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Abstract Dendritic cells (DCs) are specialized antigen-presenting cells that play a critical role in the immune response against human papillomavirus (HPV) infection, and represent a therapeutic target in cancer. Objective: To identify and quantify DCs in tonsillar squamous cell carcinoma (TSCC) under the influence of HPV infection. Methodology: CD1a and CD83 antibodies were used to identify immature dendritic cells and mature dendritic cells by immunohistochemistry in 33 primary TSCC and 10 normal tonsils (NTs), respectively. For the TSCC samples, the number of DCs per area was evaluated in the intra- and peritumoral compartments. For the NTs, the quantification of DCs was evaluated in the intra- and peritonsillar compartments. HPV detection methods were determined according to the ASCO Clinical Practice Guidelines from the College of American Pathologists Guideline (2018). Results: There were fewer intratumoral CD1a+ DCs in the HPV-positive and HPV-negative TSCC groups than in the NT group (p<0.05). In the peritumoral compartment, there were fewer CD83+ DCs in the HPV-positive and HPV-negative TSCC groups than in the NT group (p<0.001). The quantification of DCs subtypes showed no statistical differences between HPV-positive and HPV-negative TSCC groups (p>0.137). Patients with HPV-positive TSCC had significantly better overall survival rate than those with HPV-negative TSCC (p=0.004). Conclusion: Tumor activity contributes to DC depletion regardless of intralesional HPV positivity. An improved prognosis has been reported in patients with HPV-positive TSCC.
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El linfoma es la neoplasia maligna de cabeza y cuello más común en la población pediátrica. Las anifestaciones clínicas de linfoma en amígdala palatina son generalmente asimetría amigdalina, alteración en la apariencia de la mucosa y adenopatías cervicales. Ante una hipertrofia amigdalina unilateral, se debe diferenciar de cuadros infecciosos, procesos crónicos, otros tumores o simplemente una hiperplasia amigdalina benigna. El seguimiento estricto de la asimetría amigdalina es un pilar importante a la hora del diagnóstico de los pacientes con linfoma amigdalino, debido a que un tratamiento temprano es fundamental para el pronóstico. Se presenta una niña de 14 años con hipertrofia amigdalina unilateral y odinofagia, de aproximadamente 21 días de evolución sin respuesta al tratamiento antibiótico, con diagnóstico de linfoma de Burkitt. Presenta remisión completa de la enfermedad al año del diagnóstico.
Lymphoma is the most common childhood malignancy in the head and neck. The most common clinical manifestations of lymphoma in palatine tonsil are the tonsils asymmetry, alteration in the appearance of the mucous and cervical lymphadenopathy. The unilateral tonsillar hypertrophy must be differentiated with infectious processes, with chronic processes, other tumors or benign tonsillar hyperplasia. The monitoring of tonsillar hypertrophy is strict, because early diagnosis and treatment are of great importance in the prognosis of tonsillar lymphoma patients. A 14 year-old girl presents unilateral tonsillar enlargement and odynophagia. After 21 days of antibiotic treatment, she has not clinical improvement. The diagnosis is Burkitt's lymphoma. One year after diagnosis, she presents complete remission of the disease.
Subject(s)
Humans , Female , Adolescent , Tonsillar Neoplasms , Burkitt Lymphoma/diagnosis , Burkitt Lymphoma/therapyABSTRACT
Sarcomatoid carcinoma, a malignant tumor containing both epithelial-derived malignant cells and malignant mesenchymal cells. Microscopically, cancer cells and sarcoma cells migrate to each other, and CK and Vimentin are simultaneously expressed. A rare case of tonsillar sarcomatoid carcinoma is discussed in our department with dysphagia as the first symptom.
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Summary@#Sarcomatoid carcinoma, a malignant tumor containing both epithelial-derived malignant cells and malignant mesenchymal cells. Microscopically, cancer cells and sarcoma cells migrate to each other, and CK and Vimentin are simultaneously expressed. A rare case of tonsillar sarcomatoid carcinoma is discussed in our department with dysphagia as the first symptom.
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Objective@#To investigate the clinicopathological features of long-term tumor-free survival in patients with untreated primary diffuse large B-cell lymphoma (DLBCL) of the tonsil.@*Methods@#The study included 80 consultation cases of primary tonsillar DLBCL from April 2006 to July 2017 in the Department of Pathology, Beijing Friendship Hospital, Capital Medical University. The patients were divided into two groups: experimental groups of 10 untreated patients with long-term tumor-free survival, and 70 patients who had been treated (control group). The clinical data, histopathological features, immunohistochemical staining, and molecular biology test results of the patients were analyzed retrospectively.@*Results@#Patients who had long-term tumor-free survival with untreated primary diffuse large B-cell lymphoma had the disease mostly confined to the tonsil. Biopsy showed that the tonsil structure was only partially effaced and the lesions were relatively "fresh". EBER and FISH test for t (14;18) results were negative. Gene rearrangement detection showed monoclonality. There was statistically significant difference between the age, bcl-2 expression, CMYC protein expression and co-expression of CMYC and bcl-2 between the untreated group and the treated group(P<0.05). Patient gender, tumor site, histological type and clinical stage showed no difference between the untreated group and the treated group (P>0.05); The median overall survival of the untreated group and treated group was 81 months and 20 months, respectively, and the difference was not statistically significant (P>0.05).In patients younger than 40 years of age, the untreated group had a statistically significant difference in primary site and CMYC protein expression compared with the treated group (P<0.05), and there was no statistical significance in other aspects.@*Conclusions@#Long-term tumor-free survival patients with untreated tonsillar primary DLBCL have relatively unique clinical characteristics. There is no significant difference in the prognosis between the untreated and treated groups, indicating radiotherapy and chemotherapy may not be required and therefore, avoiding related side effects.
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OBJECTIVE: To evaluate the factors affecting long-term prognosis for dysphagia in tonsil cancer patients, after treatment. METHOD: This was a retrospective study of subjects who underwent a videofluoroscopic swallowing study (VFSS) following treatment for stage 3 or 4 tonsil cancer. Data including sex, age, cancer characteristics, and methods of cancer treatment were collected. To evaluate the swallowing-related outcome, we collected data including findings regarding the last VFSS, method of feeding, and history of aspiration pneumonia requiring in-patient care. We evaluated the correlation between these data and the characteristics of cancer and treatment methods. RESULT: Among 32 subjects included in this study, eight had aspiration or penetration confirmed by the last VFSS. There were no significant differences in swallowing-related factors according to the presence of aspiration or penetration in the last VFSS. Patients who underwent curative tonsillectomy retained more residues on the last VFSS than those who did not. CONCLUSION: Among subjects with tonsil cancer, history of curative tonsillectomy was correlated with more pharyngeal residue. However, other cancer- or treatment-related factors did not affect the outcome of swallowing.
Subject(s)
Humans , Deglutition , Deglutition Disorders , Methods , Palatine Tonsil , Pneumonia, Aspiration , Prognosis , Retrospective Studies , Tonsillar Neoplasms , TonsillectomyABSTRACT
Objective@#To investigate clinicopathological features and prognosis of tonsillar mantle cell lymphoma(TMCL).@*Methods@#Clinical data of 25 patients with TMCL at Beijing Friendship Hospital, Capital Medical University from 2002 to 2016 were included. All the cases were reviewed microscopically. Various immunohistochemical stains were performed using the MaxVision two-step method. IgH/CCND1 gene fusion was detected by fluorescent in situ hybridization(FISH). Additionally, randomly selected 40 cases of non-tonsil MCL of the same period were compared.@*Results@#Among all mantle cell lymphomas (MCL), TMCL accounted for 5.6%(25/449). The median age of the patients was 60 years(range: 44-82 years) with a M∶F ratio of 5.3 to 1.0. The main symptoms were sore throat and foreign body sensation and patients usually presented with enlargement or mass of tonsil. At the early stage of the disease, 18 cases(72.0%) were clinically misdiagnosed as tonsillitis. Lymph node involvement was present in 76.0%(19/25) of the patients. There were 4 cases(16.0%)with current splenic involvement, 11 cases(44.0%) with pharyngeal focal recidivism, and 3 cases(12.0%) with involvement of other non-lymphoid organs. Morphologically, tonsillar architectures were effaced at various degrees. Eighteen MCL cases showed classical type and 7 cases were blastoid variant. All tumors were positive for CD20 and cyclin D1. 92.0%(23/25) tumors showed weakly positive or positive expression for CD5. FISH test that IgH/CCND1 gene fusion was positive in two CD5 negative classical cases. 18 patients(72.0%) had a median follow-up time of 26 months(range: 6-81 months). The difference of survival rate between stage Ⅰ-Ⅱ and stage Ⅲ-Ⅳ patients was not statistically significant(P>0.05). Compared with NTMCL, TMCL was found to have higher proportion of stage Ⅰ-Ⅱ disease (χ2=12.789, P<0.01), lower the proportion of non-lymphatic organ involvement (χ2=8.125, P<0.01), and better prognosis (χ2=4.351, P=0.037).@*Conclusion@#The incidence of TMCL is low and prone to be misdiagnosed as tonsillitis. Patients with TMCL are more likely at stage Ⅰ-Ⅱ at presentation and the prognosis is better than that of NTMCL.
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@#PURPOSE: The impact of postoperative ipsilateral neck radiotherapy (INRT) versus bilateral neck radiotherapy (BNRT) on the clinical outcomes of patients with tonsillar squamous cell carcinoma was analyzed retrospectively. MATERIALS AND METHODS: Between October 2001 and June 2012, 241 patients with T1-2 and N0-N2b tonsillar carcinoma from 16 institutes underwent postoperative INRT (n=84) or BNRT (n=157) following a tonsillectomy. Seventy patients were identified from each group by propensity score matching and compared in terms of the overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS) rates calculated using the Kaplan-Meier method with a log-rank test. RESULTS: The median follow-up was 55 months (range, 3 to 133 months). The survival outcomes in the INRT and BNRT groups were similar: 5-year OS (92.8% vs. 94.0%, p=0.985), DFS (80.5% vs. 94.2%. p=0.085), LRRFS (88.1% vs. 97.1%, p=0.083), and DMFS (92.7% vs. 97.0%, p=0.370). Subgroup analysis revealed no contralateral neck recurrence in 61 patients with T1-2N0-2a regardless of the treatment groups. For 79 patients with N2b, contralateral neck recurrence was more common in the INRT group than in the BNRT group (7.9% vs. 0.0%), but the difference was not significant (p=0.107). The overall grade ≥ 2 toxicities were lower in the INRT group: acute (45.7% vs. 74.3%, p=0.001) and late (4.3% vs. 31.4%, p < 0.001), respectively. CONCLUSION: INRT is an attractive strategy for patients with T1-2N0-2a tonsillar carcinoma compared to BNRT. For patients with N2b, there was a small risk of contralateral neck recurrence when treated with INRT, but its impact on the OS was limited with successful salvage treatment.
Subject(s)
Humans , Academies and Institutes , Carcinoma, Squamous Cell , Disease-Free Survival , Epithelial Cells , Follow-Up Studies , Methods , Neck , Palatine Tonsil , Propensity Score , Radiotherapy , Radiotherapy, Adjuvant , Recurrence , Retrospective Studies , Salvage Therapy , Tonsillar Neoplasms , TonsillectomyABSTRACT
Branchiogenic carcinoma (BC), which is defined as squamous cell carcinoma arising from a branchial cyst, was first described by Volkmann in 1882. This rare disease is regarded as hypothetical, and remains a controversial disease entity. Among the diagnostic criteria of BC, the key point is the histologic demonstration of a cancer developing from the wall of an epithelial-lined cyst in the lateral site of the neck. In previous literature, many authors argued that this malignancy is actually cystic metastasis from oropharyngeal squamous cell carcinoma. We report a case of a 49-year-old female who was diagnosed as a primary BC patient with a synchronous tonsillar squamous cell carcinoma. Although this case did not meet the traditional diagnostic criteria because of existing tonsil cancer, we could diagnose these diseases as primary malignancies, since the transition zone was clearly seen, and there was no lymph node component in the histopathologic examination.
Subject(s)
Female , Humans , Middle Aged , Branchioma , Carcinoma, Squamous Cell , Epithelial Cells , Lymph Nodes , Neck , Neoplasm Metastasis , Neoplasms, Multiple Primary , Palatine Tonsil , Rare Diseases , Tonsillar NeoplasmsABSTRACT
El tumor maligno de amígdalas es poco frecuente en niños. La asimetría amigdalina es, generalmente, secundaria a un proceso benigno, ya sea patología inflamatoria, diferencia en la profundidad de la fosa tonsilar o asimetría del pilar anterior. Sin embargo, puede indicar un trastorno subyacente grave, como el linfoma. El linfoma es el tumor maligno infantil más común en la cabeza y el cuello. En el 15% de los casos, afecta al anillo de Waldeyer. Las manifestaciones clínicas más comunes del linfoma de la amígdala palatina son la hipertrofia amigdalina unilateral, la alteración en la apariencia de la mucosa y la adenopatía cervical ipsilateral. El diagnóstico precoz y el tratamiento adecuado son de gran importancia en el pronóstico. Presentamos un caso de linfoma amigdalino en un niño con asimetría amigdalina y destacamos la importancia del examen de la cavidad oral y del cuello para identificar alteraciones sospechosas de linfoma tonsilar.
Tonsil malignancy is uncommon in children. Tonsillar asymmetry is usually secondary to a benign process, either inflammatory conditions, differences in the tonsillar fossa depth or anterior pillar asymmetry. However, it may indicate a serious underlying disorder such as lymphoma. Lymphoma is the most common childhood malignancy in the head and neck. Approximately, 15% of the cases affect the Waldeyer's ring. The most common clinical manifestations of palatine tonsils lymphoma are unilateral tonsillar hypertrophy, alteration in the appearance of the mucosa and ipsilateral cervical lymphadenopathy. Early diagnosis and appropriate treatment are of great importance in the prognosis. We present a case of palatine tonsil lymphoma in a child with tonsillar asymmetry and we emphasize the importance of the examination of the oral cavity and the neck to identify suspicious alterations compatible with tonsillar lymphoma.
Subject(s)
Humans , Male , Child , Palatine Tonsil/pathology , Tonsillar Neoplasms , Burkitt LymphomaABSTRACT
In most ear, nose, and throat services, it is routine to send the material extracted from tonsillectomy for histologic study to research malignancy, to analyze suspect material, or to provide medical-legal documentation. Recent studies have shown that this routine analysis is dispensable. Objective: To evaluate the actual need and perform a costbenefit analysis of routine histopathologic examination in tonsillectomy with no signs or symptoms of malignancy. Methods: A retrospective observational study evaluated the charts of patients undergoing adenotonsillectomy, tonsillectomy, or adenoidectomy from January 2008 to September 2009 at the Institute of Otorhinolaryngology CEMA-SP. Costs of this test for the public health system were analyzed and the literature reviewed. Results We studied 281 patients between 2 and 22 years of age; 142 (50.5%) were male and 139 (49.5%) were female. Of the surgeries, 201 were adenotonsillectomies (71.5%), 41 were tonsillectomies (14.5%), and 39 were adenoidectomies (14%). The most common indication for surgery was recurrent infection (63.3%). None of study patients had clinical suspicion of malignancy. The tests showed a cost of R$20.03 per tonsil analyzed. Conclusion: Routine histopathologic examination in patients undergoing adenotonsillectomy with no signs or symptoms of malignancy is dispensable and increases the cost of the surgeries...
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Young Adult , Adenoidectomy , Tonsillar Neoplasms , Tonsillectomy , Cost-Benefit AnalysisABSTRACT
O lipoma é um tumor muito comum nos tecidos conectivos do corpo. É uma neoplasia de característica benigna composta por células adiposas maduras. Seu surgimento é relativamente comum no trato digestório e raro na orofaringe e especialmente incomum nas tonsilas palatinas. O relato do caso descreve uma rara condição de nódulo amarelado encontrado na tonsila palatina esquerda de um paciente submetido à amigdalectomia. O paciente queixava-se de tosse seca havia três meses, sem relatar outro sintoma otorrinolaringológico. Foi feita a amigdalectomia devido a uma assimetria de volume entre as tonsilas palatinas. O exame anatomopatológico revelou fibrolipoma em tonsila esquerda. Após a cirurgia o sintoma de tosse seca regrediu totalmente.
Lipoma is a very common tumor of the connective tissue of the body. It is a neoplasm of benign characteristics composed of mature adipose cells. It is relatively common in the digestive tract, rare in the oropharynx, and especially uncommon in the palatine tonsil. A case report of a lipoma of the left tonsillar fossa is presented. The patient arrived complaining of dry cough during the last thee months, without other signal or symptom. The tonsillectomy was performed because of the volume asymmetry between the palatine tonsils. The histological findings revealed fibrolipoma in the left tonsil. After the surgery, the dry cough resolved completely.
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Com a Cirurgia Robótica Transoral (TORS), padronizada por Weinstein, houve um acréscimo de facilidades para as cirurgias transorais em áreas de difícil acesso, onde havia necessidade de acessos combinados. Relata-se o caso de um doente com carcinoma espinocelular de orofaringe, T1N2bM0, submetido a TORS, onde se ressecou totalmente o tumor com margens, sem mandibulotomia. Não houve falhas do sistema, complicações ou acidentes. Foi realizada traqueostomia de proteção, retirada no dia da alta, no quarto pós-operatório, com alimentação oral. A TORS ofereceu excelente acesso para a ressecção da amígdala, mesmo em seu coto mais caudal, ao nível da epiglote.
The Transoral Robotic Surgery (TORS), standardized by Weinstein, provides facilities to transoral surgeries in difficult access areas, where a combined access would be indicated.We describe the case of a patient with a T1N2bM0 squamous cell carcinoma of the oropharynx, treated through TORS, transorally ressected without a mandibulotomy access. The surgery was conducted without any systems' failure, accidents or complications. We performed a tracheotomy, deccanullated at the forth postoperative day, at the time of the patient discharge, receiving oral feeding. The TORS offered an excellent access for radical tonsilectomy, including the transition to the hypopharynx, at the level of the epiglottis.
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BACKGROUND AND OBJECTIVES: The aim of this study was to find out if Ku70/80, p53, EGFR and COX-2 expressions are associated with prognostic variables and to examine the survival rate in tonsillar squamous cell carcinoma. SUBJECTS AND METHOD: From October 1991 to April 2006, 52 cases of paraffin-embedded tonsillar specimens were obtained by surgical resection in the Asan Medical Center. All tissue samples were subjected to immunohistochemical staining for Ku70/80, p53, EGFR and COX-2. Clinical factors such as age, treatment modality, TNM stage were evaluated nad detailed analyses were performed regarding the relationship between the expression of molecular markers, overall survival and disease free survival rates. RESULTS: In the Ku70 expression, there were no cells that did not stain and 3 cases where less than 75% of cells stained positive. In the Ku80 expression, there was one case that did not stain and 3 cases where less than 75% of cells that stained positive. The positivity of p53, EGFR and COX-2 was 19% (10/52), 2% (1/52), 50% (26/52), respectively. There was a significant correlation between p53 and survival (overall and disease free) in the univariate analysis (p=0.049, p=0.017). However, there was no correlation in the multivariate survival analysis (p=0.187, p=0.078). CONCLUSION: This study finds that the expression of p53 correlates with an unfavorable prognosis in tonsillar squamous cell carcinoma. The p53 protein can be a biological marker for prediction of prognosis in tonsillar squamous cell carcinoma.
Subject(s)
Biomarkers , Carcinoma, Squamous Cell , Disease-Free Survival , Epidermal Growth Factor , Immunohistochemistry , NAD , Palatine Tonsil , Prognosis , ErbB Receptors , Survival Rate , Tonsillar NeoplasmsABSTRACT
BACKGROUND AND OBJECTIVES: Squamous cell carcinoma of the tonsil has a relatively poor prognosis. Surgery, radiation therapy and combinations of irradiation and surgery have been employed but there exists some controversy about the efficacy of these treatment modalities. The purpose of this study was to evaluate the efficacy of the neoadjuvant chemotherapy and radiotherapy in the treatment of tonsillar neoplasm. MATERIALS AND METHOD: Medical records of 21 patients who received neoadjuvant chemotherapy and radiotherapy for tonsillar neoplasm at Pusan National University Hospital from April 1995 through August 2000 were retrospectively reviewed. RESULTS: The three year survival rate was 81.0%. The three year survival rates for stages I,II were both 100%. For stages III, IV, the rates were 83.3%, 87.5%, respectively. The three year survival rate for T1, T2, T3 were 100%, 92.3%, 40.0%, respectively. CONCLUSION: Neoadjuvant chemotherapy and radiotherapy would be effective treatment modality for tonsillar neoplasm with high survival rate and low morbidity.
Subject(s)
Humans , Carcinoma, Squamous Cell , Drug Therapy , Medical Records , Palatine Tonsil , Prognosis , Radiotherapy , Retrospective Studies , Survival Rate , Tonsillar NeoplasmsABSTRACT
0.05). Conclusion Brachytherapy ,when used to increase the dose effect,may enhance the local effect without any change in the overall survival.