[Myoepithelioma (or myoepithelial cell adenoma). Report of a case]. / Myo-épithéliome (ou adénome à cellules myo-épithéliales). A propos d'un cas.

One case of myo-epithelioma occurring in the parotid gland is reported. This tumor was composed of spindle cells. The diagnosis was confirmed by ultrastructural and immunohistochemical analysis demonstrating myofilaments aggregation pattern and positive staining for S100-protein and keratin antibodies. Of all salivary gland tumors, myo-epithelioma accounts for less than 1% of the total and has a good prognosis. Conservative surgical management is curative.

Keratins 6, 13 and 19. Differential expression in squamous cell carcinoma of the head and neck.

One hundred forty-one head and neck squamous cell carcinomas were analyzed for keratin (K) 6, 13 and 19. Staining was evaluated by light microscopy (with or without grading) and image analyzer and expressed as a percentage of positive versus all tumor surface (PSA). Both techniques rendered strongly correlated results. Strong expression was noted in 108 carcinomas (76.1%) for K6, in 18 (12.7%) for K19 and in 21 (14.8%) for K13 (P = .001). One hundred thirty-six (96%) tumors were positive for K6, and their PSA ranged from 0.6% to 48.8%; K19, 48 cases (0.2-44%); K13, 59 (0.2-38.1%). Expression of K6 was related to differentiation. K19 was expressed mainly in moderately and poorly differentiated tumors, and K13 was manifest more in well-differentiated carcinomas or in keratinized areas of less-differentiated ones. Nineteen (13.38%) tumors were positive for both K13 and K19. K19 thus was related to tumor progression and K13 to differentiation. There was no correlation with tumor site or TNM category.

Basaloid squamous carcinoma of the head and neck. Immunohistochemical comparison with adenoid cystic carcinoma and squamous cell carcinoma.

Basaloid squamous carcinoma (BSC) is a rare distinct variant of squamous cell carcinoma of the head and neck region. This entity may commonly pose diagnostic difficulties, especially on small biopsy material. We report the clinicopathological characteristics of 12 new cases and compare their immunohistochemical features with those of solid adenoid cystic carcinomas and conventional squamous cell carcinomas. Our results show that neoplastic BSCs and squamous cell carcinomas do not react to vimentin and S100 protein, while adenoid cystic carcinomas manifest both. The BSCs, however, are S100 protein-positive in intratumoral dendritic Langerhans' cells that are lacking in squamous cell and adenoid cystic carcinomas. Our findings indicate that the immunohistochemical differences between BSC and adenoid cystic carcinoma could assist in their differential diagnosis.

Histological re-evaluation of 101 intraoral salivary gland tumors by an EORTC-study group.

Tumors of the salivary glands constitute a heterogeneous group of lesions of great morphologic variation and for this reason present many difficulties in histologic classification. The histologic slides of 101 consecutive intraoral salivary gland tumors of the Department of Oral Pathology of the Free University in Amsterdam were reviewed, retrospectively, by an EORTC-study group on salivary gland tumors. Complete concurrence of diagnosis was reached in 54 cases. In 33 cases there were minor disagreements, mostly related to subclassification. Major disagreements, relating to benign versus malignant, occurred in eight cases (7.9 per cent).

Metastatic papillary endometrial carcinoma of the tongue. Case report and review of the literature.

Tongue metastases are exceptional, with a frequency of 0.1% to 0.2% in autopsy series of patients with disseminated cancer. A case of secondary papillary endometrial carcinoma of the tongue is reported as the first sign of metastasis in a 78-year-old white woman treated 7 years before by complete hysterectomy and radiotherapy. The lesion presented as a 3 x 3-cm submucosal mass of the dorsum of the tongue. Fine-needle aspiration and excisional biopsy established the diagnosis. Metastases to the lungs, liver, and bone developed 3 months later, and she died 6.5 months after initial diagnosis. A review of reports of 77 lingual metastases showed that the mean age was 57 years, with a male predominance. The lung, kidney, and skin were the most common primary sites. The tongue was the first site of metastases in 61% and the first sign of the primary malignant neoplasm in 15% of the cases. Average survival was 10 months.

Adenoid cystic carcinoma of the head and neck: evaluation with MR imaging and clinical-pathologic correlation in 27 patients.

Twenty-seven adenoid cystic carcinomas (ACCs) of the head and neck in 27 patients were evaluated in a retrospective study based on findings at magnetic resonance (MR) imaging and pathologic and clinical examination. Clinical follow-up was obtained over a mean period of 6.3 years (range of follow-up, 3 months to 17 years); all patients underwent one to seven MR examinations. On T2-weighted images, lesions with low signal intensity corresponded to highly cellular tumors (solid subtype) with a poor prognosis; lesions with high signal intensity corresponded to less cellular tumors (cribriform or tubular subtype) with a better prognosis. MR images were not specific in differentiation of ACCs from other types of tumors; this result underscores the need for biopsy to ensure correct diagnosis. Local, intracranial, osseous, and perineural invasion was depicted, but because of its lack of specificity, MR imaging caused overdiagnosis of tumor extension, particularly perineural spread and bone abnormalities.

Hypopharyngeal sebaceous carcinoma: a case report.

A hypopharyngeal squamous-cell carcinoma with sebaceous differentiation is reported. In the primary as well as the metastatic lymph nodes, the tumor showed basaloid, squamous, and sebaceous cells. In addition, immunostaining for S-100 protein and vimentin manifested scattered cells showing cytoplasmic processes suggesting myoepithelial cells. An exhaustive review of the literature revealed only one similar case previously reported. The probable origin from the minor salivary glands is discussed.

Primary prostatic Wilms' tumor.

The first case of primary Wilms' tumor of the prostatic gland is described. It occurred in a 32-year-old man. Histologically, it consisted of a triphasic tumor; tubular and glomeruloid structures were identified, among prominent blastematous sheets and in an edematous stroma. No teratomatous components were encountered. We propose that this prostatic primary, nonteratomatous Wilms' tumor can arise from persistent, nephrogenic, blastematous rests in the prostate, in relation to the Wolffian duct system.

Paragangliomas of the head and neck. Immunohistochemical analysis of 16 cases in comparison with neuro-endocrine carcinomas.

Sixteen cases of paragangliomas of the head and neck including 8 of the vagal body, 3 of the carotid body, 2 jugulotympanic, 2 vagal or jugulotympanic and 1 of the larynx were analysed. Clinically, 13 tumors were benign, 2 showed local aggressivity and 1 showed metastases. All tumors were tested with antisera directed against neuron-specific enolase (NSE), chromogranin A (CGA), S-100 protein, neurofilaments (NF), glial fibrillary acid protein (GFAP) and cytokeratin (CK). Immunohistochemical results were compared with those of 5 cases of neuroendocrine carcinoma (NC) (1 of the oral vestibule, 1 of the larynx, 1 Merkel-cell tumor of the skin and 2 medullary thyroid carcinomas). Immunoreactivity for NSE and/or CGA was always positive in all paragangliomas and NC. S-100 protein was positive in sustenticular cells in all cases of paragangliomas and focally in two cases of NC. NF and GFAP were focally positive in 3 and 2 paragangliomas respectively; and in 1 NC. CK was constantly negative in all cases of paraganglioma and constantly positive in all cases of NC. Antibody anti-CK is the single most useful immunomarker for differential diagnosis between paraganglioma, frequently benign neoplasms and NC commonly aggressive in the head and neck. These findings are consistent with the current concepts of the neuroendocrine system.

Squamous cell carcinoma of the upper aerodigestive tract associated with well-differentiated carcinoma of the thyroid gland.

The association of squamous cell carcinoma of the upper aerodigestive tract with well-differentiated thyroid carcinomas has rarely been reported in the literature. We report 10 cases illustrating this occurrence. In eight cases, the thyroid carcinoma was discovered accidentally on histological examination of a single neck node, a neck node dissection specimen, an unexpectedly found thyroid nodule, or a systematically resected thyroid lobe, all during surgical treatment of an upper aerodigestive tract carcinoma. In the other two cases, metastatic thyroid neck nodes appeared during the follow-up of a patient with an upper aerodigestive tract carcinoma. No case of upper aerodigestive tract carcinomas was found during the follow-up of thyroid cancer patients. In most cases, adequate thyroid cancer surgery was performed simultaneously or later. Prognosis was essentially determined by the upper aerodigestive tract cancer.

Papillary carcinoma in thyroglossal duct remnants.

About 100 cases of carcinoma arising in thyroglossal remnants have been reported in the world literature. Five additional cases were discovered incidentally on histopathological examinations of specimens following Sistrunk's operation for removal of thyroglossal cysts and are now reported. The possibility of preoperative clinical diagnosis and the modalities of treatment are discussed.

Oral and pharyngeal adenosquamous carcinoma. A report of four cases with immunohistochemical studies.

Four cases of adenosquamous carcinoma from the oral and pharyngeal cavities were analyzed by light microscopy and immunohistochemistry. Lymph node metastases were present in three cases. One patient died 2 years after treatment. All four carcinomas presented a mixture of squamous and glandular mucus-secreting neoplastic elements. Immunostaining for high-molecular-weight cytokeratins (KL1) was constantly positive in both squamous and glandular tumor cells. Antibodies against low-molecular-weight cytokeratins (K19) and carcinoembryonic antigen were positive only in the glandular component. The histological aspect and the immunohistochemical phenotype of these tumors is similar to the ordinary squamous cell carcinoma and adenocarcinoma, respectively.

Analysis of the c-Ha-ras-1 gene for deletion, mutation, amplification and expression in lymph node metastases of human head and neck carcinomas.

The c-Ha-ras gene was analysed by Southern blot hybridisation in 67 specimens of lymph node metastases and in 25 specimens of primary tumours obtained from 85 untreated patients with head and neck squamous cell carcinoma. The loss of one c-Ha-ras allele was observed in 10/46 (22%) tumours from heterozygous patients for this locus. Different genes, located as the c-Ha-ras gene on the short arm of chromosome 11, were also found to be deleted suggesting that the deletion of other genes could play a role in aggressiveness of head and neck carcinomas. Using polymerase chain reaction, mutation at codon 12 was detected in only 2/54 (3.8%) tumours but no mutation involving codon 61 was found. Neither gene amplification nor gene rearrangement could be observed. Total RNA was prepared from 79 of these tumour specimens and analysed by Northern and slot blot hybridisation. A 1.2 kb c-Ha-ras transcript band was detected in all the RNA preparations. Relatively high c-Ha-ras transcript levels were found in 18% of lymph node metastases and in 21% of primary tumours, indicating no significant differences between these cancers. Moreover, the c-Ha-ras mRNA levels were not significantly greater in the primary tumours than in the normal mucosae in 10/12 cases for which both tissues were analysed. These data indicate that c-Ha-ras gene does not seem to be strongly involved in head and neck carcinomas at that advanced stage of the disease, as this was previously reported for earlier clinical stages.

So-called branchiogenic carcinoma is actually cystic metastases in the neck from a tonsillar primary.

In 1974, we reported on six patients with squamous cell carcinoma arising in the tonsillar area who presented with a characteristic form of cystic nodal metastasis. This study reports on an additional 21 patients with this entity. Treatment of these patients included removal of the cystic metastasis with or without radical neck dissection and irradiation of Waldeyer's ring. Two patients have died of unrelated disease and two were lost to follow-up, but the remainder are alive without disease 2 months to 12 years following initial diagnosis. We believe that cystic metastases from tonsillar squamous cell carcinomas have often been mistaken for either primary squamous cell carcinomas of branchiogenic origin or with branchial cleft cysts. The distinctive histological features of cystic metastases reviewed after its correct identification can lead to the discovery of an unsuspected primary lesion and result in specific treatment options.

Glutathione and cysteine levels in human tumour biopsies.

There is evidence that some human tumours could be treated with a combination of buthionine sulfoximine and hypoxic cell sensitizers. However, clinical application of this technique requires a prior knowledge of the level of non-protein bound sulfhydryl (NPSH) compounds in these tumours. The present study provides data on the levels of glutathione (GSH) and cysteine (CYS) in human tumour biopsies from the cervix and from the head and neck. The NPSH compounds were measured by high performance liquid chromatography. The median GSH values were 20.5 nmol/mg protein (cervix) and 23 nmol/mg protein (head and neck) while the median CYS values were 4.4 (cervix) and 4.2 nmol/mg protein (head and neck). The values varied widely from one patient to another.

Malignant tumours of the parotid: a study of 76 patients.

This study presents a series of malignant parotid tumours treated at the Institut Gustave-Roussy between 1975 and 1984. The lesions represented a wide variety of histological types. Few preoperative investigations were required, management being based on histology. Effective local control requires a total parotidectomy preserving the facial nerve where possible. It should be followed by routine radiotherapy which appears to reduce the incidence of local recurrence. The rate of local recurrence also depends on the histological type. It is seen more frequently in an adenocarcinoma following a pleomorphic adenoma than in simple adenocarcinoma. Patients with inoperable disease are treated with radiotherapy alone as chemotherapy has not so far been effective. Percentage 5-year survival for the three most common tumour types is as follows: adenocarcinoma: 49; adenoid cystic carcinoma: 83, and mucoepidermoid carcinoma: 75.

[Phalangette metastases of cancer of the mouth. An uncommon mode of propagation]. / Métastases aux phalangettes des cancers de la cavité buccale. Un mode de propagation inhabituel.

The direct propagation of a cancer of the buccal cavity or oropharynx to the bone of a distal phalanx is demonstrated in two patients suffering from onychophagy. This exceptional way of cancer propagation must be searched for if an unusual site of metastasis is encountered.

Histology of the major salivary glands.

Major salivary glands are characterized by the presence of numerous excretory units that consist of acini and a peculiar duct system. Under normal conditions, sebaceous glands are annexed to the duct system in the parotid and the submaxillary glands. The excretion of the saliva is assisted by the myoepithelial cells, which play an important role in the morphology of several kinds of salivary gland tumors. Interstitial lymphocytes give rise to the formation of lymph nodes in the parotid gland. Heterotopic salivary tissue is found in many locations throughout the head and neck. Age-induced variations and reactive changes include oncocyte proliferation, fatty infiltration, squamous and mucous metaplasia, hyperplasia, atrophy, and regeneration. An analysis of the normal salivary gland structure permits a morphogenetic approach to an understanding of the variability in histologic types of salivary gland tumors.