papillomavirus Infections , Humans , Squamous Cell Carcinoma of Head and Neck/genetics , Squamous Cell Carcinoma of Head and Neck/complications , Prognosis , Human Papillomavirus Viruses , Papillomavirus Infections/genetics , Papillomavirus Infections/complications , Carcinoma, Squamous Cell/complications , Head and Neck Neoplasms/genetics , Head and Neck Neoplasms/complications , Biomarkers , RNA , Gene Expression Regulation, Neoplastic , Gene Expression Profiling , Ligases
14.
Environ Res ; 247: 118117, 2024 Apr 15.
Article in English | MEDLINE | ID: mdl-38218521

ABSTRACT

BACKGROUND: The incidence of non-melanoma skin cancers (NMSCs) increased over last decades, probably due to environmental concerns or to the increase of frail patients with age related comorbidities. Currently, the relationship of increasing global skin cancer rates with increased ultraviolet radiations (UVRs) resulting from stratospheric ozone depletion, global warming, and air pollution from fossil-fuel combustion. AIMS: We conducted a retrospective epidemiological study including 546 NMSC patients managed at the Dermatology Unit of the Tor Vergata Hospital to highlight different trends of sun exposure or different comorbidities. METHODS: Descriptive and inferential statistical analyses were performed to evidence differences between continous variable and Spearman rank test for dicotomical variables. Charlson Comorbidity Index was calculated to obtain the 10-years survival rate in order to identify the mean comorbidity burden of our patients. RESULTS: Considering patients with comorbidities (73.81%), actinic keratoses (AKs) was the most frequent lesion. In patients with a history of previous melanoma, basal cell carcinoma (BCC) was predominant (ANOVA test, p < 0.05) with a statistically significant correlation (rho = 0.453; p < 0.01). Squamous cell carcinoma (SCC) showed a higher rate in arterial hypertension patients, followed by the chronic heart failure and hematologic neoplasms (60%, 29.7% and 32.1%, respectively) groups. Men were more affected than women, representing 61.54% of patients. Chronic sun exposure is directly correlated with SCC rho = 0.561; p < 0.01), whereas BCC correlated with a history of sunburns (rho = 0.312; p < 0.05). CONCLUSIONS: History of photo-exposition had an important role on NMSC development especially for work or recreational reasons. Sex, age, and presence of comorbidities influenced different NMSC types. BCC was more frequent in younger patients, associated with melanoma and sunburns. The presence of SCC is associated with older patients and the hypertension group. AKs were diagnosed predominantly in oldest men, with a chronic sun-exposure history, and hematologic neoplasms group.


Subject(s)
Carcinoma, Basal Cell , Carcinoma, Squamous Cell , Hematologic Neoplasms , Hypertension , Melanoma , Skin Neoplasms , Sunburn , Male , Humans , Female , Skin Neoplasms/epidemiology , Skin Neoplasms/etiology , Melanoma/etiology , Melanoma/complications , Retrospective Studies , Sunburn/complications , Carcinoma, Basal Cell/etiology , Carcinoma, Basal Cell/complications , Carcinoma, Squamous Cell/etiology , Carcinoma, Squamous Cell/complications , Hematologic Neoplasms/complications
15.
Medicine (Baltimore) ; 103(4): e37057, 2024 Jan 26.
Article in English | MEDLINE | ID: mdl-38277516

ABSTRACT

BACKGROUND: Cancer of unknown primary (CUP) is a very challenging disease, accounting for 2% to 9% of all new cancer cases. This type of tumor is a heterogeneous tumor whose primary site cannot be determined by standard examination. It has the characteristics of early metastasis, strong aggressiveness, and unpredictable mode of metastasis. Studies have shown that there is no consensus on the treatment of CUP and that there is a wide range of individual differences. In most cases, surgical removal of tumor is the most typical treatment for pelvic tumors. Herein, we report a case of a large pelvic tumor of unknown origin that had compressed the sigmoid colon and ureter and was completely removed by surgery. Postoperative diagnosis was pelvic metastatic squamous cell carcinoma. CASE SUMMARY: A 68-year-old man with pelvic tumor who initially complained of recurrent low back pain and painful urination. The mass was initially diagnosed as a pelvic tumor of unknown origin. The patient underwent complete resection of the tumor by laparotomy. The tumor was pathologically diagnosed as squamous cell carcinoma. CONCLUSION: Based on the treatment experience of this case, surgery alone cannot improve the poor prognosis of CUP. Since chemotherapy and immunotherapy have achieved promising efficacy in various cancers, and immunotherapy has the characteristics of low side effects and good tolerability, we recommend that patients with CUP should receive chemotherapy and/or immunotherapy for better survival outcomes.


Subject(s)
Carcinoma, Squamous Cell , Hydronephrosis , Neoplasms, Unknown Primary , Pelvic Neoplasms , Ureteral Obstruction , Male , Humans , Aged , Neoplasms, Unknown Primary/pathology , Constriction, Pathologic , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/pathology , Hydronephrosis/etiology , Hydronephrosis/surgery , Ureteral Obstruction/etiology , Ureteral Obstruction/surgery
16.
Head Neck ; 46(4): 896-904, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38216834

ABSTRACT

BACKGROUND: Massive oropharyngeal bleeding post-chemoradiotherapy is a life-threatening condition that requires emergent management. METHODS: This retrospective case series included 11 patients with oropharyngeal squamous cell carcinoma who suffered from massive bleeding during or following treatment with definitive chemoradiotherapy. Details of acute and definitive management of oropharyngeal bleeding are reported. RESULTS: Nine of 11 hemorrhagic events occurred a mean (SD) of 88.6 days (53.6) after radiotherapy. Airway intubation and embolization were performed in 10 of 11 patients, followed by surgery in 7 of 11 patients. The most commonly embolized vessels were the external carotid and lingual arteries. At the time of discharge, 3 of 11 patients had a tracheostomy, and 7 of 11 continued to use a gastrostomy tube. Four patients died. CONCLUSIONS: Hemorrhagic complications in oropharyngeal cancer treatment require emergent responses. Developing a workflow for coordination between multidisciplinary teams can maximize probability of survival and decrease morbidity.


Subject(s)
Carcinoma, Squamous Cell , Oropharyngeal Neoplasms , Humans , Retrospective Studies , Oropharyngeal Neoplasms/complications , Oropharyngeal Neoplasms/therapy , Oropharyngeal Neoplasms/pathology , Hemorrhage/etiology , Hemorrhage/therapy , Chemoradiotherapy/adverse effects , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/therapy
17.
Am J Emerg Med ; 77: 231.e5-231.e6, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38290919

ABSTRACT

Carotid blowout syndrome (CBS) is an uncommon but potentially life-threatening condition characterized by the spontaneous or traumatic rupture of the carotid artery in the neck. Oftentimes, CBS is due a loss of structural arterial integrity from local radiotherapy or surgical procedures. A vast majority of patients who develop CBS also have a previous diagnosis of head and neck cancer. Due to the specific patient population who develop CBS and its life-threatening nature, CBS should be a part of emergency physicians differential for those who present with a chronic neck wound or neurological symptoms in those with a previous head and neck cancer diagnosis. In this case report, a patient with a history of squamous cell carcinoma of the oropharynx who was treated with chemoradiation therapy, presented to the emergency department with spontaneous bleeding from an existing chronic wound on the left lateral neck. Conservative measures were taken including wound dressing, and the patient was discharged to see dermatology for biopsy of a suspected cancerous lesion. Once the chronic lesion was biopsied, the patient had to be immediately rushed to the operating room due to a brisk pulsatile bleeding from puncturing the carotid artery. Proper wound packing and an ultrasound of the neck for a proper diagnosis may have prevented the need for surgical intervention in this case. Although CBS is not common, complications can lead to death as seen in this case. Timely recognition and proper interventions are critical for preventing potentially fatal outcomes in those with CBS.


Subject(s)
Carcinoma, Squamous Cell , Carotid Artery Diseases , Head and Neck Neoplasms , Humans , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/etiology , Carotid Arteries , Head and Neck Neoplasms/complications , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/therapy , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/therapy , Hemorrhage/complications , Stents/adverse effects
18.
Br J Oral Maxillofac Surg ; 62(2): 184-190, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38272707

ABSTRACT

In the elderly population there is increasing evidence that frailty predicts adverse outcomes better than chronological age. Sarcopenia is an important component of frailty. This study aimed to establish the relevance of sarcopenia in elderly patients with oral squamous cell carcinoma (OSCC) undergoing surgery. This retrospective, single-centre, cohort study included patients over the age of 75 years who were diagnosed with OSCC between 2007 and 2016. Cross-sectional imaging of the neck was used to predict the Skeletal Muscle Index (SMI) using validated equations. Based on established thresholds, patients were categorised as having either a normal or low SMI, indicative of sarcopenia. Sixty-nine patients met the inclusion criteria. Patients with a low SMI had a longer length of stay (16.9 days vs 9.8 days, p = 0.030); they had more severe complications, defined as Clavien-Dindo grade IIIb or higher (17.6% vs 4.0%, p = 0.042); and their mean Comprehensive Complication Index (CCI) was also higher (14.1 vs 4.7, p = 0.051). Furthermore, 2/34 patients in the low SMI group died within 30 days of surgery compared with none in the normal SMI group (5.9% vs 0%, p = 0.503). Whilst patients with a low SMI who underwent surgery had lower five-year overall survival, the difference was not statistically significant. This study shows that sarcopenia negatively influences surgical outcomes in elderly patients. Routine measurement of SMI could be an indication for a comprehensive geriatric assessment (CGA).


Subject(s)
Carcinoma, Squamous Cell , Frailty , Head and Neck Neoplasms , Mouth Neoplasms , Sarcopenia , Humans , Aged , Sarcopenia/complications , Sarcopenia/diagnosis , Sarcopenia/epidemiology , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/complications , Squamous Cell Carcinoma of Head and Neck/complications , Frailty/complications , Frailty/diagnosis , Retrospective Studies , Cohort Studies , Mouth Neoplasms/surgery , Mouth Neoplasms/complications , Head and Neck Neoplasms/complications
19.
J Laryngol Otol ; 138(3): 345-348, 2024 Mar.
Article in English | MEDLINE | ID: mdl-37681549

ABSTRACT

BACKGROUND: Pharyngocutaneous fistula is one of the most common complications following total laryngectomy. It increases hospital stay and the financial burden on patients, and prolongs nasogastric feeding. This paper presents novel techniques for prevention of pharyngocutaneous fistula. METHOD: A retrospective study was conducted at a tertiary referral centre to assess the effectiveness of continuous extramucosal pharyngeal suturing and the hydrogen peroxide leak test in prevention of pharyngocutaneous fistula in 59 patients who had undergone total laryngectomy with or without partial pharyngectomy for locally advanced cancers of the larynx and hypopharynx. RESULTS: The incidence of pharyngocutaneous fistula in our study was 6.8 per cent, which is considerably lower than the incidence reported in various previous studies. CONCLUSION: The continuous extramucosal suturing technique provides watertight closure of the neopharynx and can be recommended as a reliable method for neopharyngeal closure post total laryngectomy to reduce the occurrence of pharyngocutaneous fistula.


Subject(s)
Carcinoma, Squamous Cell , Cutaneous Fistula , Hypopharyngeal Neoplasms , Laryngeal Neoplasms , Larynx , Pharyngeal Diseases , Humans , Hypopharyngeal Neoplasms/surgery , Retrospective Studies , Laryngeal Neoplasms/surgery , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/complications , Cutaneous Fistula/etiology , Cutaneous Fistula/prevention & control , Cutaneous Fistula/epidemiology , Laryngectomy/adverse effects , Laryngectomy/methods , Pharyngeal Diseases/etiology , Pharyngeal Diseases/prevention & control , Pharyngeal Diseases/epidemiology , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/prevention & control
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