[A comparative study of concurrent chemoradiotherapy with S-1 or CDDP for pharyngeal or laryngeal cancer].

Adverse events and therapeutic effects were analyzed in patients with pharyngeal or advanced laryngeal squamous cell carcinomas(SCCs)receiving concurrent chemoradiotherapy (CCRT) with S-1 or weekly CDDP between 2004 and 2007. Low-dose CDDP (25 mg/m2) was administered once a week and S-1 (65 mg/m2) was administered for 3 weeks with one-week rest during conventional radiation with 2 Gy/fraction. Both of the two CCRT regimens showed little toxicity with grade 4 toxicities in less than 5%of the patients. However, CCRT with S-1 more frequently induced grade 3 and 4 oral mucositis than CCRT with CDDP. As a result, the completion rate of CCRT with S-1 was lower than that of CCRT with CDDP. The two regimens achieved a similar complete response rate of the primary sites, local control rate(LCR)and larynx preservation rate; the LCR for T1 and 2 disease was more than 70%. However, the LCR for T3 or 4 disease by the two regimens was less than 50%. CCRT with S-1 showed significantly higher LCR in patients with poorly or undifferentiated SCCs than those with well or moderately-differentiated SCCs. It is suggested that the two CCRT regimens are useful treatment modalities for patients with locally(primary site)non-advanced pharyngeal or laryngeal SCCs, and that CCRT with S-1 is highly sensitive to poorly or undifferentiated SCCs. In order to achieve local control and larynx preservation, more intensive CCRT might be necessary for patients with locally(primary site)advanced pharyngeal or laryngeal SCCs.

[A case of follicular carcinoma of thyroid gland with concurrent tuberculous lymphadenitises].

We report a case of follicular carcinoma of the thyroid gland with concurrent tuberculous lymphadenitises as neck lymph node metastases of thyroid carcinoma. A 71-year-old woman presented with multiple painless masses in the thyroid gland and painless lymphadenopathies in the right neck. She and her family had no previous history of tuberculosis. A diagnosis of thyroid cancer with lymph node metastases was made, and the patient underwent total thyroidectomy with neck dissection. Lymph nodes were hard and severely adhered to the internal jugular vein. The histopathological diagnosis was follicular carcinoma and multiple nodes of adenomatous goiter of the thyroid gland, and tuberculous lymphadenitises of lymph nodes in the right neck. There was no findings of coexisting pulmonary tuberculosis. The possibility of coexisting tuberculous lymphadenitis must thus be ruled out when we find painless lymph node swelling in aged patients with head and neck cancer including thyroid cancer.

Hypopharyngeal squamous cell carcinoma bordering ectopic gastric mucosa "inlet patch" of the cervical esophagus.

OBJECTIVE: Ectopic gastric mucosa of the cervical esophagus, referred to as inlet patch (IP), is considered to be a common development abnormality of the esophagus. We report here a case of hypopharyngeal squamous cell carcinoma bordering on IP of the cervical esophagus. METHODS: A 44-year-old female underwent partial pharyngectomy, total laryngectomy, cervical esophagectomy, and bilateral neck dissection under the diagnosis of hypopharyngeal carcinoma. RESULTS: Resected specimens of the hypopharynx revealed a well-differentiated squamous cell carcinoma in the ulcerative tumorous lesion (3.5 cm x 0.5 cm). A brown patch (2 cm x 1.5 cm) bordering the anal aspect of the tumor comprised ectopic gastric mucosa of fundic type epithelium. Immunohistochemistry revealed the surface mucosal cells of this lesion were strongly positive for human gastric mucin (HGM) and the fundic cells were positive for gastrin. CONCLUSION: The hypopharyngeal squamous cell carcinoma likely developed in association with chronic irritation due to gastric acid from the IP. To our knowledge, this is the first reported case of squamous cell carcinoma related to IP.

Spindle epithelial tumor with thymus-like differentiation (SETTLE): youngest reported patient.

Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a very rare thyroid tumor. It is one of a family of tumors arising either from ectopic thymus or remnants of branchial pouches that retain the potential to differentiate along the thymic line. Herein is reported a case of SETTLE in a 2-year-old girl. The patient underwent right thyroid lobectomy for a tumor of the right thyroid lobe. The resected specimen of this tumor revealed a whitish and solid mass. On microscopy, the tumor exhibited an area of spindle cells, glandular epithelium, and mucinous cystic lesions. The following findings were obtained on immunohistochemistry: the spindle cell area was diffusely positive for cytokeratin AE1/3 and vimentin, and partially positive for alpha-smooth muscle-specific actin. The glandular structures consisted of columnar cells and the cystic area was also positive for cytokeratin AE1/3. All three components of the tumor were negative for thyroglobulin, thyroid transcription factor-1, S-100 protein, carcinoembryonic antigen, somatostatin, synaptophysin, and chromogranin A. On the basis of the aforementioned findings, SETTLE was diagnosed. The patient remains disease free to date, 2 years after surgery with no additional treatment. To the best of the authors' knowledge the present SETTLE patient is the youngest yet reported.

[Blood concentration of laminin gamma2 chain in patients with head and neck cancer].

Laminin gamma2 chain (LN gamma2), expressed in human cancer cells and correlated with cancer malignancy, is cleaved by proteases and secreted into circulation. We measured the blood concentration of LN gamma2 in patients with head and neck cancer by an immuno-fluorescence assay using monoclonal antibodies against human LN gamma2. The normal blood concen- showed normal LN gamma2 concentration less than 50 ng/ml and 20 (33%) increased concentration exceeding 50 ng/ml. The relative ratio of the number of patients who showed increased LN gamma2 concentration correlated with the clinical stages of cancer. The blood concentration of LN gamma2 in 24 who initially showed normal concentrations did not change after radical treatments. Five who initially showed increased LN gamma2 concentration showed decreased concentration of less than 50 ng/ml after radical treatment. Four showed increased LN gamma2 concentration after treatment, and presented residual cancer, which killed them. Three of the 4 patients showed marked increase in LN gamma2 concentration exceeding 100 ng/ml and developed multiple distant metastases to the lung, liver, bone, and skin. The blood concentration of LN gamma2 in patients with head and neck cancer may thus indicate the amount of highly malignant cancer cells expressing LN gamma2. The blood concentration of LN gamma2 could therefore serve as a new tumor marker that might indicate the malignancy of and efficacy of treatments for head and neck cancer.

Basal cell adenoma and lymphoepithelial cyst as recurrent tumors of pleomorphic adenoma of the parotid gland.

Basal cell adenoma of the parotid gland is a rare benign tumor. Lymphoepithelial cyst of the parotid gland is also a rare benign tumor-like lesion. We report an elderly woman, who previously underwent a removal of pleomorphic adenoma, with multiple masses in the left parotid gland. Physical, MR and intra-operative examination suggested the masses as multiple recurrences of the previous pleomorphic adenoma. A total parotidectomy with facial nerve preservation was performed. The histological examination revealed that the masses were two basal cell adenomas and one lymphoepithelial cyst. These rare tumors should be considered in the differential diagnosis of recurrent masses after a removal of pleomorphic adenoma of the parotid gland.

A new in vitro model for analyzing the biological behavior of well-differentiated squamous cell carcinoma.

A suitable model analyzing the behavior of well-differentiated squamous cell carcinoma has not yet been established. We tried to establish such a system using a reconstructed oral mucosa, in which T3M-1 squamous cell carcinoma cells were cultured on 3T3 fibroblast-containing collagen gel. Fibroblasts promoted the stratification and keratinization of T3M-1 cells. During growth, the Ki-67 index of T3M-1 cells with fibroblasts was higher than that of T3M-1 cells alone. Fibroblasts increased the expression of involucrin, a differentiating marker of keratinocytes, in T3M-1 cells. They also promoted the invasion of T3M-1 cells into the gel. When T3M-1 cells alone were cultured in a fibroblast-conditioned (FC) medium, the fibroblast-induced phenomena mentioned above were almost replicated. In addition, epidermal growth factqr (EGF) promoted T3M-1 cells growth, but not the invasion. cDNA microarray analysis showed that FC medium increased the expression of EGF receptor and several other mRNAs of T3M-1 cells. The data suggest that T3M-1 cells, under cancer-stromal fibroblast interaction, undergo invasive growth with their well-differentiated squamous phenotype, and that this interaction may be mediated partly by soluble molecules (e.g., EGF) in an autocrine or paracrine pathway. Our system will probably provide a useful model for analyzing the biological behavior of well-differentiated squamous cell carcinoma.