Adenoid cystic carcinoma — Clinical presentation and cytological diagnosis

Adenoid cystic carcinoma is a tumor arising from the minor salivary glands, the palate being the commonest site. It accounts for about 1% of all head and neck malignancies. We report a case with the typical presentation of a palatal growth with extensive intra-cranial invasion. The diagnosis of this case and a brief review of literature is discussed. Final diagnosis of this case was made from cytological reports. The dry smears stained with MGG were found to be definitely superior to the alcohol fixed slides stained with papanicolaou. The aim here is to highlight the importance of cytology in the diagnosis of such tumors.     

Rapid cytological diagnosis during thyroid surgery.

The authors report the results of the use of intra-operative cytological examinations of the thyroid gland. In their hands, the method has a 96.3% accuracy in 757 patients with thyroid disorder. Benign conditions and malignant tumours can be correctly diagnosed. False negative diagnosis can arise with well-differentiated follicular carcinoma and the differentiation of follicular adenoma may be difficult. Atypical adenomas may give a false positive diagnosis. The incorrect diagnosis of chronic lymphocytic thyroiditis is unlikely when sufficient attention is given to the whole clinical picture.     

Diagnosis and differential diagnosis of lymphoepithelial carcinoma in lymph nodes: histological, cytological and electron-microscopic findings.

(1) Lymphoepithelial carcinoma, which occurs in the nasopharynx and palatine tonsils, is a special variant of squamous-cell carcinoma with a non-neoplastic lymphocytic component. (2) The morphology of lymphoepithelial carcinoma is very characteristic if not specific. Therefore, whenever lymphoepithelial carcinoma is diagnosed in a cervical lymph node, the clinician must try to find the primary tumour in the nasopharynx or tonsils, by blind biopsy if necessary. (3) The 'inflammatory' component of lymphoepithelial carcinoma is often very conspicuous. Tuberculoid lesions, with or without caseation necrosis, and marked eosinophilia and plasmacytosis are highly characteristic and help to confirm the diagnosis. (4) The 'inflammatory' component, including the lymphocytes among and around the tumour cells, is not fully understood; but it would appear that T lymphocytes are responsible for all, or most, of the cellular reactions against the tumour.     

Cutaneous metastasis from carcinoma of the oesophagus

A rare case of cutaneous metastasis from carcinoma of the oesophagus is presented and various metastatic skin lesions are briefly reviewed.     

Small cell carcinoma of the oesophagus: a clinical and immunohistopathological review.

Primary small cell carcinoma of the oesophagus (SCCO), histologically indistinguishable from its counterpart of the lung, is a rare tumour. Less than 100 cases are reported. A review of 558 consecutive patients with oesophageal carcinomas referred to our department revealed seven cases. These were studied and compared to a survey of 80 cases collected from 24 reports. The present results, as well as the survey, indicate a poor prognosis with rapid and widespread dissemination, and that death is attributed to distant metastases rather than local failure. Freedom from local symptoms was achieved in all seven patients, regardless of therapy modalities employed. A complete response of the primary lesion was observed in three patients after chemo- and subsequent radiotherapy. According to these findings the most suitable treatment approach seems to be the same as for small cell carcinoma of the lung. A detailed immunohistochemical analysis revealed more characteristics similar to small cell carcinoma of the lung than that of the skin, viz 'Merkel cell carcinoma'.     

Folate intake and squamous-cell carcinoma of the oesophagus in Italian and Swiss men.

BACKGROUND: Dietary folate has been inversely related to the risk of several cancers. However, studies on the role of dietary folate in oesophageal cancer are scanty. PATIENTS AND METHODS: Using data from a multicentric case-control study conducted in Italy and Switzerland between 1992 and 1999, we investigated the association between dietary folate intake and oesophageal squamous-cell carcinoma (OSCC) among 351 men with incident, histologically confirmed OSCC and 875 hospital controls admitted for acute, non-neoplastic conditions, unrelated to alcohol and smoking consumption. Intake of folate and other nutrients was computed from a validated food frequency questionnaire. RESULTS: The multivariate odds ratios (ORs) of OSCC were 0.68 (95% confidence intervals, CI: 0.46-1.00) for the highest versus the lowest tertile of folate intake, and 0.84 (95% CI: 0.72-0.99) for an increment of folate intake equal to a standard deviation (98 microg/day). The inverse relation was somewhat stronger in strata of high methionine, vitamin B6 and alcohol intake, and did not vary substantially according to age and smoking habits. CONCLUSION: Dietary folate was inversely related to OSCC risk in this population with high alcohol consumption and infrequent use of supplements and multivitamins.     

Early adenoid cystic carcinoma of the upper oesophagus

A 70-year-old male patient with an early stage primary adenoid cystic carcinoma of the oesophagus is reported. The 1.5 cm protuberant tumour, located in the upper oesophagus and found during examination for heartburn, was radically resected. It was restricted to the submucosa, which strongly suggests that it originated from the oesophageal glands. Microscopically, the tumour showed sparse S100 cells. This finding is in contrast with that in adenoid cystic carcinomas of the salivary glands.     

Histological and molecular mapping of adenocarcinoma of the oesophagus and gastroesophageal junction: loss of heterozygosity occurs in histologically normal epithelium in the oesophagus and stomach

Seventy malignant, premalignant and histologically normal biopsies from 7 oesophagogastrectomy specimens of adenocarcinomas of the lower oesophagus and gastroesophageal junction were analysed for loss of heterozygosity (LOH) at 9 known or putative gene loci. LOH was detected in 20 of 27 (74%) malignant biopsies, 4 of 7 (57%) biopsies of dysplasia, 2 of 12 (25%) biopsies of histologically normal oesophagus adjacent to adenocarcinoma, and in 2 of 14 (14%) biopsies of histologically normal stomach adjacent to adenocarcinoma. LOH at the VHL, APC, CDKN2 and DCC tumour suppressor and MSH3 mismatch repair gene loci can be detected in histologically normal tissue and in adjacent adenocarcinoma, and are potential markers of early neoplastic progression.     

Results of radiotherapy in carcinoma of oesophagus

Results of radiotherapy in 50 patients of carcinoma of oesophagus are presented. Of these, 28 patients were in stage I and stage II disease and were treated with curative doses of radiotherapy. 22 patients received palliative doses of radiation because of their advanced disease. Radiation treatment in carcinoma of oesophagus showed good palliative response with minimal complications. However, there was high incidence of failure of radiotherapy to cure the disease locally in oesophagus. Six months’ survival rate in the curative treatment group was 75% and in the palliative treatment group 31%. One year survival rate was about 29%.     

Definitive and neoadjuvant radiochemotherapy of squamous cell carcinoma of the oesophagus

In cases of advanced carcinoma of the oesophagus with no metastatic spread, a concurrent radiochemotherapy can improve the patient's prognosis in comparison to radiotherapy alone. This approach increases the treatment-related toxicity, in particular haematological side effects. Therefore therapy must be adapted to the general condition of the patient, demanding an intensive supportive treatment and monitoring of the patient. At present the optimal radiation dose and the role of brachytherapy for the reduction of the still high rate of local recurrences has not been determined. The value of neoadjuvant radiochemotherapy for operable or inoperable tumours is unclear. Meta-analyses did show an improvement of the prognosis, however most of the randomised studies found improvement only for the recurrence rate but not for survival. The reasons for this are numerous; however, the high postoperative lethality after radiochemotherapy in some studies is conspicuous. Conversely, the initial results of randomised studies show that operative measures could possibly be forgone if a complete remission is achieved by concurrent radiochemotherapy. Nevertheless, this approach must also be regarded critically, as the local recurrence rate after radiochemotherapy alone is high and long-term results are not available.     

Incidence of carcinoma of the oesophagus and gastric cardia. Changes over time and geographical differences

Background. The incidence of adenocarcinoma of the oesophagus is rising in many western countries including Sweden. Methods. We have studied the latest data concerning this as well as trends in the incidence of squamous cell carcinoma and adenocarcinoma of gastric cardia. Data was extracted from the Swedish cancer registry and analyzed regarding gender, age, region, histology and location of tumour. Results. The results show an increasing incidence of adenocarcinoma in both oesophagus and gastric cardia. Squamous cell carcinomas show a more stable development with a slight decrease of incidence. Adenocarcinoma is now the most common histological type of cancer in the oesophageal/cardia region in Sweden. Results also suggest a possible drift in location of adenocarcinoma from gastric cardia towards oesophagus. Overall a higher incidence was found in the male population and no trends in patient age at onset could be found. Squamous cell carcinoma is still slightly more common in urban regions.     

Immunohistochemical expression of SKALP/elafin in squamous cell carcinoma of the oesophagus.

In this study, the immunohistochemical expression of a new inducible elastase inhibitor, SKALP (skin-derived anti-leucoproteinase)/elafin, in the tissue of squamous cell carcinoma and uninvolved oesophageal mucosa was studied using a polyclonal rabbit anti-serum against SKALP/elafin. The results were compared with the immunohistochemical staining of proliferating cell nuclear antigen (PCNA) and the TUNEL assay in serial sections. In non-malignant oesophageal mucosa, the expression of SKALP/elafin was localized in the cells of the stratified zone overlying the PCNA-positive basal zone. In oesophageal cancer, the incidence of the expression was significantly related to the degree of the differentiation of the tumour. Characteristically, the expression was almost limited in tumour cell nests that had a clear squamous phenotype. In tumour cell nests, the expression of SKALP/elafin was localized in the cells overlying PCNA-expressing cells and no expression was found in the cells that expressed PCNA; DNA fragmentation was often observed in the same cell layers as those in which SKALP/elafin immunoreactivity was found. This enzyme inhibitor is speculated to be involved in the induction of the cell differentiation and apoptosis of human squamous cell carcinoma cells of the oesophagus.