RESUMO
Aim of this study was to investigate the clinical characteristics, management and prognosis of non-Hodgkin lymphomas of the nasal cavity and paranasal sinuses. Overall 12 patients with non-Hodgkin malignant lymphoma, at our Institute, were studied over an eight-year period from 1997 to 2005. Patients' data collected were age, sex, presenting signs and symptoms, histology, treatment, complications, and outcome. Also available were computerised tomography findings, and paraffin-embedded tissue bocks. Mean age was 62 years (range: 42-81), with a male dominance (male to female ratio: 7:5). Most patients had not presented any specific symptoms, such as nasal obstruction, headaches, epistaxis and facial swelling. Using immunocytochemistry on paraffin-embedded tissue sections, the predominance of large B-cell subtype was detected. Treatment administered: only radiotherapy (stage IEA) or in combination with chemotherapy (IIE-IVE). Of these patients, 5 died from the disease, 4 survived without disease, 2 survived with the disease, and one died of non-related causes. Non-Hodgkin's lymphomas are relatively rare. Early diagnosis, based mainly on tissue biopsy and computerised tomography, is essential in the management of non-Hodgkin lymphoma.
Assuntos
Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/imunologia , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Neoplasias dos Seios Paranasais/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Terapia Combinada , Feminino , Humanos , Imuno-Histoquímica , Linfoma não Hodgkin/terapia , Masculino , Pessoa de Meia-Idade , Cavidade Nasal , Estadiamento de Neoplasias , Neoplasias dos Seios Paranasais/terapia , Tomografia Computadorizada por Raios XRESUMO
We used the PCR technique to detect the Epstein-Barr virus (EBV) and human papillomavirus (HPV) DNA in paraffin-embedded tissues from Greek patients with nasopharyngeal carcinoma (NPC). The oligonucleotide primers used for the detection of EBV amplify a 375-bp long sequence from the EcoRI B fragment of the viral genome, whereas for HPV the primers amplify a 151-bp long sequence of the viral genome. The PCR products were analysed by agarose gel electrophoresis and visualised by UV illumination after staining with ethidium bromide. Sixty-three specimens were examined. EBV specific sequence was amplified in 20 (32%) and HPV in 12 (19%) out of the 63 samples. There was no co-infection with EBV and HPV. Although there is a high correlation of EBV infection with poorly differentiated NPC in patients from Southern China and South-East Asia, the restricted distribution suggests genetic or environmental cofactors in the development of the neoplasm. Our results confirm this suggestion since there was only a 32% correlation of EBV with NPC in Greece. HPV may also be involved in the carcinogenesis of EBV-negative squamous cell nasopharyngeal carcinomas.
Assuntos
Herpesvirus Humano 4/isolamento & purificação , Neoplasias Nasofaríngeas/virologia , Papillomaviridae/isolamento & purificação , Sequência de Bases , DNA Viral/análise , Herpesvirus Humano 4/genética , Humanos , Dados de Sequência Molecular , Papillomaviridae/genética , Reação em Cadeia da PolimeraseRESUMO
AIM: This study was designed to examine the prognostic significance of the coexpression of three genes (bax, bcl-2 and p53) which play a critical role in the apoptotic mechanisms in patients with squamous cell laryngeal carcinoma. MATERIALS AND METHODS: The immunohistochemical expression of bcl-2, bax and p53 genes was retrospectively examined in 38 patients with squamous cell laryngeal carcinoma and in five controls (necrotomic tissue). Tissue specimens were obtained both during the diagnostic biopsy and at the time of surgery. Clinicopathological and survival data were correlated with the staining results. RESULTS: Bcl-2 protein expression (P=0.0472), stage (P=0.0087) and lymph-node involvement (P=0.0488) were found to be independent prognostic factors. Increased bcl-2 protein expression correlated with a better 5-year survival (P=0.0472). Patients who were bcl-2(-)/p53(-) (n=25) or bax(+)/bcl-2(-) (n=13) had a significantly worse overall survival (P=0.0305 and P=0.0482, respectively). Similarly, patients who were bax(+)/bcl-2(-)/p53(-) (n=11) also had a worse 5-year survival compared with the rest of the group (P=0.0088). Changes that were noticed in bax and p53 protein expression from the time of biopsy until the time of surgery did not correlate with a significant increase in the overall survival. CONCLUSIONS: The expression of bcl-2 gene appears to be an independent prognostic factor for patients with laryngeal carcinoma. The coexpression of the genes studied can be used to determine aggressive clinical phenotypes.
Assuntos
Carcinoma de Células Escamosas/genética , Genes bcl-2/genética , Genes p53/genética , Testes Genéticos , Neoplasias Laríngeas/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Biópsia por Agulha , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Intervalos de Confiança , Feminino , Expressão Gênica , Marcadores Genéticos/genética , Humanos , Imuno-Histoquímica , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/patologia , Masculino , Pessoa de Meia-Idade , Probabilidade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Sensibilidade e Especificidade , Análise de SobrevidaRESUMO
PURPOSE: To determine whether the combined use of markers of host immune response (HLA-DR) and apoptosis (bax and bcl-2) can predict prognosis in laryngeal carcinoma patients. PROCEDURES: Immunohistochemical staining for HLA-DR, bax and bcl-2 proteins was investigated retrospectively in 37 patients with laryngeal squamous cell carcinoma. Seven healthy adult males were used as the control group. RESULTS: HLA-DR antigen expression was detected in the tumor cells of 18 patients (48.6%). Another 18 patients (48.6%) expressed HLA-DR antigen in the peritumoral inflammatory infiltrate, while bax and bcl-2 protein expressions were detected in 17 (45.9%) and 9 (24.3%) patients, respectively. None of the controls expressed any of the proteins studied. bcl-2 and HLA-DR protein expressions of the tumor infiltrate were statistically significant independent prognostic factors suggesting improved survival (p = 0.0272 and p = 0.0285, respectively). bax+/bcl-2- patients demonstrated an unfavorable clinical outcome (p = 0.0298), followed by a significantly increased mean HLA-DR antigen expression observed both in the tumor and the stroma cells (p = 0.024 and p = 0.045, respectively). CONCLUSIONS: bcl-2 and HLA-DR proteins independently predict a dismal prognosis among laryngeal carcinoma patients. The bax+/bcl-2- protein coexpression pattern correlates with elevated immunohistochemical expression of HLA-DR antigen both by tumor and peritumoral stromal cells. MESSAGE: bcl-2 and HLA-DR are significant prognostic markers in laryngeal carcinoma patients. Further prospective investigation is required to validate our findings.
Assuntos
Apoptose/fisiologia , Carcinoma de Células Escamosas , Antígenos HLA-DR/imunologia , Neoplasias Laríngeas , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteínas Reguladoras de Apoptose/metabolismo , Proteína 11 Semelhante a Bcl-2 , Biomarcadores , Carcinoma de Células Escamosas/imunologia , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/patologia , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Neoplasias Laríngeas/imunologia , Neoplasias Laríngeas/metabolismo , Neoplasias Laríngeas/patologia , Masculino , Proteínas de Membrana/metabolismo , Pessoa de Meia-Idade , Prognóstico , Proteínas Proto-Oncogênicas/metabolismo , Estudos Retrospectivos , Células Estromais/metabolismo , Células Estromais/patologia , Proteína X Associada a bcl-2/metabolismoRESUMO
We describe the rare case of a diabetic patient who was successfully treated for cytomegalovirus viremia and leishmaniasis following liver transplantation for hepatitis C virus-related cirrhosis, but also developed invasive sinus Aspergillus infection, while still on liposomal amphotericin B (AmBisome). The patient refused radical surgery including eye enucleation, and received a combination of intravenous caspofungin and voriconazole, along with repeated, conservative, local surgical debridement. At follow-up, 15 months after the onset of sinusitis, the patient remains culture-negative, fully active, and without evidence of local recurrence.