Schwerpunktmäßig setzt die HNO-Klinik Großhadern die Navigationschirurgie im Bereich der Nasennebenhöhlen ein. Das neue Kolibri Navigationssystem stellt eine Neuentwicklung der Firma Brain LAB dar, das bei kompakten Abmessungen und einer benutzerfreundlichen Bedienbarkeit ein hohes Leistungsspektrum anbietet. An 25 Patienten konnten wir das Kolibri Navigationssystem in Kombination mit der z-touch und soft-touch Registrierung in der klinischen Routine beurteilen und bestehende Erfahrungen im Bereich navigationsunterstützter Operationstechniken erweitern.
Background: The epithelial cell adhesion molecule (EpCAM) is expressed in most normal epithelia, but is absent from squamous stratified epithelia. However, a de novo expression can be observed in squamous epithelia during carcinogenesis. Materials and Methods: In order to evaluate EpCAM as a molecular marker to indicate borders of high risk for the development of local recurrences, its expression was examined in the marginal zone of malignancies. Specimens of squamous cell carcinoma of the head and neck (SCCHN), of the histologically tumor-free defined resection margin and of healthy epithelia of 20 patients were examined by RT-PCR in order to identify the expression of EpCAM in these three different areas. Additionally, immunohistochemistry was performed on biopsies from 10 patients in order to confirm these findings and to investigate a potential correlation between EpCAM expression and the degree of dysplasia. Results: By RT-PCR, high expression of EpCAM was found in the tumor. An inverse correlation was observed between EpCAM expression and the distance from the tumor, with no expression being detectable in healthy oral mucosa. In 70% of the cases, EpCAM was expressed in the marginal zone, which had been defined as tumor-free by routine histopathological assessment. Additional immunohistology revealed no correlation between EpCAM expression and the grade of dysplasia. Conclusion: Our data provide evidence that EpCAM is restricted as a marker for redefining the real tumor margin by RT-PCR. To complement routine histology, immunohistochemical staining with EpCAM is limited due to its expression in hyperplastic tissue without dysplastic changes. Both observations limit the reliable use of EpCAM for the molecular definition of the critical tumor border and resection margins. The standard treatment of squamous cell carcinoma of the head and neck (SCCHN) is surgical resection of the tumor in combination with radio- and chemotherapy. The patient's survival strongly depends on a complete resection of the tumor, including an appropriate distance to the tumor margin. Therefore, histopathological assessment of the surgical margins is routinely performed. Due to the selective choice of few sections during routine histological workup and disseminated tumor cells in the margin, early stages of metastasis can be missed. Recently, new efforts have been made to improve histological diagnosis by using molecular methods (1).
In previous studies, we demonstrated a loss of major basement membrane (BM) components in laryngeal squamous cell carcinomas and provided initial evidence that this was of potential prognostic significance. In our current study, we extended the panel of BM antibodies and enlarged our study group in order to perform a multivariate statistical analysis. We analyzed 26 laryngeal squamous cell carcinomas immunohistochemically for the distribution of the BM-components collagen IV, collagen VII, laminin-1, laminin-5, perlecan and fibronectin. The resulting data were correlated with clinical prognostic factors and statistical correlation coefficients were determined for independent uni- and multivariate analysis. All carcinomas analyzed revealed defects of the peritumoral BM with more extensive loss of collagen VII than collagen IV, laminin-1, perlecan and fibronectin. Laminin-5 in contrast was present even in poorly differentiated tumors showing an enhanced intracytoplasmatic staining in the tumor cells. Furthermore, our statistical analysis did not show independent prognostic significance of any of the BM-components. Our observations indicate a divergence between the loss of several major BM-components (collagens IV, VII, laminin-1, perlecan) and an enhanced deposition of laminin-5. This suggests a severly altered cell-matrix interaction, since laminin-5 links the collagen VII-containing anchoring fibrils to cell receptors of the integrin type.
We investigated three clonally related human keratinocyte cell lines of different biological behaviour, HaCaT (non-tumorigenic), A5 (benign, tumorigenic) and II-4RT (malignant, tumorigenic), with regard to the expression of TGF-beta-isoforms -1, -2 and -3 and that of the TGF-beta-cell-receptors TBR-I, -II and -III. In addition, we amplified and sequenced the genome of TBR-II which is known to be a target for mutations in several types of malignant tumors including squamous cell carcinomas. In all three cell lines, TGF-beta1 and -beta3 were present only in very low amounts. Western blots provided no evidence for differences in TGF-beta1 between the cell lines. However, in immunohistochemistry more cells were slightly positive for this cytokine in HaCaT than in A5 and II-4RT cells. In contrast, a significantly variable expression of TGF-beta2 was seen by both Western blot and immunohistochemistry. Thereby, the non-tumorigenic HaCaT-cells contained significantly more TGF-beta2 than the tumorigenic, benign A5 cells and the malignant II-4RT cells. TBR-I, -II and -III were present in all three cell lines. While most cells were positive for TBR-I, only part of the cells contained TBR-II and -III, however, without obvious differences between the three cell lines. The molecular analysis of all 7 exons of TBR-II by PCR amplification and direct sequencing revealed in all three cell lines correct sequences without evidence for mutations. Our study indicates differences in the expression of TGF-beta in a human model of keratinocytes of varying tumorigenicity, but presents no evidence for mutations in the functionally most important TGF-beta-receptor TBR-II. This suggests a dysregulation of cytokine control on the level of TGF-beta expression, which may be responsible for the biological behaviour.
Aims: The aim of our study was to evaluate retrospectively the results of different surgical approaches in orbital floor reconstruction between January 2001 and November 2005 at our clinic.
More than 90% of laryngeal tumors are squamous cell carcinomas. Primary hematopoetic neoplasms of the larynx are rare, being mainly extramedullary plasmocytoma and non-Hodgkin's lymphoma (NHL). These are mainly located in the supraglottic and glottic area, with only a few reported in the subglottic region.We report on a 58-year-old man, who presented at our clinic with severe dyspnea. On microlaryngoscopy, a subglottic stenosis at the level of the cricoid cartilage was found. The biopsy revealed the diagnosis of a MALT-type lymphoma (marginal zone B-cell lymphoma). The tracheostomy was followed by locoregional radiotherapy.This is the first report of a subglottic MALT-type lymphoma causing a tracheal stenosis. The preferred treatment is locoregional radiotherapy including the draining lymph nodes.
Hintergrund: Das extratemporale Neurofibrom des Nervus facialis ist ein sehr seltener, gutartiger Tumor, der von den Hüllstrukturen des Nerven ausgeht. In der Ohrspeicheldrüse stellt das Neurofibrom eine äußerst seltene Ursache einer parotidealen Raumforderung dar, oft in Zusammenhang mit einer generalisierten Neurofibromatose. Aufgrund des sehr langsamen Wachstums kann diese Erkrankung lange unbemerkt verlaufen. Fallbericht: Dargestellt wird die Krankengeschichte eines 53jährigen Patienten, der über drei Jahre wegen einer diskreten Fazialisparese immer wieder in ärztlicher Behandlung war. Erst eine ausführliche Diagnostik inklusive aktueller Bildgebung führte zur Diagnose einer parotidealen Raumforderung, die dann komplett operativ entfernt wurde. Histologisch zeigte sich ein Neurofibrom. Postoperativ bestand eine inkomplette Fazialisparese. Schlußfolgerung: Um nicht von der Diagnose intraoperativ überrascht zu werden, ist bei einer parotidealen Raumforderung eine genaue Faszialisdiagnostik und Untersuchung unerläßlich. Eine frühzeitige Operation sollte aus Gründen der Nervenerhaltung angestrebt werden. Die Möglichkeit einer Nervenerhaltung kann beim Neurofibrom, bei dem der Nerv in den Tumor eingebaut wird, umso problematischer sein, je ausgeprägter die präoperative Fazialisschwäche ist. Die Problematik dieser Neubildungen in prekärer topographischer Lage wird erörtert.
