Papiloma invertido: aspectos radiográficos / Inverted papiloma: radiologic findings

O papiloma invertido é um tumor epitelial incomum que compromete a regiäo nasal e os seios paranasais. Este tumnor, embora originariamente benigno, tem alto grau de recorrência, podendo sofrer transformaçäo maligna. Ele pode destruir estruturas ósseas e se estender para as fossas cranianas anteriores e média, e tornar-se, desse modo, indistinguível radiologicamente de lesäo malígna. 8 pacientes com papiloma invertido histologicamente confirmados säo descritos e os seus achados radiológicos apresentados e comparados com os da literatura

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.

Whole cell preparation of squamous cell carcinoma for cytometric analysis of DNA.

To date, analysis of the DNA content of head and neck squamous cell carcinomas has relied on the homogenation of the entire tissue specimen and subsequent staining and quantitation of the naked nuclei. This methodology does not make allowance for the extremely variable nature of these tumors with respect to their cellular composition. Further, by destroying the cytoplasm and cell membranes, this methodology makes it impossible to distinguish the DNA content of the tumor cells from that of the background stromal and inflammatory cells. The authors present a methodology for the selective exclusion of inflammatory cell infiltrates from the DNA analysis of these tumors. Using this technique, it has been found that exclusion of the inflammatory cells allows the investigator to look more specifically at the malignant cell population. This has been most helpful in those samples in which the tumor cells have been diploid or near-diploid. With this technical refinement, the relationship between DNA ploidy and clinical prognosis may be more accurately assessed.

[Squamous cell carcinoma-associated antigen (SCC) as a tumor marker in the initial diagnosis of carcinomas of the head and neck region. Results of a prospective study after 24 months]. / Das plattenepithelkarzinomassoziierte Antigen (SCC) als Tumormarker bei der Initialdiagnostik von Karzinomen des Kopf-Hals-Gebietes. Ergebnisse einer prospektiven Studie nach 24 Monaten.

The serum--SCC antigen levels of patients with head and neck tumors were studied prospectively to determine their value in the initial diagnosis of head- and neck-cancer patients. Serum concentrations above 2 ng/ml are considered abnormal. Preliminary results of the study after a 12-month period have been reported elsewhere (1). The final results of the study show an increased percentage (53%) of pathologic findings, mostly due to the increasing number of advanced stage tumors. High serum levels were found in 60% of the T4-tumors (Fig. 4a). Well differentiated carcinomas seem to be associated with the antigen more frequently than poorly differentiated tumors (Fig. 5). SCC antigen levels were examined as many as five times before the start of treatment (85 patients), and in one-third of those cases the differences between the serum levels exceeded 1 ng/ml. As far as 85% specificity is concerned, the ROC-curve shows a sensitivity of only 40% (Fig. 2) which, in addition to the fact that the antigen was most frequently found in cases of advanced tumors, indicates that the usefulness of the SCC antigen as a tumor marker for head and neck cancer must still be regarded as low.

[Tumor markers in patients with head-neck carcinomas]. / Tumormarker bei Patienten mit Kopf-Hals-Karzinomen.

The clinical relevance of the tumor-associated antigens SCC (squamous-cell carcinoma), CEA (carcinoembryonic antigen), and CA (carbohydrate antigen) 19-9 as tumor markers is evaluated. Twenty-six patients with squamous-cell carcinoma of the head and neck region were studied in a six-month period. Concentrations above 2 ng/ml (SCC), 5 ng/ml (CEA), and 37 U/ml (CA 19-9) are regarded as markers of abnormal activity. Elevated tumor markers were found only in 12-15%. No correlation between the serum levels and tumor localization, staging, grading, or general condition was detected for any of the markers. In the follow-up, they revealed no disease-related information despite treatment variation. The results obtained suggest that, given the present state of biochemical possibilities and considering the rather low sensitivity for head and neck cancer, the routine assessment of SCC, CEA, and CA 19-9 serum levels is of no account.

Keratin expression in equine normal epidermis and cutaneous papillomas using monoclonal antibodies.

Keratin expressions in normal equine epidermis and experimentally induced equine papillomas were studied by immunohistochemical methods with three different human cytokeratin monoclonal antibodies, 34 beta B4 (directed against component 1), 34 beta E12 (directed against components 1, 5, 10, 11) and 35 beta H11 (directed against component 8). Staining patterns with 34 beta B4 and 34 beta E12 in the normal equine epidermis did not differ from those in the normal human epidermis. In the early developing papilloma, keratinocytes showed an abnormal suprabasal staining pattern and expressed an additional 56 kD keratin protein detected by 34 beta E12. In the advanced papilloma, cytolytic cells in the outer spinous and the granular layers did not stain positively with any of the three antibodies used. In both early and advanced papillomas, the expression of high molecular weight keratin proteins, as detected by 34 beta B4 and 34 beta E12, did not correlate with the degree of keratinization. By electron microscopy, keratinocytes in the advanced papilloma showed a marked decrease of tonofibrils and desmosome-tonofilament complex. These alterations may result from an abnormality in both proliferation and functional terminal differentiation of keratinocytes in the papilloma. There were obvious differences in staining patterns with 35 beta H11 between the normal human and equine epidermis; 54 kD keratin protein was expressed in suprabasal layers of the equine normal and papillomatous epidermis. Thus, this keratin protein may be regarded as a "permanent" marker for the equine epidermis.

Rapid in vitro bromodeoxyuridine labeling method for monitoring of therapy response in solid human tumors.

In vitro bromodeoxyuridine (BrdUrd) incubated single-cell suspensions obtained from solid tumors were fixed on slides for subsequent sample processing. As dispersal of nuclei largely was avoided, only small amounts of cells were needed for examination. The sensitivity of detecting even low BrdUrd incorporation rates could be improved by treatment with intense DNA denaturation conditions. This technique was applied to monitor cytokinetic response to chemotherapy and radiation in oral carcinomas by analysing biopsies taken consecutively in the course of treatment. By combining BrdUrd labeling and DNA flow cytometry, cells arrested in S phase easily could be distinguished from cells showing continuous proliferation.

Inhibition of growth and squamous-cell differentiation markers in cultured human head and neck squamous carcinoma cells by beta-all-trans retinoic acid.

Vitamin A and some of its metabolites such as beta-all-trans retinoic acid (RA) have been implicated in the regulation of differentiation of normal and malignant epithelial cells in vivo and in vitro. In the present study the effects of RA on the growth and differentiation of 7 cell lines derived from human head and neck squamous-cell carcinomas (HNSCCs) were examined. RA (greater than 0.01 microM) inhibited the proliferation in monolayer culture of 6 of 7 HNSCC cell lines. One cell line (UMSCC-35) was very sensitive, 5 (UMSCC-10A, -19, -30, -22B and HNSCC 1483) were moderately sensitive, and 1 (HNSCC 183) was insensitive. Three of the cell lines (UMSCC-22B, -30, and HNSCC 1483) were capable of forming colonies in semisolid medium--a capability that was suppressed by RA. The HNSCC cell lines expressed various levels of the squamous-cell differentiation markers type I (particulate, epidermal) transglutaminase (TGase) and cholesterol sulfate (CS). RA treatment (I microM, 6 days) decreased TGase activity by more than 50% in 3 (UMSCC-10A, -22B and 1483) of the 7 cell lines, and the effect on UMSCC-22B was dose-dependent. Type II TGase (soluble, tissue type) activity was detected in 3 cell lines, and after RA treatment its activity increased in HNSCC 1483 and 183 cells and decreased in UMSCC-19. Following RA treatment, CS levels decreased by 20, 25, 70, 76, 89 and 91% in cell lines UMSCC-30, -10A, 183, UMSCC-35, -22B, and HNSCC 1483, respectively. The suppression by RA of CS accumulation in the 1483 cells was dose-dependent. Cholesterol sulfotransferase activity, which is responsible for CS synthesis, was suppressed by 40-97% after RA treatment of UMSCC-19, -22B, and HNSCC 1483. Our results demonstrate that RA inhibits the growth and decreases the level of 2 squamous differentiation markers in HNSCC cells.

Adenoid cystic carcinoma. A clinicopathologic study with flow cytometric analysis.

Forty-five patients with adenoid cystic carcinoma (ACC) of salivary glands were retrospectively studied to determine the prognostic use of DNA ploidy analysis compared with clinicopathologic features. Nuclear suspensions were prepared from 37 of these tumors by the Hedley technique on paraffin-embedded material. The DNA content was analyzed by flow cytometry after propidium iodide staining. Thirty-five tumors were diploid and 2 were tetraploid. Mean survival was 117 and 52 months for the diploid and tetraploid patients, respectively. The median S-phase fraction (Spf) of the 35 diploid tumors was 4.45%. Of the 17 diploid patients who died of disease, there were 11 tumors with high Spf (greater than 4.45%) and 6 tumors with a low Spf (P less than 0.05 chi-square test). The presence of more than 30% of a solid pattern in the tumor was strongly associated with poor median survival in Kaplan-Meier survival curve analysis (P less than 0.05 log rank test). Grade, stage, recurrence, and metastases were also found to be important prognostic factors. Because few tumors were nondiploid, these results suggest that S-phase fraction analysis may be a more useful prognostic indicator than ploidy classification.

[Flow cytometry for the determination of DNA in head and neck carcinomas]. / La citometría de flujo para la determinación de DNA en los carcinomas de cabeza y cuello.

The technique used for DNA determination in tumoral cells from carcinomas of head and neck is described. Results obtained are commented on as is too the future of this technique for the better understanding of the behavior of the tumor and consequently of its treatment.

Malignant dermal cylindromas. Do they exist? A morphological and immunohistochemical study and review of the literature.

Malignant dermal cylindromas are very rare. We present a case of multiple cylindromas of the scalp with metastasis to a cervical lymph node. The morphology of the tumour was unusual in that it contained eccrine spiradenoma-like areas and foci of squamous differentiation with keratin formation. The immunohistochemical phenotype of the eccrine spiradenoma-like areas and the metastatic tumour was similar, but different from the areas of typical cylindroma. Although alleged "malignant" cylindromas have been reported, none have been described to have metastasized, whereas metastatic eccrine spiradenoma is well-documented. We reiterate that overlaps between dermal cylindroma and eccrine spiradenoma are more common than has been documented. In the rare event of metastases, it is the eccrine spiradenomatous component that is metastatic. We contend that there is no evidence that pure dermal cylindromas have metastasized.

Prenatal diagnosis of Turner syndrome using cells cultured from cystic hygromas in two pregnancies with normal maternal serum alpha-fetoprotein.

In two cases of prenatally detected cystic hygroma with oligohydramnios, successful cytogenetic diagnosis of Turner syndrome was achieved using cells obtained from direct aspiration of the cystic hygroma. Exceptionally high levels of alpha-fetoprotein were found in the cystic hygroma fluid, as might be expected. However, the maternal serum alpha-fetoprotein levels were within normal limits. Elevated alpha-fetoprotein levels in 'amniotic fluid' noted previously in the literature may have resulted because of inadvertent tapping of the cystic hygroma. It is clear from our cases that maternal serum levels of alpha-fetoprotein will not necessarily be elevated and will not serve as a screening mechanism for cystic hygromas.

[Desmoid fibromatosis in absorption infrared spectroscopy, emission spectral analysis and roentgen diffraction recording]. / Desmoidní fibromatóza v absorpcní infracervené spektroskopii, emisní spektrální analýze a v rentgenovém difrakcním záznamu.

The authors present results of serial quality and quantity microanalyses of bone patterns and dental tissue patterns in patient with desmoid fibromatosis. Methods of absorption spectroscopy, emission spectral analysis and X-ray diffraction analysis with follow-up to x-ray examination are tested. The above mentioned methods function in a on-line system by means of specially adjusted monitor unit which is controlled centrally by the computer processor system. The whole process of measurement is fully automated and the data obtained are recorded processed in the unit data structure classified into index sequence blocks of data. Serial microanalyses offer exact data for the study of structural changes of dental and bone tissues which manifest themselves in order of crystal grid shifts. They prove the fact that microanalyses give new possibilities in detection and interpretation of chemical and structural changes of apatite cell.

Immunoreactivity of granular cell lesions of skin, mucosa, and jaw.

Granular cell lesions from many different sites share similar light and electron microscopic features. Immunologically, however, these lesions do not appear to be a homogenous group. This study determines the extent of immunologic heterogeneity of granular cell lesions from a wide variety of sites in skin, mucosa, and jaw. Thirty-one granular cell lesions (26 granular cell tumors [GCT] and five other granular cell lesions) from 18 different sites were evaluated immunohistochemically for keratins, vimentin, desmin, muscle actin, ACT, HLA-DR, and S-100 protein. Paraffin-embedded sections were utilized with an avidin-biotin complex immunoperoxidase technique. Except for ameloblastomas, all lesions were negative for keratin and positive for vimentin. All lesions were negative for desmin and actin. Positive ACT reactivity was found in one of seven GCT of tongue, a colonic lesion, a nose lesion, and a granular cell ameloblastic fibroma. All lesions were positive for HLA-DR except a few in which fixation appeared inadequate. S-100 immunoreactivity was found in all lesions except the congenital epulis, a GCT of the skin of the nose, a colonic lesion, and the odontogenic tumors. The antigenic profile of GCT of skin and mucosa is consistent with Schwann cell origin. However, some GCT and other granular cell lesions appear to be derived from macrophages, epithelial cells, or other cells. The expression of HLA-DR by granular cells is believed to be unrelated to cellular origin but rather to some common immunologic function.

DNA quantitation and histologic characteristics of squamous cell carcinoma of the upper aerodigestive tract.

DNA analysis is currently being applied to many solid tumors to determine DNA content and synthesis phase fraction. We compared DNA content measured by flow cytometry with multiple histologic parameters in 155 squamous cell carcinomas of the upper aerodigestive tract. Abnormal DNA content (aneuploidy) was identified in 107 (69%) of the neoplasms. Abnormal DNA content or aneuploidy correlated with above-median synthesis phase fraction and increased frequency of mitotic figures. Other histologic features predicting aggressive tumor behavior also correlated with abnormal DNA content and included small cords or single cell pattern of tumor invasion, high nuclear grade, and decreased stromal or desmoplastic response to the invading squamous cell carcinoma.

Flow cytometric analysis of benign and malignant tumors of the oral and maxillofacial region.

One hundred eight fresh tissue samples obtained from normal tissues, benign tumors, and malignant tumors of the oral and maxillofacial region were analyzed for nuclear DNA content and cell kinetics by flow cytometric analysis (FCM). Mean DNA indices for 22 normal tissues and 18 benign tumors were 1.00 and 1.02, respectively, and all samples but one showed diploid pattern. On the other hand, the value for 68 malignant tumors was 1.38, and 66% of them showed an aneuploid pattern. The S phase and G2 + M phase cell populations for malignant tumors were 17.2% and 7.0%, respectively. With the exception of G2 + M phase cell population, all values for malignant tumors were significantly higher than those of normal tissue and benign tumors. Although statistical differences were not observed in most of the values, they were higher in squamous cell carcinomas than in malignant salivary gland tumors. The incidence of aneuploidy and DNA index showed a tendency to increase with the increase of T classification, in N2 and N3 tumors, and in the group of patients with recurrence or who died. The DNA index and the type of DNA ploidy were well correlated to malignancy grade determined by six histologic parameters, whereas the S phase cell population was correlated to mitosis. The analysis by the two-dimensional diagnostic supporting system showed that more than 80% of malignant tumors can be correctly diagnosed by combined values of DNA index and S phase cell population. The results indicate that nuclear DNA analysis by FCM is quite useful as a supplement to histologic diagnosis and evaluation of malignancy grade.

Potential use of in vivo proton spectroscopy for head and neck lesions.

Early experience with in vivo MRS has shown its potential for obtaining biochemical information, thus enhancing the diagnostic sensitivity of MRI studies. Further work on combined MRI and in vivo MRS is needed, with the goal of characterization and abnormal conditions according to their spectral patterns and for identification of tumor markers. We presented in this communication our preliminary results. It seems that the resonance from melanin can be used as a marker for melanotic tumors.

Immunohistochemical spectrum of rhabdomyosarcoma and rhabdomyosarcoma-like tumors. Expression of cytokeratin and the 68-kD neurofilament protein.

Twenty-five rhabdomyosarcomas (RMSs), including 12 alveolar and 13 embryonal types, were immunohistochemically studied for the presence of different classes of intermediate filament proteins and muscle actins (MAs). For the most part, formaldehyde-fixed and paraffin-embedded tissue was used in immunostaining. All RMSs showed desmin and MAs, usually in a major portion of tumor cells. The number of MA-positive cells was sometimes higher than that of desmin-positive cells. Vimentin was present in all tumors studied in frozen sections. Eight of 12 alveolar RMSs showed small number of cytokeratin-positive neoplastic cells. Cytokeratin-positive cells were present less commonly in embryonal RMS (3/13 cases). The 68-kD neurofilament protein was found in frozen sections of two embryonal RMSs. The cytokeratin and neurofilament immunostaining could be reproduced by immunofluorescence technique. In addition, we studied three childhood sarcomas, which showed abundant desmin and MA immunostaining but did not conform to the ultrastructural criteria of RMS. Scattered cytokeratin-positive cells were found in two of these tumors, and neurofilaments were found in the two cases for which frozen sections were available. The results show that typical RMS may demonstrate immunohistological pleomorphism with cytokeratin and neurofilament immunoreactivity suggesting the presence of multidirectional differentiation. In addition, there are tumors that by morphology look like RMS and have muscle cell markers but cannot be verified as RMS by electron microscopy; also, these tumors seem to show immunohistological pleomorphism. The presence of nonmyoid markers in RMS should be considered when making immunohistological diagnosis of soft tissue sarcomas.

Prognostic implications of nuclear DNA content in head and neck cancer.

The nuclear DNA content was measured in formalin-fixed and deparaffined specimens of 296 oral, pharyngeal, and laryngeal squamous cell carcinomas from patients in whom the clinical outcome was known. One hundred ninety (64%) contained cells with abnormal DNA (DNA aneuploid or tetra/polypoid). Only 32% (60 of 190) of the patients with DNA nondiploid cancers survived 5 years, compared with 49% (52 of 106) of the patients with DNA diploid cancers. When the findings were controlled for clinical stage, patients whose tumors were DNA diploid had a survival advantage at each stage. Histologic grading showed less correlation, because only patients with well-differentiated carcinomas had a survival advantage if their tumors were DNA diploid. These data showed that determination of DNA content in cancers of the head and neck can offer prognostic information not provided by other means and enhance the diagnosis of cancer.