Transnasal endoscopic surgery of post-operative maxillary cysts.

OBJECTIVE: The present study investigates the indications for transnasal endoscopic surgery in treating post-operative maxillary cysts. METHODS: In this retrospective study, the records of 118 patients with post-operative maxillary cysts (88 unilateral and 30 bilateral) consisting of 148 procedures were reviewed. RESULTS: A transnasal endoscopic approach was performed in 144 lesions (97.3 per cent). A combined endonasal endoscopic and canine fossa (external) approach was performed in 4 of 148 lesions, because the cysts were located distant from the nasal cavity and had a thick bony wall. A ventilation stent was placed in four patients (four cysts) to avoid post-operative meatal antrostomy stenosis. Recurrence was observed in five patients (4.2 per cent), all of whom subsequently underwent transnasal endoscopic revision surgery. CONCLUSION: Transnasal endoscopic surgery is an effective treatment for post-operative maxillary cyst with the exception of cysts located distant from the nasal cavity.

Endonasal endoscopic surgery with combined middle and inferior meatal antrostomies for fungal maxillary sinusitis.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of the combination of inferior and middle meatal antrostomies for treatment of a maxillary sinus fungus ball by functional endoscopic sinus surgery. METHODS: A retrospective analysis including 28 patients with non-invasive fungal maxillary sinusitis was performed. Fourteen patients underwent FESS with both middle and inferior meatal antrostomies (combined group). The remaining 14 patients were treated with FESS through only the middle meatal antrostomy (control group). RESULTS: Post-operative computed tomography showed normal maxillary sinuses in all patients in the combined group. In contrast, in the control group, five patients (36 per cent) exhibited a normal maxillary sinus, seven (50 per cent) showed maxillary mucosal thickening and two (14 per cent) had persistent fungus balls in the maxillary sinus. CONCLUSION: FESS with a combination of middle and inferior meatal antrostomies proved more effective for treating fungal maxillary sinusitis.

Safe and rapid contouring of fibro-osseous lesions in the orbital area using navigation with minimally invasive cranial bone registration.

BACKGROUND: Bone contouring is currently the best treatment for fibro-osseous lesions after bone growth arrest. Navigation systems available for this surgery allow intra-operative visualisation with improved cosmetic outcomes. However, conventional navigation systems using superficial skin registration cannot prevent subtle discrepancies. METHOD: To address this problem, we used a non-invasive cranial bone registration that uses patient-specific dental templates to maintain exact registration. We created the preset goal using the mirror image of the unaffected side for unilateral lesions, and using images obtained before the onset of symptoms for bilateral lesions. This system achieved precise pre-operative simulation. A sound aid in the navigation system provided information regarding proximity to critical structures and to the preset goal. RESULTS: We used this system to contour fibro-osseous lesions in three patients. All patients achieved good facial contours and improvement in symptoms. CONCLUSIONS: This method offers a safe, rapid surgical aid in treating orbital fibro-osseous lesions.

Association of vascular endothelial growth factor and mast cells with angiogenesis in laryngeal squamous cell carcinoma.

We investigated the expression of vascular endothelial growth factor (VEGF) and microvascular density in 54 cases of invasive laryngeal squamous cell carcinoma (SCC) and in ten samples of normal laryngeal tissue using immunohistochemistry methods. The study also focused on the distribution of mast cells in and around the SCCs. The microvascular density in laryngeal carcinoma tissue was higher than that in normal tissue (P = 0.02). VEGF was localized in SCCs, stromal cells, endothelial cells, minor salivary glands, and non-cancer epithelium adjacent to the tumor. VEGF expression in the tumor cells was found in 13 of 54 cases (24.1%), whereas mast cells around the carcinomas were VEGF positive in all 54 cases. Staining of VEGF in SCCs was strong in the area of high microvascular density (P = 0.0002). Using a multi-labeling subtraction immunostaining method, VEGF-positive stromal cells were classified mostly as mast cells and, in a few instances, as macrophages. VEGF staining in SCCs was associated with the mast cell count (P = 0.0001). There was no distinct correlation between VEGF expression and pTNM stage of an SCC. In conclusion, the results suggest that VEGF might be an important angiogenic factor in cancer invasion. Laryngeal cancer cells and mast cells may control the angiogenic response by releasing VEGF.

A case of ALK-positive large T-cell lymphoma expressing epithelial membrane antigen with favorable prognosis.

We describe the case of a 59-year-old woman with Ki-1-negative, T cell-type, anaplastic lymphoma kinase (ALK)-positive large cell lymphoma that was positive for epithelial membrane antigen. She was histopathologically diagnosed as having a metastatic undifferentiated carcinoma from a cervical lymph node biopsy. Clinical and radiographic studies revealed no other primary tumor. The patient underwent a left radical neck dissection. Surgically resected lymph nodes revealed an ALK1-positive large cell lymphoma. Thereafter the patient has had an unusually favorable prognosis.

Loss of retinoblastoma protein expression in laryngeal squamous cell carcinoma.

Laryngeal carcinomas are among the most curable malignancies, but some of them show poor clinical outcomes with local recurrence or regional neck metastasis. Multiple genetic alterations of oncogenes and tumor suppressor genes are thought to occur in the development some tumors. The frequency, however, and the prognostic significance of these genes or gene products still remain unknown in laryngeal carcinoma. Epidemiologic data suggest that cigarette smoking is closely related to the development of these neoplasms; and human papillomavirus (HPV) infections have also been postulated to play a role in development of laryngeal tumor. The objective of this study was to investigate the presence of retinoblastoma protein (pRb), p53 protein, and HPV infection in laryngeal squamous cell carcinoma, as well as the correlation of these factors with clinicopathologic and carcinogenic factors. Tumors from 79 patients with primary laryngeal squamous cell carcinoma were studied. The expression of pRb was immunohistochemically assessed in 79 such tumors, and the expression of p53 was assessed in 76 tumors. HPV Type 16 expression was estimated by nonisotopic in situ hybridization in 78 cases. Follow-up periods ranged from 15 to 90 months. pRb was detected in 82% of the tumors and p53 in 43%. Lack of staining for pRb was significantly associated with a high-histologic grade (P<.05), high T classification (P<.05), recurrence (P<.05), and a relatively short disease-free interval (P<.01). p53 overexpression was observed frequently in heavy smokers with an average Brinkman index of more than 800, but it was not associated with any of the clinicopathologic factors studied. These findings suggest that tumors exhibiting loss of pRb expression have a more aggressive biologic behavior than do those that express pRb and that loss of pRb expression might predict clinical outcome in patients with primary laryngeal squamous cell carcinoma.

Localization of vascular endothelial growth factor in synovial membrane mast cells: examination with "multi-labelling subtraction immunostaining".

Mast cells are believed to play a novel part in the development of destructive synovial pannus in rheumatoid arthritis (RA). This study was undertaken to investigate the localization of vascular endothelial growth factor (VEGF) in the synovial membrane using a unique immunostaining technique. Synovial specimens of RA patients were examined immunohistochemically and were compared with specimens from non-RA controls. Multi-labelling subtraction immunostaining, a modification of double- and triple-labelling immunostaining, revealed that the VEGF-positive cells were identical to tryptase-positive cells (mast cells). No other cell types were found to be positive for VEGF. The synovium of RA patients showed a larger number of VEGF-positive mast cells than that of non-RA controls (P<0.001). The study suggests that mast cell-derived VEGF may contribute to the development of synovial pannus in RA.

Expression of MMP-1, TIMP-1, and type I collagen in laryngeal carcinoma.

Matrix metalloproteinases (MMPs) are thought to play an important role in tumor invasion and metastasis. To our knowledge, however, no previous report examined the histologic localization of matrix metalloproteinase-1 (MMP-1), tissue inhibitor of metalloproteinase-1 (TIMP-1) and Type I collagen in laryngeal carcinoma from the same samples. In this study, immunohistochemical staining for MMP-1, TIMP-1, and Type I collagen was performed on paraffin-embedded sections from 83 laryngeal squamous cell carcinomas. Twenty of the 83 tumors were examined for MMP-1 and TIMP-1 mRNA using in situ hybridization (ISH). Immunohistochemical and ISH analyses indicated that squamous cancer cells as well as stromal cells such as fibroblasts, macrophages, and mononuclear and endothelial cells expressed MMP-1 and TIMP-1 in the area adjacent to the tumor. The localization of MMP-1 and TIMP-1 protein is similar to that of their respective transcripts. Dense or moderate patterns of Type I collagen were associated with a tendency toward positivity for TIMP-1 and negativity for MMP-1 (P < .002). A sparse pattern of Type I collagen was associated with a tendency toward positivity for MMP-1 and negativity for TIMP-1 (P < .004). The patterns of Type I collagen staining correlated significantly with imbalances in MMP-1 and TIMP-1 expression (P < .001). Matrix degradation and remodeling in squamous cell carcinoma of the larynx might be attributable to an imbalance in the expression of MMP-1 and TIMP-1.

Expression of c-Met in laryngeal carcinoma.

Expression of c-Met, a gene for the hepatocyte growth factor/scatter factor (HGF/SF) receptor, is known to be associated with tumour development in several human carcinomas. The expression of c-Met was examined using immunohistochemistry in 82 cases of primary laryngeal carcinoma to evaluate the tissue distribution of c-Met and the clinicopathological significance of c-Met expression. In normal larynx, c-Met expression was observed only in some minor salivary glands. Positive reaction for c-Met in neoplastic epithelium was noted in 45 out of 82 (54.9%) cases. In 44 cases, structures adjacent to the carcinoma (noncancerous squamous epithelium, some stromal fibroblastic cells, and endothelial cells) showed positive reaction for c-Met. c-Met expression in cancerous epithelium was significantly correlated with lymph node status (P<0.04) and proliferating activity expressed by the Ki-67 labelling index (P<0.02). There was no correlation between c-Met expression and age, sex, histological type, T category, distant metastasis or clinical stage. The data suggest that overexpression of c-Met in laryngeal carcinomas represents a growth advantage for cancer cells, which may be conferred by the mitogenic effect of HGF/SF. Simultaneous c-Met expression in noncancerous components of the larynx may represent a paracrine modification of c-Met.