Systemic inflammatory response and survival in patients undergoing curative resection of oral squamous cell carcinoma.

Prognostic stratification in squamous cell carcinoma (SCC) of the head and neck has traditionally relied on the pathological staging of a tumour, but it is increasingly being recognised that host-related factors have an important role in the assessment of survival and recurrence. We aimed to evaluate the prognostic value of systemic inflammation scores including the modified Glasgow Prognostic Score (mGPS) in patients undergoing potentially curative resection for oral SCC. We retrospectively identified 178 patients who had curative operations for cancer of the oral cavity and soft palate between January 2006 and April 2011. Among the inclusion criteria were preoperative estimates of C-reactive protein and serum albumin. We analysed established pathological prognostic factors and scores for systemic inflammation as predictors of cancer-specific and overall survival. On univariate analysis, the mGPS was a significant predictor of both cancer-specific (p<0.001) and overall survival (p<0.001), and it remained an independent predictor of cancer-specific (HR: 2.12, 95% CI 1.49 to 3.00; p<0.001) and overall survival (HR: 1.69, 95% CI 1.23 to 2.31; p=0.001) on Cox regression analysis. The mGPS of activated systemic inflammation seems to be a powerful adverse prognostic indicator in resectable oral SCC.

Mantle cell lymphoma presenting with a tumor of the hard palate.

We report a 71-year-old man with a disseminated disease of mantle cell lymphoma (MCL). He initially noticed instability of the maxillary denture due to swelling of the hard palate. Combined positron-emission tomography and computed tomography demonstrated a marked accumulation of fluorodeoxyglucose in the palate. A biopsy of the palatine tumor disclosed diffuse infiltrates of lymphoid cells, which were positive for CD20 and cyclin D1. The peripheral blood contained lymphoma cells with the characteristic immunophenotype, and fluorescence in situ hybridization detected fusion signals indicative of t(11;14)(q13;q32). In a literature review we identified only three cases of MCL with palatine involvement to date.

[18F-FDG PET-CT in a case of solitary plasmacytoma of the soft palate]. / Tomografía por emisión de positrones con ¹8F-fluorodeoxy-glucosa en un caso de plasmocitoma solitario de paladar blando.

Solitary plasmacytoma is an uncommon tumor of plasma cells that can appear in the head and neck. It must be differentiated from multiple myeloma because of its initial presentation. A case of solitary plasmacytoma on the palate is presented. Furthermore, role of ¹8F-fluorodeoxyglucose Positron Emission Tomography (¹8F-FDG-PET) in its initial staging is analyzed.

Angiocentric T-cell lymphoma of the nose, paranasal sinuses and hard palate.

Sixty-five cases of malignant lymphoma of the nose, paranasal sinuses and hard palate were retrospectively analysed to identify the presence or absence of angiocentric lesions. We observed that the 23 patients with angiocentric lesions had a worse prognosis with a shorter duration of response and also a shorter duration of survival, compared with 42 cases of malignant lymphoma of the same anatomical region but without angiocentric lesions. Patients with angiocentric lymphoma were associated with other bad prognostic factors such as elevated levels of lactic dehydrogenase and beta 2 microglobulin, local bone destruction and lymphopenia. Immunophenotyping studies showed that most patients with angiocentric lesions had T cell lymphomas (18 of 23, 78 per cent). We believe that patients with angiocentric T cell lymphomas of the nose, paranasal sinuses and hard palate represent a distinctive clinico-pathological entity with different clinical presentation and outcome. Patients with angiocentric T cell lymphomas had frequent relapse at extranodal sites and combined therapy should be considered as the initial therapeutic approach.

Extramedullary plasmacytoma of the soft palate.

A 59-year-old white male presented with symptoms of an upper respiratory infection and the sensation of nasal fullness or obstruction. There were no constitutional symptoms or history of previous oropharyngeal neoplasms. Examination revealed a fleshy tan-pink 2 cm. x 1 cm. pedunculated lesion at the base of the uvula posteriorly, extending into the posterior soft palate. Indirect laryngoscopy confirmed extension of the lesion base onto the posterior soft palate. There was no palpable cervical adenopathy. CT scan of the sinuses and neck revealed no abnormality except the soft tissue mass in the area of the uvula and soft palate. Excisional biopsy of the lesion revealed a plasmacytoma which produced a monoclonal lambda chain immunoglobulin. Hemoglobin was 17.2 g/d. Serum electrophoresis and immunophoresis, Bence-Jones protein, bone marrow, and bone scan were normal. Twenty-six months later, a 1.5 cm. pedunculated lesion was noted at the site of original tumor, which was demonstrated to be recurrent plasmacytoma on excisional biopsy. No other lesions were identified on direct laryngoscopy and skeletal survey was normal. Repeat laboratory studies were normal except for a slight hypergammaglobulinemia (total protein 6.4 g/d., albumin 51.5 percent, alpha 1 globulin 4.0 percent, alpha 2 globulin 11.4 percent, beta globulin 12.8 percent, and gamma globulin 20.2 percent). The patient refused further treatment and has had no further recurrences at one year.

The distribution of blood group antigens in experimentally produced carcinomas of rat palate.

It has been shown previously that rat oral epithelia express antigens cross-reacting with antibodies against human blood group antigen B and its structural precursor, the H antigen (Type 2 chain). In the present study we investigated the expression of these antigens in malignant changes in the rat palate induced by a chemical carcinogen (4NQO). The H antigen, normally expressed on spinous cells in rats, was absent in malignant epithelium, whereas staining for the B antigen, normally expressed on basal cells, was variable. These changes are equivalent to those seen in human squamous cell carcinomas. The blood group antigen staining pattern in experimentally produced verrucous carcinomas showed an almost normal blood group antigen expression. This may have diagnostic significance. Localized areas of hyperplastic palatal epithelium with slight dysplasia revealed loss of H antigen and the presence of B antigen in suprabasal strata equivalent to the pattern seen in human premalignant epithelium. We conclude from these findings, that the rat model is well suited to study changes in cell surface carbohydrates during chemical carcinogenesis.

[Endocrine function following cranial radiotherapy of neoplasms in children]. / Función endocrina después del tratamiento radioterápico craneal de neoplasias en la infancia.

The effect of radiotherapy upon the diencephalo-hypophyseal axis was studied in 14 children that had received cranial radio-therapy (2,400 to 6,000 R) to treat different intracranial tumors. Several hormones were evaluated between 2 months and 3 years after radiotherapy was performed. 35.7 per 100 of the patients were deficient in growth hormone, 37.5 per 100 showed an alteration of prolactin secretion, and 28 per 100 an abnormal response to thyroid-stimulating hormone.