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[Mechanisms of p16 gene inactivation salivary adenoid cystic carcinoma].

OBJECTIVE: To study the mechanism of p16 gene inactivation in salivary adenoid cystic carcinoma. METHODS: 53 cases of freshly excised salivary adenoid cystic carcinomas were studied. Polymerase chain reaction (PCR) and single-stranded conformation polymorphism analysis of polymerase chain reaction products (PCR-SSCP) were used to detect deletion and mutation of p16 gene in salivary adenoid cystic carcinomas. Methylation specific PCR (MSP) was used to detect the methylation status of p16 gene. RESULTS: The homozygous deletion, mutation and hypermethylation of p16 gene were noted in 16 cases (30.2%), 4 cases (7.5%) and 26 cases (49.1%) respectively in 53 cases of salivary adenoid cystic carcinomas. CONCLUSION: The main inactivation mechanisms of p16 gene in salivary adenoid cystic carcinoma were hypermethylation and homozygous deletion. The mutation p16 gene was rare in salivary adenoid cystic carcinoma.

Carcinoma, Adenoid Cystic↗

Histopathological comparison between tonsil and adenoid responses to allergy.

In a previous study of adenoid tissue from allergic and non-allergic patients, we concluded that in allergic children edema of the "chorium" was present in 80.4% and that treatment with antihistamine drugs may reduce this edema. The purpose of the present study was to compare the histopathology of the palatine tonsil and adenoid from allergic patients. Tissue samples were obtained from 153 patients (56 tonsils and 97 adenoids from allergic children). We analysed the intensity of the edema and its cellular components in the chorium of palatine tonsils and adenoids. The frequently seen edema in the adenoids was significantly different from that in the tonsils. The squamous epithelium of the tonsils was thicker and bad stronger intercellular junctions than the columnar epithelium of the adenoids. This fact probably makes difficult the contact of the antigen with the chorium.

Adenoids↗

[Oral adenoid squemous carcinoma. Tumor markers and prognosis].

CASE REPORT: A 58-year-old female patient presented with an exophytic adenoid squamous cell carcinoma on the right alveolar process of the lower jaw. Histological and immunohistochemical differential diagnosis and cellular background of the unfavorable prognosis are described. The patient was treated with curative intent by radical tumor resection including partial mandibulectomy, extensive conservative/radical neck dissection, and postoperative radiation. The adenoid squamous cell carcinoma was classified as pT4, pN0, cM0, R0. During radiation, regional lymph node metastases and distant metastases developed. The patient died of distant metastases 7 months after the initial diagnosis. HISTOPATHOLOGIC FINDINGS: Tumor cells of adenoid squamous cell carcinoma express epithelial intermediate filament cytokeratin, epithelial membrane antigen (EMA), and epithelial basal membrane protein laminin-5 (Ln-5). Glandular differentiation can be excluded by the absence of epithelial mucins (Alcian blue, mucicarmine). Differentiation from angiosarcoma can be performed using endothelial differential markers CD31, CD34, and factor VIII-associated antigen (FVIII-ass. AG). Both entities are characterized by high proliferation and Ki-67 index of 20%. beta-catenin (cell-cell adhesive protein) loses its primary membrane-bound localization and can explain the histologic pattern of acantholysis. Ln-5 (guide rail of invasion) is massively expressed in adenoid squamous cell carcinoma cells and may be responsible for rapid progression. CONCLUSIONS: Pseudopapillary proliferation, cellular atypia, vascular-like cavities, expression of cytokeratin, EMA, and Ln-5 are common features of oral adenoid squamous cell carcinoma and angiosarcoma. Diagnosis is determined by the absence of endothelial differential markers CD31, CD34, and FVIII-ass. AG. Modulation of the beta-catenin pattern (transcription factor of Ln-5) and massive expression of invasion factor Ln-5 are suggested as cell biological reasons for rapid progression of adenoid squamous cell carcinoma.

Alveolar Process↗

Pseudovascular adenoid squamous cell carcinoma of the skin. A neoplasm that may be mistaken for angiosarcoma.

The adenoid variant of squamous cell carcinoma has been well-documented in several anatomic sites, including the skin. This tumor is characterized by acantholytic arrays of neoplastic keratinocytes that form pseudoglandular profiles. Although it is typically confused with adenocarcinomas, adenoid squamous cell carcinoma also may be mistaken for malignant vascular proliferations. This report concerns six acantholytic cutaneous squamous cell carcinomas that closely simulated angiosarcomas on conventional histologic examination. They arose in sun-exposed skin areas in middle-aged or elderly patients (mean age, 60 years), five of whom were men. In contrast to the typical clinical appearance of angiosarcoma, pseudovascular adenoid squamous cell carcinoma presented itself as a discrete cutaneous ulcer or crusted tanpink nodule. Microscopically, this lesion was characterized by interanastomosing cordlike arrays of polygonal or flattened tumor cells, with internal pseudolumina that contained detached tumor cells. A connection between the dermal neoplasm and the epidermis was apparent in three cases, but it was focal. Erythrocytes were seen in pseudovascular spaces in five tumors. Immunohistochemically, all examples of pseudovascular adenoid squamous carcinoma were reactive with antibodies to cytokeratin and epithelial membrane antigen (EMA). In addition, three expressed vimentin, two exhibited blood group antigen-positivity, and two bound Ulex europaeus I agglutinin. None of them was immunoreactive for Factor VIII-related antigen, and two of three studied for CD34-reactivity were likewise negative. A control group of six cutaneous angiosarcomas was uniformly nonreactive for cytokeratin and EMA, but they showed positivity for vimentin, Ulex binding, and CD34 positivity in all instances. Pseudovascular adenoid squamous cell carcinoma may be distinguished effectively from angiosarcoma of the skin by attention to its clinical features and by appropriate immunohistochemical studies. These two tumors differ in biologic behavior; three patients with pseudovascular adenoid squamous cell carcinoma died of their tumors, whereas all angiosarcomas in this series proved fatal.

Adenocarcinoma↗

What is the right size of the adenoid curette?

The use of an adenoid curette of appropriate size is recommended in operative textbooks for adequate adenoid removal and avoidance of potential injury to the eustachian tubes. The aim of this study is to calculate the right size of adenoid curettes to be used for children of different ages. The inter-tubal space (ITS) between the torus tubarius on both sides is the narrowest passage for adenoid curettage, and is identified in this study as the nasopharyngeal dimension to be considered in selecting the size of the adenoid curette. This prospective study is carried out on a series of 72 adenoidectomy cases aged from three to nine years at the Hearing and Speech Institute in Cairo, Egypt. The inter-tubal dimension (ITD) is measured for each child at the end of adenoidectomy and the results are recorded against the patient's age. The ITD ranged from 17-21 mm in our series with no significant difference between males and females. There is an increase in ITD with age with a sharp increase at ages five and seven years. Accordingly, the patients are divided into three age groups and recommendations for appropriate adenoid curette sizes ranging from 18 to 21 mm are given for each group.

Adenoidectomy↗

Adenoid cyst-like carcinoma of the prostate gland.

Adenoid cyst-like carcinoma of the prostate is a rare but distinctive variant of prostatic adenocarcinoma. Adenoid cystic carcinoma is most commonly encountered in the salivary glands, and the cell of origin is thought to be the myoepithelial cell. Electron microscopic studies of the human prostate have not revealed myoepithelial differentiation. Myoepithelial cells of the human prostate are thought to arise in seromucinous ectopic glands. A case of adenoid cyst-like carcinoma of the prostate gland is documented, and the histological, immunohistochemical, and electron microscopic features of this tumor are discussed. These features are compared with five cases of classic salivary gland adenoid cystic carcinoma. To define the myoepithelial cell population of the prostate gland, 12 normal prostate glands were studied. Prostatic adenoid cyst-like carcinoma differs from adenoid cystic carcinoma of salivary gland origin, and it is therefore postulated that the behavior of these tumors may likewise differ.

Adenocarcinoma↗

Carcinoma of the esophagus with adenoid cystic differentiation.

Adenoid cystic carcinoma of the esophagus is a relatively rare lesion which characteristically exhibits a clinically aggressive behavior. In spite of this aggressive nature, it is most often referred to as a counterpart of the more common adenoid cystic carcinoma of salivary gland origin, a comparatively indolent tumor. In this report, the clinical and pathologic findings in a series of six cases of esophageal adenoid cystic carcinomas are contrasted with those of typical salivary gland lesions, and also compared to similar tumors exhibiting "adenoid cystic" differentiation arising in other extrasalivary gland sites. It is concluded that the esophageal tumors, as well as certain similar lesions arising in other extrasalivary gland sites, represent a class of poorly differentiated basaloid neoplasms distinct both clinically and morphologically from the common adenoid cystic carcinoma of salivary gland origin.

Adult↗

Adenoid cystic carcinoma of the esophagus. Complete response to combination chemotherapy.

A 55-year-old man had adenoid cystic carcinoma of the esophagus metastatic to the lungs and right supraclavicular fossa. He was treated with local radiation therapy to the esophagus and supraclavicular fossa, followed by combination chemotherapy with doxorubicin, mitomycin C, and 5-fluorouracil (5-FU). After a modest initial response, disease progression was noted in the pulmonary nodules. He was then treated with cisplatin, cyclophosphamide, vincristine, and doxorubicin. After two cycles of this regimen, there was complete regression of his pulmonary nodules, which was sustained for 5 months. A review of 44 literature cases of esophageal adenoid cystic carcinoma contrasted with adenoid cystic carcinoma of salivary gland origin indicated that the esophageal adenoid cystic carcinomas have a high tendency to metastasize (76% of cases) and a much poorer prognosis, with only 23% 1-year survival rate. It was concluded that esophageal adenoid carcinoma is clinopathologically distinct from the salivary gland variant, and that combination chemotherapy may be an effective treatment modality for this cancer.

Antineoplastic Combined Chemotherapy Protocols↗

Localization and morphology of antigen-presenting cells in the adenoid of children with otitis media with effusion.

This study describes the localization of antigen-presenting cells (APC) in the different compartments in adenoids of children with otitis media with effusion (OME) and "healthy" children and adults. It is shown that the adenoid of children with OME contains a relatively high number of OKT6 and RFD1 positive cells. Moreover, accumulations of these cells are present in the extrafollicular areas of these adenoids. Very occasionally dendritic cells in the epithelial microenvironment contain Birbeck granules, indicating characteristic Langerhans cells. These OKT6 positive cells are not seen in the adenoids of the control group. Our results clearly show a relation between the presence of dendritic cells and the occurrence of OME. No differences are seen in localization and morphology of the APC in the studied adenoids.

Acid Phosphatase↗

Intracranial adenoid cystic carcinoma: case report and review of the literature.

BACKGROUND: Adenoid cystic carcinoma (cylindroma) is a relatively common head and neck tumor that is slow growing, but locally aggressive and thus prone to recurrence. It is of particular interest to neurosurgeons and neurologists because of its tendency to locally infiltrate neural structures and to spread perineurally. Intracranial involvement has been regarded as rare. METHODS: A case report of a patient with adenoid cystic carcinoma involving the Gasserian ganglion region is presented. The world literature on intracranial involvement of adenoid cystic carcinoma is reviewed. A discussion of the characteristics of this lesion is provided. RESULTS: Our literature review revealed 119 previously reported cases of adenoid cystic carcinoma with intracranial involvement. Our case represents only the tenth reported intracranial case with an unknown primary site. CONCLUSIONS: Although intracranial adenoid cystic carcinoma is regarded as rare, we have accumulated over 100 such reports. A wide variety of primary sites and intracranial sites have been described.

Adult↗

The Bcl-2 protein expression in germinal centers of hypertrophied adenoids in children.

The aim of this study was to evaluate Bcl-2 expression in the germinal centers of adenoid in children on the assumption that it can be treated as a marker of adenoidal tissue function. The study involved 95 children. The patients were divided into three age groups: aged up to 5, 5-10 and above 10 years. The analysed material were adenoids removed on the grounds of hypertrophy. Immunohistochemical analyses were carried out using monoclonal antibodies (DAKO/Bcl-2, No. M0887) directed against human Bcl-2 protein. The presence of Bcl-2 positive lymphocytes within the lymphoid follicles and Bcl-2 immunostaining were scored. The immunohistochemical staining showed Bcl-2 positive lymphocytes in the examined sections of adenoidal tissue and their characteristic location, mainly within the mantle zone. Bcl-2 reactivity was widespread in hyperplastic lymphoid tissue, including germinal centers surroundings, scattered cells within the germinal centers and the T-cell areas in general. We have not found statistically significant correlation between Bcl-2 expression and clinical status and change in Bcl-2 expression level according to age. The apoptosis presence within the germinal centers and its lack in mantle zone, the manifestation of which is Bcl-2 expression, is a sign of a proper lymphocytes maturation within lymphoid follicles. It seems that these processes are not influenced by age, so the adenoid involution is probably associated with the changes in the number of lymphoid follicles rather than change or inhibition of the processes that take place in them.

Adenoids↗

Detection of herpesvirus type 8 (HHV8) in children's tonsils and adenoids by immunohistochemistry and in situ hybridization.

OBJECTIVE: Human herpesvirus 8 (HHV8) has been associated with multicentric Castleman's disease, Kaposi's sarcoma and effusion non-Hodgkin's lymphoma. Epidemiological studies have shown seropositivity in variable proportions of populations. It seems to be sexually transmitted among adults and through oral contact among children. The virus has been demonstrated in desquamating oral epithelial cells, but there is no report on its presence in the Waldeyer's ring. The purpose of the present study is to detect HHV8 in tonsils and adenoids from children up to 20 years of age in which these organs had been surgically removed due to hypertrophy, using immunohistochemistry and in situ hybridization. METHODS: Paraffin wax-embedded sections consisting of 181 tonsils and 162 adenoids from 293 patients were analyzed. HHV8 was detected by immunohistochemistry (IHC) using the anti-LNA1 antibody (Novocastra) and the LSAB+ detection system (Dako). For the in situ hybridization (ISH), the T1-1 probe for the viral mRNA and the detection system used were provided by Novocastra. RESULTS: In 20 cases (6.83%), HHV8 was detected in cells morphologically characterized as lymphoid. In three of them epithelial cells were also positive. In 19 cases, the virus was detected in tonsils and in just 1 case in an adenoid. In all 20 cases detection was possible by ISH, whereas in only 2 of them there was a concomitant positivity by IHC. CONCLUSION: Our data support the oral route of contamination by HHV8 in children, in whom tonsils and adenoids may harbor the virus. It is found especially in tonsils and only rarely in adenoids. In these organs, ISH is the method of choice to detect this virus, probably due to the small amount of viral proteins.

Adenoids↗

A phase II study of Imatinib for advanced adenoid cystic carcinoma of head and neck salivary glands.

Adenoid cystic carcinoma of the salivary glands is characterized by a poor response to chemotherapy. Most cases of adenoid cystic carcinoma express the c-kit protein. Imatinib mesylate (Gleevec) inhibits several protein-tyrosine kinases, including c-kit. We therefore hypothesized that Imatinib may be an effective drug in patients with locally advanced or metastatic adenoid cystic carcinoma and conducted a phase 2 trial in order to study this. Patients with locally advanced or metastatic adenoid cystic carcinoma and c-kit positive tumours were eligible. Fourteen patients were screened and 10 patients (71%) with c-kit positive tumours entered the study. Treatment was begun at a dose of Imatinib of 400mg/day. Dose escalation was allowed in the absence of toxicity. The dose was increased to 600mg/d in three patients and 800mg/d in one patient. Three patients required dose reduction to 300mg/d, due to grade 3 toxicity. No grade 4 toxicity was seen. No objective responses were seen. Two patients (20%) exhibited stable disease for 11 and 14 months, respectively. All other patients stopped treatment after 2-14 (median 6) months due to progressive disease. Imatinib has no major effect on advanced adenoid cystic carcinoma of the head and neck.

Adult↗

Validation of a new grading system for endoscopic examination of adenoid hypertrophy.

OBJECTIVE: To propose and validate a new subjective grading system of adenoid size with flexible fiberoptic evaluation. STUDY DESIGN AND SETTING: Digital video clips of 24 flexible fiberoptic nasopharyngeal exams were presented to 24 examiners (otolaryngology resident and consultant physicians) at a tertiary care institution. Examiners were asked to use the proposed grading system to rate adenoid hypertrophy. Kappa statistical analysis was used to evaluate the degree of intergrader agreement or disagreement. RESULTS: Statistical analysis of intergrader agreement demonstrated an overall Kappa score of 0.71 suggesting a "substantial" strength of agreement. The Kappa strength of agreement was found to be 0.83 (almost perfect) among consultant physicians and 0.62 (substantial) among resident physicians. CONCLUSIONS: The proposed adenoid staging system is a reliable and consistent method of staging adenoid tissue size. SIGNIFICANCE: This new validated grading system may be a useful standard for reporting adenoid size in future clinical outcome studies.

Adenoids↗

[Adenoid cystic carcinoma].

Adenoid cystic carcinoma is an uncommon tumor of the head and neck. Although it is mainly located in the salivary gland, a skin location has also been described. Metastases are rare, but 50 % of the cases relapse. A 65-year-old male patient had a lesion in the upper lip. After resection, the histological diagnosis was adenoid cystic carcinoma. Treatment was completed with radiotherapy. Ten years later, a nodule was detected in the neck. Its histological diagnosis was lymphatic metastasis due to adenoid cystic carcinoma. Primary cutaneous adenoid cystic carcinoma is a very uncommon tumor in which treatment consists in extensive local excision with free margins. Radiotherapy is not curative and should be reserved for palliative treatments. Multicenter, prospective studies are necessary to determine the best treatment and especially the adjuvant treatment for adenoid cystic carcinoma.

Aged↗

Adenoid cystic carcinoma developing in the nasal orbit.

PURPOSE: To describe the clinical, imaging, and histopathologic findings of an adenoid cystic carcinoma that occurred in the medial orbit. METHODS: A 26-year-old man developed a painless soft tissue mass in the nasal aspect of the left orbit. Computed tomography was done, and incisional biopsy performed elsewhere disclosed adenoid cystic carcinoma. Orbital exenteration was performed. RESULTS: Computed tomography showed a 1.5cm mass in the antronasal region of the orbit without bone erosion. Histopathology disclosed adenoid cystic carcinoma. CONCLUSIONS: Although orbital adenoid cystic carcinoma usually originates superotemporally in the main lacrimal gland, it can develop in the nasal orbit, possibly from ectopic lacrimal gland tissue. Adenoid cystic carcinoma should be included in the differential diagnosis of tumors of the nasal orbit.

Adult↗

Human nasopharyngeal-associated lymphoreticular tissues. Functional analysis of subepithelial and intraepithelial B and T cells from adenoids and tonsils.

Subepithelial and intraepithelial lymphocytes of human adenoids and tonsils were characterized and directly compared to determine the potential contribution of these tissues to mucosal and systemic immune responses. The distribution of T and B cell subsets, cytokine patterns, and antibody (Ab) isotype profiles were similar for adenoids and tonsils. Both tissues contained predominantly B cells ( approximately 65%), approximately 5% macrophages, and 30% CD3(+) T cells. The T cells were primarily of the CD4(+) subset ( approximately 80%). Tonsillar intraepithelial lymphocytes were also enriched in B cells. The analysis of dispersed cells revealed a higher frequency of cells secreting IgG than IgA and the predominant Ig subclass profiles were IgG1 > IgG3 and IgA1 > IgA2, respectively. In situ analysis also revealed higher numbers of IgG- than IgA-positive cells. These IgG-positive cells were present in the epithelium and in the subepithelial zones of both tonsils and adenoids. Mitogen-triggered T cells from tonsils and adenoids produced both Th1- and Th2-type cytokines, clearly exhibiting their pluripotentiality for support of cell-mediated and Ab responses. Interestingly, antigen-specific T cells produced interferon-gamma and lower levels of interleukin-5. These results suggest that adenoids and tonsils of the nasopharyngeal-associated lymphoreticular tissues represent a distinct component of the mucosal-associated lymphoreticular tissues with features of both systemic and mucosal compartments.

Adenoids↗

Adenoid cystic carcinoma: a comparative pathologic study of tumors in salivary gland, breast, lung, and cervix.

Histologic, histochemical, and ultrastructural features of eight adenoid cystic carcinomas arising at diverse sites were compared in order to determine diagnostic values and to investigate histogenetic mechanisms. These tumors originated in the salivary glands, breast, uterine cervix, and tracheobronchial tree. By light microscopy each tumor was seen to have morphologic features of adenoid cystic carcinoma, yet only five of the eight cases showed differential staining for the two mucin types, stromal and epithelial, which are reportedly present in these tumors. In contrast, every case showed a set of fine structural features which, in aggregate, are specific for adenoid cystic carcinoma. These features include pseudocysts, intercellular spaces, basal lamina, and true glandular lumens. The most prominent feature is the pseudocyst, which mimics a glandular lumen by light microscopy but is actually a rounded extracellular space containing basal lamina. Ultrastructurally, the variation in composition of the extracellular compartments, including pseudocysts and true lumens, appears to explain the lack of uniformity in the histochemical staining. The tumors also contained cytoplasmic microfilaments in parallel bundles, consistent with myofilaments. The presence of these filaments combined with basal lamina suggests myoepithelial differentiation, yet it is not known whether these tumors truly originate from myoepithelium or show differentiation toward myoepithelium as a part of the neoplastic process. Regardless of their histogenesis, this study shows that true adenoid cystic carcinomas do arise in different organs. Knowledge of the specific ultrastructural features of adenoid cystic carcinomas can be useful in classifying these tumors in some cases.

Adult↗