Human papillomavirus infection in the malignant and premalignant head and neck epithelium.

A prospective study was undertaken to determine the prevalence and histological correlates of human papillomavirus infection in the head and neck epithelium. Oral, pharyngeal, and laryngeal paraffin-embedded samples were analyzed by polymerase chain reaction with use of human papillomavirus E6 consensus sequence primers. Human papillomavirus infection was detected in 20 of 126 (15.9%) patients. Twenty-five of 230 (10.9%) samples contained human papillomavirus DNA. Papillomaviruses were detected in 15 of 131 (11.4%) head and neck squamous cell carcinomas, in 3 of 32 (9.4%) dysplasias, and 2 of 19 (10.5%) keratoses. The most commonly identified human papillomavirus in cancerous, precancerous, and keratotic lesions was type 16 (80.0% of the isolates). Five papillomas were shown to contain human papillomavirus type 6. No other lesion in 42 samples contained human papillomavirus. Our data are consistent with the hypothesis that infection with certain types of human papillomavirus contributes to head and neck cancer although this may be so only in a minority of cases. Human papillomavirus infection may play a role in the earliest stages of tumorigenesis, since papillomaviruses can be found in laryngeal premalignant and keratotic lesions, which are closely linked to tobacco use.

[Primary adenoid cystic carcinoma of the skin. Histologic and ultrastructural study of two cases localized in the external auditory canal]. / Les carcinomes adénoïdes kystiques cutanés primitifs. Etude histologique et ultrastructurale de deux cas localisés au conduit auditif externe.

Primary cutaneous adenoid cystic carcinoma is a rare tumor, even if its frequency has often be underestimated, its localization in the external auditory meatus being generally considered separately. The results of the histological and ultrastructural study of two cases of adenoid cystic carcinoma, arising in the external auditory meatus, are presented, confirming the essential morphological similarity of adenoid cystic carcinoma of the skin and salivary glands. In these two cases, the ultrastructural study revealed two types of unique intra luminal inclusions, composed respectively of parallel straight tubular arrays and paracrystalline quadrangular structures, probably corresponding to a peculiar organization of secretion products or cellular debris. The review of 126 published cases of adenoid cystic carcinoma of the skin, including 89 cases developed in the auditory canal, shows that 78% of the cases were located in areas containing numerous apocrine glands, supporting an apocrine gland origin for this tumor. Contrasting with the low (8%) metastatic potential of cutaneous adenoid cystic carcinomas of other locations, adenoid cystic carcinoma of the auditory meatus present a 30% metastatic risk, similar to those or adenoid cystic carcinoma of salivary glands.

[Cellulitis of the neck due to anaerobic germs: report of 10 cases (author's transl)]. / Les cellulites cervicales à germes anaérobies. A propos de 10 cas.

Cellulitis of the neck in 10 patients was found to be due to anaerobic germ infections of either dental or tonsillar origins or following surgery. The lesion was diffuse in 8 cases, unilateral in two, and associated with signs of severe toxic infection in 9 cases. Early clinical crepitation was detected in 4 patients. The extremely poor prognosis related to the onset of infective shock and pleuropulmonary and mediastind complications, treatment including intensive care and anti-anaerobic germ antibiotic therapy. The place of surgical treatment is discussed, operative intervention being necessary when there are signs of poor general tolerance, not only in the presence of gas gangrene, but also when a diffuse cellulitis exists without signs of crepitation or the presence of fluid.

[Laryngeal immobility after intubation]. / Les immobilités laryngées après intubation.

Based on findings in 14 cases of post-intubation laryngeal immobility simulating a paralysis, it is demonstrated that a mechanical cause bringing into play the arytenoids exists in every case. The origin may be from a synechia between the vocal cords, crico-arytenoid ankylosis, inter-arytenoid and plate of the cricoid fibrosis, or a combination of these lesions. Conclusive evidence of the type of lesion involved is rarely apparent from clinical or paraclinical examinations, an exact diagnosis requiring a median thyrotomy. This emphasizes the need for pathologic investigation of the arytenoidectomy surgical specimens. These findings suggest that neurogenic theories concerning the etiopathogenicity of post-intubation laryngeal immobility be revised.

[Undifferentiated carcinoma and lymphoma of the thyroid gland. Apropos of a series of 38 cases]. / Carcinomes indifférenciés et lymphomes du corps thyroïde. A propos d'une série de 38 cas.

Twenty-seven patients with undifferentiated carcinoma and eleven with lymphoma of the thyroid are reviewed. Histologic sections of all tumors were re-examined critically. Most tumors were extensive forms spreading beyond the thyroid. Complete macroscopic excision was performed in 18 cases, incomplete excision in 12 patients. Surgery was not carried out in 8 patients, while radiotherapy was given to 27 cases. Local changes decide the prognosis whatever the findings on histology. Undifferentiated carcinomas have a poor local prognosis even after apparently satisfactory macroscopic excision. Effective local control was obtained in all cases of lymphoma treated by surgery and radiotherapy combined.

[Partial pharyngo-laryngectomy with subtotal esophagectomy and 1-stage coloplasty]. / Pharyngo-laryngectomie partielle avec oesophagectomie sub-totale et coloplastie en un temps.

A patient with cancer of both the hypopharynx and esophagus was treated by partial pharyngolaryngectomy, subtotal esophagectomy and a reconstructive one-stage coloplasty. Surgical and carcinologic problems raised by this technique are discussed.

Expression of Bcl-2 protein in human laryngeal keratoses.

Strong Bcl-2 immunostaining was detected in 2 of 21 samples of human laryngeal keratoses, one of which contained neither p53 gene mutation nor human papillomavirus sequences nor significant levels of p53 protein. The other 19 samples including 6 cases with moderate or strong p53 staining were Bcl-2-unreactive or had minimal Bcl-2 reactivity similar to that observed in normal samples. Minimal Bcl-2 staining in 5 samples with moderate or severe dysplasia was only seen in the adjacent nondysplastic area. Our study shows that (1) some laryngeal keratoses strongly express Bcl-2 protein, (2) Bcl-2 expression does not appear to be dependent on p53, and (3) moderate or severe dysplasias may occur despite a decline in Bcl-2 expression.

Expression of p53 protein related to the presence of human papillomavirus infection in precancer lesions of the larynx.

The aim of this study was to gain some insight into the relationship of human papillomavirus (HPV) infection to p53 expression and to some pathological parameters in precancerous lesions of the larynx. Formalin-fixed paraffin-embedded tissue sections containing human laryngeal precancerous lesions were screened for p53 protein by immunohistochemistry with the monoclonal antibody DO7 and for the presence of HPV infection by polymerase chain reaction with consensus primers directed against the E6 gene. The presence of p53 protein was detected in 31 of 57 specimens (54.4%) including 7 of 9 cases with mild dysplasia (78%), in 4 of 9 cases with moderate dysplasia (44%), and in 15 of 23 cases with severe dysplasia (65%). Of 16 samples with keratotic benign squamous metaplasia, 5 were also p53 positive (31%). Of 6 samples that were HPV positive, all were of type 16. Interestingly, 3 of the 6 HPV-positive samples were p53 negative. There was 1 HPV-positive case with strong p53 staining and 2 HPV-positive cases with minimal p53 staining. The 2 HPV-positive cases with minimal p53 staining had mild dysplasia. The HPV-positive case with strong p53 staining displayed severe dysplasia. Of 23 cases that were both HPV and p53 negative, 11 presented with keratosis and no dysplasia, 5 with moderate dysplasia, and 7 with severe dysplasia. Our data indicate that nuclear accumulation of p53 protein, presumably resulting from p53 gene mutation, may occur in HPV-infected epithelial tissues. On the other hand, there are many precancer lesions, some exhibiting moderate or severe dysplasia, that are both HPV negative and p53 unreactive, suggesting that alterations of genes other than the E6 oncogene and the p53 tumor suppressor gene play a role in early laryngeal carcinogenesis.

Safety of preoperative enoxaparin in head and neck cancer surgery.

BACKGROUND: Thromboembolism is a risk in major head and neck cancer surgery patients predisposed to thrombosis. This study was designed to determine whether enoxaparin (a low molecular weight heparin) administered prior to surgery induces perioperative bleeding. METHODS: Forty patients scheduled for major cervicofacial cancer surgery were randomized in a double-blind study to receive either 20 mg enoxaparin or placebo, 12 hours before surgery. Blood losses were measured at the end of surgery and 6 hours later. RESULTS: Bleeding was equal in the placebo group and in the enoxaparin group, with losses of 648 +/- 106 mL and 602 +/- 106 mL (p = 0.76), respectively. Six hours after surgery, blood collected was 159.3 +/- 25.7 mL in the placebo group vs 151.4 +/- 21 mL in the enoxaparin group (p = 0.81). CONCLUSION: Preoperative administration of enoxaparin is safe in head and neck cancer surgery, but further studies are required to evaluate its efficacy in preventing thromboembolism.