Application of direct oral microscopy in evaluating mucosal margins around invasive oral squamous cell carcinoma.

INTRODUCTION: Direct oral microscopy constitutes a novel, non-invasive diagnostic technique, which aids clinical examination of the oral cavity. The oral mucosa is examined at multiple magnifications and features such as sub-epithelial mucosal vessels, surface patterns, colour tone, transparency and the exact demarcation of mucosal lesions are estimated. The incidence of oral squamous cell carcinoma (OSCC) oscillates between 1.9% and 3.5%, which makes it the eighth most common carcinoma occurring around the world and in Poland. The 5-year survival rates oscillate between 20% and 30%. AIM: The aim of the study was to evaluate clinically unchanged mucosal margins around OSCC by direct oral microscopy. The authors approached the question whether the borders of mucosal margins around OSCC established via direct oral microscopy differ from those established based on clinical examination. MATERIAL AND METHODS: Fifteen patients diagnosed with OSCC were enrolled. Patients were first clinically examined to evaluate the extent of the tumour and to plan resection margins. Eventually, direct oral microscopy was performed to establish the width of the subclinically unchanged mucosal margins based on a standard picture of healthy oral mucosae, followed by comparison with those established by clinical evaluation. RESULTS: Histopathologic results of biopsies from areas indicated by direct oral microscopy revealed dysplasia in 86.7% of patients, whereas biopsies from areas indicated by clinical examination revealed dysplasia only in 40% of individuals, resulting in the need for widening of mucosal margins. CONCLUSIONS: Direct oral microscopy enables detection of dysplasia within clinically unaltered mucosal margins around OSCC, which results in more precise establishing of resection boundaries, contributing to improvement of resection totality.

Lymphoepithelioma-like carcinoma of the skin in a Polish patient.

Lymphoepithelioma-like carcinoma of the skin (LELCS) is a very rare cutaneous neoplasm with limited metastatic potential. It presents distinctive histopathologic features similar to undifferentiated nasopharyngeal carcinoma and clinical similarities with other skin neoplasms. We present the first case of LELCS in Polish patients. A 72-year-old woman presented with a 12 months' history of painless, solitary tumor on the nose. A wide local excision was performed. There was no evidence of local recurrence 24 months after surgical treatment.

Estimation of oral leukoplakia treatment records in the research of the Department of Maxillofacial and Oral Surgery, Medical University of Gdansk.

INTRODUCTION: Oral leukoplakia (OL) is the most common potentially malignant lesion of the oral cavity. AIM: The purpose of the study was clinical and epidemiological analysis of patients with OL diagnosed and treated in the Department of Maxillofacial and Oral Surgery, Medical University of Gdansk, comparison of effectiveness of treatment methods, defining whether van der Waal level of OL influences treatment effectiveness, correlation between localization of OL and treatment effectiveness, and defining the optimal OL therapeutic method. MATERIAL AND METHODS: Among 55 911 patients diagnosed and treated in the Department in the years 1999-2009, 204 people with OL were selected (104 women, 100 men, average age: 58.1 years). Treatment and observation period of 6 months was completed by 178 (87.25%) patients. Seventy-four patients were treated with cream containing 0.05% tretinoin. Sixty-three patients underwent cryosurgery, and 41 surgery. Control visits were made in week 2, 4, 6 and 8 and 6 months after completed treatment. RESULTS: Three hundred and twenty lesions of OL were diagnosed. According to van der Waal classification, the largest group of patients was classified into stage I and II. The percentage of totally cured patients was 90.07%. There were no statistic differences in effectiveness between surgical and cryosurgical treatment. CONCLUSIONS: Evaluation of OL treatment methods depends on localization of the lesions and its stage of progression. The effectiveness of treatment with locally applied tretinoin is smaller in comparison to surgery and cryosurgery. It allows to reduce the number and size of OL lesions, what makes it possible to reduce the number of ablative procedures.

Polymorphisms in the cytochrome P-450 (CYP) 1A1 and 17 genes are not associated with acne vulgaris in the Polish population.

INTRODUCTION: The pathogenesis of acne is complex, multifactorial and not well understood. The genetic background of this dermatosis is well documented. AIM: To assess the frequency of -34 T > C single nucleotide polymorphism in the promoter of the CYP17 gene as well as m1 (+6,235 T > C) and m2 (+4,889 A > G) mutation in the coding region CYP1A1 gene acne patients from the Northern Polish population. MATERIAL AND METHODS: The study included 115 acne patients and 94 healthy controls (aged over 20) without acne in anamnesis. The CYP1A1 polymorphism was analyzed by polymerase chain reaction (PCR). The restriction fragment length polymorphism (RFLP) was used to analyze m1 mutation and allele-specific PCR in the case of m2 mutation. The CYP17 polymorphism was analyzed by RFLP. The results were evaluated by the Pearson's χ(2) test. RESULTS: There were no statistically significant associations between allele and genotype frequencies between the acne and the control group. CONCLUSIONS: We did not confirm the role of the CYP1A1 and CYP17 gene as predictor factors for acne development in the Polish population.

Oral premalignant lesions: epidemiological and clinical analysis in the northern Polish population.

INTRODUCTION: Leukoplakia is the most common potentially malignant condition of the oral cavity. AIM: Epidemiological and clinical analysis of patients with oral leukoplakia (OL) diagnosed and treated in the Department of Maxillofacial and Oral Surgery, Medical University of Gdansk. MATERIAL AND METHODS: The study was retrospective and prospective. Among 55 911 patients diagnosed and treated in the Department in 1999-2009, 204 people with OL were selected. The material includes 104 women and 100 men with an average age of 58.1. Most of the patients were in the age group of 50-70 years, average age was 58.1. RESULTS: The most common concomitant disease was diabetes. More than 88% of the patients declared occurrence of OL predisposing development factors (50.49% - cigarette smoking). Three hundred and twenty foci of OL were found among patients. Homogeneous OL dominated (72.05%). Multifocal OL was diagnosed in 58.3% of patients. The most common location of lesions was buccal mucosa (52.2%). Cancers developed on the basis of OL in 7 patients (3.43%). The percentage of malignant transformation was 12.19% for untreated patients and 1.41% for treated patients. The floor of the oral cavity was proven to be the location of the highest risk of oral squamous cell carcinoma. Patients with diabetes may be more likely to develop OL. The risk of malignant transformation is relatively high. In our material it was equal to 3.43%. CONCLUSIONS: Cigarette smoking is the most important factor, which can influence the effectiveness of treatment.

Segmental neurofibromatosis.

Segmental neurofibromatosis or type V neurofibromatosis is a rare genodermatosis characterized by neurofibromas, café-au-lait spots and neurofibromas limited to a circumscribed body region. The disease may be associated with systemic involvement and malignancies. The disorder has not been reported yet in the Polish medical literature. A 63-year-old Caucasian woman presented with a 20-year history of multiple, flesh colored, dome-shaped, soft to firm nodules situated in the right lumbar region. A histopathologic evaluation of three excised tumors revealed neurofibromas. No neurological and ophthalmologic symptoms of neurofibromatosis were diagnosed.

-308 G/A TNF-α gene polymorphism influences the course of basal cell carcinoma in a Polish population.

INTRODUCTION: The etiopathogenesis of basal cell carcinoma (BCC) is multifactorial. The TNF-α gene seems to be an interesting gene candidate for BCC susceptibility because of the proinflammatory and immunosuppressive properties of its product. The aim of the study was to assess the frequency of -308 G/A and -238 G/A gene polymorphisms in the TNF-α gene and serum levels of cytokine in patients with BCC. MATERIAL AND METHODS: The study included 176 (94 women, 82 men) patients with BCC and 261 healthy volunteers. -308 G/A and -238 G/A TNF-α polymorphisms were analyzed using the amplification refractory mutation system-polymerase chain reaction method (ARMS-PCR). Serum concentrations of TNF-α were measured using ELISA. RESULTS: There was no statistically significant association between allele, genotype and haplotype frequencies in BCC patients in comparison with controls. Occurrence of the -308 TNF-α A allele or GA genotype in the group of patients with BCC increases risk of recurrence of tumor recurrence (OR = 4.8, 95% CI: 1.6-13.9, p = 0.004 and OR = 4.97, 95% CI: 1.7-14.5, p = 0.004). Moreover, -308 TNF-α GG genotype decreased risk of recurrence (OR = 0.2, 95% CI: 0.07-0.6, p = 0.004). The -238/-308 GA haplotype was connected with increased risk of recurrence (OR = 4.36, 95% CI: 1.49-12.7, p = 0.007). We also found significantly higher TNF-α levels among BCC patients in comparison with controls (p = 0.004). CONCLUSIONS: The obtained results did not confirm the role of the -308 G/A and -238 G/A TNF-α gene polymorphisms in BCC development, but the presence of the A allele or GA genotype in -308 G/A TNF-α gene polymorphism may have an impact on the course of the disease.

The -1154 G/A VEGF gene polymorphism is associated with the incidence of basal cell carcinoma in patients from northern Poland.

Vascular endothelial growth factor (VEGF) is believed to play a crucial role in neoplastic angiogenesis. Although the genetic background of basal cell carcinoma (BCC) has been analyzed in some papers, the mechanism of BCC pathogenesis is not fully understood. To the best of our knowledge, VEGF gene polymorphisms have not yet been explored. The aim of the study was to asses the frequency of three polymorphisms in the VEGF gene (-1154 G/A, -460 T/C and +405 G/C) in patients of Polish origin with BCC and control group. In addition, VEGF serum levels of patients with BCC and controls were measured. The study involved 180 patients (96 women, 84 men) with BCC and a mean age of 68.9 ± 11.8, and 215 healthy age- and sex-matched volunteers. The VEGF polymorphisms at positions -1154 and +405 were analyzed using the amplification refractory mutation system polymerase chain reaction method. To assess the VEGF gene polymorphism at position -460, we used the polymerase chain reaction restriction fragment length polymorphism method. Serum levels of VEGF protein were measured using the ELISA test. The presence of the G allele (GA or GG) in the -1154 VEGF polymorphism was associated with an increased risk of BCC development (OR = 7.28, p < 0.0001). Furthermore, the carriers of the AA genotype in -1154 VEGF polymorphism showed significantly reduced risks of BCC (OR = 0.14, p < 0.0001). It was also shown that the GTC haplotype of VEGF predisposes to BCC development (OR = 1.69, p = 0.013), while the presence of the ATG haplotype significantly reduces this risk (OR = 0.17, p = 0.00001). We have found significantly increased VEGF serum levels among BCC patients, in comparison with the healthy controls (mean 596.7 ± 393.5 pg/ml; range 60.1-931.4 vs. 255.9 ± 174.6 pg/ml; range 42.2-553.0 pg/ml; p < 0.0004). The serum levels of VEGF significantly correlated with tumor size: r = 0.41, p < 0.0001. Our results testify to the importance of -1154 G/A VEGF gene polymorphisms in altering the risk of BCC among the population from northern Poland.

Childhood nail alterations in Polish population.

The epidemiology and nature of childhood nail apparatus pathology is not well known. The aim of our study was to investigate the frequency and nature of nail alterations in Polish pediatric patients. Among 1588 patients diagnosed and treated at our clinic due to nail alterations, 82 (5.16%) patients under age 16 were selected. The most frequent (36.59%) diagnosis were variants of normal nails, which were observed in 30 patients. The most common pathology were viral warts (19.51%). Differences in the distribution of onychomycosis and viral warts in children and adults were statistically significant. Onychomycosis was more common in adults (60.39% vs. 9.76%), whereas viral warts were more common in children (19.51% vs. 5.86%; P<0.0001). Melanonychia was diagnosed in one (1.22%) case. Benign and malignant tumors were not observed. In conclusion, distribution of nail apparatus pathology in children is different comparing with adults. In the group of children under 6 years of age, there were mainly variants of normal nails, whereas in older children viral infection and acquired structural disorders were recorded. The risk of nail apparatus malignancy in childhood seems to be extremely low.

Normal variants in patients consulted in the Dermatology Clinic for lesions of the male external genitalia.

INTRODUCTION: So far there have been no papers analyzing the incidence of 'non-pathological' lesions or normal variants on the male external genitalia. Subsequently, the number of patients consulted due to the presence of such lesions remains unknown. The aim of the study was to estimate the incidence of normal variants in patients who were consulted due to lesions on the skin or mucosa of the male external genitalia. MATERIAL AND METHODS: The study group consisted of 400 males, aged 3-91, who were consulted due to lesions on the genitalia in the Department of Dermatology, Venereology and Allergology of the Medical University of Gdansk. RESULTS: The most common lesions were hyperpigmentation of the median raphe of the penis and scrotum (85.6%), pearly penile papules (24%), and prominent veins (24%). Sebaceous hyperplasia or ectopic sebaceous glands were revealed in 9% of patients, respectively. Melanocytic nevi were diagnosed with similar frequency (9.5%), whereas skin tags more rarely (7%). Other 'non-pathological' lesions were diagnosed in a considerably lower number of patients. In 32 patients (8% of all patients) the reason of admission to the Clinic was just the presence of some 'non-pathological' lesions. Pearly penile papules were found to be the most common condition, occurring in 78.1% patients. CONCLUSIONS: Normal variants represent a substantial percentage of generally asymptomatic lesions and the only indication for their removal is cosmetic discomfort or venerophobia.

Acne inversa of the scrotum and penis - aggressive urological treatment.

Acne inversa is a rare chronic and debilitating inflammatory skin disease. The authors report a case of a 45-year old male who presented with acne inversa in the inguinal, perineal, and scrotal areas. After unsatisfactory pharmacological treatment a wide surgical excision of the affected skin was performed in stages. On follow-up the patient presented with a very good cosmetic and functional result. A review of the most recent literature is also presented.

Impact of radiofrequency ablation on PBMC subpopulation in patients with renal cell carcinoma.

PURPOSE: With the development of diagnostic techniques, renal cell carcinoma (RCC) is currently diagnosed in earlier stages, allowing the introduction of less invasive techniques in its management. One of the most promising new treatment methods is based on the utilization of high temperature created by radiofrequency current circulating around the needle probe introduced into the tumor. Besides the direct destruction of the cancer tissue, the treatment may induce immunologic reaction to tumor antigens released from destroyed tumor cell. This paper describes changes observed in the peripheral blood lymphocyte population after radiofrequency ablation (RFA) of RCC. METHODS: Blood was tested before, and 2, 4, and 6 weeks after the RFA in 6 patients with RCC for the proportions and numbers of CD3(+), CD3(+)HLA-DR(+), CD3(+)CD4(+), CD3(+)CD8(+), and CD56(+)CD16(+) cells. The blood was stained with fluorochrome-conjugated monoclonal antibodies and percentages of cells expressing various markers were determined by flow cytometry. RESULTS: In all patients, the changes were most pronounced 2 weeks after the procedure. The proportion of CD4(+) and CD8(+) lymphocytes were changed. In 1 patient, an increase in both CD4(+) and CD8(+) cells was observed. In 5 out of 6 patients, the proportion of activated (DR(+)) cells was increased over the whole follow-up period with the highest values in the second week after RFA. The percentage of the CD56(+)CD16(+) was decreased in most of the patients. CONCLUSIONS: Our study confirms that in the majority of patients, RFA of the renal tumors causes significant changes in the proportion of the peripheral immune cells. We suggest that the results presented in this article shows the necessity for further studies.