ABSTRACT
INTRODUCTION: Beside HPV infection, there is currently no evidence of association between head and neck squamous cell carcinomas and microbial infections. We report the case of a cervical squamous cell carcinoma by Mycoplasma hominis. CASE SUMMARY: A 20-year-old woman, consulted for a swelling on the left cervical side. Clinical examination found a large fixed mass. Biological tests found no evidence of infection. Biopsies of the cervical lesion diagnosed an HPV negative squamous cell carcinoma. Microbiological tests of 16sRNA identification showed the presence of Mycoplasma hominis in the 3 specimens. The patient was treated by induction chemotherapy associated to antibiotherapy, followed by chemo-radiotherapy. DISCUSSION: The present case suggests that oropharyngeal infection by Mycoplasma hominis might be more frequent than expected, that 16sRNA is an efficient technique to isolate this pathogen and finally that further studies are required to document its potential oncogenic role in head and neck squamous cell carcinomas.
Subject(s)
Head and Neck Neoplasms/microbiology , Mycoplasma Infections/complications , Mycoplasma hominis/isolation & purification , Neoplasms, Unknown Primary/microbiology , Squamous Cell Carcinoma of Head and Neck/microbiology , Female , Humans , Young AdultABSTRACT
The Streptococcus milleri group, which also includes S. anginosus, S. intermedius and S. constellatus, is found in the oropharynx and gastrointestinal tract mucosa. Recent isolations of S. milleri DNA sequences have been made from both gastric and oesophageal carcinoma. There are only a few publications on the isolation of viable bacteria and S. milleri DNA, and their role in carcinogenesis, in otorhinolaryngologic malignoma. We present four patients with a cervical abscess and the isolation of S. milleri -group bacteria, without signs of malignancy or other risk factors. After a delay of several months, squamous cell carcinoma of the oropharynx was diagnosed in three patients and a neck metastasis without primary tumor in the fourth.
Subject(s)
Abscess/diagnosis , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/secondary , Neoplasms, Unknown Primary/diagnosis , Oropharyngeal Neoplasms/secondary , Otorhinolaryngologic Diseases/diagnosis , Streptococcal Infections/diagnosis , Streptococcus milleri Group/pathogenicity , Tonsillar Neoplasms/diagnosis , Abscess/microbiology , Aged , Carcinoma, Squamous Cell/microbiology , Disease Progression , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasms, Unknown Primary/microbiology , Oropharyngeal Neoplasms/diagnosis , Oropharyngeal Neoplasms/microbiology , Otorhinolaryngologic Diseases/microbiology , Streptococcal Infections/microbiology , Tonsillar Neoplasms/microbiology , VirulenceABSTRACT
After time-consuming and costly investigations, patients with neck metastases from an occult primary often receive unnecessarily large radiation volumes to treat a possible origin in the nasopharynx. In this study a colorimetric antisense Epstein-Barr early ribonucleoprotein 1 (EBER1) oligonucleotide probe specific for Epstein-Barr virus RNA was hybridized in situ to metastatic tissue obtained from 18 nasopharyngeal, 54 oral and pharyngeal, and 12 occult carcinomas derived from an unselected population. All 16 nonkeratinizing nasopharyngeal carcinomas (NPCs) were positive for EBER1. Both cases of keratinizing NPC and all 54 other metastases were negative. A single positive case of occult carcinoma indicated its origin from NPC. In retrospect, 7 patients with occult carcinoma had received unnecessary treatment with irradiation to the nasopharynx. Nasopharyngeal carcinoma appears to be a less common origin of occult carcinoma than previously considered. In the proper clinicopathologic context EBER1 in situ hybridization (EBER1-ISH) allows exclusion of NPC with a high degree of accuracy. Thus unnecessarily large radiation volumes and their adverse sequelae may be reduced in the treatment of occult carcinoma. Conversely, a positive result of ISH allows exclusion of further extensive diagnostic procedures.
Subject(s)
Carcinoma/microbiology , Carcinoma/secondary , Herpesviridae Infections/microbiology , Herpesvirus 4, Human/genetics , In Situ Hybridization , Lymphatic Metastasis , Nasopharyngeal Neoplasms/microbiology , RNA/analysis , Tumor Virus Infections/microbiology , Adolescent , Adult , Aged , Aged, 80 and over , Carcinoma/genetics , Carcinoma/radiotherapy , Child , Female , Herpesvirus 4, Human/isolation & purification , Humans , Lymphatic Metastasis/genetics , Male , Middle Aged , Mouth Neoplasms/microbiology , Nasopharyngeal Neoplasms/genetics , Nasopharyngeal Neoplasms/radiotherapy , Neoplasms, Unknown Primary/diagnosis , Neoplasms, Unknown Primary/microbiology , Pharyngeal Neoplasms/microbiology , RNA/genetics , RNA Probes , RNA, Antisense , Ribonucleoproteins/genetics , Sensitivity and SpecificityABSTRACT
Cervical nodal metastasis from occult carcinomas represents a diagnostic challenge. This is a common presentation of undifferentiated nasopharyngeal carcinoma (UNPC), but metastatic carcinomas from other sites must be considered. UNPC has the distinguishing feature of a close association with Epstein-Barr virus (EBV). Since the polymerase chain reaction (PCR) can detect EBV in archival tissues, it offers significant advantages over previous methods for the detection of viral genomes. Its extreme sensitivity allows analysis of small samples from needle aspirates. Using the polymerase chain reaction to amplify EBV sequences from archival tissues, 15 of 18 NPC samples were positive for EBV. Of these 18, 14 of 14 with UNPC were positive, 1 of 2 with squamous cell carcinoma (SCC) were positive, and 10 of 2 with adenocarcinoma were positive. All 6 UNPC metastatic to lymph nodes were positive. Carcinoma metastatic to cervical nodes from 17 of 17 non-UNPC occult primaries lacked EBV. This demonstrates the utility of EBV detection by the polymerase chain reaction in the evaluation of patients with metastases to neck nodes from occult primary carcinomas in order to identify cases of UNPC.
