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Adenoid-derived TH2 cells reactive to allergen and recall antigen express CC chemokine receptor 4.

BACKGROUND: Interrupting recruitment of allergen-specific T(H)2 cells to the airway is an attractive potential therapeutic strategy for allergic disease. CC chemokine receptor 4 (CCR4) is preferentially expressed on T(H)2 cells, and CCR4-expressing cells have been described at sites of allergic inflammation. However, whether selective recruitment of allergen-specific T(H)2 cells to the airways occurs through CCR4 or other chemokine receptors remains controversial. OBJECTIVE: We investigated the expression of the T(H)2-associated chemokine receptors (CCR3, CCR4, and CCR8) by primary antigen-specific human airway T(H)2 cells. METHODS: Children undergoing elective adenoidectomy were recruited, and their atopic status was determined. Adenoid cells were cultured with allergen or recall antigen. Flow cytometric analyses permitted identification of T(H) cells proliferating in response to antigen and characterization of chemokine receptor and cytokine expression. RESULTS: An increased proportion of airway CD4(+) T cells proliferated to allergen in atopic children (n = 6, of which 4 were given diagnoses of asthma or rhinitis) compared with nonatopic children (P =.0004). These cells were 44.7% (32.6% to 50.0%) IL-4(+) and only 2.5% (0.6% to 3.3%) IFN-(gamma) and showed a greater than 5-fold upregulation of CCR4 expression to 54.0% (40.7% to 67.8%) after culture, whereas CCR3 was expressed on 9.7% (7.4% to 18.9%) of allergen-reactive cells and CCR8 on less than 1%. Interestingly, increased expansion of recall antigen-specific cells was also seen in atopic children, and these cells were also predominantly of a T(H)2 CCR4(+) phenotype. CONCLUSION: We conclude that airway allergen-specific T(H)2 cells are CCR4(+), but in the atopic child CCR4 does not distinguish between recall antigen and allergen specificity.

Adenoids↗

Management of adenoid cystic carcinoma of minor salivary glands.

PURPOSE: Adenoid cystic carcinoma (ACC) is a rare malignant tumor originating from the salivary glands. The characteristic clinicopathologic features of this tumor are perineural spread, local recurrences, and distant metastases. Radical surgery combined with radiotherapy, as mentioned in the literature, is the best method of treatment. This clinical review article is intended to analyze the outcome of management of a group of 22 ACC patients, who were treated in our clinic. METHODS: Between 1985 and 2000, 22 patients with ACC of minor salivary glands were treated in the Clinic of Oral and Maxillofacial Surgery of the "G. Papanikolaou" General Hospital, in Thessaloniki. The age range was 22 to 87 years. The distribution of the primary sites was buccal mucosa (3), floor of the mouth (1), hard palate (3), soft palate (2), junction of hard and soft palate (7), and hard or soft palate with spread in the paranasal sinus etc (6). All the patients were treated radically with surgery. The surgery was combined with radiotherapy in 17 patients. A total dose of 60 Gy in a 30- to 40-day period was given, using conventional 2 Gy fractions per day. Immunohistochemical assay of the expression of the Ki-67 antigen was performed on a subset of 15 cases. RESULTS: The mean follow-up range was 4 to 14 years. From the 22 patients, 15 (68.18%) were alive for more than 5 years and 6 (27.7%) had died from the disease. Eight patients were free of the disease for more than 5 years (ranging from 7 to 14), 4 patients were free of the disease for 5 years, and 3 patients were free of the disease for 4 years. One patient lived more than 10 years and died from another cause. Local recurrence was developed in 2 patients. One recurrence occurred within the first year after the treatment and the second local recurrence occurred 13 years after the initial treatment. Lymph node metastases occurred in 2 patients, 3 years and 7 years after completing the treatment. Distant metastases (lung) occurred in 2 patients, 2 years and 6 years after completing the treatment. The Mann-Whitney statistical analysis was used for comparing the Ki-67 values in correlation with prognosis and location of ACCs. The Ki-67 value was significantly higher in tumors from patients with treatment failure than in nonfailures (P < .001). The Ki-67 expression was also higher in large tumors characterized by wide topical spread (P < .005). CONCLUSIONS: The most proper method of treatment for ACC seems to be radical resection combined with radiotherapy. The treatment failure is associated with positive margins of the excised surgical specimen and named nerve involvement. The immunohistochemical study of Ki-67 expression may provide additional prognostic information for this tumor.

Adult↗

Selective immunohistochemical comparison of polymorphous low-grade adenocarcinoma and adenoid cystic carcinoma.

PURPOSE: Polymorphous low-grade adenocarcinoma (PLGA) is a salivary gland malignancy characterized by indolent growth and a low rate of metastasis. PLGA shares histological features with adenoid cystic carcinoma (ACC), including infiltrating solid and cribriform patterns, presence of cystic spaces, and neurotropism. The degree of polymorphism of PLGA presents diagnostic challenges, particularly in small biopsy specimens. Immunohistochemical reactions to differentiate PLGA from the more aggressive ACC would be extremely valuable but controversy exists in the current literature regarding their utility. This study examines the potential use of c-kit, Ki-67, smooth muscle actin (SMA), and muscle-specific actin (MSA) as ancillary markers for distinguishing PLGA from ACC. PATIENTS AND METHODS: Medical records of 20 cases of PLGA treated at the Massachusetts General Hospital were reviewed. Patient demographic data and tumor-specific information were elicited. Formalin-fixed paraffin-embedded sections from 10 of these cases and 12 comparison cases of ACC were accessed. The histologic diagnoses were confirmed and immunohistochemical staining using antibodies to c-kit, Ki-67, SMA, and MSA was employed to determine differences in staining. RESULTS: PLGA showed a significantly weaker immunohistochemical expression of c-kit compared with ACC (P = < .001). Ki-67, correlating with proliferative behavior, was more weakly expressed in PLGA (P = .091). The exuberant myoepithelial component of ACC resulted in stronger staining with SMA and MSA (P = .047; P = .065, respectively). CONCLUSIONS: Statistically significant immunohistochemical staining patterns using c-kit and SMA in this study support their potential use as markers to differentiate PLGA from ACC in cases where the diagnosis can be challenging.

Actins↗

Adenoid cystic carcinoma and mucoepidermoid carcinoma of the maxillary sinus: report of a 44-year experience of 25 cases from a single institution.

PURPOSE: The aim of this study was to analyze the clinicopathologic characteristics of all cases of adenoid cystic carcinoma (ACC) and mucoepidermoid carcinoma (MEC) arising in the maxillary sinuses treated in a single institution. PATIENTS AND METHODS: From 1953 to 1997, 18 ACCs and 7 MECs from the maxillary sinus were studied. Clinical data were obtained from the medical records and microscopic slides were reviewed. RESULTS: Mean age was 45.9 years (range, 13 to 77 years) and TNM staging revealed 88.9% of ACCs at advanced clinical stages, while 57.1% of the MECs were initial clinical stages. Surgery combined with radiotherapy was the most common treatment. Follow-up showed 88.8% of ACC patients died from the tumor, while 42.8% of patients with MEC are alive without disease. CONCLUSION: Maxillary sinus ACC and MEC are uncommon tumors and a patient's prognosis depends on the clinical stage and histologic type; MEC has shown a better outcome.

Adolescent↗

Nerve growth factor and tyrosine kinase A in human salivary adenoid cystic carcinoma: expression patterns and effects on in vitro invasive behavior.

PURPOSE: Perineural invasion is a frequent occurrence in salivary adenoid cystic carcinoma (ACC) and may prevent complete surgical resection. Studies have indicated that nerve growth factor (NGF) and its high-affinity receptor tyrosine kinase A (TrkA) may play a role in perineural invasion in several malignancies in which perineural invasion is observed. The present study was conducted to investigate the expression of NGF and TrkA in salivary ACC and to examine the effects of NGF on adhesion, migration and invasion capacities of a salivary ACC cell line (SACC-83) in vitro. PATIENTS AND METHODS: Expression of NGF and TrkA was explored using immunohistochemistry in paraffin-embedded tissues of 32 cases of salivary ACC. The effects of NGF on in vitro adhesion, migration, and invasion capacities of the SACC-83 cell line were examined using an MTT assay and a modified Boyden chamber assay respectively. RESULTS: In ACC specimens, 31 (96.9%) and 32 (100%) tumors showed immunoreactivity for NGF and TrkA respectively. Significant correlations were found between NGF/TrkA expression levels and perineural invasion (P < .05). In cell adhesion assay, the percent adherences of SACC-83 cells co-cultured with 25 ng/ml NGF at 1.5 hours and 5, 25 ng/ml NGF at 6 hours were significantly higher than that co-cultured with 0 ng/ml NGF (P < .05). However, high concentration of NGF (500 ng/ml) resulted in a significant inhibition of invasion (P < .05). CONCLUSION: Overexpression of NGF and TrkA in human salivary ACC tissues may constitute a reason for perineural invasion in salivary ACC.

3T3 Cells↗

Brefeldin-A induces apoptosis in human adenoid cystic carcinoma cultured cells.

Adenoid cystic carcinoma (ACC) of salivary glands is characterized by a high rate of local recurrences, neurotropism and metastasis. ACC long-term survival rate is not promising. Thus, different chemotherapeutical approaches had been proposed for this neoplasm, including apoptosis induction by different drugs. This work evaluates the efficacy of Brefeldin-A (BFA), a potent apoptosis inducer, on ACC cultured cells (CAC2 cell line). CAC2 cells were treated with a 375 microM BFA solution in serum-free medium during 18 h. CAC2 cells grown in DMEM supplemented with 10% fetal bovine serum served as controls. Apoptotic cell recognition and counting were carried out through Hoechst staining. Transmission electron microscopy and immunofluorescence assessed the effect of BFA on CAC2 cells phenotype. Treated cultures showed a high apoptotic index presenting +/-30% of cells in evident apoptosis, when compared to controls. Apoptotic CAC2 cells also exhibited different alterations such as cytoplasmic vesicles formation and mitochondrial changes. Cultured ACC cells are strongly susceptible to apoptosis induction under BFA treatment, which may constitute a promising tool in further chemotherapeutical approaches.

Apoptosis↗

Adenoid cystic carcinoma of the head and neck. Clinicopathological analysis of 23 patients and review of the literature.

Adenoid cystic carcinoma (ACC) is a rare epithelial tumor with a distinct natural history characterized by an indolent but persistent growth, late onset of distant metastases and eventual death of patients. Between 1991 and 2003, 23 patients with ACC were treated in our Department. Surgery with a curative intent followed by radiotherapy (RT) was applied in 22 patients. Complete resection was achieved in 72.73% of patients. Local recurrence occurred in 26% of patients. Positive margins emerged as the only statistically significant parameter (p < 0.0001) influencing the development of local recurrence. Distant metastasis (DM) occurred in 47.8% of patients. In 54.5% of the patients developing DM, this occurred between 5 and 10 years after the initial treatment. DM was influenced by perineural invasion (p = 0.04) and was disassociated from local control of the tumor. The mean overall survival of our patients was 70.58 months and the mean disease free survival 61.85 months. Perineural invasion (p = 0.048) and DM (p = 0.001) had a statistically significant impact on final patients' outcome. The most important factor influencing survival was DM. Its late onset, irrespectively of local control, supports the hypothesis that ACC has a potential to develop DM in the very early phases of tumor growth.

Adult↗

In vivo optical imaging of human adenoid cystic carcinoma cell metastasis.

A noninvasive, whole-body, real-time fluorescence optical imaging of stable high-level green fluorescent protein (GFP)-expressing human adenoid cystic carcinoma (ACC-M-GFP) was demonstrated for in vivo visualization of metastatic behavior in nude mice. Five-week-old female nude mice were injected with ACC-M-GFP in the primary organ: submandibular gland. Metastases were only visualized by GFP expression in the lung. However, metastatic lesions of ACC-M-GFP in the lung, muscle, bladder and bony were found by imaging of GFP expression in intact mice through tail vein injection of ACC-M-GFP cells. The construction of highly fluorescent and stable GFP transfectants of ACC-M has revealed the multi-organ metastatic capability of ACC-M cells through this optical imaging.

Animals↗

Differential KIT expression in histological subtypes of adenoid cystic carcinoma (ACC) of the salivary gland.

Adenoid cystic carcinoma (ACC) of the salivary gland is characterized by a prolonged but inevitably unfavorable clinical course. Recent studies suggested the transmembrane tyrosine kinase KIT to be involved in ACC pathogenesis. To investigate KIT expression in histologically defined subgroups of ACC and to clarify whether KIT gene copy number gain contributes to KIT overexpression, tumor tissue microarray sections including 55 ACC tumors were analyzed by fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC). The prevalence of positive KIT immunostaining was 89% (49/55). Strong immunostaining of KIT was only found in cribriform and tubular but never in solid subtypes (p=0.02). Average KIT staining intensity was higher in cribriform and tubular (n=37) compared to solid (n=18) ACC subtypes (p=0.005). FISH analysis revealed copy number gains of the KIT gene in 6.1% (3/49) of tumors analyzed. Our results implicate that specific KIT tyrosine kinase inhibitors such as imatinib, might be used in future therapeutic approaches against subgroups of ACC.

Carcinoma, Adenoid Cystic↗

Prognostic factors in head and neck adenoid cystic carcinoma.

The aim of this study was to analyse the clinical, histological and immunohistochemical prognostic factors of a large series of adenoid cystic carcinoma, using univariate and multivariate survival analyses. All cases of head and neck ACC (n = 129) treated in a single institution in Brazil, between 1955 and 1997, were selected for the study. Univariate survival analysis revealed that age older than 45 years (p = 0.04), period of complaints inferior to 18 months (p = 0.007), presence of paresthesia (p = 0.04), T stage (p = 0.01), N stage (p = 0.04), M stage (p < 0.001), clinical stage (p = 0.003), solid histological type ( p< 0.001), presence of residual tumor (p < 0.001) and expression of p53 (p = 0.08) correlated with a poor prognosis. In the multivariate survival analyses, clinical stage, solid histological subtype and increased expression of p53 were independent significant prognostic factors. According to our findings, clinical stage, solid growth pattern and expression of p53 were the most important prognostic factors in patients with ACC.

Adolescent↗

Genes associated with early development, apoptosis and cell cycle regulation define a gene expression profile of adenoid cystic carcinoma.

Adenoid cystic carcinoma (ACC) is an uncommon salivary gland malignancy characterized by indolent yet relentless growth that exhibits inherent resistance to systemic chemotherapy, surgical salvage and conventional radiotherapy. We used microarray analysis to characterize gene expression changes associated with ACC. Eight ACC patient specimens were compared with normal parotid gland tissue and the ACC3 cell line. Differentially expressed genes were identified (512 total) using supervised analysis methods and functional categories assigned using OntoExpress. Genes associated with morphogenesis, neurogenesis, proliferation and apoptosis characterized ACC tumors. Genes associated with saliva production and immune response characterized normal parotid tissues while the ACC3 cell line expressed genes primarily associated with proliferation, chromosome maintenance and the cell cycle. These results demonstrate that ACC tumors express genes associated with early developmental processes including morphogenesis and neurogenesis implicating oncogenic events that result in dedifferentiation of normal salivary glands.

Adult↗

Salivary gland adenoid cystic carcinoma: a review of chemotherapy and molecular therapies.

Adenoid cystic carcinoma (ACC) accounts for about 1% of all head and neck malignancies. It has a tendency for a prolonged clinical course, with local recurrences and distant metastases sometimes occurring many years after presentation. Standard treatment for salivary gland ACC is surgery and post-operative radiotherapy. The aim of this review was to examine the reported efficacy of various chemotherapy regimens and molecular therapies on recurrent/metastatic salivary gland ACC. One hundred and fourteen publications were reviewed on chemotherapy as well as possible molecular targets of therapy, including KIT, epidermal growth factor receptor (EGFR), human epidermal growth receptor-2 (HER-2), oestrogen and progesterone receptors, proliferating cell nuclear antigen (PCNA), Ki-67 and the p53, bcl-2 and SOX-4 genes. Reported response rates to combination chemotherapy are low and response duration generally short lived. The response to molecular therapies is low also. More research into novel molecular targets is needed.

Antineoplastic Agents↗

Application of alpha-smooth muscle actin and c-kit in the differential diagnosis of adenoid cystic carcinoma from polymorphous low-grade adenocarcinoma.

The expression of vimentin, alpha-smooth muscle actin (alpha-SMA) and c-kit in adenoid cystic carcinomas (AdCCs) and polymorphous low-grade adenocarcinomas (PLGAs) was investigated immunohistochemically to evaluate the application of these markers to distinguish AdCCs from PLGAs when the histological features are equivocal. Tissue specimens of AdCCs and of PLGAs, formalin-fixed and paraffin-embedded were retrospectively studied using vimentin, alpha-SMA and c-kit. Positive staining for alpha-SMA was identified in all AdCCs and 25% of PLGAs. The immunoreactivity of c-kit in all positive cases of AdCCs (83%) and PLGAs (41%) was more than 50% and less than 50% of tumor cells respectively. The expression pattern for both alpha-SMA and c-kit, in tubular structures of AdCCs was different of that seen in the same structures in PLGAs. The results of this study support the potential application of alpha-SMA and c-kit as an adjunctive aid in the differential diagnosis of AdCCs from PLGAs.

Actins↗

Metallothionein immunostaining in adenoid cystic carcinomas of the salivary glands.

Metallothionein (MT) is a protein that has been studied in several tumors as a prognostic factor and as a potential myoepithelial cell marker in breast cancer. The aims of this study were to assess the immunohistochemical staining of MT in adenoid cystic carcinomas of the salivary glands (ACC), and to analyze possible morphological and quantitative variations among the solid, cribriform, and tubular histological subtypes. MT was investigated in 15 cases of ACC using the immunohistochemical technique. All of the cases expressed the MT antigen. This expression was noteworthy in cells depicting myoepithelial differentiation. ACC with predominant tubular pattern presented a significantly lower mean index of MT immunopositivity than did solid or cribriform subtypes, while these two latter groups did not differ in terms of MT expression. Our results suggest that MT may be an important tool for immunolocalization of myoepithelial tumor cells in salivary gland neoplasms.

Adult↗

Galectin-3 immunoprofile in adenoid cystic carcinoma and polymorphous low-grade adenocarcinoma of salivary glands.

Adenoid cystic carcinoma (ACC) and polymorphous low-grade adenocarcinoma (PLGA) are malignant neoplasms of salivary glands, which are similar in histologic patterns but very different in clinical behavior, treatment and prognosis. Galectin-3 is a multifunctional protein of a growing family of beta-galactoside-binding animal lectins, which is implicated in a variety of biological events such as tumor cell adhesion, proliferation, differentiation and angiogenesis. This protein was found to be implicated in cellular transformation and a correlation between its expression and cancer progression and metastasis has been described. The aim of this study was to determine the galectin-3 immunoprofile in 14 cases of ACC (2 cases of tubular subtype, 4 cases of solid subtype and 8 cases of cribriform subtype) and in 12 cases of PLGA with different histologic patterns, including lobular, tubular and cribriform aspects. Moreover, slides of normal salivary glands were included. In normal salivary glands there was strong nuclear and cytoplasmic staining for galectin-3 in ductal luminal cells. ACC showed specific staining in luminal cells mainly in the nuclei. In the tubular subtype of ACC, galectin-3 strongly stained luminal cells of the ductiform structures. The cribriform and solid subtypes showed a few positive luminal cells of small ducts present in the cribriform structures and in solid nests respectively. In the cases of PLGA, independent of the histologic architecture, all tumor cells revealed a positive cytoplasmic reaction. Galectin-3 expression seems to be related to cell differentiation more than to tumor progression and prognosis in the neoplasms studied.

Adult↗

Expression of thymidylate synthase and dihydropyrimidine dehydrogenase in adenoid cystic carcinoma of the head and neck: correlation with clinical outcome.

The purpose of this study was to estimate the possibility of using thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD), and p53 as predictive values of clinical outcome in adenoid cystic carcinoma (ACC). The expressions of TS, DPD, and p53 were examined with immunohistochemistry in 27 ACC patients, and the association with clinicopathological factors was determined. Cases with high DPD expression had significantly higher distant metastasis rates compared to those with low DPD expression (p=0.001), whereas neither TS nor p53 expression showed any significant correlation to clinicopathological factors. Interestingly, six of 14 early-stage patients had distant metastases and all of their tumors showed high DPD expression. Kaplan-Meier analysis revealed that a solid histological pattern and distant metastasis correlated with a poor prognosis. In early-stage patients, whose tumor was completely resected, those with high TS or DPD expression had a worse prognosis compared to those with low expression, but the difference did not reach statistical significance (TS, p=0.178; DPD, p=0.251). Our results suggest that assessment of DPD expression in ACC may be a useful tool in determining the mode of treatment as well as evaluating clinical outcome.

Adult↗

Overexpression of cyclin D1 and cortactin is primarily independent of gene amplification in salivary gland adenoid cystic carcinoma.

Adenoid cystic carcinoma (ACC) of the salivary glands exhibits persistent growth, invasion and metastasis. Chromosome 11q13 amplification is a frequent event associated with tumor progression in a number of carcinomas and is associated with poor prognosis. Two genes within the 11q13 amplicon that are overexpressed as a result of 11q13 amplification are the cell cycle regulatory protein cyclin D1 (CCND1) and cortactin (CTTN), a protein involved cell motility and invasion. To determine the expression and gene status of cyclin D1 and cortactin in ACC, we evaluated 39 ACC cases by immunohistochemistry (IHC) for cyclin D1 and cortactin expression. Amplification of CCND1 and CTTN was determined by fluorescent in situ hybridization (FISH). Cyclin D1 overexpression was present in 90% (35/39) and cortactin expression in 62% (24/39) of evaluated cases, although CCND1 and CTTN levels were elevated in only two cases (5%) as determined by FISH. Our results indicate that chromosome 11q13 amplification is uncommon in ACC, but that cyclin D1 and cortactin are frequently overexpressed and may therefore contribute to the growth and invasive potential of ACC.

Adult↗

Paired analysis of primary adenoid cystic carcinoma and derived cell lines reveals a mesenchymal and stem-like shift associated with therapy resistance.

Adenoid cystic carcinoma (ACC) is a salivary gland malignancy characterized by slow but persistent growth, frequent local recurrence, and late metastatic progression. Patients with unresectable, recurrent, or metastatic disease have limited therapeutic options. Efforts to identify effective therapeutic targets have been hindered by the limited availability of well-characterized ACC models. In this study, we established 11 ACC cell lines and performed RNA sequencing of nine cell lines and their matched primary tumors to evaluate the preservation and evolution of molecular and lineage-associated characteristics during cell line establishment. Comparative transcriptomic analysis revealed reduced epithelial and luminal differentiation programs in the cell lines, accompanied by enrichment of myoepithelial, EMT-, and cancer stem cell-associated transcriptional programs. Digital deconvolution and single-sample gene set enrichment analysis supported enrichment of hybrid EMT/stem-like states during in vitro propagation, while comparison with publicly available primary-recurrent ACC data demonstrated partial preservation of recurrence-associated plasticity and invasion programs. Protein-level validation of representative epithelial, myoepithelial, EMT, and stemness markers supported the major transcriptomic changes. In addition, a cell line with a higher stemness signature showed reduced sensitivity to cisplatin. Together, these findings indicate that ACC cell line establishment is associated with transcriptional reprogramming and enrichment of plastic, EMT/stem-like states while retaining selected ACC lineage characteristics. These models provide experimentally tractable platforms for investigating ACC progression, therapeutic response, and mechanisms of treatment resistance.

Adenoid cystic carcinoma↗