Complete response to weekly carboplatin-docetaxel chemotherapy in a 91-year-old woman with anaplastic thyroid cancer.

Anaplastic thyroid cancer (ATC) is an unusual tumor with the worst prognosis among thyroid malignancies. Treatment of the patients diagnosed with ATC is not standardized and the feasible options include surgery, radiotherapy and chemotherapy. ATC cannot be regarded as a very chemo-sensitive tumor. Herein, we reported a case of a 91-year-old woman with complete response after induction chemotherapy (weekly carboplatin and docetaxel) that underwent subsequent radiotherapy.

Late onset (22 years) of simultaneous tonsillar and cervical lymph node metastases from breast ductal carcinoma.

Breast cancer is the leading cause of cancer-related mortality in women worldwide; the most common metastatic sites are lymph nodes, lung, liver, and brain. Tonsil metastases from breast cancer are extremely rare. Herein, we report a case of a 74-year-old woman with simultaneous occurrence of tonsillar and cervical lymph nodes metastases after a disease-free interval of 22 years.

Laryngeal carcinoma prognosis after postoperative radiotherapy correlates with CD105 expression, but not with angiogenin or EGFR expression.

Patients with head and neck squamous cell carcinoma (SCC) respond very differently to radiotherapy (RT). Since clinical factors cannot accurately predict its effects, biological parameters have been investigated, including tumor hypoxia. CD105 is a hypoxia-inducible glycoprotein emerging as a potential prognostic indicator for several solid malignancies. Angiogenin is upregulated under hypoxic conditions and supports primary and metastatic tumor growth. Epidermal growth factor receptor (EGFR) activation stimulates tumor proliferation and angiogenesis. The aim of the present study was to ascertain the prognostic importance of hypoxia-inducible factors (CD105, angiogenin) and EGFR in a series of patients who underwent primary surgery followed by RT for laryngeal SCC. 25 consecutive patients with laryngeal SCC given postoperative RT have been investigated. CD105, angiogenin, and EGFR immunohistochemical expressions in primary laryngeal SCCs have been evaluated also with image analysis. The recurrence rate was significantly higher in SCC patients with a CD105 expression >10.0% (P = 0.012) and their disease-free survival (DFS) was shorter (P = 0.044). Neither angiogenin (in the carcinoma cells or endothelial cells) nor EGFR expression were associated with the prognosis in our patients after primary surgery followed by RT for laryngeal SCC. CD105 should be studied as a potentially predictive biomarker for identifying laryngeal SCCs at higher risk of early recurrence after postoperative RT. Targeted anti-CD105 therapy associated with RT should also be investigated in patients with laryngeal SCCs characterized by high CD105 expression.

Neoadjuvant carboplatin and vinorelbine followed by chemoradiotherapy in locally advanced head and neck or oesophageal squamous cell carcinoma: a phase II study in elderly patients or patients with poor performance status.

BACKGROUND: The purpose of this study was to evaluate the efficacy and toxicity of neo-adjuvant carboplatin and vinorelbine followed by concomitant chemoradiotherapy in patients > or =70 years of age or with Karnofsky performance status (PS) 70-80, diagnosed with locally advanced head and neck (H&N) or oesophageal carcinoma. PATIENTS AND METHODS: The treatment plan consisted of three courses of carboplatin AUC4 on day 1 and vinorelbine 25 mg/m2 on day 1 and 8, every 21 days, followed by chemoradiotherapy. Carboplatin 100 mg/m2 was delivered weekly for the duration of the radiation therapy (70 Gy, 2 Gy/daily). RESULTS: Thirty-five patients with an average age of 68 years (range 42-85, 16 patients > or =70 years) were treated. Twenty-seven patients (77.1%) responded to neo-adjuvant chemotherapy (2 complete and 25 partial responses). Haematological toxicity was grade 3-4 in 13 patients (37.2%), while gastrointestinal toxicity was grade 3-4 in 20 patients (57.1%). All the patients completed the chemoradiotherapy plan, with grade 4 mucositis plus febrile neutropenia in 3 patients (8.5%). Median time to progression (TTP) was 10.2 months, with 31.5% of patients being alive at two years. CONCLUSION: The regimen of neo-adjuvant carboplatin and vinorelbine followed by chemoradiotherapy is feasible and active in older (> or =70 years) or low PS (Karnofsky 70-80) patients, although toxicity is not negligible and long-term outcome remains poor.

Squamous cell carcinomas of the lung and of the head and neck: new insights on molecular characterization.

Squamous cell carcinomas of the lung and of the head and neck district share strong association with smoking habits and are characterized by smoke-related genetic alterations. Driver mutations have been identified in small percentage of lung squamous cell carcinoma. In parallel, squamous head and neck tumors are classified according to the HPV positivity, thus identifying two different clinical and molecular subgroups of disease.This review depicts different molecular portraits and potential clinical application in the field of targeted therapy, immunotherapy and chemotherapy personalization.

Expression of MASPIN and angiogenin in nasopharyngeal carcinoma: novel preliminary clinico-pathological evidence.

CONCLUSIONS: Further studies based on large series are necessary to investigate the role of MASPIN and angiogenin (ANG) in angiogenetic mechanisms of nasopharyngeal carcinoma (NPC) and their potential as prognostic markers. OBJECTIVES: NPC is a malignancy with an incidence among Caucasians of < 1 per 100 000 per year. In NPC, the aberrations of many pathways and the alteration in expression of several proteins have been reported. Tumor angiogenesis is the result of an imbalance between pro- and anti-angiogenic factors. MASPIN exerts several anti-tumor effects including inhibition of tumor-induced angiogenesis. ANG regulates angiogenesis under both physiological and pathological conditions supporting primary and metastatic tumor growth. METHODS: For the first time, we preliminarily investigated by immunohistochemistry the subcellular localization and expression of MASPIN, and the expression of ANG (in both carcinoma cells and intra-tumor vessels) and Ki-67 in 15 Caucasian patients with NPC treated with the same chemo-radiotherapeutic protocol. RESULTS: MASPIN-positive NPCs had a prevalent cytoplasmic localization pattern. A trend towards significant direct correlation between MASPIN presence and disease-free survival (DFS) (p = 0.08) and a trend towards significant inverse correlation between ANG expression and DFS (p = 0.07) were found. An association between MASPIN presence and lower ANG expression in carcinoma cells was disclosed (statistical trend, p = 0.10).

A case of anaplastic thyroid cancer with long-term survival.

Anaplastic thyroid carcinoma (ATC) (less than 10% of all thyroid cancer) is a high-grade neoplasm, characterized by an aggressive clinical course and refractoriness to currently available local and systemic modalities of treatment. It is considered the most aggressive solid tumour, there is no adequate therapy for this disease and few patients with ATC live more than 1 year following diagnosis. We report herein an unusual case of ATC in a 59-year-old woman. She presented to our Institute in December 2004. She received many kinds of chemotherapeutical and multimodal treatment; we obtained a long period of localized disease (about two years) and an excellent response to therapy. She is still alive 58 months from diagnosis.

FNA cytology and frozen section examination in patients with follicular lesions of the thyroid gland.

Patients with solitary thyroid nodules should have fine-needle aspiration (FNA) cytology as the initial screening test, but the most of those referred to a surgeon usually undergo frozen section examination (FS). The aim of this retrospective study was to assess the usefulness of FNA cytology and FS together in patients with a solitary thyroid nodule (TN). Two-hundred and ten patients with a TN and FNA cytology suggesting follicular neoplasm underwent intraoperative FS and subsequent hemithyroidectomy or total thyroidectomy. There were 47 (22.4%) men and 163 (77.6%) women, with a median age of 43 years (range 18-76 years). In all patients, ultrasound-guided FNA was successfully performed using 22-G needle prior to surgery. Smears of the FNA samples were stained by May-Grünwald-Giemsa stain and evaluated immediately by the cytologist. Final histology was follicular carcinoma in 23 (10.9%), follicular adenoma in 181 (86.2%), and hyperplasia in 6 (2.9%) patients. No difference (p=NS) in age of the patients, and greatest diameter on the TN was found between groups. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 13.0%, 97.3%, 37.5%, 90.0%, and 88.1% for FNA cytology, and 17.4%, 100%, 100%, 90.8%, and 91.0% for FS, respectively. The combination of FNA plus FS did not significantly improve the results. In conclusion, both FNA cytology and FS are highly specific tests, but their sensitivity is low, even when they are used in combination. Thus, in patients with smears suggesting follicular neoplasm, FS should be considered unnecessary because it does not affect the intraoperative decision making. FS is most useful in those cases that are diagnosed as suspicious for papillary carcinoma by FNA.

MASPIN's prognostic role in patients with advanced head and neck carcinoma treated with primary chemotherapy (carboplatin plus vinorelbine) and radiotherapy: preliminary evidence.

CONCLUSIONS: Our very preliminary results support the hypothesis that MASPIN expression in primary head and neck squamous cell carcinoma (HNSCC) may be a valuable parameter for predicting patients' responses to a treatment based on carboplatin plus vinorelbine combined with radiotherapy. OBJECTIVES: The roles of induction chemotherapy and combined chemoradiotherapy in the treatment of locally advanced unresectable HNSCCs have evolved rapidly. MASPIN has a unique tumour-suppressing activity. Experimental evidence has shown that MASPIN suppresses tumour growth, angiogenesis, invasion and metastasis. We investigated the potential prognostic roles of MASPIN and p53 in a series of HNSCCs treated with carboplatin plus vinorelbine combined with radiotherapy. PATIENTS AND METHODS: Nineteen consecutive stage III or IV HNSCC patients were recruited. The treatment plan consisted of the administration of carboplatin on day 1 and vinorelbine on days 1 and 8. Four weeks later, carboplatin was administered concomitantly with radiation therapy. Expression of MASPIN and p53 was determined immunohistochemically in HNSCC diagnostic biopsies. RESULTS: A significant inverse relation was found between MASPIN expression and cN staging (p = 0.003). From a prognostic viewpoint, MASPIN expression was directly correlated with chemoradiotherapy response (p = 0.041). Moreover, the log-rank test showed a significant relationship between higher MASPIN expression and longer disease-free survival (p = 0.03), overall survival (p = 0.006) and disease-specific survival (p = 0.007).

Tongue base metastasis from neuroendocrine endometrial small cell carcinoma.

The endometrial small cell carcinoma (ESCC) is a rare and aggressive malignancy with an estimated prevalence of less than 1% of endometrial carcinomas. Endometrial small cell carcinoma is frequently diagnosed at an advanced stage and has a poor prognosis. Although the most common presenting sign of ESCC is definitely a peri- or postmenopausal vaginal bleeding, we report for the first time the occurrence of tongue base bleeding as first manifestation of disseminated neuroendocrine ESCC. From a clinical viewpoint, tongue metastasis from primary endometrial carcinoma is a manifestation of widespread disease. Albeit, our patient underwent complete hysterectomy and postoperative chemotherapy, she died of disseminated disease 3 months after ESCC diagnosis.