Intraductal Carcinoma: The Carcinoma In Situ of the Salivary Gland.

Intraductal carcinoma of the salivary gland (IDC) is a rare in situ neoplasm of the salivary gland with similar features to the ductal carcinoma in situ of the breast. This report aims to present the clinical presentation and histological features of IDC. The authors present a 90-year-old gentleman with an indurated and painless tumor within the right parotid. Preoperative diagnostics, including fine needle aspiration cytology, ultrasound scan, and magnetic resonance imaging, were suggestive of Warthin tumor. The tumour was excised by extracapsular dissection. The patient is disease free within the follow-up period of 33 months. Intraductal carcinoma is an indolent phenotype with only a few reported cases with nodal metastases, and to the best of our knowledge, no cases have been reported with distant metastases. Complete surgical excision is recommended to prevent a recurrence. The knowledge of this underreported salivary gland malignancy is important to prevent misdiagnosis and insufficient treatment.

Cutaneous head and neck SCCs and risk of nodal metastasis - UK experience.

AIM: To identify the risk of developing metastases to regional nodes in patients with cutaneous squamous cell carcinomas (CSCCs) of the head and neck. METHODS: A retrospective study of patients with CSCC treated with surgical excision alone between 2000 and 2002 was performed. Demographic details of the patients, the site, size, differentiation, depth of invasion, clearance of surgical margins, and the presence of perineural or lymphovascular invasion of the lesion were documented. During the follow up period, patients with regional metastases were identified. The site of the metastasis and the time after the primary resection were documented and statistical analysis was performed using Chi-square and logistic regression analysis. RESULTS: One hundered and ninety-four patients were included and 218 CSCCs were excised in total during the period of 3 years. The scalp was the most common site of skin lesion, followed by the ear. The incidence of regional metastatic disease was found to be 5.15%. The parotid gland was the most common area of regional metastasis. No metastases occurred after the first 2 years of follow up. The pinna, the poor differentiation and incomplete excision margins were found to be associated with regional metastasis independently, with odds ratio of 16, 21, and 2 respectively. CONCLUSIONS: The rate of regional metastasis from CSCC remains low. The parotid gland was the most favoured metastatic site. Patients with poorly differentiated squamous cell carcinoma (SCC) located on the ear and incomplete excision margins were at the greatest risk for developing regional lymph node metastasis and require close follow up.

Lipomatous lesions of the parotid gland.

PURPOSE: Lipomatous lesions of the parotid gland are rare and seldom considered in the initial diagnosis of a parotid mass. We report our experience in the management of patients with lipomatous lesions affecting the parotid gland. PATIENTS AND METHODS: Retrospective analysis of all parotidectomies performed for neoplastic lesions in the maxillofacial unit between 1975 and 2003 and patients with lipomatous lesions involving the parotid gland were identified; 638 parotidectomies were performed in this period on 629 patients in which 660 neoplasms were identified. Eight patients were found to have lipomatous lesions and form the basis of this study. RESULTS: Lipomatous lesions accounted for only 1.3% of parotid tumors and occurred more frequently in males, at a ratio of 3 to 1. The most common presentation was that of a slowly enlarging, painless mass. Computed tomography scan was the most frequent imaging modality undertaken, and in 3 patients a diagnosis of a lipoma was made preoperatively. Seven patients underwent a superficial parotidectomy and 1 patient had a total conservative parotidectomy because of the deep lobe location of the mass. Five patients were found to have a focal lipoma and 3 patients had diffuse lipomatosis. There were no recurrences. Temporary facial nerve palsy and Frey's syndrome were the most frequent complications. CONCLUSION: Lipomatous lesions accounted for only 1.3% of all parotid tumors. There were no specific distinguishing clinical features in our patients, and an accurate preoperative diagnosis was made in 3 patients based on imaging investigations. A well-circumscribed lipoma was more common than diffuse lipomatosis. Superficial parotidectomy was the treatment of choice and there were no recurrences in our series.

Pseudoporfiria en paciente dializada / Pseudoporphyria in a dialyzed patient

Se presenta el caso de una paciente de 34 años de edad con insuficiencia renal crónica de varios años de evolución. A los 6 meses de empezar el tratamiento con hemodiálisis presentó lesiones clínica e histológicamente características de pseudoporfiria. A su vez presentaba niveles normales de porfirinas en sangre. Se inició el tratamiento con N-acetilcisteína a razón de 600 mg dos veces al día (AU)

Does administration of isosorbide mononitrate affect cellular proliferation in oral squamous cell carcinoma? A prospective randomized clinical study.

PURPOSE: There has been much interest in the role that the signaling molecule nitric oxide (NO) plays in cancer. NO has both tumor-promoting and tumor-inhibiting effects that are dependent on its local tissue concentration. In animal studies, the administration of exogenous NO has reduced both tumor growth and dissemination, and in vitro NO administration causes death of oral cancer cell lines. We evaluated the oral administration of the NO donor drug isosorbide mononitrate (ISMO) on cellular proliferation in patients with oral squamous cell carcinoma. MATERIALS AND METHODS: A prospective randomized double-blind study was performed on 31 patients with biopsy-confirmed oral squamous cell carcinoma. Following incisional biopsy, patients were randomized to receive either ISMO (at a dose of 20 mg twice a day) or placebo tablets for 2 weeks before definitive resection. Cellular proliferation was compared between biopsy and resection specimens, using the immunohistochemical marker Ki-67. RESULTS: No statistical difference was found between Ki-67 indices in initial biopsy and resection specimens after ISMO (P =.23) or placebo (P =.5) administration. There were no obvious clinical changes seen in the tumor during the clinical trial as a result of ISMO administration. CONCLUSION: Although high concentrations of NO are cytotoxic, it is unlikely that administration of NO at an increased dose would be useful in the management of oral cancer because this would result in unacceptable systemic side effects. The possible manipulation of NO in oral cancer is discussed.

Expression of type 2 nitric oxide synthase and vascular endothelial growth factor in oral dysplasia.

PURPOSE: The small molecule nitric oxide (NO), produced by a family of enzymes called NO synthase (NOS), has a diverse array of functions in both physiologic and pathologic states. Prolonged production of NO by the isoform NOS2 has been implicated in human cancer progression. NO has an important role in angiogenesis, being both an upstream signal and a downstream effector molecule to vascular endothelial growth factor (VEGF). The latter group of proteins are crucial for vascular endothelial cell proliferation and permeability. The expression of VEGF increases with cancer progression. Because angiogenesis is a prerequisite for the development of invasive cancer, this immunohistochemical study investigated the expression of NOS2 and VEGF in oral epithelial dysplasia. MATERIALS AND METHODS: An immunohistochemical study was performed using monoclonal antibodies to NOS2 and VEGF on archival formalin-fixed, paraffin-embedded tissue of 33 cases of oral dysplasia. RESULTS: A significant correlation was found between NOS2 and VEGF expression in oral dysplasia (P <.001). Expression of both NOS2 and VEGF also correlated with the severity of dysplasia (P <.001, P <.002). CONCLUSIONS: These findings may provide further understanding to the complex transformation of oral epithelial dysplasia to invasive carcinoma and the role of angiogenesis in this process.

Expression of vascular endothelial growth factor in basal cell carcinoma and cutaneous squamous cell carcinoma of the head and neck.

BACKGROUND: Basal cell carcinomas (BCC) and squamous cell carcinomas (SCC) can both arise from any cutaneous epithelial surface. BCC are slow growing and rarely metastasise, whereas SCC are usually more aggressive. It is likely that the angiogenic process plays a key role in determining rate of growth and propensity for dissemination. Angiogenesis is a complex process requiring many factors and a pivotal group of proteins involved in this process is vascular endothelial growth factor (VEGF). METHODS: Immunohistochemical expression of VEGF was assessed in 44 cases of BCC and 41 cases of cutaneous SCC from the head and neck region. RESULTS: VEGF was expressed by blood vessel endothelial cells in both adjacent skin and tumour, and in the basal keratinocyte layer of epidermis. In BCC, VEGF was expressed by tumour epithelial cells, predominantly at the invasive tumour front, in 24/44 cases and its expression was significantly greater than in adjacent skin (p = 0.038). More widespread VEGF expression was found in 32/41 cases of SCC, and it was significantly associated with the degree of tumour differentiation (p < 0.001). CONCLUSIONS: The patterns of VEGF expression in BCC and SCC may help to explain the different behaviour that is usually seen with these tumours.

Expression of type 2 nitric oxide synthase and p53 in Warthin's tumour of the parotid.

Although the pathogenesis of Warthin's tumour is not fully understood, it is generally thought that the tumour arises from heterotopic salivary ducts within pre-existing lymphoid tissue. Prolonged nitric oxide (NO) production by the enzyme type 2 nitric oxide synthase (NOS2) has been implicated in the pathogenesis of many solid tumours, but not in Warthin's tumour. Since NO and NOS2 are known to be associated with p53, the immunohistochemical expression of both NOS2 and p53 was investigated in 23 cases of Warthin's tumour. Widespread diffuse cytoplasmic immunostaining for NOS2 was found in tumour epithelial cells of all 23 cases studied, and it was additionally expressed in normal salivary duct epithelium. p53 staining was localised to the nuclei of tumour epithelium in 16 cases, with a similar pattern of distribution to tumour NOS2 expression. A significant correlation was found between NOS2 and p53 staining in the tumours (P < 0.001). In contrast to NOS2, p53 was not expressed by normal salivary ductal cells in any of the cases studied. NOS2 is widely expressed by the tumour epithelium of Warthin's, and its association with p53 expression is discussed. The role of NO in the pathogenesis of Warthin's tumour remains to be established.