(2002). Diagnosis and Classification of Salivary Neoplasms: Pathologic Challenges and Relevance to Clinical Outcomes. Acta Oto-Laryngologica: Vol. 122, No. 7, pp. 758-764.
In this study we determined the frequency of association of human papillomavirus (HPV) and laryngeal carcinomas and investigated the possibility that HPV may be associated with larger or more aggressive tumors. Laryngeal squamous cell carcinomas from 40 patients who did not have preexisting papillomas by clinical history were retrieved from formalin-fixed, paraffin-embedded blocks and analyzed for HPV. Twenty-two cases were tumors of the true vocal folds, and 18 were supraglottic. Clinical follow-up was available for 25 patients. We used the polymerase chain reaction (PCR) with the “hot start” modification and consensus primers that can detect over 30 distinct HPV types. Three of the 40 patients (8%) had detectable HPV DNA. These 3 patients did not have unusual age demographics and were smokers. All but 1 of the 22 HPV-negative patients who were questioned were also smokers. We compared the outcomes for large (4 cm or greater) HPV-positive and -negative tumors. Six of the 40 tumors were 4 cm or greater and involved contiguous structures. Two of these 6 were HPV-positive, and these patients died of disease after 3 and 16 months, respectively. Of the 4 HPV-negative patients with tumors greater than 4 cm, 3 are disease-free at 41, 42, and 3 months, respectively, and 1 was lost to follow-up. The third HPV-positive patient had a tumor less than 1 cm, and is disease-free after 38 months. While the number of HPV-positive cases is too small for definitive conclusions, it is possible that for large tumors the presence of HPV DNA may portend a worse prognosis. However, in the population of patients with laryngeal carcinoma whom we have studied, we conclude that the L1 region of HPV DNA is rarely seen to be present in the tumors by “hot start” PCR, and hence HPV is probably not a common cancer promoter for laryngeal carcinoma.
A 36-year-old man presented with a recurrent, rapidly enlarging laryngeal tumor causing upper airway obstruction. Microscopic study revealed a granular cell tumor (GCT) with marked atypia, pleomorphism, and pagetoid spread to the overlying epithelium. Histologic pleomorphism occurs rarely and is usually mild in laryngeal GCT. Malignant granular cell tumor (MGCT), a very unusual entity, can be diagnosed with confidence when there is clinical evidence of malignancy (i.e., metastasis). We support the concept of "atypical" GCT when marked pleomorphism is present, yet no metastasis has occurred. This will indicate to the otolaryngologist and pathologist the possibility of greater potential for aggressive clinical behavior.
Although lymphatic malformations are often found to be well circumscribed when surgery is undertaken in early childhood, complete surgical excision can be difficult when the lesion is infiltrative. This study retrospectively evaluates these patients in an attempt to identify prognostic factors that may predict recurrence.A retrospective chart review was conducted covering the years 1991 to 1998. Seventeen patients were identified having undergone 32 surgical resections of tumors described as lymphatic malformations. Data abstracted from the charts included the site of the lesion, surgical and histologic assessment of encapsulation, and status at follow-up examination.Six of 17 patients developed a recurrence after surgery. Correlation between recurrence and histologic or operative impressions of encapsulation was significant by chi(2) analysis (P<0.01).On the basis of the findings of this case series, lymphatic malformations that are found to be nonencapsulated and infiltrative by intraoperative or histologic assessment are more likely to recur.
Patients diagnosed with early stage (Stage I/II) Oral Cavity Cancer (OCC) are typically treated with surgery alone. Unfortunately, 25-37% of early stage OCC patients experience loco-regional tumor recurrence after receiving surgery. Currently, pathologists use the Histologic Risk Model (HRM), a clinically validated risk assessment tool to determine patient prognosis. In this study, we perform image registration on two cases of serially sectioned blocks of Hematoxylin and Eosin (H and E) stained OCC tissue sections. The goal of this work is to create an optimized registration procedure to reconstruct 3D tissue models, which can provide a pathologist with a realistic representation of the tissue architecture before surgical resection. Our project aims to extend the HRM to enhance prediction performance for patients at high risk of disease progression using computational pathology tools. In previous literature, others have explored image registration of histological slides and reconstructing 3D models with similar processes used. Our work is unique in that we are investigating in-depth the parameter space of an image registration algorithm to establish a registration procedure for any serial histological section. Each parameter set was sequentially perturbed to determine the best parameter set for registration, as evaluated through mutual information.
Sinonasal hemangiopericytoma (SNHPC) is a rare lesion usually of low-grade malignant potential. Aggressive and metastatic cases are uncommon, and experience using adjuvant therapy on these cases has been limited. Tumor-induced osteomalacia has a very rare association with SNHPC. Further, the diagnosis of SNHPC remains one of histologic-pattern recognition. Traditionally, immunohistochemistry has aided in excluding other diagnoses; only vimentin has been consistently expressed by the tumor spindle cells of HPC. Recent studies have shown that Factor XIIIa is also expressed by HPC, (as well as tumors of fibrohistiocytic differentiation) and hence may be yet another helpful positive marker in establishing an immunohistochemical profile.We identified 7 patients at this institution with SNHPC from 1990 to 1994. Immunohistochemistry was performed on seven formalin-fixed paraffin-embedded tumors utilizing antibodies to factor XIIIa as well as antibodies to vimentin, factor VIII, muscle-specific antigen, cytokeratin, and S-100.All 7 patients were initially seen with nasal obstruction or epistaxis and underwent surgical resection. The period of follow-up was from 3 months to 14 years (mean 54 months) for 7 patients. Three patients had recurrent disease after 3, 5, and 10 years. The first 2 were known to have been originally treated by polypectomy. One patient required adjuvant radiotherapy for metastatic disease and local extension. One patient was initially seen with tumor-induced osteomalacia which dramatically improved following resection of the lesion. The immunohistochemical profile revealed strong expression of vimentin in 7/7 cases, and of factor XIIIa in 4/7 cases; tumor cells did not express the other markers studied.Adequate surgical resection with negative margins appears to be the appropriate therapy for SNHPC. Our 1 case associated with tumor-induced osteomalacia was reversible after surgical excision of the tumor. The immunohistochemical results suggest that the pattern of vimentin and factor XIIIa positivity, as well as lack of expression of other markers, is consistent with the diagnosis of HPC, which still remains in the domain of histopathology.
“Hairy polyp,” or dermoid polyp, of the nasopharynx is a rare tumor of early life composed of ectodermal and mesodermal derivatives. We present a case, consider its embryological origins, and discuss the differential diagnosis of nasopharyngeal polypoid masses in infancy.
