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PubMed2000

The immune response in adenoids and tonsils.

The adenoid and tonsils are lymphoid tissues located in the pharynx that play an important role in host defense against invading antigens of the upper respiratory tract. Histologically, these structures consist of four well-defined microcompartments which all participate in the immune response: the cryptepithelium, the follicular germinal center with the mantle zone and interfollicular area. With the uptake of antigen by M-cells present in the cryptepithelium a process is initiated which ultimately results in the generation and dissemination of antigen-specific memory and mainly dimeric IgA-producing effector B-lymphocytes. This process requires successful cognate interactions between antigen-presenting cells and lymphocytes and mutually between lymphocytes, which depend not only on antigen-specific signals but also on the expression of various complementary adhesion and costimulatory molecules.

Adenoids↗
PubMed2001

Prognostic impact of molecular analyses in adenoid cystic carcinomas of the salivary gland.

BACKGROUND: Adenoid cystic carcinoma (ACC) of the salivary gland is a generally slow-growing but highly malignant neoplasm with a remarkable capacity for recurrence. Prognosis is greatly influenced by the histological subtype (tubular, cribriform or solid), presence of tumour at the margins, anatomic size, and lymph node metastases. However, none of these parameters has proven to be an unequivocal predictor of disease activity. Therefore, the current study was undertaken to investigate the prognostic value of molecular markers. PATIENTS AND METHODS: Samples from 22 patients, including 4 patients with recurrent disease, were included in the study. By means of immunohistochemistry, the staining pattern of p53, bcl-2, P-glycoprotein, glutathione S-transferase, and topoisomerase as well as sequence analyses of p53 were performed. These molecules were chosen because of their proven association with poor prognosis and therapy resistance in other malignancies. RESULTS: Homozygous p53 mutations were found in all of the 4 recurrent tumors. The other proteins were detected in some tumors, but showed no correlation with histological subtype or recurrence of tumor. CONCLUSION: The results of the current study emphasize the prognostic value of a p53 alteration as an independent prognostic marker. Further, it could be demonstrated for the first time that proteins known for their association with radio- and chemotherapy resistance can be overexpressed in some ACCs suggesting that those molecules could influence the outcome of new therapeutical approaches.

Biomarkers, Tumor↗
PubMedDate not supplied

Expression of p16 protein and hypermethylation status of its promoter gene in adenoid cystic carcinoma of the head and neck.

Reduced expression of the p16 gene product (protein), an inhibitor of cyclin-D-dependent protein kinase which regulates cell cycle at the G1/S boundary, is implicated in tumor progression in various neoplasms. Hypermethylation of the p16 promoter gene has recently been suggested to be one of the reasons for the reduced protein expression. To explore the role of p16 in the biological behavior of adenoid cystic carcinomas (ACC), we investigated the immunohistochemical expression of p16 protein in 38 ACC tumors (32 primary, 3 recurrent, and 3 metastatic tumors) and the methylation status of its promoter gene. We also examined their relationships to the histological grade of malignancy. Positive reaction of p16 protein was demonstrated in the nuclei of luminar cuboidal cells in areas with tubular patterns. The reactions were reduced in the areas with solid or large cribriform patterns. The levels of p16 expression correlated with the histological grade of malignancy. Recurrent or metastatic tumors did not differ with respect to histological grades from the original tumor except for 1 case, in which p16 expression was reduced compared to the primary tumor. Methylation-specific PCR demonstrated the hypermethylation status of the p16 promoter gene in 4 of 22 primary tumors (21%), all of which showed negative or low expression of the p16 protein. The study indicated that p16 expression was reduced in ACC cases of higher histological grade of malignancy and that hypermethylation of its promoter gene may be involved in its process in some cases.

Adult↗
PubMed2006

Stereotactic radiosurgery as a salvage treatment for recurrent skull base adenoid cystic carcinoma.

Twelve patients (15 lesions) with recurrent skull base adenoid cystic carcinoma (ACC) were treated by Gamma Knife stereotactic radiosurgery (SRS). The tumor volume ranged from 2 to 103 ml (median 15 ml). Treatment was prescribed at the 40-60% isodose line and ranged from 10 to 18 Gy (median: 13.0 Gy). The median follow-up period was 18 months (range 3-55). Six patients were alive and 6 dead at the end of the follow-up period. Only 1 patient died from local tumor recurrence. Ten among 15 tumors treated by SRS decreased in size until the end of the follow-up period or the patients' death. Three remained unchanged in size. Two tumors initially regressed but then increased in size. In selected patients with recurrent skull base ACC, SRS can be considered as a salvage treatment with good local control.

Adolescent↗
PubMed1986

[Radiotherapy in adenoid cystic carcinoma].

Between 1962 and 1982, 45 patients with adenoid cystic carcinomas (ACC) of various localizations received a radiotherapy-treatment. Most of the cases had advanced tumors or recurrences. 41 patients underwent radiotherapy either alone or following an operation, in 35 cases with curative intention. 6 patients had already distant metastases at the beginning of treatment. In 4 cases only a palliative treatment of metastases of the skeleton and the lung was performed. Median two- and five-year survival of 35 patients with localized tumors was 83% and 45%, respectively (29/35 two-years and 14/31 five years). Best results were obtained by operation and postoperative radiotherapy (10/18 = 55.5% five year-survival). Radiotherapy alone resulted in a five-year survival of only 37.5% (3/8). Advanced ACC or postoperative recurrences should be treated by surgery as radically as possible, followed by a radiotherapy with generously sized portals and doses between 60 to 65 Gy. Radiotherapy alone leads to comparatively poor results. Large and inoperable tumors may well be treated by a combination of hyperthermia and radiotherapy.

Adult↗
PubMed1987

Seasonal variation of mast cell function in human adenoid tissues.

The number of mast cells which can be recovered from human adenoid tissues varies characteristically in the course of the year. The yield was found to be highest in May and lowest in July. The average histamine content was above average in April, June, July and September. Although the spontaneous histamine release remained relatively constant, the concanavalin A-stimulated histamine release was significantly reduced from June to September.

Adenoids↗
PubMed1983

Biological behaviour of laryngeal adenoid cystic carcinoma. Therapeutic considerations.

Two cases of adenoid cystic carcinoma of the larynx are reported with a review of the world literature. This tumour, though capable of metastasizing via the blood stream to various organs (brain, lung, bone, etc.), seldom spreads to the cervical lymph nodes, usually by direct infiltration. Because of the biological behaviour of the neoplasm, radical neck dissection is not indicated.

Adult↗
PubMed1991

Reduced concentration of secretory IgA indicates changes of local immunity in children with adenoid hyperplasia and secretory otitis media.

Children with adenoid hyperplasia and secretory otitis media show significantly lower immunoglobulin A (sIgA) concentrations in their saliva compared to matched controls. Salivary albumin and cortisol levels do not differ in both groups. Changes in local immunity, dilution or stress as possible factors for the reduction of sIgA concentrations are discussed.

Adenoids↗
PubMedDate not supplied

New criterial for cytologic diagnosis of adenoid cystic carcinoma.

OBJECTIVE: To formulate new criteria for adenoid cystic carcinoma (ADCC). STUDY DESIGN: The usefulness of 17 items for a cytologically definitive diagnosis of ADCC was examined. The frequency (- - +++) of the 17 items in 18 cases of ADCC and 10 non-ADCC cases (pleomorphic adenoma, basal cell adenoma, myoepithelioma and epithelial-myoepithelial carcinoma) that displayed mimicking cytology was examined cytologically. The total score for cases of ADCC was compared with that for non-ADCC cases. RESULTS: The 17 items included broad intercellular spaces with adhesion; green, granular/cobwebby cytoplasm with translucent intercellular matrix with Papanicolaou staining; coarse hyperchromatin with little nuclear clearing; indistinct and partially distinct nucleoli; small nuclei; broad, smooth margin (SM) space; and translucent M/HG/SM. All cases with a total score of > 21 were ADCC (93.8%). All cases with a total score of < 12 were non-ADCC (87.5%). CONCLUSION: The 17 items appear to be useful as new criteria for ADCC.

Adenocarcinoma↗
PubMedDate not supplied

Extracellular hyaline material in association with other cytologic features in aspirates from collagenous spherulosis and adenoid cystic carcinoma of the breast.

OBJECTIVE: To reevaluate breast aspirates showing extracellular hyaline material (EHM) and globules to assess if clinicoradiologic and cytologic features could help in differentiating between benign and malignant lesions, especially collagenous spherulosis (CS) and adenoid cystic carcinoma (ACC). STUDY DESIGN: Fine needle aspiration was performed on 884 patients with breast lumps. The cytomorphologic features of 6 cases showing EHM, including classic hyaline globules (HGs), were analyzed in detail. Three cases also had hemorrhagic nipple discharge. Tissue diagnosis (4) and mammography (6) were available. RESULTS: Aspirate smears revealed high cellularity composed of monolayers: clusters of uniform, small cells; EHM; and HGs surrounded by similar cells. Benign naked nuclei and stromal fragments (4), nuclear pleomorphism (3), apocrine cells (2), foam cells (2), naked HGs (2) and spindle cells in proximity to HGs were also seen (4). Nipple discharge smears showed foam cells, erythrocytes (3) and epithelial cell clusters with hyaline material (1). The cytologic diagnosis was CS (4) and ACC (2). Histopathology confirmed the diagnosis of CS (2) and ACC (1). CONCLUSION: There may be a morphologic overlap between the cytomorphologic features of CS and ACC, leading to diagnostic errors. The presence of EHM and HGs in association with bland cellular features should be interpreted with caution to avoid erroneous diagnoses. Histopathology is mandatory in these cases because of their different prognostic implications.

Adult↗
PubMedDate not supplied

Fine needle aspiration of pleomorphic adenoma and adenoid cystic carcinoma of salivary gland origin.

OBJECTIVE: To determine the cytologic similarities, distinctive features and diagnostic problems on fine needle aspiration in patients with pleomorphic adenoma (PA) and adenoid cystic carcinoma (ACC) of salivary gland origin. STUDY DESIGN: We reviewed the preoperative cytology and histologic sections in 22 patients in whom the resected specimens were diagnosed as PA (17 cases) or ACC (5 cases) of salivary gland. RESULTS: Concordant results were noted between cytologic and histologic diagnoses in 20 cases (91%) and discordant results in 2 cases (9%). Both discordant aspirates had been diagnosed as PA; however, their resected specimens were diagnostic of ACC. Although there were cytologic features common to both tumors, each had a unique relationship of epithelial cells to stroma. Aspirates in PA showed cell clusters with a "sunburst" appearance caused by peripheral spindled cells streaming into a fibrillar myxoid stroma. In ACC well-delineated, tightly cohesive, basaloid cells surrounded mucoid/hyaline globules or clear spaces in a honeycomb pattern. CONCLUSION: The cytologic distinction between PA and ACC in most cases was easily made on adequately cellular aspirates. In the two aspirates with discordant results, diagnostic difficulty resulted when the distinctive relationship between epithelial cells and extracellular matrix was not recognized in sparsely cellular specimens, in part due to lack of observer familiarity with the different patterns.

Adenoma, Pleomorphic↗
PubMedDate not supplied

Influence of adenoid hypertrophy on secretory otitis media.

The prognostic influence of adenoidectomy on the clinical course of chronic secretory otitis media (SOM) is reported after an observation period of five years in 166 children. Adenoidectomy was performed in connection with the first tubulation on the basis of concurrent symptoms of nasal obstruction, and resulted in a significant reduction in the need for repeated insertion of tympanostomy tubes in patients younger than eight years of age. The tubulation rate was also significantly reduced when adenoidectomy was performed in association with the first recurrence of SOM. This effect was, however, absent when the operation was performed at later stages, and both the otoscopic and audiological findings after five years revealed no significant differences between the adenoidectomy and nonadenoidectomy groups. Possible pathogenetic mechanisms leading to the development of SOM in the presence of large adenoids are discussed.

Adenoidectomy↗
PubMed1989

Adenoid cystic carcinoma of the parotid gland: a review of surgical management with reference to the facial nerve.

The purpose of this study was to review a large series of patients with adenoid cystic carcinoma of the parotid gland in order to develop clinical criteria for sacrifice versus selective sparing of the seventh nerve. We studied 43 patients followed over 36 years. Study patients were grouped according to the preoperative status and intraoperative management of the facial nerve. Criteria for choosing various management strategies are discussed.

Carcinoma, Adenoid Cystic↗
PubMed1990

Histopathologic grading of salivary gland neoplasms: III. Adenoid cystic carcinomas.

Histopathologic grading of adenoid cystic carcinomas can provide valuable prognostic information, particularly when the presence or absence of a solid growth architecture is noted. Other growth patterns, exemplified by a tubuloductal or cribriform-cylindromatous differentiation, are associated with a more protracted biologic course and less rapid mortality. A three-tiered grading system based on the three growth patterns of the carcinoma is presented.

Carcinoma, Adenoid Cystic↗
PubMedDate not supplied

Nasopharyngeal irradiation treatment of hyperplastic adenoids.

Radiotherapy treatment in childhood is an important cause of thyroid cancer. In the 1930 to 1950 era, radium irradiation of the nasopharynx was used to control hyperplastic adenoids. Because of the technical characteristics of this applicator, sufficient radiation was not applied to the thyroid by this technique to stimulate the development of thyroid malignancies. No malignancies have been reported thus far as a result of this treatment.

Adenoids↗
PubMed1985

Reflections on the management of adenoid cystic carcinoma of the nasal cavity and paranasal sinuses.

Adenoid cystic carcinoma of the nasal cavity and paranasal sinuses has a unique natural history. It has a propensity for frequent local recurrence and early perineural and hematogenous spread. These factors, together with a complex anatomic situation, make adequate oncologic surgery extremely difficult. The incidence of local recurrence is lower in those patients receiving more radical primary surgery, but the choice between conservative and radical management may not alter prognosis. Indeed, it is doubtful if any patients are cured of this disease.

Adult↗
PubMed1992

Seropositivity, adenoid hypertrophy, and secretory otitis media in adults--a recognized clinical entity.

Otolaryngologic manifestations of AIDS have been described in the past. In this study, I had examined 14 adults with nasal obstruction and mouth breathing. Nine patients also reported deafness--unilateral in three of them and bilateral in six. All of them revealed a mass in the nasopharynx, either on the posterior rhinoscopy or the x-ray neck-lateral view. To exclude nasopharyngeal malignancy, all of the patients underwent examination of the nasopharynx while under general anaesthesia and biopsy. The histopathologic diagnosis in every patient was nonspecific, reactive lymphoid hyperplasia, which has been described in the background of HIV infections. Four were already confirmed HIV-positive and 10 were found positive on the HIV antibody test. A strong association was established between seropositivity, adenoid hypertrophy, and secretory otitis media in adults.

Adenoids↗
PubMed1991

The use of fine-needle aspiration in the diagnosis of metastatic pulmonary adenoid cystic carcinoma.

Nine patients with a history of adenoid cystic carcinoma (ACC) arising in the head and neck and in whom transthoracic fine-needle aspiration (FNA) was performed to investigate pulmonary lesions are described. FNA yielded a definitive diagnosis of metastatic ACC in all cases. In six of the nine patients, the pulmonary metastases were asymptomatic. Lung lesions were discovered up to 19 years after primary tumor presentation, and in two, pulmonary spread was the only evidence of recurrent disease. On the basis of the FNA diagnosis, these two patients were treated surgically for their isolated pulmonary metastases, and are disease free at 107 and 139 months. Six of the nine patients received radiation or chemotherapy; one initially refused treatment. Thoracotomy was avoided in these patients on the basis of the FNA diagnosis. All are alive with disease at 25 to 246 months. The metastatic tumors were indistinguishable cytologically from two primary pulmonary ACCs that were available for comparison. Our experience suggests FNA is a useful tool in the diagnosis of ACC in pulmonary material--one which obviates the need for thoracotomy with its associated morbidity.

Adult↗