RESUMEN
AIMS: Androgen receptor (AR) signalling is involved in cancer progression. The expression of AR has been reported in carcinoma ex pleomorphic adenoma (CXPA) of salivary gland, however AR gene status and the expressions of cofactors for AR signalling have not been investigated. The aims of this study were to investigate the expressions of each of the molecules that contribute to AR activation with or without ligands in CXPA. In addition, AR gene amplification and single-nucleotide polymorphism were investigated. METHODS: Ten cases of CXPA and 23 cases of pleomorphic adenomas (PA) of the salivary glands were immunostained for the AR co-regulators (SRC1, p300, and NCoR1) and the signalling molecules involved in the ligand-independent pathway (i.e., HER-2/neu and STAT3). AR gene amplification and single-nucleotide polymorphism were investigated by dual-coloured fluorescent in situ hybridisation and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), respectively. RESULTS: AR expression was observed in nine of 10 cases of CXPA and in 30.4% of PA cases, a statistically significant difference. The expression, with low or high intensity, of HER-2/neu and STAT3 was more frequent in CXPA (6/10 and 9/10, respectively) than in PA (0% and 46.7%). The expression of co-activators was also stronger, though only slightly, in CXPA than in PA. The gain of chromosome X and AR gene amplification were not observed in any CXPA or PA cases, and the G --> A allele in codon 211 was detected in only one case (a CXPA). CONCLUSIONS: These results suggest that although AR may be activated in the pathway with or without ligands, the expression of co-regulators and AR gene aberrations are not involved in the carcinogenesis of CXPA.
Asunto(s)
Adenoma Pleomórfico/genética , Carcinoma/genética , Neoplasias Primarias Secundarias/genética , Receptor ErbB-2/genética , Receptores Androgénicos/genética , Factor de Transcripción STAT3/genética , Neoplasias de las Glándulas Salivales/genética , Adenoma Pleomórfico/metabolismo , Adenoma Pleomórfico/patología , Anciano , Biomarcadores de Tumor/metabolismo , Carcinoma/metabolismo , Carcinoma/patología , ADN de Neoplasias , Femenino , Amplificación de Genes , Regulación Neoplásica de la Expresión Génica , Humanos , Hibridación Fluorescente in Situ , Masculino , Persona de Mediana Edad , Neoplasias Primarias Secundarias/metabolismo , Neoplasias Primarias Secundarias/patología , Polimorfismo de Longitud del Fragmento de Restricción , Receptor ErbB-2/metabolismo , Receptores Androgénicos/metabolismo , Factor de Transcripción STAT3/metabolismo , Neoplasias de las Glándulas Salivales/metabolismo , Neoplasias de las Glándulas Salivales/patología , Transducción de SeñalRESUMEN
An aberrant internal carotid artery (ICA) in the middle ear is rare and difficult to diagnose, and may lead to severe complications. We present here a case of aberrant ICA with a deficiency in the origin of the anterior cerebral artery. The only symptom was aural fullness, and a nonpulsatile and white tympanic mass in the anteroinferior area was noted. Computed tomography (CT) and magnetic resonance angiography (MRA) are useful tools that provide excellent visualization of the temporal bone for the diagnosis of aberrant ICA by the following features: intratympanic mass, enlarged inferior tympanic canaliculus, absence of the vertical segment of the ICA canal, and absence of bone covering the tympanic portion of the ICA. In addition, in this case, a deficiency in the origin of the anterior cerebral artery on the same side was identified by MRA, and cerebral arteriography and a carotid occlusion test were performed. Because of the deficiency in the origin of the anterior cerebral artery, the ICA compression revealed that there was almost no cross flow from the other ICA. Our experience illustrates that after confirmation of the diagnosis of aberrant ICA, localized treatment and/or surgical procedures should be considered carefully.
Asunto(s)
Arteria Cerebral Anterior/anomalías , Arteria Cerebral Anterior/cirugía , Arteria Carótida Interna/anomalías , Arteria Carótida Interna/cirugía , Oído Medio/irrigación sanguínea , Oído Medio/cirugía , Arteria Carótida Interna/patología , Oído Medio/diagnóstico por imagen , Femenino , Humanos , Angiografía por Resonancia Magnética , Persona de Mediana Edad , Hueso Temporal/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: This study was undertaken to assess the prognostic factors for the management of squamous cell carcinoma (SCC) of the maxillary sinus, who received preoperative chemotherapy and radiation therapy (RT). We also elucidated the appropriate sequence of chemotherapy. METHODS: A total of 124 patients (median age 62 years) with SCC of the maxillary sinus were analysed retrospectively. T3 or T4 disease was found in 93% of the patients. Thirty-nine patients received neoadjuvant chemotherapy (NA), 38 patients received concurrent chemoradiotherapy (CRT) and 47 patients received NA followed by CRT. The median dose of RT was 60 Gy. Maxillectomy was undertaken in 98 patients. RESULTS: The 5 year overall survival (OAS) and local control probability (LCP) were 56.6 and 73.7%, respectively. On univariate analysis, surgery (P < 0.0001) and T classification (P < 0.04) were significant prognostic factors for OAS and LCP. Histological grade and nodal status were also related to OAS. However, any chemotherapy sequence was not associated with the treatment outcome. On multivariate analysis, surgery (P < 0.0005) and T classification (P < 0.05) were identified as significant prognostic factors for LCP and OAS. CONCLUSIONS: This study suggests that both surgery and T stage are important prognostic factors for LCP and OAS in the management of SCC of the maxillary sinus. The appropriate sequence of chemotherapy remains to be elucidated in the future study.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/radioterapia , Neoplasias del Seno Maxilar/tratamiento farmacológico , Neoplasias del Seno Maxilar/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/cirugía , Quimioterapia Adyuvante , Cisplatino/administración & dosificación , Supervivencia sin Enfermedad , Esquema de Medicación , Femenino , Fluorouracilo/administración & dosificación , Humanos , Masculino , Neoplasias del Seno Maxilar/cirugía , Persona de Mediana Edad , Terapia Neoadyuvante , Peplomicina/administración & dosificación , Pronóstico , Dosificación Radioterapéutica , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND AND PURPOSE: Salivary duct carcinoma (SDC) is regarded as a high-grade malignancy in the current classification of salivary gland neoplasms. The aim of our study was to describe the MR imaging features of SDC. METHODS: Nine patients with SDC underwent MR imaging study. The apparent diffusion coefficient (ADC) values of SDCs were measured from diffusion-weighted images. Time-signal intensity curves (TICs) of the tumors on dynamic MR images were plotted, and washout ratios were also calculated. TICs were divided into four types: type A, curve peaks <120 seconds after administration of contrast material with high washout ratio (> or =30%); type B, curve peaks <120 seconds with low washout ratio (<30%); type C, curve peaks >120 seconds; type D, nonenhanced. We correlated the MR findings of SDC with the pathologic findings. RESULTS: All tumors had ill-defined margins and showed low to moderately high signal intensity for contralateral parotid gland on T2-weighted images. The average of the ADC values of the SDCs was 1.16 +/- 0.14 [SD] x 10(-3)mm(2)/s. Seven of nine (78%) tumors had type B enhancement. On the other hand, six of nine (67%) tumors with rich fibrotic tissue also had type C enhancement. CONCLUSION: The findings of ill-defined margin, early enhancement with low washout ratio (type B), and low ADC value (1.22 x 10(-3)mm(2)/s) were useful for suggesting malignant salivary gland tumors. Although it was reported that type C enhancement was specific for pleomorphic adenoma, SDC frequently has type C-enhanced focus.
Asunto(s)
Imagen por Resonancia Magnética , Neoplasias de la Parótida/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Parótida/diagnóstico por imagen , RadiografíaRESUMEN
OBJECTIVES/HYPOTHESIS: The technique of the ipsilateral full-thickness forearm skin graft for covering the defect of radial forearm free flap (RFFF) improves aesthetic impairment at the recipient and donor sites by split-thickness skin graft repair and omits the need to make an extraoperative site for harvesting the skin graft. However, in this technique, the RFFF is limited in size. In the present study, we considered a model of the forearm and calculated the possible size of the RFFF for using this technique. METHODS: The calculation was conducted under assumptions that the isosceles-triangle skin graft is elevated as its height is twice the RFFF length in the direction of the forearm axis and that the forearm skin defect can be primarily closed with a width shorter than one-fourth of the wrist circumference. The calculation revealed that this technique is feasible when the RFFF width, that is, the length vertical to the forearm axis, is shorter than half of the wrist circumference. We repaired the RFFF defect using this technique in 15 patients with head and neck cancer in whom the RFFF size conformed to the above-mentioned condition. RESULTS: When the RFFF width was shorter than half of the wrist circumference and the isosceles-triangle skin graft was elevated as its height was twice the RFFF length, the RFFF defect could be repaired using this technique in all 15 patients. CONCLUSION: The above-mentioned condition (that the RFFF width is shorter than half of the wrist circumference) is useful for determining whether or not the technique of ipsilateral full-thickness forearm skin graft can be used for covering the RFFF defect.
Asunto(s)
Antebrazo/cirugía , Neoplasias de Oído, Nariz y Garganta/cirugía , Trasplante de Piel/métodos , Colgajos Quirúrgicos , Recolección de Tejidos y Órganos , Muñeca/cirugía , Estética , Humanos , Técnicas de Sutura , Cicatrización de Heridas/fisiologíaRESUMEN
After radial forearm flap harvesting, there is some risk for hand circulatory disorders. To reveal the changes in circulatory dynamics in the hand after harvesting this flap, the authors compared blood pressure and flow by color Doppler ultrasonography in the donor and nondonor hands, and evaluated the long-term changes in these factors in 40 patients undergoing this operation. Blood pressure and flow of the index finger in the donor hands were lower than those in the nondonor hands during the first 2 months postoperatively, but they virtually returned to the level of those in the nondonor hands within 1 year of the operation. These results suggest that after harvesting the radial artery, collateral circulation in the hand developed during a short postoperative period. Therefore, the authors can predict the long-term safety of forearm flap harvesting by evaluating the hemodynamic changes of the digits caused by acute occlusion of the radial artery preoperatively, which would reflect the hemodynamics at an early postoperative stage.
Asunto(s)
Mano/irrigación sanguínea , Isquemia/etiología , Arteria Radial/cirugía , Colgajos Quirúrgicos/efectos adversos , Colgajos Quirúrgicos/irrigación sanguínea , Recolección de Tejidos y Órganos/efectos adversos , Adulto , Anciano , Circulación Colateral/fisiología , Femenino , Mano/diagnóstico por imagen , Hemodinámica , Humanos , Isquemia/prevención & control , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Arteria Radial/diagnóstico por imagen , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía Doppler en ColorRESUMEN
This report focuses on the monitoring of intraoperative and postoperative hemodynamics of free flaps for repair of head and neck defects by color Doppler sonography (CDS). The study group included 20 patients with head and neck cancer who underwent resection and reconstruction with free flaps. The hemodynamics in the feeding arteries of the flaps were measured during the following six stages: before surgery, immediately after microvascular anastomosis, and on postoperative days 1, 3, 5, and 7. The pulsatility index (PI) was used as the index for measuring changes in hemodynamics over time. Grafts showed the maximal PI immediately after vascular anastomosis. PI decreased over 3 to 7 days. Of the 20 patients, 1 patient in whom the hypopharynx was reconstructed with the radial forearm flap developed venous occlusion. This was diagnosed during the early stage using CDS, allowing the flap to be saved. CDS proved to be very useful for real-time observation of the hemodynamics in free flaps.